Getting the Word Out: Multiple Methods for Disseminating Evaluation Findings Nancy B. Mueller, Ryan C. Burke, Douglas A. Luke, and Jenine K. Harris rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Objective: To evaluate the effectiveness of different strategies for disseminating evaluation results to program stakeholders. Methods: The results from a process evaluation of eight states’ tobacco control programs were disseminated to the state programs that were assigned to one of four dissemination conditions: print reports only, reports and Web site, reports and workshop, or all three dissemination modes. Key measures included levels of usefulness of the evaluation results and satisfaction of participation by study participants. Results: Although exposure to the Web site and workshop individually did not provide a statistically higher degree of usefulness, a clear upward trend was observed in usefulness as the number of dissemination modes increased. Participants who engaged in all three dissemination modes found the results more useful (P < .05) for their work and the work of their agency than participants using one or two dissemination modes. Participants who engaged in the three dissemination modes also appeared to be more likely to share the results with their colleagues (P = .06). Conclusions: This study shows that disseminating evaluation results through multiple, active modes increased usefulness, satisfaction, and further dissemination of the results. Evaluators should consider implementing more than one mode of dissemination to share findings with stakeholders. KEY WORDS: evaluation studies, information dissemination,
tobacco
practice, another important area to examine is the dissemination of evaluation results to program stakeholders. Many funding agencies now require grantees to evaluate their programs to show effectiveness and maintain accountability. The Centers for Disease Control and Prevention Office on Smoking and Health identifies program evaluation as one of its nine best practices for comprehensive tobacco control programs and recommends at least 10 percent of a program’s budget be allocated to evaluation and surveillance activities.4 The primary reason for conducting a program evaluation is to ensure that a dissemination feedback loop exists so that evaluation results are shared with stakeholders, who use the information to improve their programs and guide future planning efforts. Furthermore, the REAIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework5 and Rogers’ diffusion of innovations6 offer approaches for evaluating the potential for dissemination and public health impact of interventions.
Disclaimer: The views expressed herein are those of the authors and do not necessarily reflect the official views of the American Legacy Foundation (Legacy), the Association of State and Territorial Chronic Disease Program Directors (CDD), or the Centers for Disease Control and Prevention (CDC) Office on Smoking or Health. Human subjects approval was obtained from Saint Louis University Institutional Review Board. The authors thank the tobacco control partners in Florida, Indiana, Michigan, Minnesota, Nebraska, New Mexico, North Carolina, and Oregon for participating in this project. They also thank Tanya Montgomery, Stephanie Herbers, Sarah Shelton, and Rachael Zuckerman for their contributions to this project. This research was supported by the CDD and the Legacy with guidance from the CDC. Corresponding Author: Nancy Mueller, MPH, Center for Tobacco Policy Research, Saint Louis University, 3545 Lafayette Ave, Suite 300, St. Louis, MO 63104 (
[email protected]).
Understanding how to disseminate evidence-based interventions (ie, closing the discovery-delivery gap) has become an important focus for researchers, practitioners, and funding agencies in recent years.1–3 While current efforts focus on translating basic science into
qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq Nancy B. Mueller, MPH, is Assistant Director, Center for Tobacco Policy Research, Saint Louis University School of Public Health, St. Louis, Missouri. Ryan C. Burke, MPH, Center for Tobacco Policy Research, Saint Louis University School of Public Health, St. Louis, Missouri. Douglas A. Luke, PhD, is Principal Investigator, Center for Tobacco Policy Research, Saint Louis University School of Public Health, St. Louis, Missouri.
J Public Health Management Practice, 2008, 14(2), 170–176 Copyright C 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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Jenine K. Harris, MA, Center for Tobacco Policy Research, Saint Louis University School of Public Health, St. Louis, Missouri.
