Dissemination Framework Research Articles

Commentary: Bridging and Reducing the Gaps Between Research and Practice: Pathways to Outcomes and the Interactive Systems Framework for Dissemination and Implementation 2.0

There are many ways proposed to achieve better societal outcomes (e.g., in health, education, and well-being) including: (1) bridging research and practice, (2) building the motivation and capacity of service delivery organizations (e.g., schools, hospitals, clinics, and community-based organizations) to innovate, and (c) providing service delivery systems with high-quality support via training and technical assistance. The Interactive Systems Framework for Dissemination and Implementation (ISF) was developed to describe how relevant systems, organizations, and processes can interact and work toward these goals. Stimulated by the 13 articles contained in the two special issues of Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers, we describe several enhancements to the ISF including: how service delivery systems can operate better, how motivation and capacity can be built, and how training and technical assistance centers can provide more evidence-informed technical assistance and other promising innovations. ISF 2.0 incorporates these and other enhancements with the goal of achieving better outcomes. We conclude that the actions and accountability of funders and of organizations and systems to funders would accelerate progress in the systems to achieve outcomes—and result in improving the science and practice of implementation support.

Development of the Guide to Disseminating Research (GuiDiR): A consolidated framework

BackgroundLess than one third of research evidence is translated into policy or practice. Knowledge translation requires effective dissemination, adoption and finally implementation. These three stages are equally important, however, existing knowledge translation models and frameworks provide little and disparate information about the steps and activities required for effective dissemination. ObjectiveThis study aimed to empirically develop a consolidated framework of evidence-based steps and activities for disseminating research evidence. MethodsWe identified models and frameworks from a scoping review and dissemination and implementation webtool. We synthesised them into a prototype dissemination framework. Models and frameworks were eligible to inform steps in our framework if they fulfilled at least one of three elements of dissemination: intending to generate awareness of a message, incorporates targeting an audience: tailoring communication. An initial coding framework was created to organise data into dissemination steps.Drawing on ‘co-approach’ principles, authors of the included models and frameworks (dissemination experts) and health service researchers (end users) were invited to test and refine the prototype framework at a workshop. ResultsFrom 48 models and frameworks reviewed, only 32 fulfilled one or more of the three dissemination elements. The initial coding framework, upon refinement, yielded the Guide to Disseminating Research (GuiDiR) comprising five steps.1) Identify target audiences and dissemination partners.2) Engage with dissemination partners.3) Identify barriers and enablers to dissemination.4) Create dissemination messages.5) Disseminate and evaluate.Multiple activities were identified for each step and no single model or framework represents all steps and activities in GuiDiR. ConclusionsGuiDiR unifies dissemination components from knowledge translation models and frameworks and harmonises language into a format accessible to non-experts. It outlines for researchers, funders and practitioners the expected structure of dissemination and details the activities for executing an evidence-based dissemination strategy.

Genetic Algorithm-Based Cooperative Coding and Caching Data Dissemination Scheme in Multi-UAV-Enabled Internet of Vehicles.

Unmanned Aerial Vehicles (UAVs) have emerged as efficient tools in disaster-stricken areas, facilitating efficient data dissemination for post-disaster rescue operations. However, the limited onboard energy of UAVs imposes significant constraints on their operational lifespan, thereby presenting substantial challenges for efficient data dissemination. Therefore, this work investigates a data dissemination scheme to enhance the UAVs' bandwidth efficiency in multi-UAV-enabled Internet of Vehicles, thereby reducing UAVs' energy consumption and improving overall system performance when UAVs hover along designated flight trajectories for data dissemination. Specifically, first, we present a software-defined network-based framework for data dissemination in multi-UAV-enabled IoV. According to this framework, we formulate a problem called C2BS (Coding-based Cooperative Broadcast Scheduling) that focuses on optimizing the UAVs' bandwidth efficiency by leveraging the combined benefits of coding and caching. Furthermore, we demonstrate the NP-hardness of the C2BS problem by employing a polynomial time reduction technique on the simultaneous matrix completion problem. Then, inspired by the benefits offered by genetic algorithms, we propose a novel approach called the Genetic algorithm-based Cooperative Scheduling (GCS) algorithm to address the C2BS problem. This approach encompasses a coding scheme for representing individuals, a fitness function for assessing individuals, operators (i.e., crossover and mutation) for generating offspring, a local search technique to enhance search performance, and a repair operator employed to rectify infeasible solutions. Additionally, we present an analysis of the time complexity for the GCS algorithm. Finally, we present a simulation model to evaluate the performance. Experimental findings provide evidence of the excellence of the proposed scheme.

