systematic review open access disseminating research

SYSTEMATIC REVIEW Open Access

Disseminating research findings: what shouldresearchers do? A systematic scoping review ofconceptual frameworksPaul M Wilson1*, Mark Petticrew2, Mike W Calnan3, Irwin Nazareth4

Abstract

Background: Addressing deficiencies in the dissemination and transfer of research-based knowledge into routineclinical practice is high on the policy agenda both in the UK and internationally.However, there is lack of clarity between funding agencies as to what represents dissemination. Moreover, theexpectations and guidance provided to researchers vary from one agency to another. Against this background, weperformed a systematic scoping to identify and describe any conceptual/organising frameworks that could be usedby researchers to guide their dissemination activity.

Methods: We searched twelve electronic databases (including MEDLINE, EMBASE, CINAHL, and PsycINFO), thereference lists of included studies and of individual funding agency websites to identify potential studies forinclusion. To be included, papers had to present an explicit framework or plan either designed for use byresearchers or that could be used to guide dissemination activity. Papers which mentioned dissemination (but didnot provide any detail) in the context of a wider knowledge translation framework, were excluded. Referenceswere screened independently by at least two reviewers; disagreements were resolved by discussion. For eachincluded paper, the source, the date of publication, a description of the main elements of the framework, andwhether there was any implicit/explicit reference to theory were extracted. A narrative synthesis was undertaken.

Results: Thirty-three frameworks met our inclusion criteria, 20 of which were designed to be used by researchersto guide their dissemination activities. Twenty-eight included frameworks were underpinned at least in part by oneor more of three different theoretical approaches, namely persuasive communication, diffusion of innovationstheory, and social marketing.

Conclusions: There are currently a number of theoretically-informed frameworks available to researchers that canbe used to help guide their dissemination planning and activity. Given the current emphasis on enhancing theuptake of knowledge about the effects of interventions into routine practice, funders could consider encouragingresearchers to adopt a theoretically-informed approach to their research dissemination.

BackgroundHealthcare resources are finite, so it is imperative thatthe delivery of high-quality healthcare is ensured throughthe successful implementation of cost-effective healthtechnologies. However, there is growing recognition thatthe full potential for research evidence to improve prac-tice in healthcare settings, either in relation to clinicalpractice or to managerial practice and decision making,

is not yet realised. Addressing deficiencies in the dissemi-nation and transfer of research-based knowledge to rou-tine clinical practice is high on the policy agenda both inthe UK [1-5] and internationally [6].As interest in the research to practice gap has

increased, so too has the terminology used to describethe approaches employed [7,8]. Diffusion, dissemination,implementation, knowledge transfer, knowledge mobili-sation, linkage and exchange, and research into practiceare all being used to describe overlapping and interre-lated concepts and practices. In this review, we haveused the term dissemination, which we view as a key

* Correspondence: [email protected] for Reviews and Dissemination, University of York, YO10 5DD, UKFull list of author information is available at the end of the article

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element in the research to practice (knowledge transla-tion) continuum. We define dissemination as a plannedprocess that involves consideration of target audiencesand the settings in which research findings are to bereceived and, where appropriate, communicating andinteracting with wider policy and health service audi-ences in ways that will facilitate research uptake in deci-sion-making processes and practice.Most applied health research funding agencies expect

and demand some commitment or effort on the part ofgrant holders to disseminate the findings of theirresearch. However, there does appear to be a lack ofclarity between funding agencies as to what representsdissemination [9]. Moreover, although most considerdissemination to be a shared responsibility betweenthose funding and those conducting the research, theexpectations on and guidance provided to researchersvary from one agency to another [9].We have previously highlighted the need for research-

ers to consider carefully the costs and benefits of disse-mination and have raised concerns about the nature andvariation in type of guidance issued by funding bodiesto their grant holders and applicants [10]. Against thisbackground, we have performed a systematic scopingreview with the following two aims: to identify anddescribe any conceptual/organising frameworks designedto be used by researchers to guide their disseminationactivities; and to identify and describe any conceptual/organising frameworks relating to knowledge translationcontinuum that provide enough detail on the dissemina-tion elements that researchers could use it to guidetheir dissemination activities.

MethodsThe following databases were searched to identifypotential studies for inclusion: MEDLINE and MED-LINE In-Process and Other Non-Indexed Citations(1950 to June 2010); EMBASE (1980 to June 2010);CINAHL (1981 to June 2010); PsycINFO (1806 to June2010); EconLit (1969 to June 2010); Social ServicesAbstracts (1979 to June 2010); Social Policy and Practice(1890 to June 2010); Cochrane Database of SystematicReviews, Cochrane Central Register of Controlled Trials,Cochrane Methodology Register, Database of Abstractsof Reviews of Effects, Health Technology AssessmentDatabase, NHS Economic Evaluation Database(Cochrane Library 2010: Issue 1).The search terms were identified through discussion

by the research team, by scanning background literature,and by browsing database thesauri. There were nomethodological, language, or date restrictions. Details ofthe database specific search strategies are presentedAdditional File 1, Appendix 1.

Citation searches of five articles [11-15] identifiedprior to the database searches were performed inScience Citation Index (Web of Science), MEDLINE(OvidSP), and Google Scholar (February 2009).As this review was undertaken as part of a wider pro-

ject aiming to assess the dissemination activity of UKapplied and public health researchers [16], we searchedthe websites of 10 major UK funders of health servicesand public health research. These were the British HeartFoundation, Cancer Research UK, the Chief ScientistOffice, the Department of Health Policy Research Pro-gramme, the Economic and Social Research Council(ESRC), the Joseph Rowntree Foundation, the MedicalResearch Council (MRC), the NIHR Health TechnologyAssessment Programme, the NIHR Service Delivery andOrganisation Programme and the Wellcome Trust. Weaimed to identify any dissemination/communication fra-meworks, guides, or plans that were available to grantapplicants or holders.We also interrogated the websites of four key agencies

with an established record in the field of disseminationand knowledge transfer. These were the Agency forHealthcare Research and Quality (AHRQ), the CanadianInstitutes of Health Research (CIHR), the CanadianHealth Services Research Foundation (CHSRF), and theCentre for Reviews and Dissemination (CRD).As a number of databases and websites were searched,

