Fostering interactive exchange and dissemination

Description

This resource looks at dissemination as the process of knowledge translation (KT) and knowledge transfer and exchange (KTE), where there is an interactive exchange between decision-makers and researchers. Research findings are disseminated so that research can inform decisions that may require a change in practice. Dissemination is an active process of spreading a message to defined target groups, in contrast to diffusion, the passive spread of information. Dissemination is often tied to implementation of research findings, where interventions aim to reduce barriers and/or enhance facilitators to promote change.

This report has six sections:

• Chapter 1: Overview
• Chapter 2: Knowledge Translation of Research Findings
• Chapter 3: Knowledge Transfer and Exchange (KTE): a systematic review, key informant interviews and design of a KTE strategy
• Chapter 4: SBU's Ambassador Program in Northern Sweden
• Chapter 5: The Alberta HTA Chronic Pain Ambassador Program
• Chapter 6: CADTH's Liaison Program

Steps for Using Method/Tool

This report has six sections:

Chapter 1: Overview

Chapter 2: Knowledge Translation of Research Findings

The evidence base of knowledge translation activities targeting practitioners and patients in clinical settings is substantial, although incomplete. However, the evidence base of knowledge translation activities targeting policy-makers and decision-makers is weaker and requires further study.This section summarizes concepts and evidence in knowledge translation using key questions proposed by Lavis and colleagues (2003). These questions are also available in the summary statement, Worksheets to guide knowledge transfer and exchange initiatives:

1. What should be transferred?
   • Systematic reviews or other syntheses of evidence should be the basic unit of knowledge translation.
   • Single studies need to be evaluated within the context of the evidence base before deciding whether it is ready for knowledge translation.
2. To whom should research knowledge be transferred and with what effect?
   • Consider the target audiences by the type of research. Target audiences for population health research include administrators, policy-makers and researchers.
3. How should research knowledge be transferred?
   • Knowledge translation involves identifying potential barriers to change and factors influencing the selection of interventions.
   • There is limited evidence of the effectiveness of strategies to overcome barriers to change.
   • The steps required to overcome barriers include the following:
     • Identify modifiable and non-modifiable barriers related to behaviour change.
     • Identify potential adopters and practice environments.
     • Prioritize which barriers to target.
     • Assess the potential for addressing these barriers through knowledge translation activities.
     • Determine the availability of resources to implement knowledge translation strategies.
4. With what effect should research knowledge be transferred?
   • Consider the impact of evidence in the practice environment by the specific target audience.
   • For policy-makers and other decision-makers, the research evidence, in addition to the policy context, constraints and opportunities, will influence how research is ultimately used in a particular setting.
   • Effectiveness of professional behaviour change strategies (p. 12-16)
     • The Cochrane Effective Practice and Organization of Care (EPOC) has identified over 150 systematic reviews of professional behaviour change strategies. It has prepared two overviews of systematic reviews that highlight evidence of the effectiveness of these strategies.
     • Printed educational materials: Printed educational materials are generally effective, resulting in a 4.9% improvement of care across 21 studies (Farmer et al., 2007). This strategy is commonly used, relatively inexpensive and is feasible in most settings.
     • Educational meetings: Educational meetings (interactive workshops targeting knowledge, attitudes and skills at the individual level) are generally effective, resulting in moderate effects (between 11-20% in improvement in care) (O'Brien et al., 2001).
     • Didactic meetings are largely ineffective.
     • Educational outreach: Educational outreach (or academic detailing) involves a trained individual who meets with professionals in their work environments to give information with the intent of changing the provider's practice. This strategy is generally effective in improving care by 4.9% across studies (Grimshaw, 2004). Educational outreach has been used to change prescribing behaviours, although its effectiveness for changing more complex behaviours is less known. Educational outreach is resource intensive.
     • Local opinion leaders: Opinion leaders are generally effective in improving care by 10% across 12 RCTs (Doumit, 2007). The potential success of opinion leaders is dependent on the existence of intact social networks within professional communities. Also, opinion leaders are specific to the issue of concern, and change over time. Use of opinion leaders can be resource intensive, given the costs of identifying and training opinion leaders.
     • Audit and feedback: Audit and feedback assesses professionals' perceptions of current performance levels and provides a summary of performance over a specified period of time. Audit and feedback is generally effective in improving care by 5% (Jamtvedt, 2006). However, larger effects are seen if baseline performance is low.
     • Reminders: Reminders have been used to support implementation of clinical practice guidelines and are effective for relatively simple decisions. Reminders are less effective for more complex decision support, such as chronic disease management.
     • Multifaceted interventions: Multifaceted interventions developed on an assessment of barriers can potentially target different barriers to implementation. It is important to consider how components may interact to maximize benefits.
   • Effectiveness of knowledge translation strategies focusing on policy-makers and senior health service managers
     • There is very little evidence of the effectiveness of knowledge translation strategies targeting health policy makers and managers.
     • Commonly reported facilitators promoting the use of evidence in policy are personal contact, timely relevance and the inclusion of summaries with recommendations (Innvaer et al., 2002).
     • Barriers include absence of personal contact, lack of timeliness or relevance of research, mutual mistrust and power and budget constraints (Innvaer et al., 2002).
     • Three knowledge translation approaches targeting policy-makers and decision-makers are:
       1. Push activities: focus on researchers disseminating their findings to end users. Examples include increasing emphasis on knowledge syntheses; using actionable messages; using graded information formats that allow end users to access information at the level of detail needed; using multiple communication channels specific to the audience; and developing tools to help end users apply research findings in their work.
       2. Pull activities: focus on the needs of users to drive the research agenda. Activities include training to improve policy-makers' and decision-makers' research literacy.
       3. Linkage and exchange activities: focus on building and maintaining new relationships between decision-makers and researchers to exchange knowledge and ideas. Examples include the use of knowledge brokers and decision-makers participating in research teams.

