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© Fraser Health Authority, 2007
The Fraser Health Authority (“FH”) authorizes the use, reproduction and/or modification of this publication for purposes other than commercial redistribution. In consideration for this authorization, the user agrees that any unmodified reproduction of this publication shall retain all copyright and proprietary notices. If the user modifies the content of this publication, all FH copyright notices shall be removed, however FH shall be acknowledged as the author of the source publication.
Reproduction or storage of this publication in any form by any means for the purpose of commercial redistribution is strictly prohibited.
This publication is intended to provide general information only, and should not be relied on as providing specific healthcare, legal or other professional advice. The Fraser Health Authority, and every person involved in the creation of this publication, disclaims any warranty, express or implied, as to its accuracy, completeness or currency, and disclaims all liability in respect of any actions, including the results of any actions, taken or not taken in reliance on the information contained herein.
22
Lost and Found in Knowledge Translation
B McCoyKnowledge Integration
SpecialistFraser Health Research
Administration and Development
M SandrelliKTE Coordinator
Mental Health and Addictions
33
Objectives
1) Understand terminology and concepts pertaining
to Knowledge Translation aka Knowledge
Transfer and Exchange (KTE)
2) Understand the process of KTE
3) Understand best practice methods for KTE---
tried, true and otherwise novel !
4) Understand the challenges of KTE in practice
44
Beware! Be aware of the fact that the science of KTE has a
deluge of terminology which is often used interchangeably (and often incorrectly !)
terms actually all have a specific meaning and action(s) associated
In today’s presentation, we will introduce the same terminology from two (or more) perspectives:
1) the academic research perspective –CIHR / CHSRF 2) the continuing health education perspective-CACHE
The key is to remember the source and its objective
Kno
wledge
Trans
fer
?
Knowledg
e Synthesis
??
Knowledg
e Exchange
?Knowledge to Action ?
Knowledge Dissemination?
KT
KSTE
Knowledge Utilization
Terminology?
Dissemination Utilization
Actionable
MessageKTE KSE
Knowledge Sharing
diffusion
Push / Pull
Linkage & Exchange
Knowledge Translation
Knowledge
Mobilization
Knowledge management
66
What is most important?
To understand:
That KTE is an iterative process that takes time How the KTE process works That a range of stakeholders need to be involved Effective strategies for KTE Useful frameworks for facilitating the use of best
evidence in practice or decision making
777
Terminology- Knowledge Creation/Generation
Creation of “evidence-based” knowledge through scientific research/study or evaluation
888
Terminology- Knowledge Translation
“The exchange, synthesis & ethically-sound application of knowledge---within a complex system of interactions among researchers & users----to accelerate the capture of benefits of research for Canadians through improved health, more effective services & products, and a strengthened health care system”
• Canadian Institutes of Health Research (CIHR-2000)
“The purpose is to bridge the gap between what we know (evidence) with what we actually do; any KT strategy takes into account that translation and learning occurs in a complex social system, thus, it requires a learner-centered approach”
• Canadian Association of Continuing Health Education (CACHE)
99
Terminology- Knowledge Synthesis
The importance of understanding how the results from a single research study mesh with the larger body of knowledge / research on the topic
Conducted by completing a synthesis of the global literature on the topic
Allows determination of the effectiveness of interventions or practices
Canadian Institutes of Health Research (CIHR-2000)
1010
Terminology- Knowledge Exchange
The interactions between the research user and the research producer that result in mutual learning
• Canadian Institutes of Health Research (CIHR-2000)
Emphasizes a collaborative approach that spans knowledge creation to its implementation.
