Transcript Slide 1

Reza Majdzadeh
Professor of Epidemiology
Tehran University of Medical Sciences
TUMS-KTE group
47 Slides
Accept the necessity of knowledge translation (KT) activities,
Explain some definitions and concepts of KT,
Know the difference between dissemination and implementation,
Explain Push, Pull and Exchange efforts,
Become familiar with the characteristics of knowledge brokers,
Explain five stages of research result delivery.
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Source: National Science Indicators, 1981-2005 – standard version
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Regional ranking by impact (2001-2005)
Source: National Science Indicators, 1981-2005 – standard version
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 Research is consistently producing new findings that
may contribute to effective and efficient care,
 The findings of
such research will not change
population outcomes unless health services and health
care professionals adopt them in practice.
Grimshaw, Ward, Eccles. Oxford Handbook of Public Health.
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1.
Creation of new knowledge often does not, by
itself, lead to its widespread adoption or impact
health
2.
Increased emphasis on research governance
and accountability even for the public.
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s
m
le
ob
e
h
Pr
s
Re
c
ar
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Science
Technology
Knowledge
creation
Innovation
Changing
knowledge to
a service and
or a good
Providing
service and or
a good to
people
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LUNG CANCER TREATMENTS
SURGERY OR RADIATION THERAPY?
SURGERY (/100)
90 survive surgery
68 alive after 1 year
34 alive after 5 years
Patients
Physicians
84%
78%
RADIATION THERAPY (/100)
100 survive therapy
77 alive after 1 year
22 alive after 5 years
SURGERY (/100)
10 die during surgery
32 dead after 1 year
66 dead after 5 years
Patients
Physicians
50%
60%
RADIATION THERAPY (/100)
0 die during therapy,
23 dead after 1 year,
78 dead after 5 years
McNeil, Pauker, Sox, & Tversky (1982)
in Redelmeier et al (1993)
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Prospect Theory Curve
Subjective value
Prospect theory
value function
Losses
Gains
Reference
point
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
The Journal of Continuing Education in the Health Professions, Vol. 26 No. 1, Winter 2006 • DOI:
10.1002/chp.
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
The Journal of Continuing Education in the Health Professions, Vol. 26 No. 1, Winter 2006 • DOI:
10.1002/chp.
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 Data: Raw facts
 Information: Organized data
 Knowledge: Meaningful information
J Knowledge Management 2001;5:68-75.
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 Knowledge translation
 Knowledge utilization
 Knowledge dissemination
 Knowledge brokering
 Knowledge transfer
 Knowledge exchange
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A linear process through which research is first
conceptualized and conducted, and the results are
then handed over to the end-users.
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The unidirectional nature of knowledge transfer has
been criticized and recent studies have demonstrated
that such strategies “have not proven to be effective in
encouraging the adoption and implementation of new
research results
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“The exchange, synthesis and ethically-sound
application of research findings within a complex set of
interactions among researchers and knowledge users.
In other words, knowledge translation can be seen as
an acceleration of the knowledge cycle; an acceleration
of the natural transformation of knowledge into use.”
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“the human forces behind knowledge transfer…it helps
build relationships and networks for sharing existing
research and ideas and stimulating new work.”
Knowledge brokering supports evidence- based
decision-making by encouraging the connections that
ease knowledge transfer.
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Decision Makers
Policy Makers
Politicians
Board Members
Managers
Institutional CEOs
Program Managers
Service Professionals
Physicians
Nurses
Problems
Solutions
Researchers
Mission Oriented
In-house Employees
Management Consultants
Applied Research Institutes
Insulated Academics
Discovery
Driven
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Decision Makers
Issues and Priorities
Policy Makers
Research
Funders
Service Delivery
Problems
Managers
Service Professionals
Dx, Tx, Px
Applications
Commercial R&D
Grant Agencies
Self-funding
Solutions
Problems
Discovery
Researchers
Incentives
Mission Oriented
Researchable
Questions
Discovery Driven
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Decision Makers
Ideas
Knowledge
Purveyors
Stories
Issues and Priorities
Policy Makers
Best Practice
Service Delivery
Problems
Managers
Research
Funders
Applications
Interventions
Service Professionals
Dx, Tx, Px
Discovery
Anecdotes
Interests
Wants
Values
Myths
Problems
Solutions
Facts
Researchers
Incentives
Mission Oriented
Researchable
Questions
Evidences
Discovery Driven
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Decision Makers
Ideas
Knowledge
Purveyors
Policy Makers
Best Practice
Stories
Research
Funders
Applications
Interventions
Service Professionals
Dx, Tx, Px
Discovery
Problems
Facts
Personal
Experiences
Anecdotes
Interests
Wants
Values
Myths
Assumptions
Service Delivery
Problems
Managers
Solutions
Public Relations
Media
Think Tank
Conferences
Journals
Books
Issues and Priorities
Researchers
Incentives
Mission Oriented
Researchable
Questions
Evidences
Discovery Driven
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Lavis, J; Roberston, D.; Woodside, J.; McLeod, C.B.; Abelson; J. (2003). « How Can Research
Organizations More Effectively Transfer Research Knowledge to Decision-Makers »; The Milbank
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Quarterly, 81 (2) : 221-248.