A novel and optimized computational framework for energy efficient data dissemination in wireless sensor network

Wireless sensor network (WSN) is an integral part of internet-of-things (IoT), where a large scale of data transmission and various complex services are identified to be delivered. In order to facilitate these services, energy efficiency is one critical demand for resource-constraint sensor nodes. Carrier sense multiple access (CSMA) has been considered for effective traffic management for high-end data delivery services. A review of existing literature on CSMA-based schemes shows that it has not yet achieved an optimal case of energy efficiency. Hence, the proposed study presents a novel computational framework in order to address this research gap. The prime contribution of the proposed study is towards presenting an optimal computational model for maximized fairness in data dissemination services in WSN especially focusing on energy efficiency. The presented study model also contributes towards optimizing route buffer and buffer power, which facilitates towards availability of energy-efficient path information. The study also introduces a mobile auxiliary node that aggregates the data from sensor nodes and delivers it to the sink node considering dynamic location updates for seamless transmission. Scripted in MATLAB, the proposed scheme exhibited 70% energy saving compared to conventional schemes of CSMA in WSN.

How do the Substance Abuse and Mental Health Services Administration's Technology Transfer Centers Decide What Evidence-Based Practices to Disseminate and Determine How to Do So? A Cross-Sectional Study of a National Network.

It is important to use evidence-based programs and practices (EBPs) to address major public health issues. However, those who use EBPs in real-world settings often require support in bridging the research-to-practice gap. In the US, one of the largest systems that provides such support is the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Technology Transfer Center (TTC) Network. As part of a large external evaluation of the Network, this study examined how TTCs determine which EBPs to promote and how to promote them. Using semi-structured interviews and pre-testing, we developed a "Determinants of Technology Transfer" survey that was completed by 100% of TTCs in the Network. Because the study period overlapped with the onset of the COVID-19 pandemic, we also conducted a retrospective pre/post-pandemic comparison of determinants. TTCs reported relying on a broad group of factors when selecting EBPs to disseminate and the methods to do so. Stakeholder and target audience input and needs were consistently the most important determinant (both before and during COVID-19), while some other determinants fluctuated around the pandemic (e.g., public health mandates, instructions in the funding opportunity announcements). We discuss implications of the findings for technology transfer and frame the analyses in terms of the Interactive Systems Framework for Dissemination and Implementation.

Continuous Quality Improvement in the Substance Abuse and Mental Health Services Administration's Technology Transfer Center Network: A Process Evaluation.

In healthcare and related fields, there is often a gap between research and practice. Scholars have developed frameworks to support dissemination and implementation of best practices, such as the Interactive Systems Framework for Dissemination and Implementation, which shows how scientific innovations are conveyed to practitioners through tools, training, and technical assistance (TA). Underpinning those aspects of the model are evaluation and continuous quality improvement (CQI). However, a recent meta-analysis suggests that the approaches to and outcomes from CQI in healthcare vary considerably, and that more evaluative work is needed. Therefore, this paper describes an assessment of CQI processes within the Substance Abuse and Mental Health Services Administration's (SAMHSA) Technology Transfer Center (TTC) Network, a large TA/TTC system in the United States comprised of 39 distinct centers. We conducted key informant interviews (n = 71 representing 28 centers in the Network) and three surveys (100% center response rates) focused on CQI, time/effort allocation, and Government Performance and Results Act (GPRA) measures. We used data from each of these study components to provide a robust picture of CQI within a TA/TTC system, identifying Network-specific concepts, concerns about conflation of the GPRA data with CQI, and principles that might be studied more generally.

420 Computable Phenotyping with “Big Data” as a Foundation for Artificial Intelligence Algorithm Construction: Puberty as a Transdisciplinary Case Example

