KNOWLEDGE TRANSLATION IN KNOWLEDGE TRANSLATION IN HEALTH PROMOTION: FUTURE HEALTH PROMOTION: FUTURE

PERSPECTIVESPERSPECTIVES

Sujan Babu Marahatta, PhD, Member of American College of Epidemiology (MACE)

Associate, Institute of Public Health Calgary University CANADA

Associate Professor, Manmohan Memorial Medical College/MMIHS

First National Health Promotion Conference

March 30-April 1 2013

Knowing is not enough; we must apply

Willing is not enough; we must do

Goethe

Doesn’t all health research have Doesn’t all health research have an impact?an impact?

Consistent evidence of failure to translate research findings into Consistent evidence of failure to translate research findings into clinical practiceclinical practice• 30-45% patients do not get treatments of proven effectiveness30-45% patients do not get treatments of proven effectiveness• 20–25% patients get care that is not needed or potentially 20–25% patients get care that is not needed or potentially

harmfulharmful (McGlynn et al, 2003; Grol R, 2001; Schuster, McGlynn, Brook, (McGlynn et al, 2003; Grol R, 2001; Schuster, McGlynn, Brook,

1998;)1998;)

Cancer outcomes could be improved by 30% with optimum Cancer outcomes could be improved by 30% with optimum application of what is currently knownapplication of what is currently known

10% reduction in cancer mortality with widespread use of 10% reduction in cancer mortality with widespread use of available treatment available treatment (CSCC 2001; (CSCC 2001; Ford et al, 1990)Ford et al, 1990)

This is Not a New Problem : The Case of Scurvy

1601 : Lancaster shows that lemon juice supplement eliminates scurvy among sailors

1747 : Lind shows that citrus juice supplement eliminates scurvy

1795 : [ 194 years after discovery ] British Navy implements citrus juice supplement

Science l981; 221: 881

Knowledge translationKnowledge translation

‘‘All breakthrough, no follow All breakthrough, no follow through’through’

Woolf (2006) Washington Post op edWoolf (2006) Washington Post op ed

The benefits of the US $100 The benefits of the US $100 billion/year worldwide investment in billion/year worldwide investment in biomedical and health research are biomedical and health research are not optimally achieved because of not optimally achieved because of knowledge translation failuresknowledge translation failures

Knowledge Translation is the Knowledge Translation is the bridge between discovery and bridge between discovery and

impactimpact

RESEARCH

INPUT

RESEARCH

IMPACTS

KNOWLEDGE TRANSLATION

Knowledge Translation: Knowledge Translation: DefinitionDefinition

The synthesis, exchange, and The synthesis, exchange, and application of knowledge by relevant application of knowledge by relevant stakeholders to accelerate the stakeholders to accelerate the benefits of global and local benefits of global and local innovation in strengthening health innovation in strengthening health systems and improving people’s systems and improving people’s healthhealth

CIHR CIHR DefinitionDefinition

Knowledge synthesis

Ethically sound application of knowledge

Dissemination

Knowledge exchange

What is Knowledge Translation? The contextualization and integration of research findings of individual research studies within the larger body of knowledge on the topic. Synthesis is a family of methodologies for determining what is known in a given area or field and what the knowledge gaps are.

The iterative process by which knowledge is actually considered, put into practice or used to improve health and the health system. KT activities must be consistent with ethical principles and norms, social values as well as legal and other regulatory frameworks

Refers to the interaction between the knowledge user and the researcher resulting in mutual learning, it encompasses the concept of collaborative or participatory, action oriented research where researchers and knowledge users work together as partners to conduct research to solve knowledge users’ problems (Integrated KT).

Involves identifying the appropriate audience for the research findings, and tailoring the message and medium to the audience.

What is Knowledge What is Knowledge Translation?Translation?

