After randomised trials: issues related to dissemination of evidence‐based interventions
Abstract
Demonstrating the efficacy and effectiveness of prevention programmes in rigorous randomised trials is only the beginning of a process that may lead to better public health outcomes. Although a growing number of programmes have been shown to be effective at reducing drug use and delinquency among young people under carefully controlled conditions, we are now faced with a new set of obstacles. First, these evidence‐based programmes are still under‐utilised compared to prevention strategies with no empirical support. Second, when effective programmes are used the evidence suggests they are not being implemented with quality and fidelity. Third, effective programmes are often initiated with short‐term grant funding, creating a challenge for sustainability beyond seed funding. We discuss each of these challenges, and present lessons learned from a large‐scale dissemination effort involving over 140 evidence‐based programme replications in one state in the US.
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Better implementation fidelity and quality are linked to stronger program outcomes.
“The central motivation for understanding factors that affect implementation fidelity and quality is that high levels of implementation fidelity and quality are associated with better outcomes.”
From Translational research in South Africa: evaluating implementation quality using a factorial design (2012) · cites this paper as Bumbarger and Perkins 2008
Although controlled studies can achieve high fidelity, strict fidelity is usually lost when programs are scaled up in real-world settings.
“Although high levels of fidelity have occurred in well controlled studies (e.g., Mihalic et al. 2004), when programs go to scale in the “real world,” strict fidelity to implementation typically is lost (Dusenbury et al. 2003; Bumbarger and Perkins 2008).”
From Translational research in South Africa: evaluating implementation quality using a factorial design (2012) · cites this paper as Bumbarger and Perkins 2008
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“…period of an intervention, technical assistance (by community based organizations, extension agents, university partnerships, and others with expertise in YAP development) is believed to support continued implementation quality and sustainability of the innovation (Bumbarger & Perkins, 2008).”
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“Introduction into England Background A national context of readiness for this kind of implementation, emphasized as an important first step by Bumbarger and Perkins (2008), has been growing for more than a decade and the introduction of NFP into England can be linked with central government policy.”
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“Finally, understanding adaptations to the intended intervention involves exploring whether they improve the contextual fit or compromise the functioning of the intervention [23] or whether they represent innovation or intervention drift [24].”
BackgroundHollis, C. P., Hall, C. L., Khan, K., Novere, M. L., Marston, L., Jones, R., Hunter, R. M., Brown, B. J., Sanderson, C., Andrén, P., et al. (2023) · Health Technology Assessment · doi:10.3310/cpms3211 · Cited by 15 · see citing works
Developing congruent children's services to improve child well‐being
Axford, N. (2009) · Child & Family Social Work · doi:10.1111/j.1365-2206.2008.00579.x · Cited by 14 · see citing works
Olson, J., Welsh, J. A., & Perkins, D. F. (2015) · Journal of Extension · doi:10.34068/joe.53.03.09 · Cited by 14 · see citing works
“If a program was not properly implemented, it is possible that key components of the program were not fully delivered, rendering the program ineffective (Bumbarger & Perkins, 2008; Chen, 1990, 1998; McHugh, Murray, & Barlow, 2009).”
BackgroundInfluentialSelf-citationPerkins, D. F., Aronson, K. R., Karre, J. K., Kyler, S. J., & DiNallo, J. M. (2015) · Military Behavioral Health · doi:10.1080/21635781.2015.1100563 · Cited by 13 · see citing works
“As a result, there has been a tremendous increase in the number of evidence-based programs and practices developed and marketed to providers (Bumbarger & Perkins, 2008), as well as a concomitant increase in the awareness of these interventions among social service and health care practitioners…”
BackgroundSelf-citationBehavioral Economics and Parent Participation in an Evidence-Based Parenting Program at Scale
Hill, Z., Spiegel, M., Gennetian, L. A., Hamer, K.-A., Brotman, L. M., & Dawson‐McClure, S. (2021) · Prevention Science · doi:10.1007/s11121-021-01249-0 · Cited by 13 · see citing works
“However, optimizing parent attendance in scaled programs remains challenging (Bumbarger & Perkins, 2008; DawsonMcClure et al., 2017; Fagan et al., 2009).”
BackgroundServices are not enough: child well‐being in a very unequal society
Rowlands, J. (2010) · Journal of Children s Services · doi:10.5042/jcs.2010.0553 · Cited by 12 · see citing works
An Evaluation of Youth at Risk's Coaching for Communities Programme
Berry, V., Little, M., Axford, N., & Cusick, G. R. (2008) · The Howard Journal of Criminal Justice · doi:10.1111/j.1468-2311.2008.00540.x · Cited by 12 · see citing works
“The need to ‘mainstream’ effective practice identified through RCTs and to do so using effective strategies is an area of growing research and policy interest (Bumbarger and Perkins 2008).”
