The considerable investment in development of guidelines, critical pathways, and treatment protocols has given increased urgency to moving these recommendations into clinical practice. While methods for bringing this information to practitioners have expanded, interventions designed to change practice behaviors have had, at best, mixed results. Traditional dissemination efforts may make practitioners aware of a guideline or the results of a consensus conference, yet rarely do they improve practice. In instances where the dissemination strategy addresses knowledge and skills, there is little consistent evidence that clinical behavior is affected. The conceptual model we propose posits that to achieve long-lasting change in practice behavior, practitioners must be predisposed to change and must have the appropriate knowledge and skills to implement change, and structures within their organizations must enable and maintain these new behaviors. Elements and relationships of this model are drawn from a diverse body of literature in the behavioral sciences, health education, educational research, group dynamics, and organizational development. In reviewing strategies developed to disseminate innovations and promote their adoption, we note that the model provides insight into the factors that influence movement between the stages in the change process and the rationale for an integrative, multivariate approach to changing practice behavior. Since the model provides the basis for predicting the effect of various change strategies, as well as a blueprint for the design of such strategies, we conclude with a brief description of an experiment designed to test the model.