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National Collaborating Centre for Methods and Tools

November 2013 · Issue 59

In this issue:

Find Out How to Make Research Work for You

a story from Toronto Public Health

While we hear a lot about getting evidence into practice, it is actually a complex process that involves various disciplinary approaches, beliefs, values and world views. 1  To improve their organizations’ capacity for evidence-informed decision making, three Ontario health units had the opportunity to try out a tool – "Is Research Working for You?” – as part of a “Partnerships for Health System Improvement” project, working with Health-Evidence at McMaster University. The tool, designed by the former Canadian Health Services Research Foundation (CHSRF) – now the Canadian Foundation for Healthcare Improvement (CFHI) – uses self-assessment to help organizations understand their ability to use research. Four consultants at Toronto Public Health, including Julie Charlebois, a health promotion consultant, were part of the project team.

Toronto Public Health worked through the entire tool, devoting 1.5 hours to a structured discussion about all aspects of evidence-informed decision making: acquire, assess, adapt and apply. The tool can help organizations identify weaknesses in their decision-making processes, and uncover the functions and skills of colleagues in other departments. It can be very useful in developing knowledge translation strategies.

According to Julie, “The tool is really thorough. Had we sat down and talked about how we gather and use evidence, I don’t think we would have had as full a discussion as we did by using the tool.” Research supports the fact that the discussion is key to success, sometimes even more important than the ranking that results.  2, 3

What did we learn? The discussion is very important!

CFHI is considering revising the tool to eliminate some of the limitations identified by users, including the use of jargon and the time required to complete the tool.  The revised version would also allow for different responses from individual as well as organizational perspectives.

According to Maria Judd, Senior Director of Innovation and Development at CFHI, “The power of the tool is in structuring a process for discussion and self-reflection for an organization – asking, ‘Do we have appropriate human and structural resources in place to support the use of research in decision making?’”

1. Speller V, Wimbush E, Morgan A (2005). Evidence-based health promotion practice: how to make it work Promotion & Education March 2005 12: 15-20, [cited April 15, 2013] online at: http://ped.sagepub.com/content/12/1_suppl/15.full.pdf+html
2. Kothari A, Edwards N, Hamel N, Judd M (2009). Is Research Working for You? Validating a tool to examine the capacity of health organizations to use research, Implementation Science 2009, 4:46. [cited April 15, 2013] online at: http://www.implementationscience.com/content/4/1/46
3. Thornhill J, Judd M, Clements D (2009). CHSRF Knowledge Transfer: (Re)Introducing the Self-Assessment Tool That Is Helping Decision-Makers Assess Their Organization's Capacity to Use Research. Healthcare Quarterly, 12(1) January 2009. [cited May 16, 2013] online at: http://www.longwoods.com/content/20410

Read more user stories!

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New in Registry of Methods and Tools

New from Public Health+

Effect of risk-reduction counseling with rapid HIV testing on risk of acquiring sexually transmitted infections: the AWARE randomized clinical trial.

IMPORTANCE: To increase human immunodeficiency virus (HIV) testing rates, many institutions and jurisdictions have revised policies to make the testing process rapid, simple, and routine. A major issue for testing scale-up efforts is the effectiveness of HIV risk-reduction counseling, which has historically been an integral part of the HIV testing process. OBJECTIVE: To assess the effect of brief patient-centered risk-reduction counseling at the time of a rapid HIV test on the subsequent acquisition of sexually transmitted infections (STIs). DESIGN, SETTING, AND PARTICIPANTS: From April to December 2010, Project AWARE randomized 5012 patients from 9 sexually transmitted disease (STD) clinics in the United States to receive either brief patient-centered HIV risk-reduction counseling with a rapid HIV test or the rapid HIV test with information only. Participants were assessed for multiple STIs at both baseline and 6-month follow-up. INTERVENTIONS: Participants randomized to counseling received individual patient-centered risk-reduction counseling based on an evidence-based model. The core elements included a focus on the patient`s specific HIV/STI risk behavior and negotiation of realistic and achievable risk-reduction steps. All participants received a rapid HIV test. MAIN OUTCOMES AND MEASURES: The prespecified outcome was a composite end point of cumulative incidence of any of the measured STIs over 6 months. All participants were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum (syphilis), herpes simplex virus 2, and HIV. Women were also tested for Trichomonas vaginalis. RESULTS: There was no significant difference in 6-month composite STI incidence by study group (adjusted risk ratio, 1.12; 95% CI, 0.94-1.33). There were 250 of 2039 incident cases (12.3%) in the counseling group and 226 of 2032 (11.1%) in the information-only group. CONCLUSION AND RELEVANCE: Risk-reduction counseling in conjunction with a rapid HIV test did not significantly affect STI acquisition among STD clinic patients, suggesting no added benefit from brief patient-centered risk-reduction counseling. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01154296.

