Moving toward an evidence based public health system in canada

Translating Research into PracticeJuly 14, 2004

Moving Toward an Evidence-Based Public Health System in Canada

Maureen Dobbins RN, PhD, Kara DeCorby, MSc,Donna Ciliska, RN, PhD, Helen Thomas, RN, MSc,

and the Knowledge Transfer Research Team


Setting the Scene

• Knowledge transfer from a theoretical perspective

• Findings from current studies

• Looking to the present and future

• Strategic planning for progress


Knowledge Persuasion Decision Implementation Confirmation

Research Dissemination

Evidence-basedDecision-making

Research Utilization

Outcomes

Dissemination strategies

Innovation characteristics

Organizationalcharacteristics

Environmental characteristics

Individual characteristics

type of decisionvalues/beliefsevidenceculturedecision-making styletype of innovation

Knowledge Transfer and Uptake Framework


Barriers to Evidence Based Decision Making

• Time

• Availability of research results

• Resources to implement research findings

• Relevance

• Timeliness (having research when needed)

(Ciliska et al, 1999)


Facilitators of Evidence Based Decision Making

Systematic reviews overcome barriers• Time (82%)

• Timeliness (62%)

• Relevance (46%)

• Availability of research results (30%)

• Resources to implement research (22%)

(Ciliska et al, 1999)


Facilitators (cont’d)

Significant Predictors of Use• Position in organization

• Critical appraisal skills

• Reviews easy to use

• Expectation to use reviews in future

(Dobbins et al, 2001)


Other Important Characteristics

• Perception that research is relevant to decisions

• Perception that the organization values the use of research evidence

• Routine reading of the literature

• Overcome issues of time

(Dobbins et al, 2001)


Questions for target users:

• What are decision makers’ preferences for receiving research evidence?

• How can we promote use and overcome barriers to use?

• How can ownership of knowledge be distributed amongst users?


Sample• Canadian public health and health promotion

decision makers:

• CMOHs and MOHs• Program managers/directors/coordinators• Federal and provincial/territorial government

decision makers• Executive directors, program/project

coordinators in NGOs


Results (interviews)

• 54 Decision-makers

• Representation from most provinces/territories

• Representation from all decision-making levels


User’s Preferences• Short summaries

• Access to full document

• Divided on issue of hard copy vs. electronic

• Commentary, and rating of methodological quality

• Need practical, implementation-related information• E-mailed updates

• Interest in being able to indicate areas of interest so that only relevant research is received


Challenges faced by decision makers:“I don’t need to hear a lot about what further research needs to be

done or a lot of tentativeness. I have to make decisions today...I think that reality has to be taken into account when research findings are presented to decision makers...It simply doesn’t help me to know all of the problems.”

“we’re flooded with information. The information age has meant a lot in information and so absolutely anything that is done needs an executive summary and provide the information in a short and sweet format and it needs to be very clear.”


Designing and Testing a Strategy:

• Incorporation of decision makers’ preferences

• Consultation with marketing and graphic design firm

• Distribution to focus group participants


Overview of focus groups:

• 9 focus groups in 7 Canadian cities: Halifax, Montreal, Ottawa, Winnipeg, Calgary, Edmonton, Vancouver, Oct 2002 -Jan 2003

• 5-7 participants• Range of decision making levels • Semi-structured interview guide• Audiotaped sessions with interview notes


What decision makers liked most:

• Length, writing style, plain language use

• Could pass it on without having to ‘translate’

• 2-page synthesis of each review

• Issue framed in a Canadian context

• Implications spelled out

• Contact information for asking questions


Main theme - Time

Key features:– credibility– high quality design– customizability– applicability– timeliness– reliability & consistency– accessibility

Challenges:– information management– skill building– list serves not universally

appealing


High Quality Design

Content• current• all info dated• jargon-free• transparent• + and - findings• ranked by strength• cost data• Canadian

Format• well-written• concise• understandable to all• well-organized• lends itself to quick visual

scanning


Products:

• Online resource to be launched in September 2004 as an interactive web site URL: www.health-evidence.ca

web site is part of a multi-component strategy for – Knowledge translation– Supporting users in accessing and interpreting research

evidence– Facilitating connections among users– Facilitating connection between researchers and users

http://www.health-evidence.ca/


Implications:

• Opportunities to receive updates of new research in a program area

• Contact information for authors and document links where available

• Venue to facilitate online communities of practice







Next Steps:

• maintain and market the online registry

• refine the site’s functionality and locate and reach potential users

• a 3-year, CIHR-funded RCT evaluating effectiveness of knowledge transfer strategies among public health and health promotion decision makers across Canada

• First evaluation of its kind in Canada to evaluate quantitatively the impact of a knowledge broker

Health & Medicine

Moving toward an evidence based public health system in canada