After randomised trials: issues related to dissemination of evidence-based interventions

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.