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Jaleh Gholami Eshlaghi
MD. MPH. PhD Candidate in Epidemiology
اهداف آموزشی این بخش
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آشنایی با اصول کلی که در هنگام انتقال دانش باید در نظر گرفت
آشنایی با برخی از روش های انتقال دانش برای گروه های متفاوت
مخاطبین
آشنایی با روش های موثر انتقال دانش
توجه به اثربخشی روش های انتقال هنگام تدوین استراتژی انتقال
Review
Message (WHAT?)
Level of Evidence
Target Audience ( To WHOM?)
Messenger (BY WHOM?)
Barriers
Knowledge transfer process and support system (HOW?)
Evaluation (with what EFFECT should it be transferred?)
Consider the audience
• Knowledge sharing requires an understanding of the
problems audiences face, the level of detail they need, and
the style of thinking they use.
• The message must be one that is valuable to an audience
based on their needs, delivered by a messenger they can
trust, in language they are comfortable with.
Use Plain Language
• Researchers, service providers, and policymakers may talk
about their work in diverse ways. Researchers may
communicate with one another in highly technical terms,
whereas service providers may discuss similar issues in
language based on their daily work, and policymakers in
political jargon. If a community of people sharing
knowledge spans several disciplines and contexts, a common
language is needed.
Example
• مرور نظام مند و متاآنالیز كارازمايي هاي بالیني شاهد دار تصادفي
شده نشان مي دهد كه میزان خطر نسبي شكستگي ران براي
مصرف ويتامین Dبه تنهايي ( 1.1با حدود اطمینان )1.36-0.89 %95
مي باشد در حالي خطر نسبي شكستگي ران در صورت مصرف
ويتامین Dو مكمل كلسیم برابر با ( 0.82با حدود اطمینان %95
)0.71, 0.94مي باشد.
• ويتامین Dدر صورت مصرف مكمل كلسیم باعث كاهش خطر
شكستگي ران مي شود در صورتي كه مصرف ويتامین Dبه تنهايي
اين تاثیر را ندارد.
Evidence based medicine should be
complemented by evidence based
implementation.
Richard Grol
professional behavior change strategies
– Printed Educational material (Clinical Practice
Guideline, audio-visual materials, and electronic
publications)
– Educational Meeting
• Didactic meeting (Lectures, Conferences)
• Interactive Educational Meeting (workshop)
– Educational Outreach (Prescribing behavior)
– Local opinion leaders (Educationally influential
providers)
– Audit and feedback (Any summary of Clinical
performance)
– Reminders (Patient or encounter specific information)
Clinical Practice Guideline
• Evidence-based clinical practice guidelines are knowledge
tools defined as systematically developed statements that
help clinicians and patients make decisions about
appropriate health care for specific clinical circumstances.
• clinical practice guidelines should facilitate high-quality
practice informed by evidence,
How are clinical practice guidelines
developed?
essential elements
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Establish multidisciplinary guideline team
Identify clinical question that explicitly defines the patients,
intervention/exposure, comparisons (if relevant), outcomes of interest
and setting
Conduct a systematic review of evidence
Appraise and interpret evidence and come to consensus on its meaning
Draft guideline recommendations that align with evidentiary base
Complete an external review of draft report among intended users and
key stakeholders
Revise the guidelines in response to external review
Read the final guideline report for distribution and dissemination
Prepare implementation strategy
How do we determine the quality of
clinical practice guidelines?
• Appraisal of Guidelines Research and Evaluation
(AGREE)
• Guideline Implementability Assessment (GLIA) tool
• The ADAPTE tool that provides criteria to evaluate the
clinical fidelity of recommendations and their link to
evidence.
Local opinion leaders
• local opinion leaders are “providers nominated by their
colleagues as educationally influential”.
• Opinion leadership is the degree to which an individual is
able to influence other individuals’ attitudes or overt
behavior informally in a desired way with relative
frequency.
Local opinion leaders
This informal leadership is not a function of the individual’s
formal position or status in the system, it is earned and
maintained by the individual’s
– Technical competence,
– social accessibility, and
– conformity to the systems norms.
opinion leaders have more:
– external communication,
– higher social status,
– innovative.