• Canadian Association of Continuing Health Education (CACHE-)
Lavis, Lomas et al (2006). Bulletin of the WHO. 11
The Push Model
Push
the researcher is the catalyst for change• packages tools (syntheses, policy briefs, videos) in
order to make research more accessible for decision-makers & other research users
Decision-maker is the target of information in the push model, but may be involved in the research also
Lavis, Lomas et al (2006). Bulletin of the WHO. 12
The Pull Model
Pull
Focus is on the decision-maker’s desire for information
They may be looking for new evidence that will change programs/services
They may be learning how to critically appraise the evidence or learning how to use the evidence in decision-making
Lavis, Lomas et al (2006). Bulletin of the WHO. 13
Linkage and Exchange Model Researchers and research-users
collaborate for mutual benefit May be a short or long-term
collaboration and may occur at any point in the research / policy process
May include priority setting exercises, collaborative research projects, or projects with a developmental product at the end eg. database
1414
Terminology- Knowledge Transfer
“A systematic approach to capturing, collecting & sharing tacit knowledge in order for it to become explicit knowledge”
Government of Alberta
KT is about transferring good ideas, research results & skills between universities, other research organizations, business & the wider community to enable innovative new products and services to be developed
UK Office of Science and Technology
“Successful knowledge transfer involves much more than a one way, linear diffusion of knowledge & skills from a university to industry; it depends on access to people, information and infrastructure”
UK Particle Physics & Astronomy Research Council
Refers to the process of having all forms of knowledge used by stakeholders; has been criticized for implying a unidirectional process.
Canadian Association of Continuing Health Education (CACHE)
151515
Terminology-Diffusion and Dissemination
Diffusion: The process by which an innovation is communicated through certain channels over time among members of a social system
• Rogers (1995 -5th ed.)
Dissemination: targets a specific audience and (inter) actively uses specific styles and levels / types of communication (small group discussion, one-one meetings, didactic pres) of information to improve knowledge or skills or elicit change
The spreading of knowledge or research eg in journals or at conferences
Concerns the transmitting of knowledge, but does not emphasize the development of knowledge, nor the context of the receiver of knowledge.
• Canadian Association of Continuing Health Education (CACHE)
1616
Terminology
Research Utilization The process by which specific research-
based knowledge is implemented in practice• Estabrooks et al, 2003
Implementation The execution of the adoption decision where
the research or decision is put into practice
171717
Terminology
Adoption and Uptake: To implement and sustain the innovation or
program over time as a regular ingredient of practice/policy
Evaluation: Measure how successful knowledge
exchange activities are based on a pre-determined set of outcomes or indicators
1818
Knowledge Transfer and Exchange (KTE)
WHAT IS THE GOAL OF KTE?: To produce and disseminate information that
is useful for intended end-users (managers, decision makers, policymakers)
The style, format, content, and process of reporting information influences the ability for the information to be used
1919
Dissemination Activities- when and who?
What is the preferred order of these dissemination activities and why?
Who will take the lead on each of these?
Suggest: Each committee member responsible for at least one dissemination activity with report-back at next meeting to group
2020
Consider the goal…..
What is the goal of disseminating?
A single change in a program?
A change in practice?
A change in culture?
Are there both short-term & long-term goals
to consider?
2121
Consider the context….
In creating a plan, we will need to consider the context or the environment that it is being completed within
• political, organizational, social, cultural context?
• utility?• relevance?
Grol and Grimshaw (2003) 2222
Consider the Barriers…..Potential barriers exist- examples :
The practice environment / organizational context
• Financial disincentives (lack of re-imbursement)
• Lack of time
• Risk of formal complaint
The social context
• Usual Routines
• Opinion leaders do not agree with the evidence
• Obsolete knowledge
Professional Context aka knowledge and attitudes
• Clinical uncertainty
• Self confidence in skills
• Need to do something
• Inability to appraise the evidence
Who is your target audience?
2424
Who is your Target Audience?
Who are the people who can
use these findings/results?• Primary Audience?• Secondary Audience?
Target audiences should be identified and engaged early in the process to
build their interest and give them a sense of ownership in the program
2525
Developing key messages……
262626
Develop Key Messages ….
identify the most important, and locally relevant
findings, results, information
What does it mean? why it is important? How does it fit
into the local context?