OBJECTIVES/GOALS: Artificial intelligence (AI) depends on quality machine learning (ML) algorithms constructed with high-quality training data. This TL1 trainee project develops a disease-agnostic computable phenotype framework for ML algorithm construction, modeling male puberty as a case example. METHODS/STUDY POPULATION: A computable phenotype of male puberty was constructed to answer the question: “Does early pubertal timing increase the risk of developing type II diabetes (T2D) in males?” A computable phenotype of males < 18 years old was created in the TriNetX© Diamond Network utilizing Boolean operator data queries. TriNetX© contains patient electronic health record information (ICD-10 diagnoses, anthropometric measures). An exploratory analysis of patient counts reflecting various computable phenotypes allowed for outcome (T2D) comparison of males diagnosed with precocious puberty (E30.1, ICD code for early pubertal timing) to those without, controlling for body mass index (BMI). RESULTS/ANTICIPATED RESULTS: Subjects (n=12,996,132) displayed the following computable phenotype: Male, < 18 years old, without ever having a BMI documented >85th percentile. Males diagnosed with precocious puberty (E30.1) were 6.89 times more likely to develop T2D when aged 14-18 years old than those without (OR 6.89, 95% CI: 5.17-9.19, p<0.0001). Next steps involve training a ML model on each computable phenotype groupings’ health data, with anticipated results identifying underlying salient pathophysiologic variables. A generalized computable phenotype approach is further developed to: 1) explore clinical questions in large databases like TriNetX©, and 2) model disease development with AI/ML algorithm construction. DISCUSSION/SIGNIFICANCE: Computed phenotypes reveal males with precocious puberty may have increased T2D risk. Next steps utilize subject data to train an AI/ML algorithm, model development to identify salient pathophysiologic variables, and synthesize a generalized AI/ML developmental research framework for dissemination.

Secure and lightweight message dissemination framework for internet of vehicles

AbstractThe Internet of Vehicles (IoV) revolutionizes vehicle communication in dynamic networks. Message dissemination in IoV involves sharing critical information for the safety and convenience of the IoV network. It is very crucial to secure message dissemination due to potential cyber‐attacks, traffic disruptions, and privacy breaches. Data integrity, authentication, and privacy are vital to maintaining trust and safety in the IoV network. This network consists of resource‐constrained IoV devices with limited resources due to the availability of embedded components in vehicular systems. Therefore, optimizing algorithms and protocols is crucial for efficient vehicle‐to‐everything (V2X) communication, enhancing safety and transportation efficiency. Solutions often include lightweight protocols and secure message exchange. This paper proposes a machine learning (ML) based secure and lightweight message dissemination framework for resource‐constrained IoV. First, we present an ML‐based threat classification model capable of effectively categorizing adversarial and nonadversarial data streams and delivering an optimized model with superior accuracy. Furthermore, we also propose a secure message dissemination scheme using lightweight cryptographic primitives, which significantly reduces computational, communication, and energy overhead. To validate the robustness of our proposed ML‐based secure and lightweight message dissemination framework, we evaluate it using various security parameters and performance measures such as computation cost, communication cost, energy cost, accuracy, precision, recall, and F1‐score. Our contributions promise to significantly enhance the security and efficiency of message dissemination in IoV environments and advance lightweight, secure, and reliable transportation systems for the future.

Ensuring fidelity: key elements to consider in disseminating a diabetes telemanagement program for underserved Hispanic/Latinos living with type 2 diabetes.

The Hispanic/Latino population has greater risk (estimated >50%) of developing type 2 diabetes (T2D) and developing it at a younger age. The American Diabetes Association estimates costs of diagnosed diabetes in 2017 was $327 billion; with medical costs 2.3x higher than patients without diabetes. The purpose of this manuscript is to describe the methodology utilized in a randomized controlled trial aimed at evaluating the efficacy of a diabetes telemanagement (DTM) program for Hispanic/Latino patients with T2D. The intent is to provide information for future investigators to ensure that this study can be accurately replicated. This study was a randomized controlled trial with 240 participants. Eligible patients (Hispanic/Latino, aged 18+, living with T2D) were randomized to Comprehensive Outpatient Management (COM) or DTM. DTM was comprised of usual care, including routine clinic visits every three months, as well as: Biometrics (a tablet, blood glucose meter, blood pressure monitor, and scale); Weekly Video Visits (facilitated in the patient's preferred language); and Educational Videos (including culturally congruent diabetes self-management education and quizzes). COM consisted of usual care including routine clinic visits every three months. For this study, COM patients received a glucometer, glucose test strips, and lancets. Establishing a therapeutic nurse-patient relationship was a fundamental component of our study for both groups. First contact (post-enrollment) centered on ensuring that patients and caregivers understood the program, building trust and rapport, creating a non-judgmental environment, determining language preference, and establishing scheduling availability (including evenings and weekends). DTM were provided with a tablet which allowed for self-paced education through videos and weekly video visits. The research team and Community Advisory Board identified appropriate educational video content, which was incorporated in diabetes educational topics. Video visits allowed us to assess patient involvement, motivation, and nonverbal communication. Communicating in Spanish, and awareness of diverse Hispanic/Latino backgrounds was critical, as using relevant and commonly-used terms can increase adherence and improve outcomes. Shared decision-making was encouraged to make realistic health care choices. Key elements discussed above provide a framework for future dissemination of an evidence-based DTM intervention to meet the needs of underserved Hispanic/Latino people living with T2D.

