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Title: A qualitative exploration of contextual factors that influence dissemination and implementation of evidence-based chronic disease prevention across four countries
Authors: Budd, EL
Deruyter, AJ
Wang, ZX
Sung-Chan, P 
Ying, XJ
Furtado, KS
Pettman, T
Armstrong, R
Reis, RS
Shi, J
Mui, T 
Saunders, T
Becker, L
Brownson, RC
Keywords: Australia
United States
Chronic disease
Issue Date: 2018
Publisher: BioMed Central
Source: BMC health services research, 2 Apr. 2018, v. 18, 233, p. 1-13 How to cite?
Journal: BMC health services research 
Abstract: Background: Little is known about the contextual factors affecting the uptake of evidence-based chronic disease interventions in the United States and in other countries. This study sought to better understand the contextual similarities and differences influencing the dissemination and implementation of evidence-based chronic disease prevention (EBCDP) in Australia, Brazil, China, and the United States.
Methods: Between February and July 2015, investigators in each country conducted qualitative, semi-structured interviews (total N = 50) with chronic disease prevention practitioners, using interview guides that covered multiple domains (e.g., use of and access to EBCDP interventions, barriers and facilitators to the implementation of EBCDP interventions).
Results: Practitioners across the four countries reported only a few programmatic areas in which repositories of EBCDP interventions were used within their workplace. Across countries, academic journals were the most frequently cited channels for accessing EBCDP interventions, though peers were commonly cited as the most useful. Lack of time and heavy workload were salient personal barriers among practitioners in Australia and the United States, while lack of expertise in developing and implementing EBCDP interventions was more pertinent among practitioners from Brazil and China. Practitioners in all four countries described an organizational culture that was unsupportive of EBCDP. Practitioners in Brazil, China and the United States cited an inadequate number of staff support to implement EBCDP interventions. A few practitioners in Australia and China cited lack of access to evidence. Partnerships were emphasized as key facilitators to implementing EBCDP interventions across all countries.
Conclusions: This study is novel in its cross-country qualitative exploration of multilevel constructs of EBCDP dissemination and implementation. The interviews produced rich findings about many contextual similarities and differences with EBCDP that can inform both cross-country and country-specific research and practice to address barriers and improve EBCDP implementation among the four countries long-term.
EISSN: 1472-6963
DOI: 10.1186/s12913-018-3054-5
Rights: © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
The following publication Budd, E. L., Deruyter, A. J., Wang, Z. X., Sung-Chan, P., Ying, X. J., Furtado, K. S., … & Brownson, R. C. (2018). A qualitative exploration of contextual factors that influence dissemination and implementation of evidence-based chronic disease prevention across four countries. BMC Health Services Research, 18, 233, 1-13 is available at
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