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Knowledge translation – Public health perspectives Stachenko, Sylvie 2009-04-30

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Knowledge Translation –Public Health PerspectivesSylvie Stachenko,Dean, School of Public HealthUniversity of AlbertaNEXUS Spring InstituteUBCApril 16, 2009OverviewEvidence in Public HealthKnowledge Translation (KT) and Evidence-Informed Decision-MakingShifting Paradigms of KTCurrent OpportunitiesKT in Practice– National– InternationalSome Practical Ingredients for SuccessSummary 2Challenges  for facilitating use of knowledge in Public health• Work often done in silos in highly structured organizations• Few incentives to share resources and knowledge • New information produced at increasing rate • Many stakeholders with multiple needs but limited coordination mechanisms • KT under-resourced • Potential for inconsistent information between knowledge providersNature of Interventions in Public HealthImplications for evidence• Complex, multi-faceted programs that cannot be randomized• Natural, community environments and complex set of factors that cannot be controlled• Time lag to see final outcomes,• Role of context in interpreting and using knowledge/evidence, importance of assessing applicability & transferability• Evidence in Public Health–Research– Surveillance– Practice/experience– Evaluation findings• Other factors/influences– Media– Advocacy–Politics–Timing– Opinions etc.Evidence based or Evidence informed?adapted from Levesque, 2007DECISIONJudgementResourcesValuesHabitsTraditionPartners & Interest GroupsEvidenceTimingPolicy Decision-making ProcessMilne, 2008Long Lag Period Between Knowledge and Actionhttp://www.ccnpps.ca/515/Timeline-Tobacco+story.htm7So how does “Knowledge Translation”fit with Evidence-Informed Action?Definitions and Terms• Knowledge Translation (KT) – Making users aware of knowledge/innovations and facilitating their use of it to improve health– Closing the gap between what we know and what we do (reducing the know-do gap)– Moving knowledge into action• Confusing terminology:– knowledge mobilization, knowledge development and exchange, knowledge transfer, dissemination, ….Key Elements of KT• Knowledge synthesis• Dissemination• Knowledge exchange• Ethically sound application of knowledgeWhy Should I Care About KT?• Empirical work has shown that the simple availability of knowledge does not guarantee use.• Inefficient use of limited health resources!• Large amount of information, but insufficient:– Overall synthesis to support action– Dissemination/exchange– Uptake by decision makers– Application of knowledge“Are we having an impact?”(Murphy, 2006)Some KT Theories• Push {(researcher action, e.g. dissemination}• Pull (user demand, capacity building)• Knowledge Mobilization and ExchangeKnowledge Brokers• Knowledge brokering  links researchers and decision makers, facilitating their interaction so that they are able to:• better understand each other's goals and professional culture, • influence each other's work, • forge new partnerships, and • use evidence into decision making.• Individuals or organizations can be knowledge brokersEvidenceProblemsadapted from Murphy, 2006Knowledge BrokersCase example: Tobacco• Canadian Council for Tobacco Control (CCTC)• The CCTC acts as a knowledge broker to:– Bring people and organizations together– Link key players and decision makers– Ensure timely and practical transfer of critical knowledge and skills, and– Support, promote and further a comprehensive approach to tobacco control .Shifting ParadigmsOld Paradigm• Researchers do research• They communicate it effectively• Recipients use the results . . .One way knowledge transferNew Paradigm• Researchers and users select topic, questions• Researchers and users bring different expertise• Joint interpretation, applicationin specific context . . .Knowledge translationMulti-directional, and multiple inputs from research, practice, experience and cultureGoal: more use of researchCommunication & dissemination Increasing user capacity KT literature Info sharingGoal: responsive and  relevant researchGenuine partnership mutual respectFocus on organizational structure and cultureManagement literatureChange management    Power sharingShifting Paradigms?Current Opportunities• Increased research/community collaboration• Increased multidisciplinary intervention research• Increased emphasis by research funding agencies:KT Action at CIHRKT FocusSynthesisIntegrated KTEnd of Grant KTScience of KTFunding mechanisms• CIHR funds the Canadian Cochrane Network and Centre• KT Synthesis• Operating grants competition• Partnerships in Health System Improvement (PHSI) • Strategic research funded through institutes• Meeting, Planning and Dissemination grants to develop collaborative relationships and grant proposals• Allowable expense as part of a grant application• KT Supplement Grants • Meeting, Planning and Dissemination grants to disseminate results• Operating grants competition-KT Panel• Strategic calls from the KSE Branch on theories and methods of KTKnowledge Brokering • CHSRF is evaluating the impact of knowledge brokering on organizations wishing to incorporate research into their decision-making processes through demonstration projectsThe objectives of the demonstration site program are:1) to stimulate the implementation of structures, processes, or