Research on effective communication forms and characteristics of public service advertisements for nurturing parenting skills in China

This study is part of a larger research aimed at enhancing effective communication of parenting skills knowledge to Chinese parents. The purpose is to explore how to transform public service advertisements into effective training methods for Chinese parents by studying the media form, content expression, symbolic elements and other aspects of public service advertisements in China. This study documents the identification of effective communication characteristics of PSAs, in which advertisements in the form of cold and hot media have different sensory experience characteristics, their expressions of the central processing path, and the expression of the peripheral processing path of advertisements, which could be transformed to improve information transmission and are attractive to observers. The results found different characteristics in terms of language and nonverbal advertising content, which could create different effects on observers. This article mainly studies the different roles of different media forms, content expression, and symbolic elements in public service advertisements, as well as the communication effects of different forms of public service advertisements under different themes. The results have significant implications for developing a theoretical framework for the efficient dissemination of public service commercials and, consequently, for promoting happier families for developing children by improving parents' parenting knowledge.

Disseminating for impact: creating curriculum activities for translational dissemination for the clinical and translational research workforce.

There has been an increased focus on the practices associated with dissemination for the translation of research to clinical practice and ultimately, policy. Simultaneously, there has been attention placed on the role of the clinical research workforce in supporting optimal dissemination efforts for impact and societal benefit. Curriculums focused on education opportunities for dissemination for translational scientists have been under-reported. The Translational Science Benefits Model (TSBM) is a framework that has been developed to support assessment of clinical and translational research outcomes that measure impact (both in the clinical and community setting) beyond traditional citations in academic journals/bibliometric activities. The TSBM framework outlines more than 30 different facets of impact and can provide a basis for operationalizing broad impacts of research for translational and clinical scientists. Engagement science offers methods and modalities to work with individual stakeholders, and collaborators in a team science model, and engagement with external scholars and society. This article will describe the use of the TSBM framework and engagement science strategies to develop a translational dissemination framework with novel components for evaluation of dissemination and implementation activities. We propose using the translational dissemination framework to guide the development of an educational curriculum for the clinical research workforce. We outline the educational domains and proposed evaluation criteria essential in implementing this innovative translational dissemination educational content for the clinical and translational research workforce.

Building capacity to implement sexual health risk and substance use disorder prevention services in adolescent behavioral health treatment: A case study

Adolescents with mental health and psychiatric disorders, as compared to their peers, are at increased risk for contracting sexually transmitted infections and developing substance use disorders (SUD). Practitioners need integrated programs addressing sexual health and substance misuse to promote healthy behaviors among vulnerable adolescent populations. Building agency capacity necessary to integrate sexual health education and SUD prevention can be challenging, but dissemination and implementation frameworks and models can provide a structured approach. This case study examines the application of the Interactive Systems Framework for Dissemination and Implementation and the Evidence-based System for Innovation Support to build the capacity of behavioral health agency staff to deliver an integrated sexual health risk and SUD prevention program with adolescents. Over a five-year period, researchers and behavioral health agency staff collaborated and increased agency capacity by using a training-of-trainers approach, comprehensive tools, proactive technical assistance, and quality assurance. While there were significant challenges, such as staff turnover and competing agency priorities, the team certified eight facilitators in the selected health promotion intervention and two agency trainers with the capacity for ongoing expansion and the expectation of sustainability of needed adolescent services.

Blockchain-Based Secure and Intelligent Data Dissemination Framework for UAVs in Battlefield Applications

Blockchain-Based Secure and Intelligent Data Dissemination Framework for UAVs in Battlefield Applications

프랑스 내 한국학 현황과 독립운동사 연구의 활성화 방안

Korean Studies research in France has achieved remarkable growth both quantitatively and qualitatively due to Korea's economic growth and increasing cultural influence. Currently, in-depth research is being conducted across all fields, expanding the scope to Korean studies as a whole, not just Korean language education. Unfortunately, however, the field of research on the history of the independence movement is far from the interest of institutions, researchers, and students. In this situation, the emergence of the Korean-French Independence Movement History Research Association (Libertas), founded in 2017, is encouraging. Members held several international academic conferences related to the history of the Korean independence movement, and achieved significant results through active activities such as excavation of a large number of materials and posthumous writings of independence activists. Although the framework for research and dissemination of the history of the Korean independence movement in France has been established, it is still in a basic state due to realistic limitations. Financial and academic support, as well as the interest and active participation of many researchers in Korea, are needed to vitalize research on the history of the independence movement.

