[Structural Barriers to Implementation: Clinic-Initiated Dissemination Activities and Awareness of a Family-Centered...

Evidence-based care models frequently fail to reach outpatient professionals as potential referrers. Previous analyses of CHIMPS-NET, a new family-centered care model implemented in German psychiatric clinics, showed that centrally organized information campaigns had no measurable effect on awareness among this group. The present study examines whether decentralized, clinic-initiated public relations efforts are associated with greater awareness of the care model.

Data are drawn from a postal and electronic survey of outpatient professionals across 18 psychiatric clinic sites in Germany at follow-up. Following Proctor et al.'s taxonomy of implementation outcomes, reach/penetration was operationalized as binary awareness of the care among outpatient professionals. Clinic-initiated activities were categorized into three intensity levels (low, medium, high) by two blinded raters based on internal project documentation. Associations were examined using binary logistic regression.

Of 2,828 professionals contacted, 203 returned evaluable questionnaires (response rate 7.2%). Only 9.4% of respondents (19/203) reported awareness of CHIMPS-NET. Logistic regression revealed no significant association between public relations intensity and awareness (χ²(2)=0.411; p=0.814; Nagelkerke R²=0.003).

Neither centrally nor decentrally organized dissemination efforts measurably increased awareness of the care model among outpatient professionals. The findings suggest that sustainable implementation requires structural approaches, such as embedding relevant criteria in clinical guidelines or creating billing-relevant incentives within the statutory health insurance system.