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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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