people in decision-making organizations dedicated to linking researchers with decision makers in their organizations and facilitating their interactions; and2) to increase the appropriate use of quality research in the decision-making processes of successful applicant organizations Each of the six sites will undertake formative and summative evaluations of their individual projects.Examples of KT in Practice• National– The Canadian Heart Health Initiative (CHHI)– National Collaborating Centres (NCC)– Canadian Best Practices Portal (CBPP)• International– EVIPNet (Evidence-Informed Policy Network)– Commission on Social Determinants of HealthThe Canadian Heart Health InitiativeLinking Research, Policy and Actiona planned, phased approachCanada, 2001National Collaborating Centres (NCCs)NCC An Example of a Current Activity related to KTIn Aboriginal Health Policies – developing a comparative inventory of policies, with accompanying case studies, for use as a research tool to inform policy-makers and practitioners.Launching the online Registry of Methods and Tools.Partnering with the NCC for Aboriginal Health on the development of an evidence review and educational tools for cervical cancer prevention.Emphasizing knowledge sharing and dissemination, particularly through workshops, while initiating an interactive tool for assessing and responding to the public health community’s needs.Conducting a multi-year project to enumerate past cases of waterborne illnesses in Canada and identify drinking water system risk factors (guided by a steering committee of policy-makers, practitioners, and researchers).Identifying and disseminating systematic reviews and gaps relative to early child development and public health interventions with cross-cutting themes of women and gender equity, employment and working conditions.National Collaborating Centrefor Aboriginal HealthNational Collaborating Centrefor Methods and ToolsNational Collaborating Centrefor Infectious DiseasesNational Collaborating Centrefor Healthy Public PolicyNational Collaborating Centrefor Environmental HealthNational Collaborating Centrefor Determinants of Health22Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention• Purpose: to improve policy and program decision-making by enabling access to the best available evidence on chronic disease prevention and health promotion• Target audience: Decision makers in health promotion, public health and chronic disease prevention, including:• Frontline public health workers (e.g. health promotion planners)• Non-government and voluntary organization program coordinators • All posted interventions are screened and assessed for effectivenesshttp://cbpp-pcpe.phac-aspc.gc.ca/web_tour-eng.html• EVIPNet (Evidence-Informed Policy Network)– EVIPNet Portal http://www.evipnet.org/php/index.php– is a WHO initiative that encourages policy-makers in low and middle-income countries to use evidence generated by research.– Promotes the systematic use of health research evidence in policy-making– Promotes partnerships to facilitate policy development and implementation– Uses best evidence availableActivities:• production of policy briefs, research syntheses• deliberative forums, networking opportunitiesInternational KT ActionInternational KT Action• Commission on Social Determinants of Health• Launched in March 2005• brings together leading scientists and practitioners to provide evidence on policies that improve health by addressing the social conditions which people live and work•Objectives:• To support policy change• Establishing Health as a shared goal• Help build a sustainable global movement for action on health equity and social determinants• Activities:• Country action• Knowledge Networks• E.g. Women and gender equity Knowledge Network• Reports that helped inform the Commission’s Closing the gap in a generation: Health Equity Through Action on the Social Determinants of Health ReportCommission on social determinants of healthPractical Ingredients for Success• Researcher/community collaboration• Role of credible champions• Aligning with larger policy trajectories• Linking with existing organizational activities• Addressing concerns of decision-makers• Using effective communication strategiesResearcher/Community CollaborationAction Research – University of Alberta• Healthy Alberta Communities• Addiction and Mental Health Research Laboratory• Community-University Partnership for the Study of Children, Youth, and Families (CUP)Role of Credible Champions• People and their interactions matter more than the message • On-going liaison and institution inter-connections• Personal contact and trust-building through quality relationships over time can offer systems change potential• Necessary for:– Access to decision-making settings– CredibilityIn memoriam Dr. Andrés PetrasovitsFebruary 11, 1937 – July 24, 2001Aligning with Larger Policy Trajectories• Aboriginal agenda– Growing recognition of specific needs/rights of Aboriginal communities• Children and family agendaAddressing Concerns of Decision Makers• Presenting a solution to an existing problem, NOT need for more research – Include short term objectives• Focus to specific audience (tailored message)– CHSRF 1-3-25 Format– Use of language, concepts of decision makers• Use of local case studies– “Stories” make issues real– Speak to organizational values, mission• Credible  messenger• Use of visuals– Geographic Information Systems (GIS)• Better decisions through mapping and models• Mapping of social determinants of health• Visuals and Colors (rather than stats) to communicate epidemicsUsing Effective Communication StrategiesWhat Can Universities do to Facilitate KT?