Methods for Disseminating Evaluation Findings
Despite the existence of these frameworks for understanding dissemination, little is known specifically about the process of dissemination and which strategies work best in a public health setting.7 Although many evaluations of states’ tobacco control programs have been conducted,8–10 the literature regarding dissemination and utilization of results is limited. Even when results are shared with program stakeholders, it is unclear to what extent programs are able to fully utilize the results to make improvements to their programs. For example, a recent case study by Howell and Yemane11 examined the quality of 12 large federal program evaluations, including the extent to which the evaluation results were disseminated to grantees, government stakeholders, and academia. The authors found dissemination of results to be very limited. Most disseminated materials presented only the evaluation methodology or program monitoring findings. The timeliness of the dissemination of results was a major impediment for most of the evaluations. Several reasons for the limited dissemination were identified, including a lack of dissemination planning, few incentives for the government or contractors to widely disseminate the evaluation results, and reluctance by some government personnel to disseminate unfavorable program results. One factor that may influence utilization of evaluation results is the form (or mode) in which the results are communicated to the stakeholders. Traditionally, evaluation results are communicated through printed reports. However, results can also be more actively disseminated in face-to-face meetings or via electronic media. With the advent of widespread Internet access, it has become more common to make evaluation results available on the Web. To our knowledge, no studies have been conducted that examine how the dissemination mode may affect the utilization of evaluation results. Determining the most effective way to share results with a specific audience is critical to the uptake of the information by stakeholders. In a systematic review to identify strategies used for evaluating the dissemination of cancer control interventions, Ellis and colleagues12 found that the body of research was limited regarding the evaluation of dissemination strategies. Another systematic review reported similar conclusions in the primary studies of dissemination and diffusion strategies of dietary interventions.13
● Project LEaP In 2003, the Center for Tobacco Policy Research conducted Project LEaP: Linking Evaluation and Practice, a 3-year study funded by the National Association of
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State and Territorial Chronic Disease Program Directors and the American Legacy Foundation. The two primary objectives of LEaP were to (1) conduct a process evaluation of the effects of state budget crises on eight states’ tobacco control programs and (2) test the effectiveness of three strategies to disseminate the evaluation results to states’ tobacco control program partners. This article reports the results of the latter dissemination trial. The three dissemination modes examined in this study were print reports, targeted Web site, and interactive workshop. Each of the eight states participating in the process evaluation was assigned to one of four groups: (1) print reports only; (2) print reports and Web site; (3) print reports and workshop; and (4) print reports, Web site, and workshop. We hypothesized that states receiving the evaluation results through all three dissemination modes (print reports, Web site, and workshop) would have a greater understanding and find the information more useful than states receiving only one or two of the dissemination modes. Our rationale for this hypothesis was two-fold. First, the greater number of modes provides state partners with more opportunities to access the evaluation results. Second, traditional print reports were considered passive dissemination, whereas Web sites with interactive features and intensive workshops would provide interactive ways to access the results. This hypothesis is supported by communication theory, in particular media effects research, which shows that repeated exposure to a message especially through multiple modes may intensify the impact on its audience.14,15
● Methods Participating states From 2003 to 2004, a process evaluation was conducted for the following eight states’ tobacco control programs: Florida, Indiana, Michigan, Minnesota, Nebraska, New Mexico, North Carolina, and Oregon. Table 1 provides a brief description of the programs. Upon completion of the evaluation of each program, the results were disseminated to the tobacco control program partners in each state. Each state was randomly assigned to a dissemination condition: • •
Florida and New Mexico received print reports only; Michigan and Minnesota received print reports and a targeted Web site; • Nebraska and Oregon received print reports and an interactive workshop; and • Indiana and North Carolina received all three dissemination modes.
