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Disseminating research findings Disseminating research findings to impact policyto impact policy
Jitendra KhannaTechnical Editor
The WHO Reproductive Health Library
"Ta mard sukhan na gufta baashed Aib-o-hunarish na hufta baashed" Sheikh Saadi
(Till a man says something, both his strong and weak points remain hidden).
ObjectivesObjectives
Review some basic principles of communication and information disseminationExplore channels of dissemination for peers and other stakeholdersSome exercises
_____________________________________ Based on – HRP communication workshops– Turning research into practice– Institute of Health Economics report (2008)
Global publication of scientific researchGlobal publication of scientific research
From: New Scientist, 2008
Science in IranScience in Iran
Iran increased its publication output nearly tenfold from 1996 to 2004 (Institute for Scientific Information)Iran ranks 49th for citations, 42nd in paper output, and 135th for citations per paperAccording to a British government study (2002), Iran ranked 30th in the world in terms of scientific impact.In 2008, Iran ranked 32, 46 and 56 in Chemistry, Physics and Biology, respectively, in the world.
• from Wikipedia, 2009
Generally speaking….Generally speaking….
Many problems – not as many sure solutionsMay have solutions – but no direct power to implementKnowledge – this today that tomorrowKnowledge is money (and power)The big gap – researchers and publicThe many brokers – noise or clarity?Power of science – or weaknesses?Interests – supportive and vestedOthers
Distribution of interventions in RHLDistribution of interventions in RHL
Cer
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Research to policy: Research to policy: some basics questionssome basics questions
Whose idea was it anyway?
Was there interest in it before and during the conduct of research?
Does the research group have credibility?
Where were the results published?
Who is opposed to the idea?
Is there capacity to implement the intervention?
What are the risks in implementing it?
Information disseminationInformation dissemination
The circulation or wide dispersal of information.
Medical.webends-com
What is communication?What is communication?
"Any act by which one person gives to, or receives from, another person information about that person's needs, desires, perceptions, knowledge, or affective states. Communication may be intentional or unintentional, may involve conventional or unconventional signals, may take linguistic or nonlinguistic forms, and may occur through spoken or other modes." National Joint Committee for the Communicative Needs of Persons with Severe Disabilities, 1992
Key points about communicationKey points about communication
Exchange – two-way
Information (but reflects knowledge)
Intentional or unintentional
Linguistic or nonlinguistic
Needs, wants, perceptions, knowledge
Shannon's modelShannon's modelClaude E. Shannon conceptualized the communication theory model in the late 1940s.
It remains central to communication study today.
Message Message
SignalInformation
source Transmitter DestinationReceiver
Noise source
Adapted model of communicationAdapted model of communication
Noise
SignalSender Encoding ReceiverDecoding
Noise
Feedback
Noise Noise
Noise Noise
Quality of communicationQuality of communication
Varies, depending on – Use of effective skills and strategies– Understanding of audience(s)– Use of correct channels
Skills can be learnt
Going from A to B… and backGoing from A to B… and back
Means of transport (information channel)
Timing (hook for the story)
Information about B (know the audience)– Culture– Likes / dislike– History
Risks (What can go wrong)
ResearchResearch
Research is Research is partpart of a process of a process of knowledge of knowledge production, production,
managementmanagement and and use.use.
A research institution is a A research institution is a "knowledge" factory"knowledge" factory
Input: information
Output: information
Processing
Knowledge
The policy and execution The policy and execution grinding millgrinding mill
Information Policy and communication
Processing
Knowledge
Analyses of threats and benefits
Impact
Testing Evaluation
Worlds apartWorlds apart
Since both research and policy-making are complex activities and very different from each other, mutual understanding requires concisions effort.– A generalization made based on research by
Fox and Oxman (2001)
Dealing with peopleDealing with people
Do we really make, and use reason in, all our choices?
Philadelphia project
Cornell study (Schouffle 2004)
Video on choices
Interpersonal Interpersonal communicationcommunication
(person-to-person communication)(person-to-person communication)
Interpersonal communicationInterpersonal communicationInterpersonal communicationInterpersonal communication
Conflict occurs
when communication fails
Insight No. 1Insight No. 1Insight No. 1Insight No. 1
If people perceive an attack, they will defend themselves.
ConflictConflictConflictConflict
Note: Communication seeks to better
understand other viewpoints and not necessarily
to agree with them.
Although, if you keep an open mind, you may achieve
agreement as well.
Insight No. 2Insight No. 2Insight No. 2Insight No. 2
Listening is more than just waiting quietly for your turn to speak.