• Incentives for engaged scholarship in the review process of faculty• Facilitate multidisciplinary KT curriculum• Integrated KT faculty position / focal pointClosing Reflections• KT from a Public Health perspective is important as it is inherently focused on continuous learning  • More opportunities and incentives for researchers to engage in collaborative action and co-production of knowledge with various knowledge users• Strategic use of evidence“A little knowledge that acts is worth infinitely more than much knowledge that is idle.”Khalil Gibran (1883-1931)Thank YouNEXUS Spring InstituteUBCApril 16, 2009References• Bennet, A., & Bennet, D. (2007). Knowledge Mobilization in the Social Sciences and Humanities. West Virginia: MQI Press.• Bowen, S. (2007). Using "Evidence", "Translating" Knowledge. Manitoba, Canada.• Canada, P. H. (2009, February 23). Canadian Task Force on Preventive Health Care. Retrieved April 3, 2009, from Public Health Agency of Canada: http://www.phac-aspc.gc.ca/cd-mc/ctfphc-gecssp-eng.php• Canada, P. H. (2002, September 30). In Memoriam. Retrieved April 3, 2009, from Chronic Diseases in Canada: http://www.phac-aspc.gc.ca/publicat/cdic-mcc/22-2/g_e.html• Canada, P. H. ( 2009, February 27). The Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention. Retrieved April 3, 2009, from Home: http://cbpp-pcpe.phac-aspc.gc.ca/• Canada, W. C. (2001, December). Canadian Heart Health Iniitiative: Process evaluation of the Dissemination Phase. Retrieved April 3, 2009, from Public Health Agency of Canada: http://www.phac-aspc.gc.ca/ccdpc-cpcmc/cindi/pdf/chhi-eval_e.pdf• Control, C. C. (2009). Donation form. Retrieved April 3, 2009, from Canadian Council for Tobacco Control: http://www.cctc.ca/donations/Donation_Form.pdf• Foundation, C. H. (2009). Knowledge Brokering. Retrieved April 3, 2009, from Canadian Health Services Research Foundation: http://www.chsrf.ca/brokering/index_e.php• Foundation, C. H. (2009). Knowledge Brokering Evaluation Program. Retrieved April 3, 2009, from Canadian Health Services Research Foundation: http://www.chsrf.ca/brokering/evaluation_program_e.php• Government, C. (2008). Accountable Government. Retrieved April 3, 2009, from Privy Council Office: http://www.pco-bcp.gc.ca/index.asp?lang=eng• Graham, I., Logan, J., Harrison, M., Straus, S., Tetroe, J., Caswell, W., et al. (2006). Lost in Knowledge Translation: Time for a map? Journal of Continuing Education in the Health Professions , 13-24.• Graham, I. (2008, June 28). Canada's Approach: Canadian Institutes of Health Research. Ottawa, Ontario, Canada.• Graham, I. (2008, April 24). Knowledge Translation Research: past present and future. Toronto, Ontario, Canada.• Health, N. C. (2008). About us. Retrieved April 3, 2009, from National Collaborating Centres for Public Health: http://www.nccph.ca/• Levesque, P. (2005). Knowledge Exchange and Knowledge Mobilization: A Primer. Retrieved April 3, 2009, from Knowledge Mobilization Works: http://www.knowledgemobilization.net/• Levesque, P. (2007, August 31). Knowledge Mobilization: social profits? Retrieved April 3, 2009, from Knowledge Mobilization Works: http://www.knowledgemobilization.net/• Levesque, P. (2007, November 20). Mobilizing what we know: Value from Knowledge Exchange. Retrieved April 3, 2009, from Knowledge mobilization works: http://www.knowledgemobilization.net/• Levesque, P. (2009, February 14). What is Knowledge Mobilization? Retrieved April 3, 2009, from Knowledge Mobilization Works: http://www.knowledgemobilization.net/• Milne, G. (2008). Making Policy: A guide to the Federal government's policy process. Ottawa: Glen Milne.• Murphy, L. (2006, August 22). 'Push and Pull' Strategies for Research Use in the Canadian Healthcare System. Retrieved April 3, 2009, from Canadian Health Services Research Foundation: http://www.abrasco.org.br/UserFiles/File/Apresentacoes/Dia%2022/Linda%20Murphy%20-%2015-00%20-%20World%20Congress%20final%20presentation.ppt• Organization, W. H. (2009). Commission on Social Determinants of Health. Retrieved April 3, 2009, from World Health Organization: http://www.who.int/social_determinants/thecommission/en/• Organization, W. H. (2009). EVIPNet Portal. Retrieved April 3, 2009, from Evidence Informed Policy Network: http://www.evipnet.org/php/index.php• Policy, N. C. (2009). The Tobacco Story in Canada : 1900 until today. Retrieved April 3, 2009, from Timeline-Tobacco story: http://www.ccnpps.ca/515/Timeline-Tobacco+story.htm• Research, C. I. (2008, October 22). About Knowledge Translation. Retrieved April 3, 2009, from Canadian Institutes of Health Research: http://www.cihr-irsc.gc.ca/e/29418.html• Research, C. I. (2009, April 2). Cafe Scientifique. Retrieved April 3, 2009, from Canadian Institutes of Health Research: http://www.cihr-irsc.gc.ca/e/34951.html• Robinson, K., & Turgeon, V. (2008, December). Knowledge Development and Exchange (KDE) 101. Ottawa, Ontario, Canada.• Stachenko, S. (2005, January 28). The Canadian Heart Health Initiative: Upscaling and Disseminating . Helsinki, Finland.References


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