Consider: How is this information potentially useful to
your target audience?
develop clear, simple, action-oriented messages
the tone, content, and language of a key message needs
to be appropriate for its intended audience
2727
Tips on tailoring the messages
Messages should be tailored to each audience
based on what is relevant and of interest to them
Consider your specific target audience- how would
you tailor your message so that it becomes what
the audience wants to hear?
2828
Identifying Spokespeople
Need to identify credible / influential spokespeople to spread messages in order to spread the message and increase uptake:
Champions / messengers should be people or organizations that are credible and influential within each target audience
Aim to engage them early in the process
WHO are these spokespeople? What makes them credible?
2929
Dissemination Activities-what?
What activities will be undertaken for dissemination of the key messages to each of the target audiences? What is appropriate and
effective?
Grol and Grimshaw (2003) 30
What are successful techniques ? ‘Mostly effective to effective’
Multi-professional collaboration Interactive small group meetings Regular reminders Educational outreach visits Computerized decision support Mass media campaigns
Grol and Grimshaw (2003) 31
What are successful techniques ? ‘Mixed effects’
Educational Materials Conferences Use of opinion leaders Education with different educational
strategies Feedback on performance Continuous quality improvement
3232
Dissemination Activities
Aim for INTERACTION!!
Face-to-face meetings Small groups All party involvement
Aim for two-way dialogue---avoid one way flow of information
3333
Other considerations for dissemination..
While planning, don’t forget: COSTS
print or web-based support materials: cost of design,
layout, translation if required
travel costs: whose budget? how much is required?
venue, equipment, technicians, catering costs
resources for future activities (meetings) and actions
that pertain to messages (eg new initiatives)
3434
Note to self:
What is the timeline for dissemination?
Remember: Dissemination is an iterative process of several
months / meetings, not a one-off task Meetings will provide an opportunity to assess
progress, adjust and fine-tune activities as required
3535
Time to spread the message……..
Who else needs to know?
Raise awareness internally- who else needs to know? What will they do with the information?
Managers, Directors, Executive, Front Line staff Others?
Externally-Raising public awareness Develop and distribute public reports Media releases, interviews Government Organise public forums Other ideas?
3737
External Communication Strategy
Is one required? Who needs to know? What do they need to know and
why? For media releases to the public, use plain language and
tell a story that will generate human interest Consider informing other groups e.g. rotary clubs, chamber
of commerce Enlist outsiders (public, media and externals) to assist in
spreading the messages
“Found” in KT
“We know what’s promising and what may work better in practice, so, now
what?”
“Found” in KT ?
“Continuing Professional Education? It’s frustrating because I never have the time or energy to figure out a way to include it in my practice. It’s better not to even go to workshops. They become a burden for me & managers expect us to include this new information into our practice”
“Found” in KT ?“What could any ‘outside expert’ possibly teach me? I
have been doing this for years, and it has been working. I’ll go, but don’t expect me to learn anything”
“Found” in KT ?
“The closer I look at the material
presented, the more impossible
it seems to make it work at my site”
Found in KT
There is hope & some
promising practices
in applying KTE for health service improvements
But first some important
information from our
experiences..
Found in KT
Definitions of KTE are socially and politically situated.
No matter which definition you ascribe to, knowledge translation & exchange ultimately involves the: • contextualizing of knowledge to different settings,• while ensuring knowledge efficacy.
For example, check this out . . . .
Found in KT CROSS SECTIONAL SURVEY IN ONTARIO, 2006
Executive Directors (N=161)
Clinicians (N=217),
Organization’s use of research evidence (access, assess, adapt, adopt)
* 55% of executive directors perceived their services and programs to be “somewhat” supported by research evidence;
* 31% of clinicians and managers perceived their services and programs to be “somewhat” supported by research evidence;
Determining Factors for Using Evidence from
Research . . .
Found in KT
WHY IS KTE SO DIFFICULT FOR Health Services?