some degree of duplication resulted. In order to managethis issue, the titles and abstracts of records were down-loaded and imported into EndNote bibliographic soft-ware, and duplicate records removed.References were screened independently by two

reviewers; those studies that did not meet the inclusioncriteria were excluded. Where it was not possible toexclude articles based on title and abstract alone, fulltext versions were obtained and their eligibility wasassessed independently by two reviewers. Where dis-agreements occurred, the opinion of a third reviewerwas sought and resolved by discussion and arbitrationby a third reviewer.To be eligible for inclusion, papers needed to either

present an explicit framework or plan designed to beused by a researcher to guide their dissemination activ-ity, or an explicit framework or plan that referred todissemination in the context of a wider knowledgetranslation framework but that provided enough detailon the dissemination elements that a researcher couldthen use it. Papers that referred to dissemination in thecontext of a wider knowledge translation framework,but that did not describe in any detail those process ele-ments relating to dissemination were excluded from thereview. A list of excluded papers is included in Addi-tional File 2, Appendix 2.


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For each included paper we recorded the publicationdate, a description of the main elements of the frame-work, whether there was any reference to other includedstudies, and whether there was an explicit theoreticalbasis to the framework. Included papers that did notmake an explicit reference to an underlying theory werere-examined to determine whether any implicit use oftheory could be identified. This entailed scrutinising thereferences and assessing whether any elements fromtheories identified in other papers were represented inthe text. Data from each paper meeting the inclusioncriteria were extracted by one researcher and indepen-dently checked for accuracy by a second.A narrative synthesis [17] of included frameworks was

undertaken to present the implicit and explicit theoreti-cal basis of included frameworks and to explore anyrelationships between them.

ResultsOur searches identified 6,813 potentially relevant refer-ences (see Figure 1). Following review of the titles and

abstracts, we retrieved 122 full papers for a moredetailed screening. From these, we included 33 frame-works (reported in 44 papers) Publications that did notmeet our inclusion criteria are listed in Additional File2, Appendix 2.

Characteristics of conceptual frameworks designed to beused by researchersTable 1 summarises in chronological order, twenty con-ceptual frameworks designed for use by researchers[11,14,15,18-34]. Where we have described elements offrameworks that have been reported across multiplepublications, these are referenced in the Table.

Theoretical underpinnings of dissemination frameworksThirteen of the twenty included dissemination frame-works were either explicitly or implicitly judged to bebased on the Persuasive Communication Matrix [35,36].Originally derived from a review of the literature of per-suasion which sought to operationalise Lasswell’s semi-nal description of persuasive communications as being

Figure 1 Identification of conceptual frameworks.


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Table 1 Conceptual frameworks designed for use by researchers

Author, Year, Aims Dissemination elements Theoretical foundations Description/Comment

Winkler [11]1985Develop a model to aid understanding abouthow new medical information in general andtechnology assessments in particular reachespractising physician and affects their practice

The source of communicationThe channels of communicationThe communication messageThe characteristics of the audiencereceiving the communicationThe setting in which the communication isreceived

Persuasive communicationExplicitly based on McGuire’s five attributes ofpersuasive communication.Diffusion of innovationsAlso sets framework in the context specificallythe innovation-decision process.Reference to other included frameworksNone

Communication effectiveness determined by fiveattributes. Appears to be first application ofMcGuire’s matrix to the context of medicaltechnology assessment. Argues that formalinformation dissemination followed by informalinteraction with influential and knowledgeablecolleagues likely to have most impact.

CRD [17,18]1994, 2009Presents a framework to be used by researchersseeking to promote the findings of a systematicreview.

Review topicMessageAudienceSourceSetting/contextCommunication channelsImplementation of strategyFeed back and evaluation

Persuasive communicationRevised version acknowledges McGuire’s fiveattributes of persuasive communication. Implicitin original version that is explicitly derived fromWinkler.Diffusion of innovations2009 version also sets framework in the contextof Diffusion of innovations specifically theinnovation-decision process.Reference to other included frameworksWinklerLomasGreenhalgh in 2009 versionHughes in 2009 versionLavis in 2009 version

Framework for disseminating the findings ofsystematic reviews. Originally postulated thatdissemination effectiveness influenced by thesources of communications, media used, andaudiences targeted.Later versions acknowledge other elements ofpersuasive communications and expand into athree phase ‘plan, develop, and implementprocess that assumes interaction with targetaudiences and consideration of setting in whichmessages received.

National Center for the Dissemination of DisabilityResearch (NCDDR)[19,38]1996, 2001To provide a knowledge base for strengtheningthe ways in which research results can beaccessed and used by those who need them.

source (i.e., agency, organization, orindividual responsible for creating the newknowledge or product, and/or forconducting dissemination activities)content (message that is disseminated, thatis, the new knowledge or product itself, aswell as any supporting information ormaterials)medium (i.e., ways in which the knowledgeor product is described, ‘packaged,’ andtransmitted)user (or intended user, of the informationor product to be disseminated)

Persuasive communicationNot explicitly stated but four (source, message,audience, channel) of McGuire’s five attributes ofpersuasive communication evident.Diffusion of innovationsAlso mentions Diffusion of Innovations;specifically the innovation-decision process.Reference to other included frameworksNone

Review of literature suggests that somecombination of four major dimensions ofknowledge utilization that can help to strengthendissemination efforts.A detailed practical ten step-by-step guide forresearchers later produced.

Hughes [20,60]2000Review the process of dissemination by thosewho carry it out, those who disseminate it andthose who, potentially, make use of it. Examinecurrent approaches to dissemination, consideredtheir effectiveness, highlight obstacles tosuccessful integration of research into practice,and suggest a range of strategies to assistsuccessful dissemination and implementation ofresearch findings.