A Qualitative Research Study of Experiences and Perceptions of People Living with Insulin Resistance Syndrome or Lipoatrophic Diabetes in Japan.

There are few reports on the experiences and perceptions of people living with the rare diseases of insulin resistance syndrome or lipodystrophy. This study was designed to identify treatment experiences and perceptions of disease-related burdens among affected people, as well as their needs and priorities. We discussed how to meet identified needs and expectations, in addition to the types of therapeutic drugs and support required. Qualitative data regarding participants' experiences and perceptions of the diseases were collected through individual interviews, advisory board meetings, and individual follow-up activities. Verbatim transcripts from recorded participants' statements were qualitatively analysed. Four women aged 30-41years participated in the study, two with insulin resistance syndrome and two with lipoatrophic diabetes. The diseases not only took a heavy physical toll on these women, but they and their families were also affected psychologically, with some experiencing stigmatisation. There was a lack of information for participants about their disease and little public awareness of the disease. The needs identified include initiatives to promote an accurate understanding of these diseases, information booklets, consultation service for those affected by the diseases, less burdensome treatment options, and opportunities for peer communication. People living with insulin resistance syndrome or lipoatrophic diabetes have significant physical/psychological burdens and unmet needs. The following are highly desirable to alleviate the burdens: promoting proper understanding of the diseases; establishing a framework for dissemination of disease and treatment information to those living with the diseases; development of therapeutic drugs for these diseases; educational materials that raise public awareness; and opportunities for peer communication. UMIN Clinical Trials Registry (UMIN000043693). A Japanese translation is available for this article.

A framework for the broad dissemination of hydrological models for non-expert users

A framework for the broad dissemination of hydrological models for non-expert users

Embedding the Model of Engaging with Communities Collaboratively (MECC) in the Jandu Yani U (For All Families) Project in Aboriginal communities of the Fitzroy Valley, Western Australia

This study evaluated the use of the Model of Engaging Communities Collaboratively (MECC) to guide the Jandu Yani U (For All Families) project, in which the Triple P – Positive Parenting Program was collaboratively adapted for use in very remote Aboriginal communities in Western Australia. The communities’ responses to the MECC processes were evaluated through interview-style or selfadministered surveys, semiformal interviews, focus group discussions and storytelling. The MECC processes were acceptable across all groups (mean score 3.86 on a 5-point acceptability scale). Qualitative data supported and gave context to the quantitative findings, demonstrating the acceptability and utility of the approach. The MECC provided a valuable framework for Aboriginal community engagement, program dissemination and implementation of research.

Abstract P039: Framework for genomic cancer risk assessment dissemination and implementation in Latin America: The GRACIAS (genetic risk assessment for cancer implementation and sustainment) study

Abstract Introduction: Lack of public insurance coverage for genetic testing and a limited trained genomic cancer risk assessment (GCRA) workforce are barriers to cancer screening and prevention and to understanding the genetic epidemiology of cancer in low/middle income countries (LMIC) in Latin America. Methods: We implemented an intervention that included professional education for clinicians in Mexico, Peru and Colombia, support from a community of practice and a federated consortium of collaborators, a versatile research registry with a dual purpose (research and clinical care) centralized relational database and pedigree drawing program (web-accessible), and economical NGS multigene panel tests (MGPT). We report here the outcomes of GCRA for 4181 probands (3170 breast, 301 ovarian, 965 other cancer, and 262 unaffected). Results: With a mean age of 45.2 y.o. (39.9 y.o. at breast cancer dx for carriers), a pathogenic variant (PV) was detected in 605 (14.5%) of 2,710 probands (BRCA testing only for 1387, MGPT for 1323): BRCA1 (n=250); BRCA2 (129); CHEK2 (24); PALB2 (20); ATM (14); TP53 (14); PTEN (6); CDH1 (5); MMR genes (62); RAD51C (6); and BRIP1 (3). We have documented growing reach (proportion of those eligible that access GCRA), increasing cascade testing (family member(s) tested (n=541) for 192/470 [40%] probands with a PV), and with median 2.2 years follow up, 209 risk reduction surgeries were performed. Summary: Remarkably, despite systemic limitations, integration of a skilled multidisciplinary team with access to genetic assays and practice support tools, community, and hospital outreach increased GCRA reach, and the expansion of cascade testing and performance of risk-appropriate surgeries reflect maturing prevention programs. Sustainment of progress requires increased multilevel efforts and establishment of GCRA as a supported standard of care, so the opportunity for prevention is not missed for vulnerable and underserved high-risk patients and families. Citation Format: Jeffrey N. Weitzel, Julio Abugattas, Cynthia Villarreal-Garza, Adrian Daneri Navarro, Alicia Cock-Rada, Yenni Rodriguez, Pamela Mora-Alferez, Dione Aguilar, Azucena del Toro-Valero, Francisco Gutierrez-Delgado, Ana Ferrigno, Josef Herzog, Danielle Castillo, Gubidxa Gutierrez Seymour, Bita Nehoray, Kathleen R. Blazer, Maria E. Fernandez, Yanin Chavarri Guerra. Framework for genomic cancer risk assessment dissemination and implementation in Latin America: The GRACIAS (genetic risk assessment for cancer implementation and sustainment) study. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P039.

