Exploration Stage

At some point, someone has to think about making use of an innovation. This requires some degree of awareness that leads to acquisition of information and exploration of options. A large and varied literature exist describing “diffusion” of information and how individuals and organizations make “adoption decisions” (Rogers, 1983; Westphal et al., 1997; Fitzgerald, Ferlie, & Hawkins, 2003).  Dissemination of information is another avenue for individuals and organization staff to learn more about innovations and implementation.  For example, social marketing methods have been used to disseminate information to potential users of innovations. Social marketing emphasizes knowing consumer needs and matching interventions with those needs (Andreasen, 1995). Flocks, Clarke, Albrecht, Bryant, Monaghan, & Baker (2001) provide a detailed description of social marketing strategies applied to reducing the adverse effects of pesticide exposure among farm workers. Cohen, Farley, Bedimo-Etame, Scribner, Ward, Kendall, & Rice (1999) describe the use of similar strategies to increase the availability and use of condoms in one state. 

In September 2012 a Google search for the phrase “evidence-based” produced over 27 million results, “evidence-based program” produced over 716,000 results, and “evidence-based implementation” produced nearly 73,000 results.  There seems to be no shortage of information that is well diffused and disseminated, and this provides good foundations for the Exploration Stage of implementation.

The processes of mapping consumer needs and understanding the enabling and limiting aspects of the contexts in which interventions can occur seem to be important during the exploration process. At the end of the Exploration Stage, a decision is made to proceed with implementation of an evidence-based program in a given community or state based on formal and informal criteria developed by the community and by the evidence-based program (Blase et al., 1984; Khatri & Frieden, 2002; Schoenwald & Hoagwood, 2001).

The point of entry for evidence-based practices and programs may be at the system level or at the provider level. Broad-based community education and ownership that cuts across service sectors may be critical to installing and maintaining an evidence-based program with its unique characteristics, requirements, and benefits. Kraft et al., (2000) describe a “pre-implementation” stage for implementing HIV/AIDS prevention programs where service providers, community planning groups, advisory boards, consumer population members, related organizations, and purveyors meet and exchange information to:

  • identify the need for an intervention considering the information available
  • acquire information via interactions with one another
  • assess the fit between the intervention program and community needs
  • prepare the organization, staff, and resources by mobilizing information and support.

It seems clear that evidence-based practices and programs will not be implemented on any useful scale without the support of political, financial, and human service systems at state and local levels (Schoenwald, 1997). That support is garnered during the adoption process and is important throughout all implementation stages.  Fox & Gershman (2000) summarized several years of experience with the World Bank in its attempts internationally to implement new policies to help the poor. They advised that, “…for a mutually reinforcing coalition to emerge, each potential partner must make an investment with a high degree of uncertainty regarding the commitment, capacity, and intentions of their potential partner” (p. 188).

Deciding to “adopt” an evidence-based program or practice and having well-aligned support should not be confused with actually putting that program or practice into effective use.  Rogers (1983) observed that fewer than 3% of the more than 1,000 articles he reviewed pertained to what happened after the adoption decision. Rogers noted that the diffusion literature takes us up to the point of deciding to adopt an innovation and says nothing about what to do next to implement that innovation with fidelity.

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