Local opinion leaders characteristics in Iran
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1) High level of knowledge
2) Communication skills
3) Taking into account stakeholders
4) Professional ethics
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
15/47
Effectiveness of professional behavior
change strategies
– Printed Educational material (Clinical Practice
Guideline, audio-visual materials, and electronic
publications)
– Educational Meeting
• Didactic meeting (Lectures, Conferences)
• Interactive Educational Meeting (workshop)
– Educational Outreach (Prescribing behavior)
– Local opinion leaders (Educationally influential
providers)
– Audit and feedback (Any summary of Clinical
performance)
– Reminders (Patient or encounter specific information)
strategies focusing on patients
• Patient decision aids
• Personalized risk communication (Uptake for screening
test)
• Interactive Health Communication Applications (Information
packages for patients that combine health information with
at least one of social support, decision support, or behavior
change support)
• Interventions to enhance medication adherence (Instruction,
Automated telephone monitoring and counseling, manual
telephone follow-up, Reminders, special ‘reminder’ pill
packaging, dose-dispensing units and medication charts,
appointment and prescription refill reminders, direct
observation of treatments, …)
Patient Decision Aids
A review of 2500 treatments found that only 17% had adequate
scientific evidence to be classified as black or white; the
majority were “grey” either because of insufficient
evidence or because the balance between benefits and
harms was close.
– birth control,
– options for menopause symptoms,
– back pain,
– osteoarthritis,
– end-of-life care,
– genetic testing,
– breast and prostate cancer treatment,
What are patient decision aids?
Patient decision aids translate evidence into patient-friendly
tools to inform patients about their options, help them
clarify the value they place on benefits versus harms, and
guide them in the process of decision making.
Formats for decision aids are:
• paper-based booklets,
• video/DVDs,
• decision boards,
• and internet-based materials
presentation of outcome probabilities
clarify patients’ values for outcomes
Ottawa Hospital Research Institute (OHRI)
How do we determine the quality of
patient decision aids?
Effectiveness of knowledge translation
strategies focusing on patients
• Patient decision aids
• Personalized risk communication (Uptake for screening
test)
• Interactive Health Communication Applications (Information
packages for patients that combine health information with
at least one of social support, decision support, or behavior
change support)
• Interventions to enhance medication adherence (Instruction,
Automated telephone monitoring and counseling, manual
telephone follow-up, Reminders, special ‘reminder’ pill
packaging, dose-dispensing units and medication charts,
appointment and prescription refill reminders, direct
observation of treatments, …)
Do patient decision aids work?
PDAs improve:
• patients’ participation in decision making,
• knowledge of options,
• agreement between patients’ values and the subsequent
treatment or screening decisions.
• realistic expectations of the chances of benefits, harms, and
side effects
• More use of conservative options,
• without apparent adverse effects on health outcomes or
anxiety.
Effectiveness of knowledge translation strategies
focusing on policy makers and senior health service
managers
• In contrast to the substantial evidence base on the
effectiveness of knowledge translation strategies targeting
health care professionals and patients, we are not aware of
any experimental studies evaluating the effects of
knowledge translation research that focused on policy
makers or senior health service managers.
“Reader Friendly Writing” Writing for health
policy makers, planners and managers
(Canadian Health Service Research Foundation)
1:3:25
1: Main message
3: Executive Summary
25: The Report
1صفحه :پيام اصلي
(قلب گزارش)
چه كس ي است این گزارش را می خواند؟
الزم است چه مطلبي را در مورد اين پژوهش بداند؟
چه چيز از يافته هاي اين مطالعه بر مي آيد؟
كنار گذاشتن كليه متون
نكاتی كه مخاطب بايد از آن آگاه شود به صورت فهرست وار
ذكر خالصه نتايج ممنوع
الزم نيست پيام شما حاوي توصيه هاي مشخص باشد ،اگر نمي توان نتيجه گيري قطعي نمود سوال مشخص ي را كه
بايد به آن پاسخ داد به صورت واضح مطرح نماييد و از نوشتن “پژوهش هاي بيشتري مورد نياز است” بپرهيزيد.