BackgroundLaw, G. C. Y., Dutt, A. S. K., & Neihart, M. (2019) · Research in Autism · doi:10.1016/j.rasd.2019.101411 · Cited by 12 · see citing works
Disseminators vs revisionists: attitudes to the ‘implementation gap’ in evidence‐based practice
Midgley, N. (2009) · Journal of Children s Services · doi:10.5042/jcs.2010.0019 · Cited by 12 · see citing works
Baayd, J., & Simmons, R. G. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-038049 · Cited by 11 · see citing works
Axford, N., & Berry, V. (2017) · The British Journal of Social Work · doi:10.1093/bjsw/bcx003 · Cited by 10 · see citing works
“But adaptation should arguably be planned, undertaken in consultation with the developer, and focus on peripheral rather than core components: unless there is good reason to believe the underlying mechanisms do not apply in the new context, the theory of change needs to be preserved (Bumbarger and Perkins, 2008).”
BackgroundChampion, K. E., Newton, N. C., Stapinski, L. A., & Teesson, M. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-020433 · Cited by 10 · see citing works
Richardson, B. A., Reynolds, A. J., Temple, J. A., & Smerillo, N. E. (2017) · Children and Youth Services Review · doi:10.1016/j.childyouth.2017.06.042 · Cited by 10 · see citing works
“Challenges to scale-up are adequate funding, as well as facility and leadership capacity (Lauter and Rice, 2008; Bumbarger & Perkins, 2008; Rohrbach & Dyal, 2015), but strong collaboration between school districts, school principals, and preschool providers can help scale-up efforts to achieve…”
BackgroundChampion, K. E., Teesson, M., & Newton, N. C. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-1168 · Cited by 9 · see citing works
“This is likely due to obstacles that impede program implementation, such as a lack of resources in terms of teachers, time and money available [22], as well as the fact that teachers often make unfavourable adaptations to program content [23,24].”
BackgroundZipfel, N., Horreh, B., Hulshof, C. T. J., Suman, A., de Boer, A. G. E. M., & van der Burg-Vermeulen, S. J. (2021) · BMC Public Health · doi:10.1186/s12889-021-11047-6 · Cited by 9 · see citing works
“when implementing changes into health care practice has been recognized earlier [34].”
BackgroundParekh, J., Stuart, E. A., Blum, R. W., Caldas, V., Whitfield, B., & Jennings, J. M. (2019) · Prevention Science · doi:10.1007/s11121-019-01032-2 · Cited by 8 · see citing works
Bumbarger, B. K. (2015) · Prevention Science · doi:10.1007/s11121-015-0591-6 · Cited by 8 · see citing works
Self-citationDash, D., Schumacher, C., Jones, A., & Costa, A. P. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02248-0 · Cited by 7 · see citing works
“Given that our team relied on core infrastructure and approaches from the initial stages, the probability and ease of further spread is likely [38, 43].”
BackgroundMethodMartin, M., Shenderovich, Y., Caron, E., Smith, J. D., Siu, G., & Breitenstein, S. M. (2023) · Global Implementation Research and Applications · doi:10.1007/s43477-023-00092-5 · Cited by 8 · see citing works
“Implementation fidelity refers to the extent to which an intervention is implemented as intended (Bumbarger & Perkins, 2008; Dane & Schneider, 1998; Dusenbury et al., 2003).”
BackgroundAxford, N., Morpeth, L., Little, M., & Berry, V. (2008) · Journal of Children s Services · doi:10.1108/17466660200800011 · Cited by 7 · see citing works
Hall, N. J., Mooney, J. D., Sattar, Z., & Ling, J. (2019) · BMC Health Services Research · doi:10.1186/s12913-018-3796-0 · Cited by 7 · see citing works
Developing Rigorous Programme Evaluation
Bywater, T. J. (2012) · Cambridge University Press eBooks · doi:10.1017/cbo9781139013949.006 · Cited by 7 · see citing works
The Science, and Art, of Program Dissemination: Strategies, Successes, and Challenges
McCoy, K. P. (2015) · New Directions for Child and Adolescent Development · doi:10.1002/cad.20109 · Cited by 6 · see citing works
Critical Factors in the Successful Implementation of Evidence‐Based Parenting Programmes
Axford, N., Bywater, T. J., Blower, S. L., Berry, V., Baker, V., & Morpeth, L. (2017) · Wiley eBooks · doi:10.1002/9781118976111.ch21 · Cited by 7 · see citing works
Delivering motivational interviewing early post stroke: standardisation of the intervention
Patel, K., Auton, M. F., Watkins, C. L., Sutton, C., Benedetto, V., Hackett, M. L., Holland, E.-J., & Lightbody, C. E. (2020) · Disability and Rehabilitation · doi:10.1080/09638288.2020.1864035 · Cited by 5 · see citing works
“This may be considered more acceptable than “drifting” where deviations from the intervention are unintentional [17].”
