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From knowledge to action: Knowledge translation in the “real world” of clinical psychiatry Johnson, Joy; Malchy, Syd; Baines, Katie Apr 30, 2009

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FROM KNOWLEDGE TO ACTION: KNOWLEDGE TRANSLATION IN THE “REAL WORLD” OF COMMUNTY PSYCHIATRY Katie Baines MSc RN, Syd Malchy BA MSc & Joy Johnson PhD RN FCAHS  The Problem …  …  Knowledge translation is a messy and complicated business KT theories describe the phases of the process; but give little guidance as to what to do “on the ground”.  Presentation Overview …  Knowledge translation: KTA process  …  Overview of the CACTUS project  …  Appreciative Inquiry  …  Motivational Interviewing  Terms for “Knowledge to Practice” Evidence into practice/translating scientific knowledge (N = 15) … Implementation (n = 12) … Evidence/research based (n = 8) … Knowledge/research/evidence utilization/uptake (n = 6) … Diffusion (n = 5) … Dissemination (n = 3) … Technology transfer (n = 3) … Knowledge exchange/mobilization (n = 2) … Organizational change (n = 2) … Assimilate (n = 1) … Behaviour change (n = 1) … Integrate (n = 1) … Change management (n = 1) … Scaling up (n = 1) … Improvement (n = 1) … Adoption (n = 1) (Graham & Tetroe, 2007) …  The Cactus II Project …  … …  …  A knowledge to action project focused on addressing smoking cessation in community psychiatric settings Six community case study locations Design integrated clinical tobacco reduction interventions, determine effectiveness and evaluate uptake PLAN, DO, STUDY, ACT  *Funded by CIHR  Principles of Appreciative Inquiry Inquiry into the social innovation potential of a social system (Cooperrider & Srivastva, 1987) … … … …  Change happens over conversations Change can be transitional or transformational Improvisation vs. Implementation What do you want more of?  Motivational Interviewing …  Client centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence (Miller & Rollnick, 2002)  Guiding Principles (RULE) …  Resisting the righting reflex  …  Understand your patients/organizations motivations  …  Listen to your patient/organization  …  Empower your patient/organization  General Principles …  Express Empathy  (acceptance, reflective listening, ambivalence is normal)  …  Develop discrepancy  (client/organization should voice the arguments for change)  …  Roll with Resistance  (avoid arguing for change, resistance is not directly opposed, resistance is a signal to respond differently)  …  Support Self-efficacy  (important motivator, client/organization responsible for the change, counsellor/researcher must believe in the change)  Conclusion …  …  …  Supplementary theories are required to supplement KT models Reconsider deficit-based approaches; build on strengths (from push to pull) MI principals are a helpful guide to meaningful knowledge to action engagement  Questions  

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