A Framework for the Dissemination
and Utilization of Research for
Health-Care Policy and Practice
Indexing terms: Research dissemination; diffusion of innova-
tions; nursing practice, evidence based
©2002 Sigma Theta Tau International Volume 9, Document Number 7♦ The Online Journal of Knowledge Synthesis for Nursing
Maureen Dobbins, RN, PhD
Donna Ciliska, RN, PhD
Rhonda Cockerill, PhD
Jan Barnsley, PhD
Alba DiCenso, RN, PhD
Abstract
Volume 9 November 18, 2002 Document Number 7
Purpose
(1) The purpose of this paper is to construct a
comprehensive framework of research dissemination and
utilization that is useful for both health policy and clinical
decision-making.
Organizing Construct
(2) The framework illustrates that the process of the
adoption of research evidence into health-care decision-
making is influenced by a variety of characteristics related
to the individual, organization, environment and innovation.
The framework also demonstrates the complex inter-
relationships among these characteristics as progression
through the five stages of innovation—namely, knowledge,
persuasion, decision, implementation and confirmation—
occurs. Finally, the framework integrates the concepts of
research dissemination, evidence-based decision-making and
research utilization within the diffusion of innovations theory.
Methods
(3) During the discussion of each stage of the innovation
adoption process, relevant literature from the management
field (i.e., diffusion of innovations, organizational
management and decision-making) and health-care sector
(i.e., research dissemination and utilization and evidence-
based practice) is summarized. Studies providing empirical
data contributing to the development of the framework were
assessed for methodological quality.
Conclusions
(4) The process of research dissemination and utilization
is complex and determined by numerous intervening
variables related to the innovation (research evidence),
organization, environment and individual.
Statement of the Practice Problem
Introduction
(5) The study of the use of research evidence in health-
care decision-making has changed dramatically over the last
30 years. Initial studies simply measured the use of
research evidence in health-care decision-making among
individual health professionals. Second generation studies
attempted to understand the factors that predicted,
facilitated or hindered the use of research evidence, which
led to follow-up studies on the applicability of relevant
theories to explain the phenomenon. One of the major
theories to evolve from this line of inquiry was Rogers’
Diffusion of Innovations, which has contributed significantly
to the understanding of research utilization in health-care
decision-making. More recently, research has focused on
determining the effectiveness of dissemination strategies in
promoting the use of research evidence in health-care
decision-making, as well as understanding the process of
decision-making from the perspective of various health
professionals and different health organizations (Pettengill,

©2002 Sigma Theta Tau International Volume 9, Document Number 7♦ The Online Journal of Knowledge Synthesis for Nursing
Gillies, & Clark, 1994 [62]; Champion & Leach, 1989 [15]).
The purpose of this paper is to describe a framework for
research dissemination and utilization that is applicable for
health policy and clinical decision-making. The framework
has been developed by synthesizing several bodies of
literature—organizational behavior, culture and decision-
making from the management field; and research
dissemination, utilization and evidence-based practice from
the health field. Rogers’ Diffusion of Innovations provides
the backbone for the research dissemination and utilization
process proposed in this framework.
Summary of the Research
Research Dissemination and Utilization
(6) The results from numerous diffusion of innovation
studies suggest that there is a substantial time lag of eight
to 15 years between the time technical information is
generated and the time it is used in actual practice (Lomas,
1991 [46]; Utterback, 1974 [75]). This may be problematic
in the health-care field, where time lags may adversely
affect patient outcomes because advances in knowledge
and technology take years to be implemented into practice.
Therefore, the identification of effective dissemination
strategies to reduce this time lag has become increasingly
important with the plethora of literature published on a daily
basis. However, the observed limited success of
dissemination strategies to increase the use of research
evidence in health-care decision-making suggests that
transforming research into practice is a demanding task
requiring intellectual rigor and discipline, as well as
creativity, clinical judgment and skill, and organizational
savvy and endurance (Kitson, Ahmed, Harvey, Seers, &
Thompson, 1996 [40]).
(7) Dissemination research, defined as the study of the
processes and variables that determine and/or influence the
adoption of knowledge, interventions or practice by various
stakeholders (Johnson, Green, Frankish, MacLean, &
Stachenko, 1996 [35]), has become a priority among health
services planners, decision-makers and researchers over the
last decade (Canadian Health Services Research
Foundation, 1998 [12]; 1999 [13]). Research utilization, in
contrast, is defined as the process of transferring research-
based knowledge into clinical practice (Hunt, 1996 [34];
Rodgers, 1994 [66]) and represents a process whereby
research information is translated into a useable form and
then implemented into practice (Goode, Butcher, Cipperley,
Ekstom, Gosch, Hayes, et al., 1991 [25]). Evidence-based
decision-making is defined as the use of the best possible
evidence when dealing with “real life” circumstances
(Hayward, Ciliska, DiCenso, Thomas, Underwood, &
Rafael, 1996 [30]; Nutbeam, 1996 [59]; Sackett, Rosenberg,
Gray, Haynes, & Richardson, 1996 [69]). It is important to
note, however, that the term evidence is composed of many
concepts—one of which is research evidence. Currently,
policy decisions and clinical practice are determined by a
number of distinct pieces of evidence including past
experiences, beliefs, values, skills, resources, legislation,
protocols, patient preferences and research results
(Estabrooks, 1998 [21]; Kouri, 1997 [41]; Sibbald & Roland,
1997 [71]).
(8) Several forces, such as the growth of science and
technology, increased media attention on scientific
discoveries, the Internet and the demand for political
accountability for the use of public resources, have
intensified the need for better dissemination and utilization
of research evidence (Johnson et al., 1996 [35]). However,
despite growing pressure to the contrary, there is evidence
that health-care decisions remain primarily based on
experience and opinion, with little consideration given to the
available research evidence (Baessler, Blumberg,
Cunningham, Curran, Fennessey, Jacobs, et al., 1994 [3];
Bohannon & LeVeau, 1986 [6]; Luker & Kendrick, 1992
[48]; Umlauf & Sherman, 1992 [74]). This is not to say
that health policies and practice should be determined solely
by research evidence, but rather research evidence should
be used in collaboration with other evidence, including
experience and opinion, to make health-care decisions.
(9) The research utilization literature indicates that
research-informed health policy and clinical change require
more than simply acquiring knowledge (Cavanagh & Tross,
1996 [14]), and that major gaps exist between the available
research evidence and actual practice (Power, Tunis, &
Wagner, 1994 [64]). This phenomenon is observed
throughout the world and across all health sectors. Currently
there is much confusion on how best to disseminate research
evidence to policy-makers and practitioners to promote its
routine use in decision-making. Further complicating the
issue is the lack of understanding with respect to how
health-care decisions are made by health professionals, as
well as health organizations.
Constructing a Framework: Research
Dissemination and Utilization
(10) Rogers’ Diffusion of Innovations theory has been
used extensively in the last 20 years to gain a better
understanding of the forces at work in transferring
knowledge into clinical practice. More recently, the theory
has been used to explain the adoption of research evidence
among health organizations, as well as for health policy.
Diffusion scholars have demonstrated that an individual’s
decision about an innovation is not an instantaneous act.
Rather, it is a process that occurs over time and consists
of a series of actions (Rogers, 1983 [67]). In its most basic