The "art" of listeningThe "art" of listeningThe "art" of listeningThe "art" of listening
maintain an attitude of ‘inquiry’ and interestgently probe to understand the otherdraw out the other’s reasoning ask for examplescheck your understandinglisten with an open mindrefrain from preparing to destroy the other’s argument or promote your own agenda
Insight No. 3Insight No. 3Insight No. 3Insight No. 3
To really understand someone else's viewpoint you have to be able to get out of your own logic and into theirs.
???
Understanding other Understanding other people’s logicpeople’s logic
Understanding other Understanding other people’s logicpeople’s logic
Assume that people are rational– People behave "rationally" based on
their internal logic:• how they see things• self-interest, which they are working to
maximize• their important concerns
PeoplePeople
Other helpful assumptions– Other people are going to see things
differently from you– You can understand those differences
and their likely impact
The BLM syndrome
The anatomy of The anatomy of action/communicationaction/communication
The anatomy of The anatomy of action/communicationaction/communication
Logic of actions is based onpersonal factors
Perceptionof events
Reasoning
Mind-set
Self interests
Belie
fs a
nd
assu
mptio
ns
Personality
Professional values
ExperienceCulture
Mindset Action taken
InquiryInquiry
Open/closed questionsOpen/closed questionsInquiryInquiry
Open/closed questionsOpen/closed questionsOpen– don’t influence the answer (transmit interest)– seek information
Closed:– seek agreement/disagreement– don’t draw information
The ladder of inferenceThe ladder of inferenceThe ladder of inferenceThe ladder of inference
“Our ability to achieve the results we truly desire is eroded by our thinking that:
our beliefs are the truth
the truth is obvious
our beliefs are based on real data
the data we select are the real data.”
Senge et al. The fifth discipline fieldbook.
Insight No. 4Insight No. 4Insight No. 4Insight No. 4
To influence someone you have to be able to speak their language.
In presenting your point of view:In presenting your point of view:In presenting your point of view:In presenting your point of view:
state assumption
explain reasoning
explain context
give examples
invite testing of your assertions
reveal where you are least clear
avoid being defensive (allow yourself to be vulnerable)
"The wise see knowledge and action as "The wise see knowledge and action as one." one."
-- the Bhagvad-Gita -- the Bhagvad-Gita
Information vs knowledgeInformation vs knowledgeInternal processInternal processUnderstandingUnderstandingPersonalPersonalLonger-lastingLonger-lastingShapes behavioursShapes behaviours
““True, justified beliefs”True, justified beliefs”““Sum of what is Sum of what is known”known”
WordsWordsDataDataNon-personalNon-personalRelates to mediaRelates to mediaComputers/Computers/technologytechnology
““Facts provided”Facts provided”““What is conveyed…”What is conveyed…”
Communication is to information/knowledge as packaging and transportation are to goods
Knowledge is a product that needs to be managed
"Knowledge" management"Knowledge" management
“We have managed money and buildings and people and energy. Now we need also to manage the most precious commodity of the 21st century knowledge and know how.”
J A Muir Gray, Director, Research and Development. NHS Executive Anglia and Oxford, Oxford.
BMJ, 26 September, 1998 (Volume 317)
Knowledge managementKnowledge management is about using is about using people as a resourcepeople as a resource
Information managementInformation management is about using is about using instruments, data, journals, media – what instruments, data, journals, media – what is exchanged between peopleis exchanged between people
Examples of underutilization of knowledgeExamples of underutilization of knowledge
In Mexico 14 out of 22 hospitals in Mexico City were not using magnesium sulfate for the management of eclampsia (A WHO study)In the USA, patients received 55% of recommended care and quality varied by medical condition - 79% of recommended care for senile cataract to 11% of recommended care for alcohol dependence (McGlynn 2003)20-30% of patients may get care that is not needed or care that could be potentially harmful (Schuster 2005)
Purpose of research Purpose of research communicationcommunication
Ensuring that all stakeholders are aware of and use research evidence to inform their health and health-care decision-making.
Some questions to askSome questions to ask
What should be transferred?To whom should research knowledge be transferred?By whom should research knowledge be transferred?How should research knowledge be transferred?With what effect should research knowledge be transferred?
What?What?
Knowledge ripe (synthesized) for transmission/ implementation? – Proteus phenomenon – diminishing effect size– Why systematic reviews are important
Type and quality of evidence– Single study (observational – RCT)– Systematic review
Urgency of situation/opportunity costRelevance to local setting– In time– Context– Setting in which evidence was generated
To whom To whom 1 1
Peers (for researchers) – Co-workers – Colleagues in the organization/university– Researchers in your field– Researchers in other fields
Issues– Which journal
• International, regional, local• Reputation, prestige, impact factor
– International meetings?
To whom? To whom? 2 2
Policy-makers– Government leaders/officials– Decision-makers– Regulators– Industry
Programme managers
Patients/public
Donors
By whom?By whom?
Whose responsibility is it anyway?