BackgroundImpacts of a Home Visiting Program Enhanced with Content on Healthy Birth Spacing
Zief, S. G., Deke, J., Burkander, P., Langan, A., & Asheer, S. (2020) · Maternal and Child Health Journal · doi:10.1007/s10995-020-02968-6 · Cited by 5 · see citing works
A peer-led physical activity intervention in schools for adolescent girls: a feasibility RCT
Sebire, S. J., Banfield, K., Campbell, R. M., Edwards, M. J., Kipping, R., Kadir, B., Garfield, K., Matthews, J. A., Blair, P. S., Lyons, R. A., et al. (2019) · Public Health Research · doi:10.3310/phr07160 · Cited by 5 · see citing works
Parents and the Preschool PATHS (Promoting Alternative Thinking Strategies) curriculum
Kelly, B., Edgerton, C., Graham, S., Robertson, E., & Syme, B. (2015) · Journal of Children s Services · doi:10.1108/jcs-03-2015-0012 · Cited by 4 · see citing works
Kokole, D., Jané‐Llopis, E., Rey, G. N., Aguilar, N. B., Aguilar, P. S. M., Mejía‐Trujillo, J., Mora, K., Restrepo, N., Bustamante, I. V., Piazza, M., et al. (2022) · Implementation Research and Practice · doi:10.1177/26334895221112693 · Cited by 4 · see citing works
“From this perspective, decisions of local training teams to leave out the videos that were not well received do not represent failure to adhere to the manual, but continued refinement of the training to better fit the local context – “innovation” rather than “drift” in terminology of Bumbarger and Perkins (Bumbarger &…”
BackgroundNdavi, P. M., Baldé, M. D., Milford, C., Mochache, V., Soumah, A.-M., Esho, T. C., Sall, A. O., Diallo, A., Ahmed, W., Stein, K., et al. (2024) · Global Public Health · doi:10.1080/17441692.2024.2369100 · Cited by 4 · see citing works
“…was to assess the perspectives of ANC providers and their clients around the acceptability, adoption, appropriateness, and feasibility of implementing the PCC approach for FGM prevention (Peters et al., 2013) to inform scale-up and replication in other contexts (Bumbarger & Perkins, 2008).”
Can study tours help promote evidence-based practice in children's services?
Axford, N., Jonas, M., Berry, V., Green, V., & Morpeth, L. (2010) · European Journal of Social Work · doi:10.1080/13691450903471237 · Cited by 4 · see citing works
“However, there are three problems with such programmes: they are rarely used; when they are used the implementation is often of poor quality; and when seed funding fizzles out so too do the programmes (Bumbarger & Perkins, 2008).”
BackgroundSpyrelis, A., Taylor, T. M., & Thurman, T. R. (2022) · Children & Society · doi:10.1111/chso.12533 · Cited by 3 · see citing works
Prevention in context: classroom heterogeneity as a moderator of PATHS' effectiveness
Chauveron, L. M., & Perkins, D. F. (2009) · Journal of Children s Services · doi:10.1108/17466660200900005 · Cited by 3 · see citing works
Self-citationPredictive analytics for delivering prevention services
Lee, S., Kang, Y., Ialongo, N. S., & Prabhu, V. V. (2016) · Expert Systems with Applications · doi:10.1016/j.eswa.2016.02.023 · Cited by 3 · see citing works
Scaling Up Evidence-Based Preventive Interventions
Rohrbach, L. A., & Dyal, S. R. (2015) · Springer eBooks · doi:10.1007/978-1-4939-3155-2_9 · Cited by 3 · see citing works
Program implementer perspectives replicating evidence based sexual reproductive health programs
Parekh, J., Blum, R. W., Caldas, V., Whitfield, B., & Jennings, J. M. (2018) · Evaluation and Program Planning · doi:10.1016/j.evalprogplan.2018.12.004 · Cited by 4 · see citing works
Mavodza, C., Bernays, S., Mackworth-Young, C. R. S., Nyamwanza, R. P., Nzombe, P., Dauya, E., Chikwari, C. D., Tembo, M., Apollo, T., Mugurungi, O. M., et al. (2023) · Global Implementation Research and Applications · doi:10.1007/s43477-023-00075-6 · Cited by 5 · see citing works
“Skilled implementers’ active attempts to make an intervention more suited to its population or setting, should not be considered poor fidelity (Bumbarger & Perkins, 2008), and can have an influence on users’ acceptability of the intervention.”
