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U.S. Department of Health & Human Services | National Institutes of Health

Dissemination and Implementation (D&I) Science in Communication Disorders

October 24-25, 2023          
Virtual Workshop

Workshop Summary

On this page:

Executive Summary

The NIDCD-sponsored dissemination and implementation (D&I) workshop brought together more than 150 participants with an interest in D&I research and communication disorders to (1) define the current state of D&I research in NIDCD mission areas; (2) identify research needs and opportunities faced by individual investigators conducting D&I research across NIDCD mission areas; and (3) collectively build capacity to conduct and sustain D&I research across NIDCD mission areas. Experts who participated in the workshop contributed their ideas through presentations, panels, and group discussions. These individuals have not had—nor will they have—any role in formulating, recommending, or determining any funding initiatives.

Key themes from the workshop were:

  • Training and mentoring: The field of communication sciences and disorders is at an early stage of adopting D&I theories, models, frameworks, designs, and approaches, but numerous tools and trainings from other fields can be leveraged to advance D&I research in NIDCD mission areas. Fostering training and mentoring is critical to building the field’s capacity to engage in high-quality D&I research and to develop competitive D&I-focused grant applications.
  • Partnerships: A key challenge for communication disorders researchers wanting to engage in D&I research is building partnerships with D&I experts, community members (e.g., professionals), and system leaders (e.g., in schools and hospitals). Time and effort are needed to establish relationships, and potential partners face challenges participating in collaborations due to heavy demands for their time.
  • Getting started: The work that needs to be done to facilitate D&I research, at both the individual and systems level, can be overwhelming. Identifying the first steps is critical. At an individual level, mapping out a long-term plan for both the research project and training needs can be helpful in identifying feasible first research and training steps. At a larger systems or field level, it can be useful to think about what areas are best suited for D&I research; either there is a critical need for change (e.g., momentum from multiple invested parties) or there are evidence-based innovations ready for implementation.
  • Growth pains: Existing processes and procedures around promotion and tenure, publishing, and funding are geared toward more traditional research approaches (e.g., experimental research), which can disadvantage newer approaches needed for D&I research. This disadvantage can deter researchers. D&I champions are needed in leadership positions to change existing processes and procedures to be more inclusive of D&I research. Examples from other fields that are more engaged in D&I research can be used to identify specific changes that support D&I investigators and their research endeavors.

Detailed Summary

The NIDCD sponsored a virtual workshop on October 24-25, 2023: “Dissemination and Implementation (D&I) Science in Communication Disorders.”

This workshop reflects NIDCD’s long-standing commitment to clinical and translational research. In addition, NIDCD’s 2023-2027 Strategic Plan includes a goal to develop, disseminate, and implement evidence-based practices to improve health-related outcomes. The workshop brought together NIDCD and D&I scientists to (1) define the current state of D&I research in NIDCD mission areas; (2) identify research needs and opportunities faced by individual researchers conducting D&I research across NIDCD mission areas; and (3) understand how to work collectively to build capacity to conduct and sustain D&I research across NIDCD mission areas.

More than 150 people participated via videoconference or the live NIH videocast, which was recorded and is available for viewing (Day 1, Day 2). Scientific experts who participated in the workshop contributed their ideas to the presentations, panels, and discussions. These experts have not had— nor will they have—any role in formulating, recommending, or determining any funding initiatives.

The following detailed summary is provided to augment the workshop recording. In some cases, references and weblinks on slides were not clear in the recording. In other cases, attendees shared resources in the online chat, which is not available on the recording. An attempt is made in this summary to share those references and weblinks. In some cases, references or weblinks from different talks at the workshop were consolidated into one theme for cohesiveness within this summary. Likewise, links from the chat are presented when relevant to a summary theme. Provision of these shared resources in this summary does not constitute NIDCD or NIH endorsement of the reference or website. Links are accurate at the time of posting but will not be maintained or updated.

