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A Framework for Disseminating Research Evidence to Child Health Clinicians & Policy Makers
Susan Jack, RN, PhD, McMaster University, Hamilton, ON, Canada
Lil Tonmyr, MSW, PhD, Public Health Agency of Canada, Ottawa, ON, Canada
1ST INTERNATIONAL SOCIETY FOR CHILD INDICATORS CONFERENCE, CHICAGO, IL June 2007
Workshop Objectives
Identify factors influencing the utilization of research evidence by decision-makers
Develop a knowledge transfer & exchange (KTE) strategy to disseminate research findings
Discuss a KTE strategy developed to disseminate findings from the Canadian Incidence Study of Reported Child Abuse & Neglect (2003)
A Knowledge Transfer Story ….circa 1747
1497
Vasco da Gama Rounds Cape of Good Hope to find sea route to India. Of the 160 crew, 100 die of scurvy
1747
Dr. James Lind conducts random trial of six treatments for scorbutic sailors
1795
British Navy orders citrus fruit in diet for sailors
1601
Captain Lancaster sails with 4 ships; Crew #1 given 3tsps lemon juice daily
Time Elapsed from Lancaster to Adoption: 264 years
1865
British Board of Trade orders citrus on merchant marine vessels
Injury & Child Maltreatment SectionPublic Health Agency of Canada
Canadian Incidence Study of Reported Child Abuse & Neglect
National surveillance program
5 year cycle of surveillance
Two cycles completed (1998 & 2003)
Strong collaboration between ICMS, Provincial/Territorial Directors of Child Welfare, steering committee & the study team.
CIS-2003 Objectives
determine investigation and maltreatment rates over time
assess the type and severity of maltreatment
examine selected determinants of health that may be associated with maltreatment
monitor short-term investigation outcomes
CIS-2003
Data collected from investigating child protection workers after completion of investigation.
Data collected during fall and then used to develop weighted annual estimates
Does not capture unreported cases, cases only investigated by the police, and reports about already open cases
adapted from McCarthy, 1992
Data Analysis&
Interpretation
Communication of Information
for Action
Data Collection/Acquisition
National Child Health Surveillance
Scope of CIS-2003
Knowledge Persuasion Decision Implementation Confirmation
Knowledge transfer strategies
Evidence-informedDecision-making
Knowledge Uptake
Outcomes
Dissemination strategies
Innovation characteristics
Organizational characteristics
Environmental characteristics
Individual characteristics
Decision-making efforts
Adopt Reject
Implementation strategies
Pt outcomes
resource allocation
expenditures
organizational performance
(Dobbins et al, 2002)
Knowledge Transfer and Exchange Framework
Knowledge Persuasion Decision Implementation Confirmation
Research Dissemination
Evidence-informedDecision-making
Research Utilization
Outcomes
(Dobbins, 2002)
Knowledge Transfer and Exchange Framework
Lesson # 1: You need a plan!
Framework for Knowledge Transfer What should be transferred to decision
makers? To whom should research knowledge be
transferred? By whom should research knowledge be
transferred? How should research knowledge be
transferred? With what effect should research knowledge
be transferred?
(Lavis et al., 2003; Reardon, Lavis & Gibson, 2006)
Knowledge Transfer & Exchange Models
1. Producer-Push Models
2. User-Pull Models
3. Exchange Models Relationships are built & nurtured Researchers help build capacity for
decision-makers to use research Decision-makers help identify relevance
of research & new research questions
Lesson #2: Put Together a Team!
Communications sub-committee Stakeholder input & feedback
Social Development Canada P/T Directors of Child Welfare Centre of Excellence for Child Welfare First Nations Child & Family Caring Society CIS 2003 Steering Committee
PHAC Internal Communications Develop ‘Dissemination’ & ‘Communication’
plans
Creating Key Messages
Type 1 Message Credible facts & ideas
Type 2 Message Due to strength or type of evidence, can’t
direct decisions, but can be used to discuss issue
Type 3 Message A body of evidence, expressed as an
actionable idea, tailored to the decision-makers needs
Key Messages
Type 1 Message“The rate of substantiated child maltreatment increased 125% between 1998 and 2003. These are likely due to increased vigilance on the part of policy makers, investigators, service providers, and the general public.”
Type 2 Message“Child maltreatment is an important health and social concern that requires organizational collaboration to prevent and treat”
Your Research: Create a Message
What type of message can be developed? Is there sufficient evidence to develop an
actionable message? Who is the message relevant for?
Reardon, Lavis & Gibson, 2006
Target Audiences
A message’s target audience must be clearly identified.
Multiple audience-specific messages are needed.
Research knowledge alone may not impact decisions.
The Challenge of Identifying Specific Target Audiences!