172 ❘ Journal of Public Health Management and Practice TABLE 1 ● Description of states participating in Project LEaP
qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq
State Florida New Mexico Michigan Minnesota Oregon Nebraska North Carolina Indiana a From
Dissemination mode
Funding allocation FY 2005 (in millions)
Per capita spending (in dollars)
% Of CDC minimum recommendationa
% Funding change (FY 2004–2005)
Reports only Reports only Reports and Web site Reports and Web site Reports and workshop Reports and workshop Reports, Web site, and workshop Reports, Web site, and workshop
2.8 6.3 6.7 30.5 5.0 4.4 13.1 12.4
0.16 3.32 0.68 6.21 1.39 2.53 1.58 2.03
3.6 45.9 12.2 107 23.7 33.1 30.7 35.6
−93.0 3.3 39.6 −27.9 −43.8 −37.1 45.6 −63.3
the Centers for Disease Control and Prevention.4
Dissemination mode conditions Reports A series of five print reports presenting state-specific evaluation findings was developed for each state. The reports were organized by the following topics: a project introduction and executive summary, program environment (eg, state financial and political characteristics), program resources (eg, human, informational, monetary), program capacity (eg, network relationships, partner roles, strategic planning), and program sustainability (eg, level of sustainability in five domains). These reports are available at http://ctpr.slu.edu. The reports were sent to all participants to ensure that the evaluation feedback loop was completed and every participant was provided with at least a basic set of evaluation results.
Web site A Project LEaP Web site was developed to disseminate evaluation results to specific state’s tobacco control programs. The Web site structure followed the same fivepart organization as the reports. The purpose of the Web site was to allow visitors user-friendly access to the evaluation results and for visitors to easily disseminate the results to their colleagues. All of the content from the reports was included in the Web site. A “tell a friend” feature was included so that visitors could easily share the link with others to increase the dissemination of the results. Other interactive features included polling questions, a feedback form, and a site search engine. The URL was e-mailed to participants in the Web dissemination states (ie, Indiana, Michigan, Minnesota, and North Carolina).
Workshop Center for Tobacco Policy Research staff conducted a 1-day in-person workshop in the four workshop states
(ie, North Carolina, Indiana, Oregon, and Nebraska). The goal of the workshop was to provide tobacco control partners with relevant evaluation results, which could be used for program planning efforts. Three major sessions of the workshop were (1) examining the communication, information, and financial relationships among the tobacco control partners; (2) exploring the program’s level of sustainability; and (3) identifying opportunities to utilize the evaluation results in short-term program planning. During the last session, participants prioritized program challenges based on discussions from the relationships and sustainability sessions and then developed short-term action plans addressing the top priorities.
Procedures and measures In early 2005, before dissemination of the evaluation results, baseline data were collected from participating agencies that were active partners of the states’ tobacco control program. These active program partners included voluntary healthcare and other advocacy organizations, local and statewide coalitions, contractors, grantees, advisory groups, and state department of health staff. One hundred forty-four agency representatives (on average 15 agencies per state) were sent letters of invitation to participate in the study. For those agreeing to participate, a Web-based survey was completed. States received their evaluation results based on their dissemination condition on a staggered timeline, starting in July 2005. A follow-up Web survey was then conducted approximately 8 weeks after the evaluation results were disseminated to program partners. The follow-up survey data collection occurred from September 2005 to February 2006. Five major outcomes measures were examined to evaluate the effectiveness of the dissemination methods. The outcomes were (1) usefulness of the evaluation results to the individual, (2) usefulness of participating in Project LEaP to the individual’s tobacco control work,
Methods for Disseminating Evaluation Findings
(3) usefulness of participating in Project LEaP to the state’s tobacco control program, (4) usefulness of participating in Project LEaP to the agency, and (5) the degree to which participating in Project LEaP was worthwhile to the individual. Each of these items were measured on a 5-point Likert-type scale, with 1 indicating not at all useful or strongly disagree and 5 indicating extremely useful or strongly agree. The primary research questions were addressed by comparing the mean response to each question across dissemination groups using an analysis of variance (ANOVA) planned comparison analysis in SPSS, Version 13.0.16
● Results One hundred thirty-one of 140 participants completed the baseline survey, whereas 167 of 185 participants completed the postsurvey (94% and 91% response rate, respectively). The larger postsurvey sample size was due to the inclusion of additional program partners who were invited to attend the workshops and any changes to the tobacco control partner lists made by the program managers (eg, new staff, new partner agencies) before the follow-up survey administration. There were 106 individuals who completed both the baseline and follow-up surveys. On average, 16 participants per state representing 14 agencies completed the baseline survey, whereas 21 participants per state representing 14 agencies completed the follow-up survey.