3صفحه :خالصه اجرايي
نكات داراي اهميت بيشتر در ابتداي متن و نكات كم اهميت تر در ادامه
نگارش با زبان شفاف و روشن ولي غيرعاميانه به گونه اي كه فرد ناآشنا به پژوهش آن
را كامال درك نمايد
اشاره به موضوع مورد بررس ي و پاسخ هاي بدست آمده
يافته هاي طرح به صورت فشرده
روش اجرا و جزئيات تكنيكي در حد 1-2سطر
25صفحه :گزارش
.1
.2
.3
.4
.5
.6
.7
.8
زمينه و سابقه :Contextسوال پژوهش ،پژوهش هاي قبلي و سهم اين پژوهش در پاسخ به سوال
مفاهيم :Implicationsمفهوم يافته ها براي مدير يا سياست گذار ،ذكر گستره تعميم نتايج ،تفكيك
پيام ها
رويكرد :Approachطراحي مطالعه ،روش ها ،منبع داده ها ،جزئيات نمونه گيري ،تكنيك هاي آناليز و ...
نتايج :Resultsنگارش نتايج به صورت خالصه و پررنگ نمودن پيام ها ،استفاده از جداول و نمودارها
منابع اضافي :Additional Resourcesساير منابع كه براي سياست گذار مي تواند مفيد باشد
پژوهش هاي بيشتر :Further Researchفهرست نمودن شكاف هاي موجود ،طرح پرسش هاي
مشخص
مراجع و كتابشناس ي :References and Bibliographyمشخص نمودن مواردي كه مفيدتر
است
پيوست :يافته هايي كه مستقيما به نتيجه گيري ارتباط ندارند ،مواد و روش هاي تكنيكي ،مراجعي کامل
Effect sizes of multifaceted
interventions by number of interventions
رسانه های گروهی
•
در یک پژوهش در شهر تهران نزديک به %50از مردم اعالم کردند ازطريق صدا و سيما اطالعات
بهداشتي وپزشکي خود راکسب مي کنند .در حالی که 16درصد پاسخگويان از«پزشکان»11 ،درصد
از«کتاب ها» 9درصد از«افراد عادي» (آشنايان واقوام) و 6درصد از«مطبوعات» اطالعات بهداشتي
وپزشکي خود راکسب مي کنند.
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در مطالعه ای %58مردم اعالم داشتند که اخبار سالمت کسب شده از طریق رسانه ،موجب تغیير رفتار
و نگرش آنها نسبت به مسائل سالمت شده است .برخی بیماران تحت تاثير اخباری که پخش می شود
حتی نحوه درمان خود را تغیير می دهند.
منبع اطالعات پزشكان و مردم در زمينه بيماري آنفلوانزاي خوكي 2
ماه پس از آغاز پاندمی بيماري
%75/6پزشكان و %80/1مردم اطالعات خود را در زمينه بيماري آنفلوانزاي خوكي
از تلويزيون و يا روزنامه ها و مجالت عمومي بدست آورده بودند.
ارزش هاي خبري از نگاه خبرنگاران
.1تازگی خبر
.2موضوع روز
.3موضوعات در مورد مسائل مهم
.4
.5
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فراگير بودن (جمعيتي مخاطب بزرگتر باشد)
عدد بزرگ
شهرت بیان کننده خبر
مجاورت (كشورهاي همسايه)
.8استثنا بودن خبر
.9اخبار در زمینه يك برخورد يا چالش
• در مطالعه ای که در مرکز تحقیقات بهره برداری از دانش
سالمت در سال 1387صورت گرفت مشاهده شد که حدود
%18اخبار سالمت درج شده در روزنامه های عمومی از نظر
شواهد علمی فاقد صالحیت انتشار می باشند.
معيارهای ارزيابي اخبار درمان
معيارهای ارزيابي اخبار مربوط به درمان در امریکا:
.1بحث در مورد هزینه ها
.2سنجش فواید
.3سنجش زیان ها
.4اشاره به دیگر گزینه های موجود
.5جستجوي منابع و توجه به تعارض منافع در منبع خبر
.6اجتناب از استفاده تجاری از بیماریها
.7کیفیت شواهد
.8جدید بودن موضوع مورد بررس ی
.9بررس ي در دسترس بودن روش
.10بررس ی های فراتر
How Do US Journalists Cover Treatments, Tests, Products, and .Gary Schwitzer
May 2008, 5(5).. PLoS Medicine.Procedures? An Evaluation of 500 Stories
Key Messages
• Knowledge sharing requires an understanding of the
problems audiences face, the level of detail they need, and
the style of thinking they use.
• Evidence based medicine should be complemented by
evidence based implementation.
• Interactive or mixed/interactive educational meetings were
generally
• effective resulting in moderate. In contrast, didactic
meetings were largely ineffective.
• There is not any evidence of the effects of knowledge
translation strategies that focused on policy makers or
senior health service managers.