Building capacity for evidence-informed public health decision making

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From 2009-2013, Health Evidence partnered with three Ontario health departments on a Canadian Institutes of Health Research (CIHR) “Partnerships for Health System Improvement” grant, studying the …

From 2009-2013, Health Evidence partnered with three Ontario health departments on a Canadian Institutes of Health Research (CIHR) “Partnerships for Health System Improvement” grant, studying the impact of tailored, knowledge translation and exchange interventions on evidence-informed decision making in public health. On June 10, 2014, Dr. Maureen Dobbins presented the results from this study and lead an interactive discussion on the implications for this work to a broader public health and knowledge translation audience.

For a recording of this webinar, visit: https://www.youtube.com/watch?v=PbQR-cRgrKI&feature=youtu.be.

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  • 1. Welcome! Building capacity for evidence-informed public health decision making You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
  • 2. Housekeeping • Use Q&A to post comments/questions during the webinar – ‘Send’ questions to All (not privately to ‘Host’) • Connection issues – Recommend using a wired Internet connection (vs. wireless), to help prevent connection challenges • WebEx 24/7 help line: 1-866-229- 3239 Q&A Participant Side Panel in WebEx
  • 3. Building capacity for evidence-informed public health decision making Partnerships for health system improvement
  • 4. The Health Evidence Team Maureen Dobbins Scientific Director Heather Husson Manager Lori Greco Knowledge Broker Robyn Traynor Research Coordinator Research Assistants Stephanie Workentine Arnav Agarwal Linda Chan Tiffany Oei Students Reza Yousefi Nooraie (PhD candidate) Yaso Gowrinathan Research Assistant/ Coordinator Jennifer Yost Assistant Professor
  • 5. What is www.healthevidence.org? Evidence Decision Making inform
  • 6. A Model for Evidence-Informed Decision Making National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision-Making in Public Health (Fact Sheet). [http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf]
  • 7. Stages in the process of Evidence-Informed Public Health National Collaborating Centre for Methods and Tools. Evidence- Informed Public Health. [http://www.nccmt.ca/eiph/index-eng.html]
  • 8. Funding for today’s webinar Partnerships for Health System Improvement (FRN 101867) Dissemination Event (FRN 126353)
  • 9. PHSI Study • CIHR ‘Partnerships for Health System Improvement’ grant – Integrated KT program – Collaborative, applied research – Researcher/knowledge user partnerships • Case study design – Three Ontario health departments (“cases”) – Tailored KTE intervention, delivered by KBs
  • 10. We asked… What is the impact of a tailored KTE strategy on knowledge, capacity & behaviour for EIDM? What contextual factors facilitate and/or impede impact?
  • 11. Case A Large, diverse MOH/AMOH vision EIDM strategic priority Resources committed Case B Large, urban centre MOH commitment Manager ‘champion’ EIDM strategic priority Case C Mid-size, urban/rural mix MOH commitment Exec commitment
  • 12. KB
  • 13. Tailored Interventions Case A Case B Case C ContextIntervention • 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 commitment • 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
  • 14. Total Activities Case A Case B Case C • 5 questions/reviews • Additional divisional training delivered (e.g. half-day workshops) • Presentations to Senior Management • Abstracts submitted to present research • 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 • EIDM Policy & Procedure developed & approved • RKEC presentations • All-staff training delivered
  • 15. Data CollectionBaselineInterimFollow-Up  Online Survey*  EIDM Skills Tool *Demographics, EBP Scale, SNA Online Survey*  Online Survey*  EIDM Skills Tool CHSRF Self- Assessment Interviews Interviews  KB Journal  Meeting Minutes  Communications  Document Collection
  • 16. Response Rate
  • 17. Response Rate
  • 18. Demographics Gender Public Health Experience Highest Degree Earned ● Diploma ● Bachelors Masters ● Doctorate 20 15 10 5 0
  • 19. We asked… What is the impact of a tailored KTE strategy on knowledge, capacity & behaviour for EIDM? What contextual factors facilitate and/or impede impact?
  • 20. 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
  • 21. 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)
  • 22. EIDM Behaviours 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
  • 23. EIDM Behaviours 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
  • 24. 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.
  • 25. 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. • Staff learned EIDM knowledge and skills, but may not yet be putting these new learnings into practice (i.e. changing behaviour).
  • 26. 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?
  • 27. Qualitative Analysis • Data collected: – 37 interviews – 170+ KB reflective journal entries – Case study notes • Analyzed using NVivo9; coding framework developed, constant comparative process
  • 28. Value of EIDM • EIDM is foundational “Critical, responsible” • Research evidence is only one aspect • Pre-existing interest, self-starters
  • 29. Identified Supports • Knowledge Broker skills and support; neutral, expert mentor • Easy access to resources and tools; template and “process” • Champions; peer support and mentoring • EIDM valued, embedded
  • 30. Potential Challenges • Time, competing priorities • Limited engagement, slow progress • Anxiety, uncertainty • Communication
  • 31. Potential Challenges EIDM EIDM EIDM • Definition of EIDM • Not a “novel” concept
  • 32. Overall Conclusions
  • 33. • 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.
  • 34. • An improved understanding of EIDM was transmitted among individuals and diffused throughout health department. • Improvement in EIDM behaviours cannot be sustained unless organizational structures are in place; process is embedded, made routine practice. • Understanding context is critical to sustaining EIDM.
  • 35. Publications • Traynor R, DeCorby K, Dobbins M. Knowledge brokering in public health: A tale of two studies. Public Health 2014, doi: 10.1016/j.puhe.2014.01.015. • Yousefi Nooraie R, Dobbins M, Marin A. Social and organizational factors affecting implementation of evidence-informed practice in a public health department in Ontario: a network modelling approach. Implementation Science 2014, 9(1):29. • Traynor R, Dobbins M, DeCorby K. Challenges of partnership research: Insights from a collaborative partnership in evidence-informed public health decision making. Evidence & Policy (accepted June 2014). • Yost J, Dobbins M, Traynor R, DeCorby K, Workentine S, Greco L. Tools to support evidence-informed public health decision making. BMC Public Health (resubmitted June 2014). • Greco L, DeCorby K, Traynor R, Dobbins M, Yost J, Workentine S. Implementing tailored, knowledge translation and exchange interventions in public health: a Partnerships for Health System Improvement study. Canadian Journal of Public Health (submitted January 2014).
  • 36. Thank you! Contact us: info@healthevidence.org