Setting the Stage: Defining the Current State of D&I in NIDCD Mission Areas

The workshop began by defining D&I research using a simple framework reported in Curran (2020) and more formal definitions provided by Feuerstein, Douglas, and Olswang (2022). Key ingredients of implementation science were then briefly reviewed using a research note by Komesidou and Hogan (2023). The continuum of research from establishing the efficacy of the evidence-based innovation (EBI) to testing implementation of the EBI was outlined, based on an article by Lane-Fall, Curran, and Beidas (2019).

It was noted that there is a need to augment this continuum by identifying the end goal at the beginning of the process. This end goal can then be used to incorporate implementation planning throughout the early development and testing of the EBI. In addition, testing of the EBI needs to carefully balance internal and external validity to facilitate a more efficient transition from testing the EBI to implementing the EBI. The PRagmatic Explanatory Continuum Indicator Summary -2 (PRECIS-2) was noted as a potentially useful tool for thinking through this balance. A logic model template for outlining elements of an implementation research project was introduced, and three NIDCD-funded projects (DC020814; DC017770; DC012760) were described, using this template.

The current state of D&I in the field of communication disorders was considered via a scoping review (Douglas, Feuerstein, Oshita, Schliep, and Danowski, 2022). Although D&I research is increasing at a rapid rate in communication disorders, much of the work is at an early stage. Many papers are concept papers, pre-implementation context assessment (e.g., barriers and facilitators to implementation), or implementation of a narrow range of strategies (primarily education and training). The majority of D&I studies in communication disorders do not include a D&I theory, model, or framework to guide the project. Likewise, most D&I research in communication disorders measures early-stage implementation outcomes.

General pitfalls in implementation science were outlined based on Beidas and colleagues (2022), and issues related to equity were identified based on Baumann and colleagues (2023), setting the foundation for three key questions:

  • What does an infrastructure that equally values multiple forms of knowledge (e.g., lived experience, clinical partnerships) look like?
  • Are we worsening healthcare inequities by implementing our interventions only in the “ready” structures (that are probably already well-resourced)?
  • Which implementation study designs will we deem acceptable to fund in our scientific community and why?

NIH and NIDCD funding history for D&I research was reviewed using publicly available data from NIH RePORT. NIH has had a multi-institute funding opportunity for D&I research since 2005. The active funding opportunities for May 10, 2022, through May 8, 2025, are PAR-22-109 for R21s and PAR-22-105 for R01s. NIDCD has participated in these funding opportunities since their inception, but few NIDCD awards have been made. Possible challenges were noted in the high level of D&I expertise needed to be competitive for this mechanism and the expectation that the research go beyond applying D&I to a field (versus, for example, advancing D&I as a field). However, D&I research is funded through many different funding opportunities beyond these specific calls.

Recently, NIH has added a Research, Condition, and Disease Categorization (RCDC) for D&I, which allows broader tracking of D&I research. Examination of projects associated with this code shows that there is room for growth in D&I research funded by NIDCD. Across both data sets, the key question is:

  • How to get more competitive D&I applications in communication disorders?

Investigator Needs and Opportunities in Conducting D&I Research

Several themes emerged from discussion of investigator challenges:

  • Building community partnerships: Time and effort is needed to build trust and share power with partners who are working in overburdened and dynamic medical and educational settings. It is difficult to find partners who want to sustain a collaborative partnership. A simple task (e.g., handing out recruitment flyers) is more feasible for many. Sustaining partnerships can be challenging as financial support waxes and wanes. Building partnerships can be particularly challenging when working with underrepresented groups. Community liaisons for underrepresented groups are already overburdened.
  • Service delivery system: U.S. service delivery systems are fragmented, which means that potential investigators may encounter many systems, each operating differently. The systems have their own goals. It can be hard to know how to frame D&I research around outcomes that are central to the context.
  • Building academic partnerships: It can be difficult to find D&I experts who have the capacity to contribute to D&I research projects in communication disorders or to mentor/train communication disorder researchers in D&I. Investigators also find it hard to build community given the lack of existing D&I communication disorders groups or venues.
  • Value of D&I in academic settings: Reward systems don’t recognize the time and effort needed for D&I research, partnership building, and formative work. The tenure system is the same clock for everyone. There is pressure to do something different to achieve a similar publication rate to other faculty who are engaged in research with less intensive infrastructure needs.
  • Publishing: It can be challenging to publish D&I research results in communication disorders journals given that expertise in mixed methods, community-engaged research, and D&I theories and methods are lacking.
  • Funding: Finding the right funding mechanism can be difficult—especially for support of formative work, such as establishing partnerships and creating a shared research agenda. Sometimes budget restrictions make it difficult to use the funds for relationship-building activities. The communication disorders field needs research aimed at applying D&I, rather than advancing D&I itself. Some forms of D&I research in communication disorders don’t seem to be a clear fit for NIDCD because they are community-based rather than clinic-based, or because they are broader-based population studies or pathways of care that may cross boundaries and professionals (e.g., screening, assessment, and treatment).
  • Efficacy of EBIs: Some of our EBIs don’t have efficacy trials. This is needed for implementation but also necessary for payers to reimburse for an EBI. It is difficult to do research in practice settings if payers won’t reimburse for an EBI.