Usefulness of dissemination results A slight majority of participants (57%) aware of the Project LEaP results reported having had time to read the reports (Table 2). Almost two thirds of those individuals (66%) who did find the time found the reports to be useful. Overall, 43 percent of the participants thought the reports were the most useful of the three dissemina-
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tion modes. Seventy-four percent of participants shared the reports with their colleagues, including supervisors and boards of directors. Fewer than half of the participants (47%) invited to visit the Web site actually did. Sixty percent of the participants read at least some of the contents of the Web site, whereas 28 percent skimmed it. Although the Web site content was exactly the same as the reports, a lower percentage of participants found its sections useful. Half of the participants forwarded the link to their colleagues. Web site tracking showed that visitors to the four different Web sites came from 167 unique IP addresses located in 25 states, Washington, DC, and countries such as Canada, Spain, Turkey, and the United Kingdom. Although the Web sites had a number of visitors, they typically did not stay long. The median visit length was less than 2 minutes. A majority of the visitors (80%) looked only at one state’s Web site, and less than a quarter of individuals (21%) were repeat visitors. Greater participation was reported in the workshops than the Web sites, with 64 percent of invited participants attending a workshop. A large majority of attendees (73%) reported learning new information about their state’s tobacco control program, and more than half (59%) said the workshop influenced their work in tobacco control. Fifty-four percent said the action plan was useful to their work in tobacco control, and 77 percent reported making progress on the action plan at the time of the postsurvey. Sixty-seven percent of participants shared the information from the workshops with their colleagues. One year later, the program managers from the workshop states reported varying levels of progress regarding the action plans during a brief phone followup. However, all four states did continue to use the plans as guides and had made some progress. Two states incorporated three of their priorities (sustainability, increasing new partners’ understanding of a comprehensive tobacco control program, and
TABLE 2 ● Summary of access to dissemination modes among survey participants
qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq Reports
Florida New Mexico Michigan Minnesota Oregon Nebraska North Carolina Indiana Total
Web site
Workshop
State Reports sent
Individuals who read reports, n (%)
Links sent, n
Individuals who read Web site materials, n (%)
Invitations sent, n
Workshop attendees, n (%)
10 12 13 17 17 34 30 31 167
6 (60) 12 (100) 11 (85) 6 (35) 8 (47) 17 (50) 9 (30) 19 (61) 92 (55)
... ... 14 17 ... ... 30 31 92
... ... 6 (43) 3 (18) ... ... 8 (27) 8 (26) 25 (27)
... ... ... ... 16 33 29 31 109
... ... ... ... 12 (75) 26 (79) 10 (34) 22 (71) 96 (88)
174 ❘ Journal of Public Health Management and Practice tobacco-related disparities) addressed by the workshop action plans into their state strategic plans. In addition, a few states worked to further develop and carry out step identified in their actions during program retreats.
FIGURE 1 ● Collapsed modes by outcomes variable.
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Relationship of dissemination modes to usefulness and satisfaction ANOVA results showed that individuals who were exposed to all three dissemination modes (reports, Web site, and workshop) were significantly more likely to find the evaluation results useful to their agency than those receiving reports only (P < .05). Similar trends were observed for the other outcomes measures, though not significant. To further explore the effect of the number of dissemination modes on satisfaction and usefulness, the four-mode model was collapsed into a three-mode model (ie, reports only; Web site and reports or workshop and reports; and reports, workshop, and Web site). The mean responses for the five outcomes measures showed an upward trend based on the number of dissemination modes in which a participant engaged. The more times participants were exposed to the project results, the more satisfied they were with their participation in the project and the more useful they found the results. Specifically, significant differences were found among the modes for the outcome variables usefulness of Project LEaP participation for your agency and usefulness of Project LEaP participation for your own tobacco control work (P = .01 and P = .03, respectively) It appears that the usefulness measures accounted for between 5 percent and 10 percent of the variance (η2 = 0.05–0.08), which can be considered a medium-size effect (Table 3).17 Figure 1 shows that exposure to all three modes of dissemination is related to higher satisfaction with the disseminated evaluation results.
