Post on 30-Jun-2015
description
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A quantitative analysis of partnerships with Canadian
public health departments to study knowledge
translation and exchange
Partnerships for Health
System Improvement
Partnering with Canadian public health departments
to study knowledge translation and exchange:
A qualitative analysis
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Maureen Dobbins, PhD
Robyn Traynor, MSc
Lori Greco, MPH
Reza Yousefi Nooraie, MSc, PhD (candidate)
Jennifer Yost, PhD
PHSI Study
• CIHR ‘Partnerships for Health System
Improvement’
– Integrated KT program
– Collaborative, applied research
– Researcher/knowledge user partnerships
• Case study design:
– Three Ontario health departments (“cases”)
– Tailored KT intervention, delivered by KBs
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We asked…
What is the impact of a
tailored KT strategy on knowledge,
capacity & behaviour for EIDM?
What contextual factors facilitate
and/or impede impact?
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Tailored Interventions
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KB
Tailored Interventions
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Case A Case B Case C
Conte
xt
Inte
rvention
• Large, diverse
• MOH/AMOH vision
• EIDM strategic priority
• Resources committed
• Sept 2010 – Jun 2012
• KB on site, 2 d/wk
Mentored staff teams
Provided training
Participated in EIDM-
related events
One-on-one consulting
• Large, urban centre
• MOH committed
• Manager ‘champion’
• EIDM strategic priority
• Apr 2011 – Feb 2013
• KB on/off-site: 2 d/wk
Mentored staff teams
Provided training
Meetings /
presentations
Advised Senior
Management Team
• Mid-size, urban/rural
mix
• MOH commitment
• Exec commitment
• Apr 2011 – Dec 2012
• KB off-site*: 2 d/wk
(on-site 2 d/mon)
Mentored staff teams
Advised RKEC on
Policy & Procedure
Provided training
Meetings /
presentations
Total Activities
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Case A Case B Case C
• 18 Rapid Reviews
• Large-scale training
sessions provided
• KB facilitated /
contributed to Critical
Appraisal Club
• Presentations of
research to staff
colleagues & Senior
Management
• 5 questions/reviews
• Additional divisional
training delivered (e.g.
half-day workshops)
• Presentations to Senior
Management
• Abstracts submitted to
present research
• 5 questions/reviews
• EIDM Policy &
Procedure developed &
approved
• RKEC presentations
• All-staff training
delivered
Data Collection Baseline
Inte
rim
Follow
-Up
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Online Survey*
EIDM Skills Tool
*Demographics, EBP Scale, SNA
Online Survey*
Online Survey*
EIDM Skills Tool
8
CHSRF Self-
Assessment
Interviews
Interviews
KB Journal
Meeting Minutes
Communications
Document Collection
Response Rate
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Response Rate
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Demographics
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Gender Public Health
Experience
Highest Degree
Earned
● Diploma
● Bachelors
Masters
● Doctorate
20
15
10
5
0
We asked…
What is the impact of a
tailored KT strategy on knowledge,
capacity & behaviour for EIDM?
What contextual factors facilitate
and/or impede impact?
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EIDM Behaviours
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Baseline Interim Follow Up
Not involved 9.2 (0.8) 8.8 (0.9) 8.9 (0.8)
Large-group
training 9.3 (1.0) 10 (1.1) 10.4 (1.0)
Intensively
involved 10.4 (1.3) 12.8 (1.4)* 13.2 (1.3)*
*p<0.05
EIDM Behaviours
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Case A Case B Case C
Baseline Interim Follow Up Baseline Interim Follow Up Baseline Interim Follow Up
Not
involved 7(9) 7(8) 7(10) 9.5(8.5) 6(9) 7(8) 3(6) 5(7) 4(7)
Large-
group
training
6.5(8) 8(8) 7.5(9) 10(7) 7.5(10) 8(7) 7(7) 8(6) 6(9)
Intensively
involved 12(9) 14(9) 15(13)* 7(4) 10.5(6)* 10.5(8) 7.5(9) 11(9)* 8.5(15.5)
All time points were compared to baseline using Wilcoxon Signed rank test.
*difference from baseline, p < 0.05
EIDM Behaviours
• Significant increase in EIDM behaviours in
those who worked intensively with KB, vs.
only attended large group sessions or not
involved at all.
• Based on SNA, of those who did not work
intensively with KB, staff who contacted an
expert in the department had significantly
improved EIDM behaviours.
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EIDM Behaviours
• “Centrality” as a predictor of improvement:
significant increase in EIDM behaviours of
staff with many connections (i.e. staff come
to them for guidance) at baseline
• Improvement in EIDM behaviours cannot be
sustained unless organizational structures are
in place; process is embedded, made routine
practice.
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EIDM Knowledge & Skills
Baseline Follow-up
Case A 11.8 (6.1) 16.3 (5.9)***
Case B 10.1 (3.5) 10.9 (4.4)
Case C 9.3 (2.5) 12.9 (4.4)**
Pooled analysis† 10.5 (1.0) 13.4 (1.0)***
**p<0.01, ***p<0.001
† marginal means from a mixed effects regression model
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EIDM Knowledge & Skills
• Increase in EIDM knowledge and skills in
those who worked intensively with KB (2.8
points, (2.0 to 3.6), p<0.001)
• Taken with behaviour results, staff learned
EIDM knowledge and skills, they may not yet
be putting these new learnings into practice
(i.e. changing behaviour)
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We asked…
What is the impact of a
tailored KT strategy on knowledge,
capacity & behaviour for EIDM?
What contextual factors facilitate
and/or impede impact?
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Qualitative Analysis
• Data collected:
– 37 interviews
– 170+ KB reflective journal entries
– CHSRF self-assessment
• Analyzed using Nvivo 9; coding
framework developed, constant
comparative process
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Value of EIDM
• “Critical”, “responsible”, “foundational”
• Research evidence is only one aspect;
need to develop skills of incorporating
evidence
• Acceptance or buy-in; pre-existing interest
• Not a “novel” concept; increasing
presence
• “Champions”: staff, managers, SMT
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Potential Challenges
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• Time, competing priorities*
• Anxiety, uncertainty
• Inefficient access to research evidence
• Choosing priority issues
• Limited engagement, slow progress
• Definition of “EIDM”
• Communication
Identified Supports
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• KB knowledge/skills and support; neutral,
expert mentor
• Easy access to resources and tools
• A “process” or template to follow
• Peer support and mentoring
• Team composition and readiness
• Visible management support
• EIDM valued, embedded in the org
Overall Conclusions
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• Public health practitioners who worked most closely
with KBs demonstrated improvement in EIDM-related
behaviours, knowledge, skills.
• Those not intensively involved did not change, with
the exception of those who interacted with someone
identified as an expert. Centrality in networks may
predict improvement.
• An improved understanding of EIDM was transmitted
among individuals and diffused throughout health
department.
• Understanding context is critical to sustaining EIDM.
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Next Steps
• Additional results dissemination via
publications, webinar (June 10)
• Application for “PHSI II” funding:
–Work with local, provincial and
national partners to further develop
context and capacity for evidence-
informed public health.
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Thank you!
Contact us:
info@healthevidence.org
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