Knowledge translationKnowledge translation is about: is about: Making users aware of knowledge and facilitating their Making users aware of knowledge and facilitating their

use of it to improve health and health care systemsuse of it to improve health and health care systems Closing the gap between what we know and what we do Closing the gap between what we know and what we do

(reducing the know-do gap)(reducing the know-do gap) Moving knowledge into actionMoving knowledge into action

Knowledge translation Knowledge translation research (KT Science)(KT Science) is about: is about: Studying the determinants of knowledge use and Studying the determinants of knowledge use and

effective methods of promoting the uptake of knowledgeeffective methods of promoting the uptake of knowledge

So What are Key So What are Key Characteristics of KT?Characteristics of KT?

Knowledge is connected to researchKnowledge is connected to research

Actively connected to user/beneficiary Actively connected to user/beneficiary group(s)group(s)

Inclusive of all activities from Inclusive of all activities from generation of new knowledge to its generation of new knowledge to its useuse

10

Two broad categories of KT

End of grant KT

Integrated KT

The researcher develops and implements a plan for making knowledge users aware of the knowledge generated through a research project

The researcher engages potential knowledge users as partners in the research process. This requires a collaborative or participatory approach to research that is action oriented and is solutions and impactimpact focused.

Health promotion …….Health promotion …….

““is the process of enabling people to is the process of enabling people to increase control over and to improve their increase control over and to improve their health” health” (Ottawa Charter ’86)(Ottawa Charter ’86)

““involves the facilitation of skills in involves the facilitation of skills in individuals and change in environments individuals and change in environments which impact positively on health” which impact positively on health” (VicHealth 2005)(VicHealth 2005)

““is everyone’s business” is everyone’s business” (CEO DHCS 2004)(CEO DHCS 2004)

Health Promotion

Focus on the whole population.

Use a number of interventionssimultaneously.

Support people to make a ‘healthy’ choice.

Historically has been skewed towards education, need all strategies and approaches, not just one

• Build healthy public policy

• Create supportive environments

• Strengthen community action

• Develop personal skills

• Re-orient health services

The Ottawa Charter for Health Promotion

Challenges of Evidence-Based Health Promotion

Defining what it meansDefining what it means Finding the relevant evidenceFinding the relevant evidence Assessing the evidenceAssessing the evidence Using the evidence Using the evidence

appropriatelyappropriately Creating new evidenceCreating new evidence Sharing the evidence Sharing the evidence

Social model of health/ life Social model of health/ life coursecourse

Social and Economic Policy Environment

Culture

Distal Social Environments

Family

Macro Environ-mental Factors

Proximal Social Environments

Neighborhood Community

Organizational Connections

Friends

Individual Characteristics

Lifecourse

Conception Adulthood

Health & Development:Physical health, mental

health, social functioning, cognitive functioning

School

Socioeconomic

BehaviouralPsychosocial

GeneticCharacteristics

Pathobiology

Genetics Human Biology

Pathological Biomarkers

Lynch 2000

Health promotion policy and Health promotion policy and practicepractice

Evidence based interventionsEvidence based interventions    

EVIDENCE

CURRENT HEALTH PROMOTION POLICY AND

PRACTICE

Evidence Based

Interventions

Increasing the use of health promotion evidence in policy and practice

Shifting Paradigms

. . .

Knowledge translationMulti-directional, and multipleinputs from research, practice,experience and culture

Old Paradigm-Researchers do research-They communicate it effectively-Recipients use the results . . .