Provide accessible summaries of researchKeep the research report brief and concisePublish in journals or publications whichare user friendlyUse language and styles of presentationwhich engage interestTarget the material to the needs of theaudienceExtract the policy and practice implicationsof researchTailor dissemination events to the targetaudience and evaluate themUse the mediaUse a combination of disseminationmethodsBe proactiveUnderstand external factors

Persuasive communicationNot explicitly stated but four (setting, message,audience, channel) of McGuire’s five attributes ofpersuasive communication evident.Reference to other included frameworksCRD

Commissioned by the Joseph RowntreeFoundation, a framework based on non-systematic literature review and survey of keyinformants and organisations (including CRD).Authors suggest that active dissemination ofresearch is often under resourced by researchcommissioners and researchers and thatinsufficient time and money are set aside whenthe original funding is consideredFive factors identified as contributing to effectivedissemination: relevance, quality, accessibility,ownership and timing. List for researchers offactors that can help them disseminate researchsuccessfully.Report also outlines suggestions forcommissioners, policy makers and practitioners forimproving the effectiveness of researchdissemination.

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Table 1 Conceptual frameworks designed for use by researchers (Continued)

Harmsworth [21]2001To help educational development projectsengaged in the dissemination of new products,materials and good practice in learning andteaching to create an effective disseminationstrategy

What is dissemination?What do we want to disseminate?Who are our stakeholders and what arewe offering them?When do we disseminate?What are the most effective ways ofdisseminating?Who might help us disseminate?How do we prepare our strategy?How do we turn our strategy into anaction plan?How do we cost our disseminationactivities?How do we know we have beensuccessful?

Persuasive communicationNot explicitly stated but three (message,audience, channel) of the McGuire’s fiveattributes of persuasive communication evidentReference to other included frameworksNone

Practical question based guide for educationaldevelopment projects.States that it is based on experiences from over100 educational development projects, inparticular, the Fund for the Development ofTeaching and Learning (FDTL) and the Teaching,Learning Technology Programme (TLTP) andInnovations Fund.

Herie [22]2002Presents an integrated dissemination model forsocial work and case study example to illustratethe practical application of the model

Assess market opportunitiesand identify target systemEngage target systemField test the interventionDisseminate the intervention broadlyGather system feedback and provideongoing consultation.

Diffusion of innovationsSocial marketingReference to other included frameworksNCDDR

Describes an integrated dissemination model forsocial work and provides an example to illustrateits practical application (OutPatient Treatment InONtario Services -OPTIONS project)Argues that diffusion of innovations and socialmarketing address the important question of howto put the products of research where they willdo the most good: into the hands of practicingclinicians.

Scullion [23]2002Examine examples of effective disseminationstrategies, provide insights and suggest pointersfor researchers, research students and others whomay be involved in dissemination.

Source of the messageMessage characteristicsMedium selected to present the messageTarget users

Persuasive communicationNot explicitly stated but four (message, source,audience, channel) of McGuire’s five attributes ofpersuasive communicationReference to other included frameworksCarpenterCRDLavis

Practical guide aimed at nursing researchers.Refers to early descriptions of the CRD approach[39].Author argues that current commitmentevidence-based practice will have limited impacton practice and patient care until a similarcommitment to dissemination is evident at bothcorporate and individual levels.

Jacobson [14]2003To develop a framework that researchers andother knowledge disseminators who areembarking on knowledge translation can use toincrease their familiarity with the intended usergroups.

Five domains:The user groupThe issueThe researchThe researcher-user relationshipDissemination strategies

None statedReference to other included frameworksNone

Novel framework derived from a review of theresearch utilisation literature and from the authors’own experience.Emphasises the importance of understanding usercontext. Each ‘domain’ provides researchers with aset of questions that can be used to aid theprioritisation of audiences and to develop andtailor relevant messages across user groups.

Lavis [15]2003Provide an organizing framework for a knowledgetransfer strategy and an overview of ourunderstanding of the current knowledge for eachof the five elements of the framework

What should be transferred to decisionmakers?To whom should it be transferred?By whom should research knowledge betransferred?How should research knowledge betransferred?With what effect should researchknowledge be transferred?

Persuasive communicationNot explicitly stated but four (message,audience, source, channel) of McGuire’s fiveattributes of persuasive communicationReference to other included frameworksNone

Organising framework and overview of literaturerelating to knowledge transfer strategies. Questionformat implicitly mirrors Lasswell’s famousdescription of the act of communications as ‘Whosays what in which channel to whom with whateffect’ [37].

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Farkas [24]2003Describe a conceptual framework for thedissemination and utilisation of information, longwith examples of its use

Exposure strategies are thosedissemination methods that focus on thegoal of increased knowledgeExperience strategies focus on the goal ofincreased positive attitudes towards thenew knowledgeExpertise strategies focus on the goal ofincreased competenceEmbedding strategies target consumerstend to be personally focused

Diffusion of innovationsDiffusion of innovations in that research hasconcluded knowledge is not a ‘thing to be sentand received. Rather disseminating new findingsor information involves communicating through‘certain channels over time among members ofa social system’Reference to other included frameworksNCDDR

Authors suggest most dissemination practices arenot organized or planned to achievecomprehensive impact. Role of framework is tohelp researchers understand dissemination andutilization as a series of active learning strategiesand to direct these at particular knowledge goalsand the needs of particular users.Paper also presents examples of ‘4E’ use.

Economic and Social Research Council [26]2004Provide advice on planning and prioritisingactivities and includes a template you can use tostructure your own strategy. Aimed at researchdirectors but is applicable to any communicationsexercise and should be useful to a wider groupof researchers.

Checking perceptionsSetting objectivesAgreeing principlesDeveloping messages and brandingPrioritising audiencesChoosing channelsPlanning activitiesEstimating timeEstimating budgetEvaluating success

Persuasive communicationNot explicitly stated but four (message,audience, source as branding, channel) ofMcGuire’s five attributes of persuasivecommunicationReference to other included frameworksNone

A detailed practical step-by-step guide onplanning and prioritising research communication.Involves all key elements of McGuire’s persuasivecommunication matrix but also addresses morepractical issues such as timing and availability ofresources.Available at: www.esrc.ac.uk/ESRCInfoCentre/CTK/communications-strategy/default.aspx

Canadian Health Services Research Foundation[25]2004List of Key elements that should be included in adissemination plan. Provide a good overview ofsome of the most critical things that should beconsidered

Project overviewDissemination goalsTarget audiencesKey messages (contextualised)Sources/messengersDissemination activities, tools, timing andresponsibilitiesBudgetEvaluation

Persuasive communicationNot explicitly stated but all (message, audience,setting, source, channel) of McGuire’s fiveattributes of persuasive communicationReference to other included frameworksNone

Brief overview of key elements that should beconsidered as part of a collaborative researchplanning process. Involves all key elements ofMcGuire’s persuasive communication matrix butalso addresses more practical issues such astiming and availability of resources.Available at:www.chsrf.ca/keys/use_disseminating_e.php

European Commission [27]2004Aims to assist project coordinators and teamleaders to generate an effective flow ofinformation and publicity about the objectivesand results of their work, the contributions madeto European knowledge and scientific excellence,the value of collaboration on a Europe-wide scale,and the benefits to EU citizens in general.