The implementation of high quality evidence in Health Services is inconsistent. Changes to clinical practices in response to high quality evidence can:
· be disproportionate in magnitude;· vary between geographic area, institute/program, clinician, context;· altered by dominant opinion due to lack of accountability;· be watered down due to lack of resources or employee will. Interventions known to provide the best outcomes may not be employed OR interventions may be prematurely employed when there is insufficient evidence to be confident in their effect.
(Grol, 2001; Grimshaw et al., 2004)
Hand Outs “Lost in Knowledge Translation: Time for a Map?” in package
Found in KT
KTE’s Chances to SUCCEED depends upon:
• Employee & Health Service’s Stage of Change Access to Resources that Promote Shared Meaning (not
technology alone – collaborative inquiry) Defined ROI- return of investment (time saved, client
satisfaction, etc) Opportunity to Apply Knowledge in Field & Generate More
Knowledge (experiential learning cycle) Employee Incentives including encouragement of
creativity, celebrations, etc
Found in KT
A few examples:1. Whiplash & WCB in Ontario
2. Female Condoms in DTES3. Risk Assessments in Harare4. Motivational Interviewing in
MH&A
Now, it’s our turn to plan a Roll Out with KTE ingredients . . . .
Details of these case examples are in your hand-out packages
Found in KT KTE Roll Out for Metabolic Monitoring
Get into groups of 3 or 4 Read the instructions from the worksheets
in your package titled “Metabolic Monitoring”
Have one person ready to share your plan
Found in KT
Key ingredients for a successful KTE experience introducing “KT Alignment Measures”
Shared Meaning in both content & context Customized content to context/capacity (constructivism & social
learning theory) ROI – return of investment Opportunities for knowledge generation
Celebration & Acknowledgement
Hand outs for KT Alignment Measures are provided in your package
Found in KT Some Thoughts . . . .from MH&A About Knowledge Generation
MHAKTE
Community Partners
Clients & Families
Researchers
MHA Employees & Contractors
Found in KT
KTE is not a quick fix’.
Knowledge translation research can help address organizational, social, political and individual factors that impact client care and decision-making. Knowledge translation will not simplify complex issues in addictions & mental health care, but rather it will treat them as the complex issues that they are.
“Lost & Found” in KT
“Lost & Found” in KT
Bonnie McCoy
604-587-4412
bonnie.mccoy@
fraserhealth.ca
Knowledge
Integration Specialist
Research Administration & Development
Fraser Health
Marika Sandrelli
604-219-2028
KTE Coordinator
Mental Health & Addictions
Fraser Health
5454
Useful KTEResources-practical examples
From CIHR, the KT Casebook titled Moving Population and Public Health Knowledge Into Action
–A casebook of Knowledge Translation stories
From CIHR, the KT Casebook titled Evidence in Action. Acting on Evidence. A casebook of
health services and policy research knowledge translation stories
http://www.cihr-irsc.gc.ca/e/30739.html
5555
Useful KTE Resources Canadian Association of Continuing Health Education
http://www.cachecanada.org
Institute of Health Economics Report (2008). Effective Dissemination of Findings from Research. www.ihe.ca
Canadian Health Services Research Foundation: www.chsrf.ca
Molapo, D (2007). Knowledge dissemination: Determining impact. IFLA Conference, Knowledge Management Workshop, Howard College Campus, University of KwaZulu-Natal, Durban.http://researchspace.csir.co.za/dspace/bitstream/10204/1255/1/Molapo_2007.pdf
Developing an Effective Dissemination Plan (2001).http://www.researchutilization.org/matrix/resources/dedp/#ten
5656
Useful KTE Resources: Canadian Health Services Research Foundation http:// www.chsrf.ca
The Foundation's Communication Notes:
Developing a Dissemination Plan Reader-Friendly Writing - 1:3:25 How to Give a Research Presentation to Decision Maker
s
Dealing With the Media Self-Editing: Putting Your Readers First Designing a Great Poster Communications Primer