National Collaborating Centre for Methods and Tools

Hi All,

I am a public health nurse in Victoria, BC. I am working with an amazing and committed group of individuals and agencies to develop a program here in Victoria for pregnant or early parenting women with substance use or alcohol use issues, and experiences of mental ill health and/or violence and trauma. Because these issues are inextricably linked and services sometimes will address one issue but not provide services to women who have other issues, we wanted to develop a relatively "low threshold" program.

I have worked in perinatal nursing for almost 30 years and I have also worked in the Woman Abuse/Violence Against Women field for 4 years prior to joining public health.

Our project is fairly complex in that we are a coalition of non-governmental community agencies or representatiave, health providers, academics, and the women who have experienced pregnancy and the challenge of accessing services in their pregnancies or during early parenting. so we are working to bring a number of service agencies with different models of working and broad perspectives, together to create a program which will provide a range of services from a single site. Our program is modeled after Sheway in Vancouver, BC; Maxxine Wright in Surrey BC and Breaking the Cycle in Toronto Ont.

I chair the Program Planning Committee- something I have never done before. All of our over 85 members are contributing to developing our program as an "off the side of the desk" project.

I am writing an "overview" document that attempts to link recent evidence, exisiting evidence, government reports and recommendations, health authority reports and strategic planning documents to the proposed program.

The challenge is that while I have a relatively extensive knowledge of perinatal care and recommendations, I have a very limitted knowledge and experience of working with our targeted population. So I need to find good research that helps to support our vision for program delivery in all areas we plan to deliver services. Our core programming includes:
Perinatal Services
Primary Health Services
Infant/Child Services
Housing
Detox & Stabilization Housing Services
D & A counselling Services
Planning, advocacy and support in working with Ministry of Children & Family Development
Mental Health Services
Nutritional Services
Grief & Loss Services
Student Placement & Research

My trials & tribulations are that I often know there is research and literature "out there" but I have very little experience with the subject matter in order to feel confident that I have the "right" literature or the subject is so broad, I am not certain of how to approach the lit search.

I have requested assistance with this, but the members of our group are so busy, that one other member has provided some literature with respect to children's programming.

My example is not brief, but neither is the challenge. I continue to muddle along and will, no doubt, eventually find some great documents that will help us to do what we want, which is complete the identification of our program goals and objectives.

Any suggestions would be great, as I work on this project in my free time as it is not part of my public health role. Ideas of where or how best to tackle such a broad array of topics when doing a lit review would really reduce my search time and allow me to finish the document.

Thanks, Betty Poag, RN, BSN- Victoria

I work in Public Health in Victoria, BC. I have used the Health-Evidence website to search for information and I have shared it with others. I found what I was looking for in one case and in another, I did not. I looked in the National Guidelines Clearinghouse as well.

I believe the second query was less "public health" focussed and more of an uncommon and specific topic which was why I was unable to find anything.

I look forward to using these sites for searching on other topics in future.
Betty Poag

Are you planning to host workshops related to evidence-informed public health in the future? If so could you provide the details?

The evaluation of specific KT interventions can be done by observing changes in practitioner behavior (ie they did not order antibiotics for the child with a cold), or by outcomes with patients or populations (lower rates of antibiotic resistance in the population).

There are a few possibilities:

1. The latter (population level stats) is possible in public health, but like most public health interventions, means you cannot "attribute" the change only to the KT strategy.

2. look for signs that the evidence has been used in documents. This can be program meeting minutes, program decisions, policies developed. This strategy has been used in some case studes of KT. SOme studies have used this type of measurement in before/after studies.

3. There are some other measurement tools re attitudes to use of evidence and research utilization (eg. Estabrooks). The latter have included people who work in public or community health.

More tools are currently being developed. Does anyone have some to suggest?

Donna

Thanks for your posting Barb!

Your comments reflect what we are seeing in the literature reviewed for the Registry of Knowledge Translation Methods and Tools for Public Health. As we review potential items for inclusion in the Registry, we find that KT is not clear cut despite examining multiples sources of evidence (e.g. research literature, web-based materials, grey literature etc.). As you have stated, there is a great deal of discussion regarding "how to do" many of the elements of knowledge translation -- whether it be dissemination, exchange or adoption.

Regarding effectiveness of KT activities, this is an area that we are still investigating as part of the Registry project. If you search the Cochrane Collaboration under the "Effective Practice and Organisation of Care" review group there are some systematic reviews related to KT activities such as the effectiveness of audit and feedback, continuing education and consensus processes on professional practice. While many of these reviews are clinically oriented, the Registry project is currently looking at whether these reviews can help inform some of these larger questions about the effectiveness of certain KT activities and strategies.

You pose a very interesting question which I hope will continue for discussion: "Are we able to determine if these efforts are really mitigating difficult decision making challenges, being implemented to influence change in programs and policies, or are we challenging health practitioners to complete one more step in the decision making process?"

This is an area that we haven't been able to answer as of yet with the Registry project and is one which warrants continued consideration. Current summaries that are posted look at individual KT activities, as opposed to evaluating the overall effectiveness on practice change. If interested, you can have a look at the "Tool for Assessing Applicability and Transferability of Evidence" and the "Is Research Working for You? Tool" on the Registry. While these tools have different goals and purposes from one another, they could be used by public health decision-makers to identify and prioritize key programming and organizational decisions.

I look forward to hearing some other thoughts on this interesting issue!

We talk a lot about the mechanics of how to do knowledge translation, knowledge exchange, knowledge dissemination; but are we able to determine if these efforts are really mitigating difficult decision making challenges, being implemented to influence change in programs and policies, or are we challenging health practitioners to complete one more step in the decision making process - without the tools to make this easy to action?

Do we have any tools that can assess whether KTE is having the impact that we desire? or being implemented as a change in practice for decision making in public health?

re there tools more than surveys and focus groups that can be less invasive into their lives and equally as reliable?

Would love to have a discussion on this - theory vs practice.

We are interested in sharing real-life examples of your trials and tribulations with finding and using research evidence.

Can you provide a brief example?

Donna

Since you attended the workshop, have you tried out any of the searching tips?
eg - health-evidence?

- Systematic reviews on Pubmed (Clinical Queries)?


Does anyone want an on-line refresher??


Donna

2 new on-line modules to help you learn more about evidence-informed decision-making;
- developed by NCCMT

1) Introduction to Evidence-Informed Decision Making


2) Critical Appraisal of Intervention Studies


posted on the Canadian Institutes of Health Research website

Learning modules


Each is designed as a stand-alone module, to be completed in 6 hours or less of independent study.

Post any questions that arise here.

We have really enjoyed the several Evidence-Informed Public Health workshops we have done (and are doing) across the country.

This forum is an opportunity to post questions and clarify issues, share information and resources and discuss your experiences with implementing evidence in decisions.

I look forward to a lively discussion

Donna Ciliska