Defining key messagesEstablishing target audiencesSelecting the appropriate modes ofcommunicationTailoring information to the intendedoutletsBuilding good relationships with themediaEvaluating resultsMaximising the exposure of messagesTapping useful Commission and otherexternal resources

Persuasive communicationNot explicitly stated but three (message,audience, channel) of McGuire’s five attributes ofpersuasive communicationReference to other included frameworksNone

Practical guide aimed at researchers in EU Sixth(now seventh) Framework Programme projects.Provides an outline of good practices to assistresearchers to generate an effective flow ofinformation and publicity about the objectivesand results of their work.Focuses primarily on research communication viamass media channels

Carpenter [28]2005Designed to assist the Agency for HealthcareResearch and Quality (AHRQ) Patient Safetygrantees with disseminating their research results

What is going to be disseminated?Who will apply it in practice?Through whom can you reach end users?How you convey the research outcomes?How you determine what worked?Where do you start?

Persuasive communicationNot explicit but four (message, audience, source,channel) of McGuire’s five attributes ofpersuasive communication derived from LavisDiffusion of innovationsReference to other included frameworksNCDDRLavis

Practical guide including six major elementsaimed at AHRQ patient safety researchers. Basicpremise is to provide a structure to what can be anebulous concept yet which researchers areincreasingly expected to respond. Emphasisesimportance of engaging end users in planningprocess.

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Bauman [29]2006Provide a six step framework for understandinginternational approaches to physical activitydiffusion and dissemination.

Describe the innovation, its rationale andevidence base, and its relevance in aninternational context;Describe the target audience fordissemination and the sequence, timing,and formatting of dissemination strategies;Define the international communicationchannels for the innovation;Determine the role of key policymakersand sustainable partnerships that areneeded to implement the innovation atdifferent levels (local, state, national,international);Identify the barriers and facilitators of theinnovation in the international context;andConduct research and evaluation tounderstand the dissemination process.

Diffusion of innovationsApplication of Diffusion of Innovations in apublic health contextPersuasive communicationNot explicitly stated but three (audience,channel, setting) of McGuire’s five attributes ofpersuasive communicationReference to other included frameworksNone

Authors emphasise that dissemination one part ofdiffusion process. Much of framework based onexpert opinion and experiences.Four case studies presented to illustrate aspects offramework. Authors suggest that these sharesome common elements, including strongadvocacy, good communications between keyindividuals and institutions, and the presence ofshared values and population-level approaches.

Zarinpoush [31]2007To provide a framework that is intended to helpnon-profit organizations plan, conduct, andevaluate efforts to transfer and exchangeknowledge with others

Define the target audiencePreparing the message (Clear, Concise,Consistent, Compelling, Continuous)Selection of transfer method (s)Messenger credibilityEvaluation of expected effects

Persuasive communicationNot explicitly stated butfour (message, source, audience, channel) ofMcGuire’s five attributes of persuasivecommunicationReference to other included frameworksLavis

Five key elements to consider when planningknowledge transfer and exchange activity. Stateselements derived from recent literature, includingLavis.

Formoso [30]2007To analyse the barriers to knowledge transfer thatare often inherent in the format of theinformation communicated. Proposes a moreuser-friendly, enriched format to facilitate thetranslation of evidence-based information intopractice.

Five dimensions for enhancing informationdelivery:Contextualization/enrichmentValidity/critical appraisalComprehensibility of data on clinicalbenefits and harmsApplicability and relevanceStraightforwardness and appeal

Social marketingReference to other included frameworksNone

Describes five dimensions for enhancinginformation delivery and argues that littleattention is focussed on the way clinicalinformation is constructed and communicatedand how it can be made more relevant,acceptable and eventually ‘got through’ topractitioners.Social marketing techniques may help thepromotion of evidence-based knowledge. Thiswould entail systematically analysing andaddressing barriers to clarity and acceptability ofinformation, and offering a comprehensive andcritical look at its validity, biases and relevance.However, paper does not fully describe or applythe key features of a social marketing approach.

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Majdzadeh [32]2008Provide a conceptual framework to identifybarriers and facilitators and design strategies toknowledge translation strategies to be used byorganisations doing research

Five domains:Knowledge creation considers thecharacteristics of researchers and researchKnowledge transferconsiders resources and strategiesResearch utilization considers thecharacteristics of decision makers andcontext of decision making;Question transfer considers researchpriorities and fundersContext of organization considers theleadership system, policies, values, andculture of the organisation doing research

None statedReference to other included frameworksJacobsonLavis

Practical Tehran University of Medical Sciences(TUMS) framework developed from review ofliteratureAuthors’ suggest universities depend primarily onthe passive dissemination of knowledge.They suggest the following strategies can makeknowledge translation more effective inuniversities: defining and setting up of a systemto assess the knowledge translation cycle;implementation and use of informationtechnology; identification and encouragement offace-to-face interactions between researchers anddecision makers; exchanging knowledgeableindividuals among centres; creating mutual trust, acommon language and culture for the creation oforganizational knowledge; using importantmotivational tools in the university; usingmultidimensional methods for knowledge transfer

Friese [33]2009To identify what the cultural divides are betweenresearchers and policymakers and how socialscientists have bridged these differences bycareful attention to several pragmatic practicesfor increasing research use in policymaking

Conceptualize policy work, not asdisseminating information, but asdeveloping relationshipsTake the initiative to contact policymakersor policy intermediariesLearn about the target policymakingaudienceCommunicate research findings in waysthat meet policymakers’ information needsUse clear, careful language when dealingwith myths about vulnerable populationsFamiliarize yourself with the policymakingprocessProvide a timely response to the questionsdriving the policy debateLearn how to approach policy work as aneducator rather than an advocateShow respect for policymakers’ knowledgeand experienceBe patient and self-rewarding in definingsuccess.

