Innovations and Knowledge Translations

Frontiers of Tomorrow

Orienting Questions...

• What does the emerging science and practice of KT ask of us as nurses, as health care professionals, as health care educators?

• How do we bring our (nursing) research findings into sustainable practices that make differences that matter for the health care of all Canadians?

A Call For New Approaches in KT

• Methods used to promote practices are not often evidence-informed

• Dearth of information on which interventions actually work and under what circumstances

• Shift efforts “from development of new interventions to consistently deliver what is already known to work”

• Shift toward Action or Utilization component of KT

• The interplay with setting, context, environment as active participant

Innovators and Knowledge Translators

Participators, Designers, andResearchers .....

Graham, Logan, Harrison et al. (2006)

What is "knowledge translation"?

Knowledge translation research (KT Science) is about:

• determinants of knowledge use • promoting the uptake of knowledge

Knowledge translation (KT) is about: • Making users aware of knowledge• Facilitating their use of it• Closing the know-do gap• Moving knowledge into action

Strauss, Tetroe, & Graham (2009)

Knowledge translation at CIHR: Definition

• dynamic and iterative process • synthesis, dissemination, exchange and

ethically sound application of knowledge• complex system of interactions between

researchers and knowledge users • may vary in intensity, complexity and

level of engagement depending on – the nature of the research and the findings– the particular knowledge user.

Two broad types of KT at CIHR

End-of-grant KT• making knowledge users aware of the

knowledge generated through a research project

Integrated KT• engages potential knowledge users as partners

in the research process • a collaborative or participatory approach to

research that is action oriented and is solutions and impact focused

Where are the Future Frontiers?

Future Design Considerations: It’s about • Processes & Participation• Engaging multiple audiences – not a uni-

disciplinary venture – Active Citizenship engagement– Partnerships & Networks – practice,

education, research• Context as a complex active participant• Armamentarium of maps• Economics – cost analysis and utility

Responding to the Frontier Challenges...

• New statistical modelling

• Community based opportunities and participatory action research designs (Patrick McGrath, Patricia Lingley-Pottie, Debbie Emberly, Cathy Thurston, &Cathy McLean)

• Evidence informed policy and practice pathway (Shelley Bowen & Anthony Zwi, 2005)

• Clinical Networks (SCN) interfaced with curriculum initiatives & Educator Networks (CASN)

Collaborative, participatory, action-oriented way of conducting research

Results in: 1. co-creation of knowledge(s) by researchers and knowledge users. 2. integration of research findings into practice in a more structured, efficient, expedient, and effective health service.

Integrated KT(McGrath et al. 2009)

Community & Participatory based Principles

• Community as a unit of identity and of analysis• Collaborative partnerships & long-term commitments• Strengths & resources within the community • Integrates knowledge & action for mutual benefit• Co-learning and responsive empowering processes• Health focus on capabilities• Responsive to settings • Disseminates findings & knowledge gained to all partners

(Israel, Schulz, Parker & Becker, 2001; Garrison & Vaughan, 2008; Dopson, 2007)

Integrated KTPlan and Implementation

• Time 1: Informing the Design– Panel of international, interdisciplinary experts and

health professionals– Material development

• Time 2: During the Research– Study Management Team– Advisory Committee– Regular reporting to stakeholders

• Time 3: Following Completion of the study phase– From research recruitment to service promotion and

awareness

Community-based research with impact:

Supportive Environments for Moms Living with PPD

Nicole LetourneauNorlien/ACHRI Chair in Parent-Infant Mental

Health

“The PHSI program supports teams of researchers and decision makers interested in conducting applied and policy-relevant health systems and services research that responds to the needs of health care decision makers and strengthens the Canadian health care system.”

http://www.cihr.ca/e/36327.html

What is PHSI?

“With PHSI, you can make a difference. Research is more likely to be used in policy and practice when researchers work hand-in-hand with decision makers.”

http://www.cihr.ca/e/36327.html

It’s all about impact

Evidence-informed Policy and Practice Pathway

Bowen & Zwi, 2005

The Importance of Settings for Health Promotion:

The analytic framework comprises three parts:

(a) understanding settings,(b) changing settings, and (c) knowledge development and

knowledge translation.Blake Poland, Gene Krupa & Douglas McCall (2009). Settings for Health Promotion: An

Analytic Framework to Guide Intervention Design and Implementation

Sustainable Telephone-Based Support for Mothers with Postpartum Depression

Funded by CIHR and the NBHRF

• Integrated KT (but not an end in itself)

• Greater buy-in – sustained ‘community’ & service

• Increased chance for impact– On health care program delivery (↑ services

for mothers with PPD)– On health care system efficiency (↓ wait

times and emergency room visits)– Client health outcomes (↓ s/s PPD)

Benefits

MMT MOMS Study

Supporting Mother’s Engagement in Community-based Methadone Treatment

MMT MOMS Study

MMT MOMS Study

PURPOSE:Examine women’s and service providers’ perspectives on the characteristics of parenting supports and resources that could facilitate mothers’ engagement in MMT

Determine the influence of MMT on mothers’ parenting

MMT MOMS Study

MMT MOMS Study

I was kind of scared when I had him, that he was going to be sick because some kids are sick and have to have Morphine and stuff like that, but I made sure he breastfed so he was still getting some Methadone for the first three months of his life. So when I did wean him off my breast milk, I done it very slowly so that he wasn’t sick. [MMT 05]

MMT MOMS Study

Current Project: Addiction and Mental Health Research Network

• Integrated KT approach to build a research team and a program of research

• Research Focus: Attachment/relationship interventions with maternal addiction (triadic relations)

• Four phases proposed

Minding the Baby

• A COLLABORATION -Yale Child Study Center, Yale School of Nursing, Fair Haven Community Health Center, Cornell Scott Hill Health Center

• Minding the Baby (MTB) – intensive home visiting program working with first-time

young mothers and their families– First developed in 2002– program is interdisciplinary – home visiting team including a pediatric nurse

practitioner and a licensed clinical social worker – promote positive health, mental health, life course, and

attachment outcomes in babies, mothers, and their families.