National Collaborating Centre for Methods and Tools

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.

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!

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