Two-communities theoryReference to other included frameworksNone

Based around notion that the underutilisation ofresearch is down to a communication gapbetween researchers and policymakers, who havediffering goals, information needs, values, andlanguage that are best thought of as a culturaldivide.Ten recommendations derived from qualitativeinterviews on the barriers and facilitators toresearch communication with social scientistsworking in family policy.

Yuan [34]2010Present a conceptual framework andpropose a eight point strategy for improving thedissemination of best practices by national qualityimprovement campaigns

Provide simple, evidence- basedrecommendationsAlign messages with strategic goals ofadopting organizationUse a nodal organizational structureEngage a coalition of credible campaignsponsorEstablish threshold of participatingorganizationsProvide practical implementation toolsCreate networks to foster learningopportunitiesMonitor progress and evaluate impact

Diffusion of innovationsBuilds on Diffusion of Innovations but with afocus on active dissemination; planned efforts topersuade targeted groups to adopt aninnovationReference to other included frameworksGreenhalgh

Authors recognise that dissemination impactdepends on contextual factors, including thenature of the innovation itself, externalenvironmental incentives, and features of theadopting organizations. They argue that althoughimportant contextual considerations are outsidethe control of disseminators, greater use of theirstrategy is likely to promote more potentcampaign efforts, more effective dissemination,and ultimately greater take-up of evidence-basedpractices.

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about ‘Who says what in which channel to whom withwhat effect’ [37]. McGuire argued that there are fivevariables that influence the impact of persuasive com-munications. These are the source of communication,the message to be communicated, the channels of com-munication, the characteristics of the audience (recei-ver), and the setting (destination) in which thecommunication is received.Included frameworks were judged to encompass either

three [21,27,29], four [15,20,23,26,28,31,38], or all five[11,18,25] of McGuire’s five input variables, namely, thesource, channel, message, audience, and setting. Theearliest conceptual model included in the review expli-citly applied McGuire’s five input variables to the disse-mination of medical technology assessments [11]. Onlyone other framework (in its most recent version) expli-citly acknowledges McGuire [17]; the original versionacknowledged the influence of Winkler et al. on itsapproach to conceptualising systematic review dissemi-nation [18]. The original version of the CRD approach[18,39] is itself referred to by two of the other eight fra-meworks [20,23]Diffusion of Innovations theory [40,41] is explicitly

cited by eight of the dissemination frameworks[11,17,19,22,24,28,29,34]. Diffusion of Innovations offersa theory of how, why, and at what rate practices orinnovations spread through defined populations andsocial systems. The theory proposes that there areintrinsic characteristics of new ideas or innovations thatdetermine their rate of adoption, and that actual uptakeoccurs over time via a five-phase innovation-decisionprocess (knowledge, persuasion, decision, implementa-tion, and confirmation). The included frameworks arefocussed on the knowledge and persuasion stages of theinnovation-decision process.Two of the included dissemination frameworks make

reference to Social Marketing [42]. One briefly discussesthe potential application of social and commercial mar-keting and advertising principles and strategies in thepromotion of non-commercial services, ideas, orresearch-based knowledge [22]. The other briefly arguesthat a social marketing approach could take intoaccount a planning process involving ‘consumer’oriented research, objective setting, identification of bar-riers, strategies, and new formats [30]. However, this fra-mework itself does not represent a comprehensiveapplication of social marketing theory and principles,and instead highlights five factors that are focussedaround formatting evidence-based information so that itis clear and appealing by defined target audiences.Three other distinct dissemination frameworks were

included, two of which are based on literature reviewsand researcher experience [14,32]. The first frameworktakes a novel question-based approach and aims to

increase researchers’ awareness of the type of contextinformation that might prove useful when disseminatingknowledge to target audiences [14]. The second frame-work presents a model that can be used to identify bar-riers and facilitators and to design interventions to aidthe transfer and utilization of research knowledge [32].The final framework is derived from Two CommunitiesTheory [43] and proposes pragmatic strategies for com-municating across conflicting cultures research and pol-icy; it suggests a shift away from simple one-waycommunication of research to researchers developingcollaborative relationships with policy makers [33].

Characteristics of conceptual frameworks relating toknowledge translation that could be used by researchersto guide their dissemination activitiesTable 2 summarises in chronological order the dissemi-nation elements of 13 conceptual frameworks relating toknowledge translation that could be used by researchersto guide their dissemination activities [13,44-55].

Theoretical underpinnings of dissemination frameworksOnly two of the included knowledge translation frame-works were judged to encompass four of McGuire’s fivevariables for persuasive communications [45,47]. Oneframework [45] explicitly attributes these variables asbeing derived from Winkler et al [11]. The other [47]refers to strong direct evidence but does not refer toMcGuire or any of the other included frameworks.Diffusion of Innovations theory [40,41] is explicitly

cited in eight of the included knowledge translation fra-meworks [13,45-49,52,56]. Of these, two representattempts to operationalise and apply the theory, one inthe context of evidence-based decision making andpractice [13], and the other to examine how innovationsin organisation and delivery of health services spreadand are sustained in health service organisations [47,57].The other frameworks are exclusively based on the the-ory and are focussed instead on strategies to acceleratethe uptake of evidence-based knowledge and orinterventionsTwo of the included knowledge translation frameworks

[50,53] are explicitly based on resource or knowledge-based Theory of the Firm [58,59]. Both frameworks pro-pose that successful knowledge transfer (or competitiveadvantage) is determined by the type of knowledge to betransferred as well as by the development and deploy-ment of appropriate skills and infrastructure at an orga-nisational level.Two of the included knowledge translation frame-

works purport to be based upon a range of theoreticalperspectives. The Coordinated Implementation model isderived from a range of sources, including theories ofsocial influence on attitude change, the Diffusion of


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Table 2 Conceptual frameworks relating to knowledge translation that could be used by researchers to guide theirdissemination activities

Author, Year, Aims Dissemination elements Theoretical foundations Description/Comment

Funk [44]1989To facilitate the use of research inclinical settings by providingfindings that are relevant and readyto use, in a form that maintains therichness of full research reports yetis still understandable to thegeneral reader.