One way knowledge transfer

New Paradigm• Researchers and users select topic,

questions• Researchers and users bring different

expertise• Joint interpretation, application in specific context

MonitorMonitorKnowledgeKnowledge

UseUse

SustainSustainKnowledgeKnowledge

UseUse

EvaluateEvaluateOutcomesOutcomes

AdaptAdaptKnowledgeKnowledge

to Local Contextto Local Context

AssessAssessBarriers/Facilitators to Barriers/Facilitators to

Knowledge UseKnowledge Use

Select, Tailor,Select, Tailor,ImplementImplement

InterventionsInterventions

Identify ProblemIdentify Problem

Identify, Review,Identify, Review,Select KnowledgeSelect Knowledge

Products/Products/ToolsTools

SynthesiSynthesiss

Knowledge Knowledge InquiryInquiry

Tailo

ring K

now

ledg

e

KNOWLEDGE CREATIONKNOWLEDGE CREATION

Defining Knowledge translationStraus et al. CMAJ 181:165-168,2009

ACTION PHASESACTION PHASES

Knowledge-to-action process

Knowledge Translation Knowledge Translation ProcessProcess

Source: Nieva VF, et al. From Science to Service: A Framework for the Transfer of Patient Safety Research into Practice, Advances in Patient Safety, Vol 2. p.441-453

Some general KT principles for Some general KT principles for achieving impactachieving impact

1.Researchers need to do the 1.Researchers need to do the rightright research research

need for synthesis to determine what we need for synthesis to determine what we already know (or should know if we were to already know (or should know if we were to summarize the existing knowledge) summarize the existing knowledge)

need to determine where there is a strong need to determine where there is a strong evidence base and move that evidence into evidence base and move that evidence into actionaction

today's health problems are complex and today's health problems are complex and interdisciplinary and require mixed methods interdisciplinary and require mixed methods to solveto solve

primary research needs to be targeted to fill primary research needs to be targeted to fill the known gaps in our knowledge base the known gaps in our knowledge base

primary research needs to be solutions-primary research needs to be solutions-basedbased

Some general KT principles for Some general KT principles for achieving impactachieving impact

2.2. TheThe rightright people need to be involved from the people need to be involved from the beginningbeginning

need applied, collaborative, interdisciplinary need applied, collaborative, interdisciplinary research (in other words: integrated KT)research (in other words: integrated KT)

users of the research need to be helping to users of the research need to be helping to set the research agenda and define the set the research agenda and define the research questions to ensure relevance and research questions to ensure relevance and greater likelihood of uptake of the results greater likelihood of uptake of the results when they become availablewhen they become available

Some general KT principles for Some general KT principles for achieving impactachieving impact

3.3. Knowledge-users need to make the research Knowledge-users need to make the research rightright for their own contextfor their own context

research is not used like a can opener research is not used like a can opener

knowledge-users need to adapt, knowledge-users need to adapt, contextualize and take ownership of contextualize and take ownership of knowledge for local useknowledge for local use

as research producers, this means we need as research producers, this means we need to help them sufficiently understand our to help them sufficiently understand our work so that they are able to put it to usework so that they are able to put it to use

Achieving impact:Achieving impact:closing the gap between evidence closing the gap between evidence

and actionand actionHow to close the gap between evidence and How to close the gap between evidence and

action:action:

shift attention from individual adopters to the shift attention from individual adopters to the organizational and environmental context for organizational and environmental context for changechange

set targets for changeset targets for change monitor uptake of the research and evaluatemonitor uptake of the research and evaluate the the

health and system outcomes/impacthealth and system outcomes/impact keep it simple keep it simple focus on a few important targets, practical focus on a few important targets, practical

indicatorsindicators

Practical ingredients for Practical ingredients for success in health promotionsuccess in health promotion

Researcher community collaborationResearcher community collaboration Role of credible champions Role of credible champions Aligning with larger policy trajectoriesAligning with larger policy trajectories Linking with existing organizational Linking with existing organizational

activitiesactivities Addressing concerns of decision makersAddressing concerns of decision makers Using effective communication Using effective communication

strategiesstrategies

TAKE HOME MESSAGETAKE HOME MESSAGE

Making users aware Making users aware of knowledge and of knowledge and facilitating their use facilitating their use of itof it

Closing the gap Closing the gap between what we between what we know and what we know and what we dodo

Moving knowledge Moving knowledge into actioninto action

THANK YOU FOR

ATTENTIONsujanmarahatta@gmail.com