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1. Message (WHAT?)
2. Target Audience (WHO?)
3. Messenger (BY WHOM?)
4. Knowledge transfer process and support system
(HOW?)
5. Evaluation (with what EFFECT should it be
transferred?)
Lavis, J; et al. (2003). « How Can Research Organizations More Effectively
Transfer Research Knowledge to Decision-Makers »; The Milbank Quarterly,
81 (2) : 221-248.
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 Information: Organized data
 Knowledge: Meaningful information
J Knowledge Management 2001;5:68-75.
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The first published study on a
scientific question may find the
most exaggerated effect size and
that as further evidence is
gathered, effect sizes tend to
diminish.
Ioannidis, J. (2006). PLOS Clinical Trials 1(7. );
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Thousands of observations
are
required
before
estimates of gene disease
associations became stable.
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 “Actionable messages” are preferable to single
research reports or the results of single studies.
Actionable message
Synthesis of research knowledge
Individual studies, articles and reports
Basic, theoretical and methodological innovations
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 2. Target Audience (WHO?) – The types of
decisions being made and the types of decisionmaking environment at hand need to be
considered (organizational and political factors
cannot be neglected). When selecting a target
audience, one should consider who will be able to
act on the basis of the research, which can
influence those who act, and with which audience
can the most success be expected.
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 When selecting a target audience, one should
consider:
1) who will be able to act on the basis of the research,
2) which can influence those who act, and
3) with which audience can the most success be expected.
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3. Messenger (BY WHOM?) – The key here is
credibility.
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Gynaecologists’ social network
G085
G001
G005
G011
G004
G009
G095
G015
G013
G089
G086
G007
G115
G113
G087
G048
G098
G112
G140
G033
G074
G032
G150
G027
G147
G047
G141
G050
G100
G111
G099
G069
G065
G128
G062
G017
G053
G071
G049
G114
G064
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Psychiatrists’ social network
in TUMS
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 Use of providers nominated by their colleagues as
‘educationally influential’. The investigators must
have explicitly stated that their colleagues identified
the opinion leaders.
 Local opinion leaders
 Up-to-date
 Good communicators
 Humanistic
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 4. Knowledge transfer process and support system (HOW?)
Passive processes are widely recognized as ineffective,
and interactive engagement is preferred. Two-way
exchanges can, in the long term, produce beneficial
cultural shifts.
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Type of activity
Diffusion
Objective
Awareness
Dissemination
Awareness +
Active
Attitude change
Attitude change + Active+++
Behavior change
Implementation
Process
Passive
Lomas (1993)
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 Peer reviewed publication
 Conference presentation
 Final report to funders
 Summary to agency
 Non-peer reviewed publication
 Website posting
Graham I. KT ICEBeRG Symposium 2005
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 Stakeholder involvement
 Media involvement
 Educational sessions with decision makers
 Use of knowledge brokers
Graham I. KT ICEBeRG Symposium 2005
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 Educational materials (1)
 Prescribing – general (10)
 Educational meetings (1)
 Prescribing - safety (2)
 Educational outreach (1)
 Changing roles – nursing (1)
 Audit and feedback (2)
 Changing roles – pharmacy
 Opinion leaders (1)
(7)
 Financial (4)
 Regulatory (1)
 Mass media (1)
 Reminders – general (4)
 Reminders – Computer
assisted drug dosage (3)
 Reminders – CPOE (1)
 Tailored interventions (1)
 General (10)
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 Most approaches to changing practice are more often
based on beliefs than on scientific evidence
 ‘Evidence based medicine should be complemented by
evidence based implementation’
Grol (1997). British Medical Journal.
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 5. Evaluation (with what EFFECT should it be
transferred?) – Judgments about the success of an
initiative depend on the objective: are we looking
for a change in behavior. An increase in awareness.
Introduction of the issue into a debate.
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Message (WHAT?)
Target Audience ( To WHOM?)
Messenger (BY WHOM?)
Knowledge transfer process and support system (HOW?)
Evaluation (with what EFFECT should it be transferred?)
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Accept the necessity of knowledge translation (KT) activities,
Explain some definitions and concepts of KT,
Know the difference between dissemination and implementation,
Explain Push, Pull and Exchange efforts,
Become familiar with the characteristics of knowledge brokers,
Explain five stages of research result delivery.
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“ Knowing is
not enough;
we must apply.
Willing is not
enough;
we must do.”
- Goethe
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