Qualities of Research(described as topic selection basedon literature reviews and surveys ofclinicians with criteria focussed onrelevance, applicability and theperceived gaps between evidenceand practice)Characteristics of thecommunication (including use ofnon-technical language, emphasison implications for practice andstrategies for implementation).Facilitation of utilisation (provisionof enquiry centre forimplementation advice and torespond to requests for furtherinformation and feedback channelfor researchers and practitioners)

None statedReference to other includedframeworksNone

Describes an approach devised bythe National Center for NursingResearch to make research resultsaccessible to practising nurses via atopic focused conference andmonograph series.

Lomas[12,45]1993Presents a coordinatedimplementation model that thatseeks to shed light ondissemination processes and onbest how to flow research findingsinto practice.

Dissemination elements withinwider implementation model:The messageIts sourceThe communication channelsThe implementation setting

MixedFull model derived from models ofsocial influence, diffusion ofinnovations, adult learning theoryand social marketing.Persuasive communicationFour (source, setting, message,channel) of McGuire’s five attributesof persuasive communicationevident (explicitly derived fromWinkler)Reference to other includedframeworksWinkler

Argues that use of research inpractice may depend more on achange in researchers behaviourthan it does on practitioners-research findings most likely to findtheir way into practice when theyare synthesised, contextualised,packaged to the needs of the enduser.Wider model recognises theexternal influencing factors on theoverall practice environmentincluding, economic resources,legislation and regulation,education, personnel as well aspublic (media) and patientpressures.

Dobbins[13]2002To construct a comprehensiveframework of researchdissemination and utilisation.

Complex interrelationshipsthat exist among five stages ofinnovation (knowledge, persuasion,decision, implementation andconfirmation) and four types ofcharacteristics (innovation,organization, environment andindividual) as progression fromresearch dissemination to researchutilization occurs

Diffusion of innovationsExplicit application of Rogersdiffusion of innovations innovation-decision processReference to other includedframeworksNone

Application of Rogers’s innovation-decision process to health researchdissemination and utilisation.Framework integrates concepts ofresearch dissemination (knowledge,persuasion), evidence-baseddecision making (decision) andresearch utilisation(implementation) within theinnovations decision process ofdiffusion of innovations theory.Argues that the extent to which anindividual or organisation becomesknowledgeable about new ideas issomewhat dependent on thedissemination strategies employedby health researchers

Elliot [46]2003Present a conceptual and analyticframeworks that integrate severalapproaches to understanding andstudying dissemination processeswithin public health systemsfocussed on cardiovascular healthpromotion

Four categories of factors shown toaffect the success of disseminationefforts:Characteristics of the disseminationobjectEnvironmental factors,Factors associated with usersRelationships between producersand users.

Diffusion of innovationsDerived from Diffusion ofInnovations-goes on to describefive approaches to dissemination(science push, problem solving,organisational, knowledge transferand interaction)Reference to other includedframeworksNone

Authors state that disseminationand capacity exist within a broadersocial, political, economic contextoperating at micro, meso andmacro levelsThe framework posits thatcontextual factors act as mediatorsshaping the behaviours and valuesof individuals and organizations,innovations, and influencing theprocess and outcome of capacitybuilding and dissemination.


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Table 2 Conceptual frameworks relating to knowledge translation that could be used by researchers to guide theirdissemination activities (Continued)

Greenhalgh [47,57]2004Review of the literature on thespread and sustainability ofinnovations in health servicedelivery and organisationDevelop and apply (in four casestudies) a unifying conceptualmodel based on the evidence.

Planned dissemination elementswithin wider model:Address needs and perspectives ofpotential adoptersTailor different strategies todifferent groupsUse appropriate messagesUse appropriate communicationchannelsUndertake rigorous evaluation

Diffusion of innovationsApplication of Diffusion ofInnovations in a health servicedelivery and organisation contextPersuasive communicationNot explicitly stated butfour (message, setting, audience,channel) of McGuire’s five attributesof persuasive communicationReference to other includedframeworksNone

Formal dissemination programs,defined as active and plannedefforts to persuade target groups toadopt an innovation are moreeffective if the program’s organizers(1) take full account of potentialadopters’ needs and perspectives,with particular attention to thebalance of costs and benefits forthem; (2) tailor different strategiesto the different demographic,structural, and cultural features ofdifferent subgroups; (3) use amessage with appropriate style,imagery, metaphors, and so on; (4)identify and use appropriatecommunication channels; and (5)incorporate rigorous evaluation andmonitoring of defined goals andmilestones

Green [48]2006Review tobacco controldissemination experience to drawguidance for physical activitypromotion

Push: strengthening sciencepush by proving, improving, andcommunicating effectiveinterventions for wide populationuse;Pull: boosting demand, or marketpull for interventions amongconsumers, and healthcarepurchasers and policymakersCapacity: building the capacity ofrelevant systems and institutions todeliver them

Diffusion of innovationsDiffusion of Innovations used toassess how tobacco control lessonsdiffuse and apply to the field ofphysical activityReference to other includedframeworksNone

Author’s state disseminationencompasses the plannedfacilitation and acceleration ofdiffusion of innovations, transferand utilization of knowledge, andimplementation of the resultingadaptations in local circumstances.Author suggest lessons fromtobacco control include the needfor a funded mandate; the massmedia to frame the public policydebate and to help underminenegative behaviour; thecomprehensiveness of interventionsat national and local levels tomutually reinforce each other; theneed for systematic evaluation; theneed for policy and funding tosupport programs; the need forcoordinated programs to supportindividuals.