Over-the-Air Software-Defined Vehicle Updates Using Federated Fog Environment

With recent advancements in software-defined vehicles, over-the-air (OTA) software updates are crucial to roll out new software and patches for connected vehicles. Traditionally, outdated vehicles are recalled by the manufacturers, however, owners are notoriously difficult to reach with recall notices. Also, organizational and procedural challenges result in many outdated vehicles with insecure and unstable software. In this paper, we propose a dissemination framework for OTA updates using a federated fog environment. Pushing the update to all vehicles via the fog nodes may congest the network, leading up to a single-point failure for update dissemination, as well as, disruption to other installed services at the fog nodes. We propose a software-defined mechanism to select a pivot, which gets the update from the fog node and streams it to other vehicles. Moreover, a timer-barrier mechanism is proposed to identify any malicious vehicles that are barred from participating in pivot selection. The experimental evaluation demonstrates that the proposed scheme improves network convergence time by 40% with 95% node trustworthiness.

Mediators of measurement-based care implementation in community mental health settings: results from a mixed-methods evaluation

BackgroundTailored implementation approaches are touted as superior to standardized ones with the reasoning that tailored approaches afford opportunities to select strategies to resolve determinants of the local context. However, results from implementation trials on this topic are equivocal. Therefore, it is important to explore relevant contextual factors that function as determinants to evaluate if they are improved by tailoring and subsequently associated with changes in implementation outcomes (i.e., via statistical mediation) to better understand how tailoring achieves (or does not achieve) its effects. The present study examined the association between a tailored and standardized implementation approach, contextual factors that might mediate change, and a target implementation outcome in an initiative to implement measurement-based care (specifically the clinical integration of the Patient Health Questionnaire [PHQ-9] for depression) in a community mental health organization.MethodsUsing a cluster randomized control design, twelve community-based mental health clinics were assigned to a tailored or standardized implementation group. Clinicians completed a self-report battery assessing contextual factors that served as candidate mediators informed by the Framework for Dissemination at three time points: baseline, 5 months after active implementation support, and 10 months after sustainment monitoring. A subset of clinicians also participated in focus groups at 5 months. The routine use of the PHQ-9 (implementation outcome) was monitored during the 10-month sustainment period. Multi-level mediation analyses assessed the association between the implementation group and contextual factors and the association between contextual factors and PHQ-9 completion. Quantitative results were then elaborated by analyzing qualitative data from exemplar sites.ResultsAlthough tailored clinics outperformed standard clinics in terms of PHQ-9 completion at the end of active implementation, these group differences disappeared post sustainment monitoring. Perhaps related to this, no significant mediators emerged from our quantitative analyses. Exploratory qualitative analyses of focus group content emphasized the importance of support from colleagues, supervisors, and leadership when implementing clinical innovations in practice.ConclusionsAlthough rates of PHQ-9 completion improved across the study, their sustained levels were roughly equivalent across groups and low overall. No mediators were established using quantitative methods; however, several partial quantitative pathways, as well as themes from the qualitative data, reveal fruitful areas for future research.Trial registrationStandardizedversus tailored implementation of measurement-based care for depression. ClinicalTrials.govNCT02266134, first posted on October16, 2014