Building Capacity in the Field: Needs and Opportunities

Several themes emerged from the discussion of building capacity:

  • Focus
    • Identifying EBIs that are ready for implementation and communicating those priorities to the field can help focus implementation efforts.
    • Convening groups of researchers, practitioners, or policy makers who are motivated to change the field can be informative in finding successes and breakdowns and determining potential high-impact actions.
  • Organizational buy-in
    • To build capacity, you need key leaders within an organization to be on board with the goals, and you need a critical mass of people within the organization who can move the work forward.
  • Training
    • Co-fund existing training opportunities available through other institutes to create capacity for communication disorder researchers to attend that training.
  • Mentoring and networking
    • Peer-to-peer interactions within a formal networking program can build D&I skills and support D&I research projects. In-person meetings can be especially helpful in forming and maintaining networks.
    • Formal associations (e.g., a special interest group within an existing organization; a pre-conference workshop within an existing conference; an organization devoted to D&I in communication disorders) can provide a venue for gaining D&I skills and advancing D&I research projects.
    • Convening or connecting principal investigators on particular types of D&I focused awards (e.g., K awards) can create informal learning networks.
  • Small businesses: Underused partners
    • Businesses are invested in clinical practice and share the same D&I objectives. Businesses provide continuing education activities. Businesses provide clinical tools and materials that clinicians use.
    • Businesses have a built-in network that could be leveraged for partnerships.
    • Businesses have flexibility in their budgets and may be able to invest in early-stage work if it has the potential to impact clinical practice.
  • Promotion and tenure
  • Navigating grant review
  • How to get started
    • Think about the larger topic that you want to impact and determine the building blocks to move that forward. You can likely start with a small step. When you are developing and testing your EBI, think about community-engaged research, understanding equity issues, and the long-term prospects (e.g., translatability, scalability, sustainability).
    • K awards are good options to support your ability to achieve your long-term objective. They can also provide funding to do some initial research.
    • For any project, build a skills matrix and think about what cells you can fill versus where you can plug in other people.
  • Building capacity in practitioners and other invested parties
    • Build capacity in practitioners and in systems in the field to get broad implementation and sustainment. There is an untapped need for training in EBI implementation, and yet the practice world is so diverse and under-resourced that it is challenging to tackle this issue.
    • Possible actions include being responsive to the needs of practitioners, starting the process early and incorporating opportunities often, building feedback loops, and using co-learning opportunities. Practice-based research networks may be another good vehicle.
    • Make learning in this area accessible. There is a lot of jargon in D&I that is not shared by practitioners and invested parties, but if you describe the concepts in a more accessible manner, shared objectives would be clearer from the beginning.
    • Funders may need to be more flexible and dynamic in supporting some of these opportunities. They need flexibility to shift to address the immediate needs of the practitioners so that the project has value for them as well as for research purposes.

