APPLES logic model for evaluating the dissemination of effective behavioral interventions

Logic models can guide researchers and practitioners in the development, delivery, and evaluation of behavioral interventions. Despite their potential to provide a theory of action for guiding dissemination efforts, there are few models that depict the linkages between the initial uptake of an EBI and its subsequent diffusion to populations that might most benefit. The APPLES logic model posits relationships between actions designed to support the dissemination of EBI and their intended dissemination outcomes. The model is grounded in theories of diffusion of innovation and stages of change, as well as social marketing principles and operations and systems research. By delineating factors that may influence the update and sustainability of EBI, APPLES provides a conceptual framework for testing empirical evidence to answer key dissemination questions: How do agencies adopt and implement an intervention, balancing the fidelity with adaptations based on local knowledge, needs, and realities (Adoption)? Do agencies recruit and deliver interventions to those at highest risk in their community (Population Penetration)? How long and consistently do agencies use interventions (Longevity)? How do agencies obtain evidence that an intervention is working, and use this evidence to strengthen adoption, population penetration, and longevity (Evaluability)? What supports are available for institutionalization and maintenance (Sustainability)? Examples illustrate how APPLES helps identify factors influencing success, including community/agency inputs and resources, intervention inputs and resources, and specific activities. Models like APPLES are needed to advance the scientific understanding of dissemination and ensure that EBI developed over the past two decades reach their intended audiences.