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).

ObjectivesObjectivesReview 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 IranIran 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 RHLCe

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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-wayInformation (but reflects knowledge)Intentional or unintentionalLinguistic or nonlinguisticNeeds, wants, perceptions, knowledge

Everybody (everything) says Everybody (everything) says something….something….

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

NoiseSignalSender Encoding ReceiverDecodingNoise

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)

Putting communication into Putting communication into practice in researchpractice in research

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

KnowledgeAnalyses of threats

and benefitsImpact

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)

Finding common ground Finding common ground

Dealing with peopleDealing with people

Do we really make, and use reason in, all our choices?Philadelphia projectCornell study (Schouffle 2004)Video on choices

Funny, lucky, religious?Funny, lucky, religious?

A B

C

Exercise 1Exercise 1

SpeakerInterviewerObserver

Interpersonal Interpersonal communicationcommunication

(person-to-person communication)(person-to-person communication)

Five insights into effective interpersonal communication

Interpersonal communicationInterpersonal communication

Conflict occurs when communication fails

Insight No. 1Insight No. 1

If people perceive an attack, they will defend themselves.

Vicious circle of attack and defenceATTACK

DEFEND

ConflictConflictNote:

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. 2Listening is more than just waiting

quietly for your turn to speak.

The "art" of listeningThe "art" of listeningmaintain 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. 3To 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

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

Logic of actions is based onpersonal factors

Perceptionof events

Reasoning

Mind-set

Self interests

Beliefs

and

assu

mptions

Personality

Professional values

ExperienceCulture

Mindset Action taken

Action and communicationAction and communication

Mindset:the invisible side of communication

InquiryInquiry

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 inference

“Our ability to achieve the results we truly desire is eroded by our thinking that:

our beliefs are the truththe truth is obviousour beliefs are based on real datathe data we select are the real data.”

Senge et al. The fifth discipline fieldbook.

Insight No. 4Insight No. 4To influence someone you have to be

able to speak their language.

Insight No. 5Insight No. 5

Humility works!

In presenting your point of view:In presenting your point of view:

state assumptionexplain reasoningexplain contextgive examplesinvite testing of your assertionsreveal where you are least clearavoid being defensive (allow yourself to be vulnerable)

The nature of knowledgeThe nature of knowledge

and information…..

"REAL science depends on the dispassionate search for truth."

– Robert K. Merton, Sociologist

"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 goodsKnowledge 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 resourceInformation 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 knowledgeIn 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 managersPatients/publicDonors

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 -1For 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

Reaching out to massesReaching out to masses

Publics are often ignored as a stakeholderVideo

What effect?What effect?

Proactively listen to what comes backMeasure your success– Success may be slow– "Reason" may be less common than assumed

Evidence is often lackingEvaluateKeep 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 researchInvolve 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.

RemarksRemarksAdult 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

People see things differently People see things differently

We experience life differentlyWe experience life differently

Information overload!Information overload!

There is always more coming!There is always more coming!

“Out beyond ideas of wrongdoing and rightdoing, there is a field. I will meet you there.”

"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.

ObjectivesObjectives

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

CommunicationInformation disseminationKnowledge transferKnowledge transfer and exchangeKnowledge 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.

The view from the other sideThe view from the other side

Quality (credibility) of evidenceExtent of benefitCosts and opportunity cost