Implementation and Evaluation

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To what extent are evidence-based interventions (EBI) that are developed and tested according to scientific standards, practically useful and effective? How should policy makers take costs into account when deciding on the implementation of health promotion interventions? These are some of the key questions in the field of Dissemination and Implementation (D&I) that are addressed in this module. The first step in the intervention process is the development and small-scaled evaluation of EBIs. In this evaluation phase, scientists are concerned with efficacy and internal validity, often by using randomized controlled trials. Internal validity is important for the interpretation of the intervention effects in the experiment. Even though this first step is crucial, using small-scaled experiments is not sufficient for achieving an impact on public health. Besides testing the effects of an intervention under ideal circumstances, it is also important to assess its effect in a ‘real world’ setting. The second step is therefore to study conditions for the effectiveness of the interventions and the actual use in practice. During this stage of real life intervention implementation, different aspects of external validity should be addressed to facilitate large-scale dissemination and implementation to other settings in the final third stage. This provides information about the settings and populations to which the observed intervention effects can be generalized. In addition, researchers may try to replicate effects in different settings. This aspect of external validity is very important; after all, why should one invest time and money into D&I if the intervention is unlikely to work in the settings of concern? For health promoters and policy makers, interventions that are not used and implemented in practice, are not only a waste of valuable time and money, but they can also seriously impede effective health promotion.