The full text may be available from PubMed

Dried plasma spots in the diagnosis of tuberculosis: IP-10 release assay on filter paper.

Interferon (IFN)-gamma release assays (IGRAs) are probably the most accurate tests for the detection of latent Mycobacterium tuberculosis infection, but IGRAs are labour intensive and the transport of samples over longer distances is difficult. IFN-gamma-induced protein (IP)-10 is expressed at 100-fold higher levels than IFN-gamma, and IP-10 release assays have comparable performance to IGRAs. The aim of this study was to explore the diagnostic potential of a novel IP-10 release assay based on dried plasma spots (DPS). The presence of IP-10 and IFN-gamma was determined in plasma and in DPS by ELISA. Diagnostic algorithms for plasma and DPS tests for IP-10 were developed on a training cohort comprising 60 tuberculosis (TB) patients and 59 healthy controls. Diagnostic accuracy was assessed in a validation cohort comprising 78 TB patients and 98 healthy controls. Plasma was measured in Spain and DPS samples were sent to Denmark using the conventional postal service for analysis. IP-10 was readily detectable in both plasma and DPS, and correlation was excellent (r(2) = 0.95). QuantiFERON-TB Gold In-Tube (QFT-TB) and IP-10 in DPS and plasma rendered comparable sensitivity (78%, 82% and 84%, respectively), specificity (100%, 97% and 97%, respectively) and indeterminate rates (p>0.55). The DPS-based IP-10 test has comparable diagnostic accuracy to the QFT-TB and samples can be sent via conventional mail over long distances for analysis without affecting the results.

The full text may be available from PubMed

Reducing risk behaviors linked to noncommunicable diseases in Mongolia: a randomized controlled trial.

OBJECTIVES: We tested the efficacy of a 6-session, evidence-based health promotion intervention aimed at reducing noncommunicable disease (NCD) risk behaviors. METHODS: Two hundred male and female factory workers in Ulaanbaatar, Mongolia were randomly assigned to groups receiving either the health promotion intervention or a time-matched financial literacy control intervention. RESULTS: The health promotion intervention increased daily fruit and vegetable intake and physical activity, increased readiness for NCD risk behavior reduction and health promotion knowledge, and reduced the number of daily alcoholic drinks and diabetes symptoms 3 months after the intervention. CONCLUSIONS: The findings support the efficacy of the intervention to reduce risk behaviors associated with NCDs. Dissemination of the intervention may improve productivity, reduce costs of health services, and better the quality of life for Mongolians.

The full text may be available from PubMed

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Webinar from the National Collaborating Centre for Determinants of Health (NCCDH)

Knowledge translation frameworks & health equity- fast friends or perfect strangers?

November 19, 2013
1:00p.m – 2:30p.m EST

Dramatic inequalities in health and social circumstances across Canada are well documented. Knowledge and effective interventions exist to address many of these inequities.  However, awareness, uptake, and the use of interventions can be poor especially with respect to interventions to improve the health of social and economically disadvantaged populations. This gap between knowledge and action to improve health equity is of increasing concern to public health researchers and practitioners, globally.

Knowledge translation (KT) is about closing the gap between knowing and doing. Public health has been particularly interested in finding effective models for moving research into action. This webinar will discuss the application of a health equity support score to knowledge translation frameworks and highlight existing knowledge– to-action frameworks that can support equity focused knowledge translation.

To register for this webinar, click here.

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NCCMT is funded by the Public Health Agency of Canada and affiliated with McMaster University.
Production of this newsletter has been made possible through a financial contribution from the Public Health Agency of Canada.
The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.
Contact us at nccmt@mcmaster.ca or www.nccmt.ca.