1. Who can act on the basis of the available research knowledge?
2. Who can influence those who can act?
3. With which of these target audience(s) can we expect to have the most success?
4. Which messages pertain most directly to them?
CIS-2003 Target Audiences
Broad spectrum of stakeholders: policy makers professionals civil society organizations women’s shelters academics & researchers media & general public
Decision-makers in these sectors: Social Development (Child Welfare), Public Health,
Health, Education, Justice, Indian & Northern Affairs Canada
Aboriginal populations Youth populations
Understand Your Audience
What decisions does the audience own that this evidence might influence?
Who is a credible messenger to this audience?
Is the audience connected to existing knowledge pathways?
Identify Barriers & Facilitators
For the audience, what is the magnitude of change suggested by the message?
Is there a cost to this change? Does the change require resources or
expertise?
Messengers
Credibility of messenger is important Who is perceived to be credible varies by
target audience Researchers, with skills & experience, to
act as messenger viewed as credible. Time consuming and skill-intensive
process Work with & through trusted
intermediaries
ICMS
Study team
CIS Steering committee
P/T Directors of Child Welfare
Representatives from Aboriginal & Youth Stakeholder Groups
Lesson #3: Identify the right people when targeting specific audiences
Process of Knowledge Transfer
If goal is uptake & utilization: Passive processes are ineffective Interactive engagement most effective Interaction between researchers & target
audience is important Supporting infrastructure can augment
interactive efforts Target to clearly identified audience General information in searchable form
Grol & Grimshaw, 1999
KTE Strategies
1. Generally effective Academic detailing/ education outreach Interactive education sessions Reminder prompts or messages Interventions tailored to overcome
identified barriers
(Grimshaw, 2001)
KTE Strategies
2. Variable Effectiveness Audit & feedback Opinion leaders
Formal opinion leaders Informal opinion leaders
Patient-mediated intervention
(Grimshaw, 2001)
KTE Strategies
3. Generally Ineffective as ‘stand alone’ Lectures Educational materials
4. No evidence of effectiveness Electronic communication Media
Communication Strategy
National launch; media & communication strategy
Dissemination Strategies
1. Producer Push: Conference presentations, broad distribution of report, submission to peer reviewed journals
2. Exchange Model: Discussion of findings, facilitated by study team, at all study centre sites
3. User Pull Model: Development of CIS-2003 web-pages
Process of Knowledge Transfer
Transfer Mechanisms
For different transfer mechanisms, assess: Availability Resources Feasibility
Lesson #4: Effective transfer takes time and resources
Resources required to develop strategies Messengers & financial resources required to
support interactive transfer strategies Identify existing personal relationships between
‘messengers’ and members of ‘target audience’…encourage integration of CIS-2003 findings into discussions
Issue of child maltreatment will continually arise….keep evidence readily available
Evaluate the KTE Impact
Indirect use Changes in knowledge, awareness or
attitudes Direct use
Behavioural changes Tactical use
Validation or legitimization of decision that is already made
Acknowledgments
Injury & Child Maltreatment Section, Public Health Agency of Canada
During this work, Dr. Jack was supported through a Canadian Health Services Research Foundation Post Doctoral Fellowship
ReferencesDobbins, M., Ciliska, D., & DiCenso, A. (2002). Dissemination and use of research
evidence for policy and practice. Online J Knowledge Synthesis Nurs, 9, Document 7.
Grimshaw, J. et al. (2001). Changing provider behaviour: An overview of systematic reviews of interventions. Medical Care, 38, 8, Supp 2.
Grol, R., & Grimshaw, J. (1999). Evidence-based implementation of evidence-based medicine. Journal of Quality Improvement, 25(10), 503-513.
Lavis, J., N., Robertson, D.M., Woodside, J.M., McLeod, C.B., Abelson, J., & the Knowledge Transfer Study Group (2003). How can research organizations more effectively transfer research knowledge to decision makers? The Milbank Quarterly, 81(2), 221-248.
McCarthy B. The risk approach revisited: a critical review of developing country experience and its use in health planning. In: Liljestrand J, Povey WG (Eds). Maternal Health Care in an International Perspective. Proceedings of the XXII Berzelius Symposium, 1991 May 27-29, Stockholm, Sweden. Sweden: Uppsala University, 1992:107-24.
Reardon, R., Lavis, J., & Gibson, J. (2006). From research to practice: A knowledge transfer planning guide. Toronto, ON: Institute for Work and Health. www.iwh.on.ca
Trocmé, N., Fallon, B., MacLaurin, B., Daciuk, J., Felstiner, C., Black, T., Tonmyr, L., Blackstock, C., Barter, K., Turcotte, D., & Cloutier, R. Canadian Incidence Study of Reported Child Abuse and Neglect, CIS-2003: Major Findings Report. Ottawa: Minister of Public Works and Government Canada, 2005.
