CPHA 2014: Partnerships for Health System Improvement

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Slides from an oral presentation given at the Canadian Public Health Association's annual conference, Public Health 2014. This presentation presented the results from a Partnerships for Health System Improvement study.

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CPHA 2014: Partnerships for Health System Improvement

  1. 1. CPHA 2014 1 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
  2. 2. CPHA 2014 2 Maureen Dobbins, PhD Robyn Traynor, MSc Lori Greco, MPH Reza Yousefi Nooraie, MSc, PhD (candidate) Jennifer Yost, PhD
  3. 3. 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 CPHA 2014 3
  4. 4. 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? CPHA 2014 4
  5. 5. Tailored Interventions CPHA 2014 5 KB
  6. 6. Tailored Interventions CPHA 2014 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 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
  7. 7. Total Activities CPHA 2014 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
  8. 8. Data CollectionBaselineInterimFollow-Up CPHA 2014  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
  9. 9. Response Rate CPHA 2014 9
  10. 10. Response Rate CPHA 2014 10
  11. 11. Demographics CPHA 2014 11 Gender Public Health Experience Highest Degree Earned ● Diploma ● Bachelors Masters ● Doctorate 20 15 10 5 0
  12. 12. 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? CPHA 2014 12
  13. 13. EIDM Behaviours CHNC 2014 13 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
  14. 14. EIDM Behaviours CHNC 2014 14 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
  15. 15. 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. CHNC 2014 15
  16. 16. 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. CHNC 2014 16
  17. 17. 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 CHNC 2014 17
  18. 18. 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) CPHA 2014 18
  19. 19. 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? CPHA 2014 19
  20. 20. Qualitative Analysis • Data collected: – 37 interviews – 170+ KB reflective journal entries – CHSRF self-assessment • Analyzed using Nvivo 9; coding framework developed, constant comparative process CPHA 2014 20
  21. 21. 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 CPHA 2014
  22. 22. Potential Challenges CPHA 2014 • Time, competing priorities* • Anxiety, uncertainty • Inefficient access to research evidence • Choosing priority issues • Limited engagement, slow progress • Definition of “EIDM” • Communication
  23. 23. Identified Supports CPHA 2014 • 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
  24. 24. Overall Conclusions CPHA 2014 24
  25. 25. • 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. CHNC 2014 25
  26. 26. 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. CPHA 2014
  27. 27. Thank you! Contact us: info@healthevidence.org CPHA 2014 27

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