Researchers and brokers
"Dr Fox Effect"THE DOCTOR FOX LECTURE: A PARADIGM OF EDUCATIONAL SEDUCTIONDonald H. Naftulin, M.D., John E. Ware, Jr., and Frank A. DonnellyJournal of Medical Education, vol. 48, July 1973, p. 630-635
The channels -1The channels -1
For peers (information)– Journals– Meetings– Newsletters– Listservs– Etc.
For peers (behaviour change beyond policy)– Educational outreach (vs self-learning)– Opinion leaders– Audit and feed-back– Etc.
The channels -2The channels -2Policy- and decision-makers– Policy briefs– Press releases
• Radio/TV• Print media (newspapers, magazines)
– Dissemination workshops and meetings– Personal contact
Publics– Internet
• Listservs• Facebook?
– Docudramas– Infotainment– Telephone– Celebrity ambassadors
How? How?
Planned dissemination efforts works better– Time it well
Know your hurdles – (Evidence for interviews and focus groups)
Know your supporters______________________________________
Select media/interventions– (Evidence for effectiveness generally weak)
Follow the planEvaluate
What effect?What effect?
Proactively listen to what comes back
Measure your success– Success may be slow– "Reason" may be less common than assumed
Evidence is often lacking
Evaluate
Keep at it
KT: What works… what doesn't…(from James Trostle)KT: What works… what doesn't…(from James Trostle)Category Influence Factor
Content Promote
Impede
Target-specific issues, concrete results, low-cost recommendationsHigh-quality research (not measured through publication)Biomedical and quantitative research favoured
Mutual intellectual disdainDifferences in technical language
Actors Promote
Impede
Groups have identified priority problemsOfficial research organizations in the health sectorInternational support for research
Differences in agendas, times, stylesLack of technical background for policy-makersPolitical culture values experience over informationActions of interest groups, especially financial interest
Process Promote
Impede
Opportunities for informal communicationFormal communication channels (e.g. monthly bulletins)Interest group equilibrium, or solutions consonant with interests
Difficulty communicating research questions or resultsVertical management of information
Context Promote
Impede
Researcher/decision-maker rotationWhen research is urgent and relevantAdministrative change can promote policy change (new audiences)
Centralization: power and informationVertical organizationHierarchical power (middle more resistant)Administrative change can impede policy change (discontinuity in priorities)Restricted economic resources
SummarySummary
Plan for use of knowledge before staring research
Involve as many potential stakeholders as possible (including end-users)
Plan for effective communication strategies (including training of researchers in communication skills)
Evaluate impact
ExerciseExercise
Group 1 - Researchers– Key messages– Stakeholders– Strategy (elaborate)
Group 2 – Policy-makers– Process for implementation– SWOT analysis– Strategy (elaborate)
SWOTSWOT
Strengths: Plus points of the findings.
Weaknesses: Potentially harmful attributes of the findings.
Opportunities: External conditions that are helpful to achieving impact.
Threats: External conditions that could do damage.
RemarksRemarks
Adult learning: Adults don’t like being told…prefer to be part of decision-making“Change is difficult” – why?Low-cost interventions preferred – but what about opportunity cost?Want best for less --- realistic?Science being sidelined? Us health insurance company policiesWhy harsh approaches to BC are a no no?RCTs best for intervention studies?
Thank youThank you
From: New Scientist
“Everyone has been made for some particular work, and the desire for that work has been put in every heart.”
– Jalal ad-Din Rumi
"Knowledge resides in the user and not in "Knowledge resides in the user and not in the collection [of information]. It is how the the collection [of information]. It is how the user reacts to a collection of information user reacts to a collection of information that matters." that matters." -- Churchman, C.W. (1971). -- Churchman, C.W. (1971). The Design of INQUIRING SYSTEMS: Basic Concepts The Design of INQUIRING SYSTEMS: Basic Concepts of Systems and Organizationof Systems and Organization, Basic Books, New York, NY, p. 10. , Basic Books, New York, NY, p. 10.
ObjectivesObjectivesObjectivesObjectives
To understand key insights that affect the quality of IPC.
To identify skills and attitudes associated with those insights.
To increase awareness of one’s own effectiveness in IPC through practice, observation and feedback.
Communication-related terms used in Communication-related terms used in research disseminationresearch dissemination
Communication
Information dissemination
Knowledge transfer
Knowledge transfer and exchange
Knowledge translation
HRP philosophyHRP philosophy
For a research institution, the job is not For a research institution, the job is not over until research findings: over until research findings:
– have been peer-reviewed and published have been peer-reviewed and published
– have been disseminated to all have been disseminated to all audiences (including lay) audiences (including lay)
– (where applicable) have led to policy (where applicable) have led to policy impact.impact.