Owen [49]2006Outline the main attributes ofDiffusion of Innovations and keyconcepts to consider in thedissemination and diffusion ofinnovations to promote physicalactivity

Advocacy: identifying andengaging key stakeholdersIncreased funding to build theevidence base to supply diffusionand dissemination strategies and toallow investigators to gainexperience with type of roleImplement surveillance systems totrack use of evidence-basedinterventions

Diffusion of innovationsApplication of Diffusion ofInnovations in a public healthcontextRE-AIM framework can be used todetermine the success and impactof dissemination effortsReference to other includedframeworksNone

Diffusion of innovations theory canbe applied to accelerate the rate ofdiffusion specifically to promotephysical activity interventions.Authors present two case studiesand argue that their successillustrates the need for dedicatedfield staff, product production,marketing, and distribution.

Landry [50]2007To determine the extent ofresearch transfer in natural sciencesand engineering among Canadianuniversity researchers;to examine any differencesbetween various disciplines withregard to the extent of transfer; toexamine the determinants ofresearch transfer

Four categories of resources (alongwith the attributes of researchknowledge) likely to enableresearchers to transfer knowledge:FinancialOrganizationalRelationalPersonal

Resource-based view of the firmResource-based view of the firm-researchershave resources and capabilitieswhich are deployed andmobilized in their knowledgetransfer activitiesReference to other includedframeworksNone

Based on a survey of 1,554researchers, presents a model ofhow researchers in natural sciencesand engineering transferknowledge outside the academiccommunityTwo determinants found to beconsistently influential: linkagesbetween researchers and researchusers, and focus of the researchprojects on end user needs. Otherdeterminants influencingknowledge transfer varied from oneresearch field to another


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Baumbusch [51]2008Describe a participatory approachto knowledge translationdeveloped during a program ofresearch concerning equitable carefor diverse populations

Two dimensions process(translation) and content(knowledge):Process (translation involving:credible messengers, accountability,reciprocity, respect, and researchchampions)Content (ongoing cycle of datacollection, analysis and synthesis ofknowledge)

None statedReference to other includedframeworksJacobsonLavis

A collaborative model ofknowledge translation betweenresearchers and practitioners inclinical settings-derived from a nonsystematic review of literature andfrom experiences drawn from aprogramme of research funded bythe Canadian Institutes of HealthResearch.Authors state at the core of theapproach is a collaborativerelationship between researchersand practitioners, which underpinsthe knowledge translation cycle,and occurs simultaneously withdata collection/analysis/synthesis

Feldstein [52]2008To provide a new tool forresearchers and healthcare decisionmakers that integrates existingconcepts relevant to translatingresearch into practice.

Program or intervention(consideration of elements fromthe perspective of the organizationand staff to be targeted)External environment(consideration of)Implementation and sustainabilityinfrastructure necessary for success(consideration of)Recipients (Characteristics of bothorganisational and patientrecipients of interventions need tobe considered to maximizeintervention effectiveness)

MixedStates that aspects of the modelderived from diffusion ofinnovations, social ecology, thePRECEDE/PROCEED model, and thequality improvement/implementation literature. Impactmeasures derived from RE-AIMReference to other includedframeworksJacobsonLavis

Practical, Robust Implementationand Sustainability Model (PRISM)considers how the program orintervention design, the externalenvironment, the implementationand sustainability infrastructure, andthe recipients influence programadoption, implementation, andmaintenance.Designed to help researchers (andorganisations) conceptualize,implement, and evaluate healthcareimprovement programs.

Clinton [53]2009To present a knowledge transfermodel and illustrate how its usecan lead to competitive advantage

Comprehensive employee skillsassessmentIdentify the type of knowledge tobe transferred (tacit or explicit)Select appropriate media requiredfor knowledge transferAppropriate generation ofcorporate university (defined as astrategic commitment toorganisational learning anddevelopment of intellectual capital)

Knowledge-based view of thefirmReference to other includedframeworksNone

The authors propose that the typeof knowledge to be transferred andthe appropriate media to transferthat knowledge, determine theeducation and training needsrequired to achieve competitiveadvantage

Mitchell [54]2009To identify dimensions that couldbe used to describe anddifferentiate models of partnerships,and illustrate how thesedimensions could be applied usingthree recent case studies inAustralia.

Decision maker involvementin research versus researcherinvolvement in decision makingInvestigator versus decision makerdriven researchValue of decision makerinvolvement at various stages ofthe research process.Discrete projects versus programsversus ongoing reciprocityFormal versus informal linkagesActive versus passive involvementConcentrated and specific versusdiffuse and heterogeneous linkages

None statedReference to other includedframeworksGreenhalghLavis

Dimensions derived from a briefnarrative review of the partnershipliterature within health servicesresearch and on a selection oftheoretical and conceptualreferences from other fields,particularly organization science.Authors argue building capacity forknowledge exchange demands anevidence-base of its own. Theysuggest their seven dimensions ofpartnerships provide a basis forresearch examining the usefulnessof particular partnership modelsand their applicability andeffectiveness in different contexts


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Innovations, adult learning, and social marketing [45].The Practical, Robust Implementation and SustainabilityModel was developed using concepts from Diffusion ofInnovations, social ecology, as well as the health promo-tion, quality improvement, and implementation litera-ture [52].Three other distinct knowledge translation frame-

works were included, all of which are based on a combi-nation of literature reviews and researcher experience[44,51,54].

Conceptual frameworks provided by UK fundersOf the websites of the 10 UK funders of health servicesand public health research, only the ESRC made a disse-mination framework available to grant applicants orholders (see Table 1) [26]. A summary version ofanother included framework is available via the publica-tions section of the Joseph Rowntree Foundation [60].However, no reference is made to it in the submissionguidance they make available to research applicants.All of the UK funding bodies made brief references to

dissemination in their research grant application guides.These would simply ask applicants to briefly indicatehow findings arising from the research will be dissemi-nated (often stating that this should be other than viapublication in peer-reviewed journals) so as to promoteor facilitate take up by users in the health services.

