A Collaborative System Approach for the Diffusion of Evidence-Based Prevention

描述（由申请人提供）：拟议的研究是对项目公告PAR-06-039的修订申请，标题为“健康领域的传播和实施研究”。二十多年的研究已经产生了基于证据的方法来防止青少年吸烟、饮酒和其他药物。迫切需要进行新的研究，以确定、开发和完善有效和高效的方法、结构和战略，以测试传播和实施循证预防的模型。拟议的研究旨在测试基于协作和适应性系统的方法和结构在促进以证据为基础的预防烟草、酒精和药物滥用的传播、采用、实施和可持续性方面的有效程度。本研究将评估基于系统的以适应为重点的实施工作与传统的（“自上而下”）以保真度为重点的实施工作的相对优势。“系统”一词既指我们在开发DAIS工作中使用的方法，也指我们为支持这些工作所采用的组织结构。协作系统思维方法将用于设计和管理DAIS工作，合作推广系统（CES）的系统结构将用于支持实施。在第一阶段（24个月），将采用一种系统方法（概念图），使利益攸关方能够确定总体上以证据为基础的预防DAIS中的关键因素，并促进制定一种系统方法，以实施具体的以证据为基础的预防计划，即生活技能培训（LST）。系统方法将利用概念映射、自适应系统思维方法和CES作为组织支持结构。第二阶段（30个月）将包括一项随机试验，在此期间，50所中学（包括4,000名参与的学生）将被随机分配到以下条件之一：(1)基于协作系统的适应性方法来实施LST，(2)以保真度为中心的标准LST实施。该项目将由来自纽约市康奈尔大学威尔医学院、伊萨卡州康奈尔大学人类生态学院和遍布纽约州的康奈尔大学合作推广服务中心的经验丰富的科学家和工作人员组成。拟议研究的最终目标是提供关键的新知识，以促进广泛传播、采用、实施和持续利用循证预防措施，以减少美国各地的烟草、酒精和非法药物滥用。与公共卫生的关系：在制定预防吸烟、饮酒和非法药物使用的有效办法方面取得了相当大的进展。但是，这些办法没有得到广泛传播和利用。拟议研究的最终目标是提供关键的新知识，以促进广泛传播、采用、实施和持续利用循证预防措施，以减少美国各地的烟草、酒精和非法药物滥用。

DESCRIPTION (provided by applicant): The proposed research is a revised application responding to program announcement PAR-06-039 entitled "Dissemination and Implementation Research in Health." More than two decades of research have produced evidence-based approaches for preventing tobacco, alcohol, and other drugs during adolescence. New research is urgently needed to identify, develop, and refine effective and efficient methods, structures, and strategies that test models to disseminate and implement evidence-based prevention. The proposed research is designed to test the extent to which collaborative and adaptive systems-based approaches and structures will be effective at promoting the dissemination, adoption, implementation, and sustainability (DAIS) of evidence-based tobacco, alcohol, and drug abuse prevention. This study will assess the relative benefits of a systems-based adaptation-focused implementation effort versus a traditional ("top- down") fidelity-focused one. The term system is used to refer both to the methodologies we will employ in developing DAIS efforts and to the organizational structures we will engage to support these efforts. Collaborative systems thinking methodologies will be used to design and manage DAIS efforts, and the system structure of the Cooperative Extension System (CES) will be used to support implementation. During Phase I (24 months), a systems methodology (concept mapping) will be utilized to enable the stakeholder community to identify key factors in the DAIS of evidence-based prevention in general, and facilitate the development of a systems approach to implementation of a specific evidence-based prevention program, Life Skills Training (LST). The systems approach will utilize concept mapping, adaptive systems thinking methods, and CES as the organizational support structure. Phases II (30 months) will consist of a randomized trial during which 50 middle schools including 4,000 participating students will be randomly assigned to one of the following conditions: (1) collaborative systems-based adaptive approach to implementation of LST and (2) standard fidelity-focused implementation of LST. The project will be conducted by an experienced team of scientists and staff from Cornell's Weill Medical College in New York City, Cornell's College of Human Ecology in Ithaca, and Cornell's Cooperative Extension Service located throughout New York State. The ultimate goal of the proposed research is to provide critical new knowledge to facilitate the widespread dissemination, adoption, implementation, and sustained utilization of evidence-based prevention in order to reduce tobacco, alcohol, and illicit drug abuse throughout the United States. PUBLIC HEALTH RELEVANCE: Considerable progress has been made in developing effective approaches to prevent tobacco, alcohol, and illicit drug use. However, these approaches have not been widely disseminated and utilized. The ultimate goal of the proposed research is to provide critical new knowledge to facilitate the widespread dissemination, adoption, implementation, and sustained utilization of evidence-based prevention in order to reduce tobacco, alcohol, and illicit drug abuse throughout the United States.