Chapter 3: Knowledge Transfer and Exchange (KTE): a systematic review, key informant interviews and design of a KTE strategy

Knowledge transfer and exchange (KTE) aims to increase the likelihood that evidence will be used in decision making and that relevant research questions are pursued. Formal evaluation of KTE activities is needed since lack of evidence on the effectiveness of KTE activities is a major issue. This section presents findings from A) a systematic review of the KTE literature, B) data from stakeholder interviews and C) steps for developing a KTE strategy.

• A) Systematic Review
  • The KTE literature is divided into non-implementation and implementation studies.
  • Non-implementation studies are organized under four headings:
  • Organizing Frameworks:
    • Two frameworks are discussed.
    • Jacobson and associates' (2003) organizing framework helps researchers identify users' information needs across five domains (the user group, issue, research, knowledge transfer relationship, dissemination strategies).
    • In Lavis and colleagues' (2003) framework, the five elements are:
      • Developing an actionable message from a body of research evidence
      • Developing audience-specific messages that consider the kinds of decisions made and the environments in which people work
      • The credibility of the messenger; interaction between researchers and decision-makers at multiple stages
      • Evaluation of knowledge transfer activities.
  • Barriers and Facilitators: (see Table 2 on p. 30-31)
    • Barriers and facilitators at the individual and organizational levels have been well documented.
    • Common facilitators include:
      • Personal contact between researchers and policy-makers
      • Clear summaries of findings with recommendations for action
      • Good quality research, research with effectiveness data
      • The inclusion of key individuals (decision-makers or opinion leaders) in the research design phase.
  • Measuring the Impact of Research Studies: This section assesses how research, documentary analysis, interviews and questionnaires have been used in policy and practice.
    • Lavis and colleagues (2003) have developed an assessment tool to measure the impact of research in policy development (see summary statement An inventory of impact measures for health research within the Registry).
  • Stakeholder Perspectives: Studies are available that look at stakeholder perspectives in KTE.
    • Goering and colleagues (2003) examine an organizational-level linkage and exchange initiative (see summary statement Advancing evidence-informed practice and policy through linkage and exchange).
    • Implementation studies of specific KTE strategies identified a number of activities in the literature, including:
      • face-to-face exchange
      • training and retreats
      • networks and communities of practice
      • facilitated meetings, etc.
  • Appendix B (p.47-54) provides a summary of the implementation studies.
    • When evaluation of the KTE strategy was conducted, a rigorous study design was often not used.
    • This review finds that there is limited evidence for developing and implementing KTE activities, and less evidence of the effectiveness of these strategies based on formal evaluation.
• B) Stakeholder interviews
  • Five themes arose from stakeholder interviews about KTE:
    • While there are multiple perspectives on the definition of KTE, stakeholders agree that interactive exchange and having receptivity for knowledge within the organization are key elements of KTE.
    • Looking at KTE within organizations, stakeholders agree that due to competing priorities, KTE often lacks sufficient attention and funding.
    • Individual issues are critical in the success of KTE efforts. These issues include lack of time, ensuring stakeholder buy-in, receptivitiy of the audience, etc.
    • There is limited understanding of both research and practice environments, and the need to bridge the divide between decision-makers and researchers.
    • There is a need for both general principles and specific approaches in doing KTE, where both strong leadership by individuals and organizational structural change are important. Recognizing the need to customize the KTE strategy to the specific context is also important.
• C) Developing a KTE strategy
  • The elements for developing a KTE strategy include the following:
    • Select an organizing framework as the foundation for the KTE strategy (including knowledge of the practice and policy environments, and information on specific tools for doing KTE, as well as methods for evaluation of KTE).
    • Consider two-way communication, networking opportunities, relationship building and interactive engagement of key stakeholders.
    • Focus on building longer-term relationships and supporting structural and organizational changes to support sustainable KTE.
  • Table 4 (p.38) outlines specific steps in developing a KTE strategy.
  • An example of a KTE intervention is provided at the end of this section.

Chapter 4: SBU's Ambassador Program in Northern Sweden

This section outlines the Ambassador Program in Sweden, which involved well-known local opinion leaders working to bring about change in clinical practice.

Chapter 5: The Alberta HTA Chronic Pain Ambassador Program

This chapter discusses the adaptation of the Swedish SBU Ambassador Program to Alberta, involving the Institute of Health Economics, the Universities of Calgary and Alberta and Alberta Health and Wellness. The aim of this initiative was to develop and test an ambassador model for knowledge translation, increase clinician knowledge of current evidence in chronic pain management and encourage clinicians to incorporate research into practice.

Chapter 6: CADTH's Liaison Program

This chapter outlines the development of the Canadian Agency for Drugs and Technologies in Health (CADTH)'s Liaison Program. The Liaison Program aims to develop closer relationships with decision-makers and ensure that decision-makers have access to and understand how to use evidence when determining which technologies achieve optimal outcomes for patients and health systems.