The six steps in the DAU process-Disseminate, Adapt, and Utilize-are: awareness, advocacy, acceptance, adaptation, application and adherence were conceptualized through the lens of a management of change process.
Summary of the six steps of the DAU process – taking evidence into practice:
Developing practice guidelines based on the best available evidence will not create change in practice. Steps must be taken to assess needs by involving key stakeholders to create awareness of the evidence-based practice and to advocate its acceptance.
ACCEPTANCE - Champion the use and acceptance of the best practice.
Information based on evidence can be used to advocate change, but to gain acceptance requires champions within the health care system who can enlist their peers and create the critical mass of people committed to taking action. Achieving this level of acceptance requires coordination and teamwork. This collective action provides a powerful lobby not only for change in policies, but also for actions that translate those policies into practice.
ADAPTATION - Adapt technical guidance to suit local needs.
For technical guidelines to affect practice, they must be adapted to suit local conditions. A collaborative process of adaptation is itself a vehicle for building consensus and developing champions. In particular, guidelines must be translated into specific protocols or behaviors that guide providers' actions.
APPLICATION - Manage change to overcome barriers to supporting the application of the best practice.
Constraints and inertia exist in any health care system. Application of a new practice, however, requires management of a strategic process of change. A systematic analysis of the gap between actual and desired performance will inform the choice of interventions that, working together, will best close that gap. Training and job aids to support providers’ new behaviors often are necessary parts of this process but often not enough.
ADHERENCE - Monitor implementation to support the sustained use of best practices.
New practices are routinely adhered to and sustained only through change in both the infrastructure of the health care system and the practices of providers.
All actors in the health care system—from those in the international arena to those in the local clinics—have to make changes. This change can be achieved only through sustained effort. Partners agreed to focus on developing systems to mentor and follow up all activities implemented at country level.