BackgroundInterventions to Support and Strengthen Parenting in Military Families: State of the Evidence
DiNallo, J. M., Kuhl, M. W., Borden, L. M., & Perkins, D. F. (2016) · Springer eBooks · doi:10.1007/978-3-319-12556-5_11 · Cited by 3 · see citing works
Self-citationSustaining Crime Prevention at Scale: Transforming Delivery Systems Through Prevention Science
Homel, R. J., Bumbarger, B. K., Freiberg, K., & Branch, S. (2016) · Springer eBooks · doi:10.1007/978-3-319-44124-5_29 · Cited by 3 · see citing works
Self-citationGiles, F. C., Crawford, S. B., Hackworth, N. J., Hokke, S., & Nicholson, J. M. (2022) · Journal of Child and Family Studies · doi:10.1007/s10826-021-02191-z · Cited by 3 · see citing works
“Successes have been reported for community-level adoption of specific EBPs (e.g., the positive parenting program (Triple P) (Prinz et al., 2009, 2016)), and for place-based approaches that adopt EBPs selected by the community (e.g., the Pennsylvania EBP Initiative (Bumbarger & Perkins, 2008)).”
BackgroundSa’id, I. I. M., Hotung, N., Benton, M., Nadal, I. P., Baharom, A., Prina, M. A., Yusof, B. N. M., Goldsmith, K., Birts, S., Ching, S. M., et al. (2024) · Interactive Journal of Medical Research · doi:10.2196/51718 · Cited by 2 · see citing works
Makhanya, Z., Moffett, B., Pozuelo, J. R., Davis, M., Gumikiriza‐Onoria, J. L., Geffen, S., Baloyi, T. C., Sodi, T., Kinyanda, E., Craske, M. G., et al. (2026) · JMIR Mental Health · doi:10.2196/86470 · Cited by 1 · see citing works
“Fidelity influences outcomes across psychological treatments in both routine clinical practice and controlled trials [44-46].”
Giles, F. C., Hokke, S., Crawford, S. B., Hackworth, N. J., & Nicholson, J. M. (2022) · Health & Social Care in the Community · doi:10.1111/hsc.14010 · Cited by 1 · see citing works
“Previous studies have shown that adherence to key features of effective programmes (such as program length and structure) can be poor when EBPs are transferred to real- world settings (Bumbarger & Perkins, 2008).”
BackgroundThe science of a good childhood: a review of Volume 2 of the Journal of Children's Services
Axford, N., Crewe, E., Domitrovich, C. E., & Morawska, A. (2008) · Journal of Children s Services · doi:10.1108/17466660200800026 · Cited by 2 · see citing works
A Critical Analysis on Social Work Practice Researches in Korea
kim, M. O. (2015) · Korean Journal of Social Welfare · doi:10.20970/kasw.2015.67.4.007 · Cited by 2 · see citing works
Implementacija pristupa temeljenog na dokazima učinkovitosti u prevencijskoj znanosti
Belošević, M., & Ferić, M. (2021) · Kriminologija & socijalna integracija : časopis za kriminologiju, penologiju i poremećaje u ponašanju · doi:10.31299/ksi.29.1.6 · Cited by 2 · see citing works
O’Halloran, T., Symonds, J. E., & Bhreathnach, L. (2024) · OBM Integrative and Complementary Medicine · doi:10.21926/obm.icm.2402026 · Cited by 2 · see citing works
Institutionalising science‐based practices in children's services
Hill, L. G., Parker, L. A., McGuire, J. K., & Sage, R. A. (2008) · Journal of Children s Services · doi:10.1108/17466660200800025 · Cited by 2 · see citing works
Federal Mechanisms to Support Intervention Dissemination
Diana, A., & Bennett, N. (2015) · New Directions for Child and Adolescent Development · doi:10.1002/cad.20114 · Cited by 2 · see citing works
Leading public health innovation in high schools across local and global settings
Joshi, A., Jha, N., Geron, K., Jeu, M., Granack, L., Shular, S., Kumar, M., Kaur, T., Guleria, P., Kumar, S., et al. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1733013 · Cited by 3 · see citing works
- Authors
- Bumbarger, B., & Perkins, D.
- Affiliations
- Pennsylvania State University (US)
- Venue
- Journal of Children's Services
- Publisher
- Emerald
- Published
- 2008-04-12
- Volume
- 3
- Issue
- 2
- Pages
- 55-64
- ISSN
- 1746-6660 (ISSN-L)
- OpenAlex
- W2118705140
- Cited by
- 122
- References
- 38
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 4 · 2023: 5 · 2022: 7 · 2021: 11 · 2020: 8 · 2019: 8 · 2018: 5 · 2017: 12 · 2016: 9 · 2015: 12 · 2014: 2 · 2013: 5 · 2012: 10
- FWCI
- 12.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Children s Services (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
- Keywords
- dissemination of evidence-based interventions, prevention programmes, implementation fidelity, implementation quality, seed funding, substance use prevention, juvenile delinquency prevention, youth, public health outcomes
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