DiscussionThis systematic scoping review presents to our knowl-edge the most comprehensive overview of conceptual/organising frameworks relating to research dissemina-tion. Thirty-three frameworks met our inclusion criteria,20 of which were designed to be used by researchers toguide their dissemination activities. Twenty-eightincluded frameworks that were underpinned at least inpart by one or more of three different theoretical

approaches, namely persuasive communication, diffusionof innovations theory, and social marketing.Our search strategy was deliberately broad, and we

searched a number of relevant databases and othersources with no language or publication status restric-tions, reducing the chance that some relevant studieswere excluded from the review and of publication orlanguage bias. However, we restricted our searches tohealth and social science databases, and it is possiblethat searches targeting for example the management ormarketing literature may have revealed additional frame-works. In addition, this review was undertaken as part ofa project assessing UK research dissemination, so oursearch for frameworks provided by funding agencies waslimited to the UK. It is possible that searches of fundersoperating in other geographical jurisdictions may haveidentified other studies. We are also aware that the wayin which we have defined the process of disseminationand our judgements as to what constitutes sufficientdetail may have resulted in some frameworks beingexcluded that others may have included or vice versa.Given this, and as an aid to transparency, we haveincluded the list of excluded papers as Additional File 2,Appendix 2 so as to allow readers to assess our, andmake their own, judgements on the literature identified.Despite these potential limitations, in this review we

have identified 33 frameworks that are available andcould be used to help guide dissemination planning andactivity. By way of contrast, a recent systematic reviewof the knowledge transfer and exchange literature (withbroader aims and scope) [61] identified five organisingframeworks developed to guide knowledge transfer andexchange initiatives (defined as involving more than oneway communications and involving genuine interactionbetween researchers and target audiences) [13-15,62,63].All were identified by our searches, but only three metour specific inclusion criteria of providing sufficient


Ward [55,56]2009Reviews knowledge transferframeworks to gain a betterunderstanding of the processesinvolved in knowledge transfer andpresents a five domain model ofthe knowledge transfer processesto help researchers, practitionersand decision makers plan andevaluate initiatives for transferringknowledge into action

Problem: Identifying andcommunicating about the problemwhich the knowledge needs toaddressContext: Analysing the contextwhich surrounds the producers andusers of knowledgeKnowledge: Developing andselecting the knowledge to betransferredIntervention: Selecting specificknowledge transfer activities orInterventionsUse: Considering how theknowledge will be used in practice

MixedPractical framework developedfrom on commonalities from 28published models including theDiffusion of InnovationsReference to other includedframeworksDobbinsGreenhalghJacobsonLavis

Authors emphasise that knowledgetransfer is an interactive,multidirectional rather than linearprocessReport outlines a series of domainspecific questions for research usersand producers to use to thinkabout and incorporate knowledgetransfer processes in to theirroutine practice.


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dissemination process detail [13-15]. One reviewedmethods for assessment of research utilisation in policymaking [62], whilst the other reviewed knowledge map-ping as a tool for understanding the many knowledgecreation and translation resources and processes in ahealth system [63].There is a large amount of theoretical convergence

among the identified frameworks. This all the morestriking given the wide range of theoretical approachesthat could be applied in the context of research dissemi-nation [64], and the relative lack of cross-referencingbetween the included frameworks. Three distinct butinterlinked theories appear to underpin (at least in part)28 of the included frameworks. There has been somecriticism of health communications that are overly reli-ant on linear messenger-receiver models and do notdraw upon other aspects of communication theory [65].Although researcher focused, the included frameworksappear more participatory than simple messenger-receiver models, and there is recognition of the impor-tance of context and emphasis on the key to successfuldissemination being dependent on the need for interac-tion with the end user.As we highlight in the introduction, there is recogni-

tion among international funders both of the impor-tance of and their role in the dissemination of research[9]. Given the current political emphasis on reducingdeficiencies in the uptake of knowledge about the effectsof interventions into routine practice, funders could bemaking and advocating more systematic use of con-ceptual frameworks in the planning of researchdissemination.Rather than asking applicants to briefly indicate how

findings arising from their proposed research will be dis-seminated (as seems to be the case in the UK), fundingagencies could consider encouraging grant applicants toadopt a theoretically-informed approach to theirresearch dissemination. Such an approach could bemade a conditional part of any grant application pro-cess; an organising framework such as those describedin this review could be used to demonstrate the ratio-nale and understanding underpinning their proposedplans for dissemination. More systematic use of concep-tual frameworks would then provide opportunities toevaluate across a range of study designs whether utilis-ing any of the identified frameworks to guide researchdissemination does in fact enhance the uptake ofresearch findings in policy and practice.

SummaryThere are currently a number of theoretically-informedframeworks available to researchers that could be usedto help guide their dissemination planning and activity.Given the current emphasis on enhancing the uptake of

knowledge about the effects of interventions into routinepractice, funders could consider encouraging researchersto adopt a theoretically informed approach to theirresearch dissemination.

Additional material

Additional file 1: Appendix 1: Database search strategies. This fileincludes details of the database specific search strategies used in thereview.

Additional file 2: Appendix 2: Full-text papers assessed foreligibility but excluded from the review. This file includes details offull-text papers assessed for eligibility but excluded from the review.

AcknowledgementsThis review was undertaken as part of a wider project funded by the MRCPopulation Health Sciences Research Network (Ref: PHSRN 11). The viewsexpressed in this paper are those of the authors alone.

Author details1Centre for Reviews and Dissemination, University of York, YO10 5DD, UK.2Social and Environmental Health Department, London School of Hygieneand Tropical Medicine, WC1E 7HT, UK. 3School of Social Policy, Sociologyand Social Research, University of Kent, CT2 7NF, UK. 4MRC General PracticeResearch Framework, University College London, NW1 2ND, UK.

Authors’ contributionsAll authors contributed to the conception, design, and analysis of thereview. All authors were involved in the writing of the first and allsubsequent versions of the paper. All authors read and approved the finalmanuscript. Paul Wilson is the guarantor.

Competing interestsPaul Wilson is an Associate Editor of Implementation Science. All decisionson this manuscript were made by another senior editor. Paul Wilson worksfor, and has contributed to the development of the CRD framework which isincluded in this review. The author(s) declare that they have no othercompeting interests.

Received: 4 January 2010 Accepted: 22 November 2010Published: 22 November 2010

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doi:10.1186/1748-5908-5-91Cite this article as: Wilson et al.: Disseminating research findings: whatshould researchers do? A systematic scoping review of conceptualframeworks. Implementation Science 2010 5:91.

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