Following these significant ANOVA results, planned comparisons for these outcomes showed that participants who reported engaging in all three modes of dissemination found the Project LEaP results significantly more useful for their work and the work of their agency (P < .05) than participants using one or two modes of dissemination.
Secondary dissemination Participants who engaged in all three dissemination modes (workshop, Web site, and reports) were more
TABLE 3 ● Utility of dissemination results by number of dissemination modes
qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq Dissemination mode exposure
Variable Overall usefulness of LEaP results to you Usefulness of Project LEaP participation for your state’s tobacco control program Usefulness of Project LEaP participation for your agency Usefulness of Project LEaP participation for your own tobacco control work Participation in Project LEaP was worth your time a Values
given are mean.
Report series only (one mode) (n = 74)a
Reports plus Web site or workshop (two modes) (n = 74)a
Workshop, Web site, and reports (three modes) (n = 19)a
F
P
η2
2.77 3.07
2.85 3.38
3.32 3.82
2.26 2.71
.11 .07
0.030 0.050
2.70
3.07
3.72
4.88
.01
0.084
2.60
2.98
3.47
3.64
.03
0.065
3.90
3.89
4.16
0.67
.52
0.012
Methods for Disseminating Evaluation Findings
likely to share the Project LEaP results with their colleagues. A marginally significant upward trend is observed in the percentage of participants sharing the evaluation results from those receiving only the reports to those receiving all three modes (χ 2 = 7.4; P = .06). Approximately 84 percent of participants receiving reports, Web site, and workshop shared the results in comparison with 52 percent in the reports-only group.
● Discussion The results of most evaluation projects continue to be disseminated using traditional print formats. This study contributes to dissemination science by formally examining whether exposure to more types of active dissemination is related to greater perceived usefulness of and satisfaction with evaluation results. In our study, traditional print reports were utilized most by study participants and were shared more with participants’ colleagues than the Web site and workshop modes. However, the reports represented the most passive dissemination mode of the three and lacked the opportunity for further discussion about the interpretation and application of the results between participants and evaluators. Although the Web site provided relatively easy access to the evaluation results, it was utilized less and was more resource intensive than expected. The workshops provided the most interactivity between participants and evaluators, with an actual product (ie, short-term action plans) being developed by workshop participants. The action planning helped move the participants from simply awareness of the results to a first step toward utilizing the results. The results of the study suggest a simple doseresponse relationship between modes of exposure and utility of evaluation results—the more times a person sees the results of the evaluation, the greater he or she views the utility of these results. This is not a surprising finding, but it does have important implications for public health evaluators. On the basis of this evidence, evaluators should consider implementing more than one mode of dissemination to share findings with their stakeholders. Dissemination of results should not be a one-time experience, but rather an ongoing, dynamic dialogue between evaluators and stakeholders. Although not the primary objective of this study, some of our results suggest the importance of secondary dissemination. Almost three quarters of the study participants reported sharing evaluation results with other program partners, and persons exposed to all three dissemination modes had the highest rates of shared results. Further study of secondary dissemina-
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tion is warranted—we know very little about how evaluation results are communicated and shared past the first direct dissemination of information. Rogers’ diffusion of innovations6 may provide a useful framework for studying secondary dissemination. Lomas18 described the dialogue between researchers and practitioners about implementing findings as “poorly organized and all too rare.” This description also applies to evaluators and stakeholders. Although funding agencies recommend at least 10 percent of the program budget be allocated to program evaluation,4 a clearly defined dissemination plan with identified target audiences and strategies is often overlooked during evaluation planning.11 The planning for the dissemination often does not occur until there are results to share and/or does not provide adequate information or discussion about how to use the results. Very little literature is currently available regarding effective dissemination processes and interventions within public health.7 Ellis et al12 reported that the evidence to recommending any one dissemination strategy as effective in the promotion of uptake of cancer control interventions was lacking. Many funding agencies (ie, government and nongovernment) have begun funding dissemination research, although funding resources are not at optimal levels.1 It is important to note the following limitations of the Project LEaP dissemination study. First, the outcome measures were based on self-reported data. The study design and budget did not allow for observational measures of evaluation utilization. However, we were able to contact the program managers from the four workshop states 1 year later to assess how the action plans had been used. It would be useful to follow the programs for a longer period to understand how programs had used the evaluation results. We were also unable to measure the effectiveness of each mode (ie, reports vs Web site vs workshop) individually because of the study design and the importance of sharing evaluation results with all eight states’ programs. Understanding the influence of each mode on utilization of evaluation results would be an important consideration for future study. Another limitation was the small sampling frame of only eight states, which may limit its generalizability. Although the findings were not unexpected or surprising, Project LEaP was one of the few studies to actively compare strategies for the dissemination of evaluation results. There remain many unanswered questions about factors leading to successful dissemination. However, this study suggests that evaluation results will be more useful if evaluators take a more active, dynamic approach to communicating their findings. Sending print reports to program partners and expecting these reports to have a large effect is clearly not a safe assumption any more.