Sustaining Change

Sustainment is an increasingly pressing issue in D&I research, but there is no clear consensus on the definition of sustainment (e.g., a phase, an outcome). Moore and colleagues (2017) offer five potential constructs for thinking about sustainment. One approach is to start early in planning for sustainment via coordinated and aligned use of the following:

  1. Guidance from a conceptual model of sustainment, such as the:
    1. Dynamic sustainability framework by Chambers, Glasgow, and Stange, 2013
    2. Design for dissemination and sustainability framework by Kwan and colleagues, 2022
    3. Logic model (see Smith, Li, and Rafferty, 2020)
  2. Iterative planning, tracking, and guiding of adaptations of the EBI, the implementation strategies, and the context, using a tool such as the:
    1. Practical, Robust Implementation Sustainability Model, PRISM, by Rabin and colleagues, 2022 which also has a web tool
    2. Expanded Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions, FRAME, by Stirman, Baumann, and Miller, 2019
    3. Framework for Reporting Adaptations and Modifications to Implementation Strategies, FRAME-IS, by Miller and colleagues, 2021
    4. Core functions and forms of complex health interventions, see Jolles, Lengnick-Hall, and Mittman, 2019
  3. Solid understanding and controlling of the cost of the EBI and the implementation strategies (see Eisman and colleagues, 2021)
  4. Significant and ongoing engagement of multiple partners with different perspectives (e.g., patients, practitioners, administrators, payers)

An example project (Baltimore HEARS) was described to illustrate how to plan for sustainment from early stage development to efficacy (R21/R33 DC015062) to effectiveness research (R21/R33 DC020149). Overall, in the earliest stage, researchers can think about a variety of factors that will make their research more relevant and rapidly accessible to the real world (see Peek and colleagues, 2014).

Another challenge is measuring sustainment. It’s helpful to think about two different conceptualizations: sustainability versus sustainment. Sustainability can be thought of as the ability to maintain programming and its benefits over time (i.e., capacity). Sustainment can be defined as a program or policy that has been continued after the research is complete (i.e., an outcome). For an example project differentiating implementation, sustainability, and sustainment, see Agulnik and colleagues (2022), especially Figure 1.

Measuring sustainability early can assist in planning for sustainment. A tool for measuring program sustainability was developed based on a framework by Schell and colleagues (2013). A parallel tool (and framework) for measuring clinical sustainability was developed. Investigation of the psychometric properties of these tools is in progress, but results to date show good usability, reliability, and validity. Ongoing work focuses on translating the tools into other languages and creating short forms. These tools can be useful for measuring sustainability early and thinking about how to build sustainability during implementation.

During discussion, critical barriers to sustainment in public policy were identified with a particular focus on Medicare reimbursement policies. In some cases, implementation or sustainment of EBI is impeded by lack of reimbursement. The importance of advocacy was noted (e.g., connecting with a policy center to help write policy briefs and communicate with policy makers) along with engaging with policy makers as a critical invested party throughout development, evaluation, and implementation of the EBI.

Planning for Action

How do you get started with D&I research? At an individual level, determine what you want to do and the actions to get you there:

How can you move your institution forward when you are in an institutional leadership role? Follow similar logic:

  • Goal: Increase awareness (and appreciation) of D&I research within the institution.
    • Actions: Invite local D&I researchers to present in events with high reach; invite researchers who attend D&I conferences and training to formally share their learning with others at the institution; bring in outside D&I experts as guest speakers; publicize D&I activities (including the above) through multiple channels (e.g., newsletters, social media).
  • Goal: Facilitate D&I research within the institution.
    • Actions: Support the development of a D&I affinity group for structured activities (e.g., journal clubs, work-in-progress discussions); sponsor an on-campus D&I training; ensure community engagement and DEI efforts, including connecting community organizations and agencies to D&I research partners; refine criteria for performance evaluations, promotion, and tenure review to recognize and reward infrastructure building for D&I research (e.g., time developing partnerships); work with the grants office to disseminate curated lists of D&I funding opportunities; provide financial support for career development in D&I, external reviews of D&I grant applications, and institutional memberships to D&I professional societies.
  • Goal: Be an institutional D&I leader.
    • Actions: Develop and support formal partnerships among departments and centers with D&I goals and methods (e.g., create a center); support D&I researchers in mentoring and training others; partner with other institutions to share D&I expertise and encourage cross-institutional endeavors (e.g., regional coalition); apply for center-level extramural funding when you reach a critical mass.
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