176 ❘ Journal of Public Health Management and Practice REFERENCES 1. Kerner J. Knowledge translation versus knowledge integration: a “funder’s” perspective. J Contin Educ Health Prof. 2006; 26:72–80. 2. Glasgow RE, Marcus AC, Bull SS, Wilson KM. Disseminating effective cancer screening interventions. Cancer. 2004;101(5)(suppl):1239–1250. 3. National Cancer Institute, Center for the Advancement of Health, Robert Wood Johnson Foundation. Designing for Dissemination: Conference Summary Report. Washington, DC: National Cancer Institute; 2002. http://cancercontrol.cancer. gov/d4d/d4d conf sum report.pdf. Accessed April 10, 2007. 4. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—August 1999 [reprinted with corrections]. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1999. 5. Dzewaltowski DA, Glasgow RE, Klesges LM, et al. REAIM: evidenced-based standards and a Web resource to improve translation of research into practice. Ann Behav Med. 2004;28(2):75–80. 6. Rogers EM. Diffusion of Innovations. 5th ed. New York: Free Press; 2003. 7. Kerner J, Rimer B, Emmons K. Dissemination research and research dissemination: how can we close the gap? Health Psychol. 2005;24(5):443–446. 8. Mueller NB, Luke DL, Herbers SH, Montgomery TP. The Best Practices: use of the guidelines by ten state to-
9.
10.
11.
12.
13.
14.
15.
16. 17. 18.
bacco control programs. Am J Prev Med. 2006;31(4):300– 306. Pierce JP, Gilpin EA, Emery SL, et al. Has the California tobacco control program reduced smoking? JAMA. 1998;280:893–899. Abt Associates Inc. Independent Evaluation of the Massachusetts Tobacco Control Program: Sixth Annual Report. Cambridge, MA: Abt Associates Inc; 2000. Howell EM, Yemane A. An assessment of evaluation designs: case studies of 12 large federal evaluations. Am J Eval. 2006;27(2):219–236. Ellis P, Robinson P, Ciliska D, et al. A systematic review of studies evaluating diffusion and dissemination of selected cancer control interventions. Health Psychol. 2005;24(5):488– 500. Ciliska D, Robinson P, Armour T, et al. Diffusion and dissemination of evidence-based dietary strategies for the prevention of cancer. Nutr J [serial online]. 2005;4:13. National Institutes of Health. Theory at a Glance: A Guide to Health Promotion Practice. 2nd ed. Washington, DC: US Department of Health and Human Services; 2005. http:// www.cdc.gov/dhdsp/CDCynergy training/Content/ activeinformation/resources/Theory at Glance Spring2005. pdf. Accessed July 26, 2007. Freimth V, Quinn SC. The contributions of health communication to eliminating health disparities. Am J Public Health. 2004;94(12):2053–2054. SPSS (for Windows). Release 13.0. Chicago: SPSS Inc; 2004. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Earlbaum; 1988. Lomas J. The in-between world of knowledge brokering. BMJ. 2007;334:129–132.
