A Framework for Disseminating Research Evidence to Child ...


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  • Captain Lancaster
    Creq #1 with lemon juice 0% mortality from scurvy
    40% mortality on other crews from scurvy
  • Slide providing information on collaboration between provinces/ICMS and info on PI’s, study team
    Identify it is a five year cycle of surveillance etc.
  • To examine the rates of maltreatment & neglect investigated by Canadian child welfare services
    To examine the severity of maltreatment in terms of chronicity & evidence of harm/risk.
    To examine selected determinants of health for investigated children & their families
    To monitor short-term investigation outcomes, including substantiation rates, placement in care, use of child welfare court, & criminal prosecution.
    To examine selected determinants of health that may be associated with child maltreatment.
    John Lavis and the Knowledge Transfer Study Group
  • Important to have strong collaboration, stakeholder input throughout the process and involve individuals with an assortment of skill sets: content expertise, knowledge of research evidence, linked with key stakeholders, experts in field of communication and knowledge transfer.
    Worked closely with Lil Tonmyr, Sophie Hyman…input and guidance from both Margaret Hebert and Anne Marie Ugnat
    Communications Sub Committee---communication via email, met together in Ottawa in April
    Peter Dudding CWLC, Shannon Bala from the Child Welfare League of Canada, Sue Sullivan from the Centre of Excellence for Child Welfare
  • Actionable messages from a body of research.
    Messages can profile & place into context single studies.
    Research in the form of ‘ideas’ & not ‘data’ most influences decision making.
  • Research literature suggest that research organizations should transfer actionable messages from a body of research
    Over long periods of time…ideas enlighten decision makers about a particular issue and how to handle it.
    Take home messages are only a starting point for discussions with decision makers
    Format of key messages will depend upon the ‘dissemination strategy’ being used…different recommendations…
    CHSRF Formula 1, 3, 25 pager
    Research to policy website 1 sentence, 1 paragraph, 1 page, long document
  • The research literature makes clear that a messages target audience must be clearly identified and the specifics of a knowledge transfer strategy must be fine tuned to the types of decisions they face and the types of decision making environments in which they live or work.
    The same message from a body of research knowledge about child maltreatment would clearly not work for general public, clinicians, managers and public policy makers.
    Public policy makers must contend with not only research knowledge but also the values and opinions of the governing party, its key supporters, interested and affected stakeholders, and the general public; calculations of who wins, who loses, and by how much, and with rules for making decisions and with past policies that may shape and constrain future policies.
  • When deciding whom the research knowledge should be transferred, the following questions should be asked:
  • policy makers in at the F/P/T and community levels
    professionals working with children, youth and families: police, teachers, nurses, physicians, child welfare
    representatives of civil society organizations
    administrators of women’s shelter/transitional housing
    academics and researchers
    members of the media and general public
  • The credibility of the messenger delivering the message, whether the messagenger is an individual, group or organization, is important to successful knowledge transfer interventions.
    Building credibility and acting as a messenger can be very time consuming and skill intensive processes, which makes it impossible to use a one size fits all approach to decide who should act as the messenger. Debate in literature: is it the role of the researcher to be the ‘disseminator’…
    Give examples of key messagengers of PI: federal level; fluent french and english; initial launch of report credibility to findings; Public Health Minister of State, Minister of Social Development Canada
  • Interactive engagement approaches are similar to marketing processes. This approach assumes that there are different subgroups in the target audience.
    Change is viewed as stepwise process:
    1. Drawing attention to the message
    2. Increasing understanding of the message
    3. Influencing acceptance of the message
    4. Changing practice/policy
    5. Maintaining the change
    Interactive engagement most effective and the message has to be spread through a variety of channels: person to person, mass media, networks of professionals, opinion leaders, academic detailing
    The strength of multiple channels lies in emphasizing the need to adapt change proposals to the characteristics of different target groups, to address their particular needs and perceived barriers to change.
    Research on the transfer of research knowledge to and its uptake by policy audiences has demonstrated that interactions between researchers and these audiences appears to be important. Interaction can occur at many stages in both the research and policy/decision making process.
    Move in health services research to these models of ‘two way’ exchange processes that give equal importance to what researchers can learn from decision makers and what decision makers can learn from researchers.
    Supporting infrastructure like websites and newsletters can augment interactive efforts, though not replace them, particularly in the materials provides targeted information to clarly identified audiences and/or more general information in a searchable form when an event generates demand for this information.
  • A Framework for Disseminating Research Evidence to Child ...

    1. 1. 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
    2. 2. 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)
    3. 3. 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
    4. 4. Injury & Child Maltreatment Section Public 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.
    5. 5. 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
    6. 6. 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
    7. 7. adapted from McCarthy, 1992 Data Analysis & Interpretation Communication of Information for Action Data Collection/ Acquisition National Child Health Surveillance
    8. 8. Scope of CIS-2003
    9. 9. Knowledge Persuasion Decision Implementation Confirmation Knowledge transfer strategies Evidence-informed Decision-making Knowledge Uptake Outcomes Dissemination strategies Innovation characteristics Organizational characteristics Environmental characteristics Individual characteristics Decision-making efforts Adopt Reject Implement ation strategies Pt outcomes resource allocation expenditures organizational performance (Dobbins et al, 2002) Knowledge Transfer and Exchange Framework
    10. 10. Knowledge Persuasion Decision Implementation Confirmation Research Dissemination Evidence-informed Decision-making Research Utilization Outcomes (Dobbins, 2002) Knowledge Transfer and Exchange Framework
    11. 11. 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)
    12. 12. 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
    13. 13. 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
    14. 14. 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
    15. 15. 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”
    16. 16. 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
    17. 17. Target Audiences  A message’s target audience must be clearly identified.  Multiple audience-specific messages are needed.  Research knowledge alone may not impact decisions.
    18. 18. 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?
    19. 19. 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
    20. 20. 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?
    21. 21. 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?
    22. 22. 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
    23. 23. 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
    24. 24. 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
    25. 25. KTE Strategies 1. Generally effective  Academic detailing/ education outreach  Interactive education sessions  Reminder prompts or messages  Interventions tailored to overcome identified barriers (Grimshaw, 2001)
    26. 26. KTE Strategies 2. Variable Effectiveness  Audit & feedback  Opinion leaders  Formal opinion leaders  Informal opinion leaders  Patient-mediated intervention (Grimshaw, 2001)
    27. 27. KTE Strategies 3. Generally Ineffective as ‘stand alone’  Lectures  Educational materials 3. No evidence of effectiveness  Electronic communication  Media
    28. 28. 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
    29. 29. Transfer Mechanisms  For different transfer mechanisms, assess:  Availability  Resources  Feasibility
    30. 30. 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
    31. 31. 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
    32. 32. 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
    33. 33. Contacts Dr. Susan Jack jacksm@mcmaster.ca Dr. Lil Tonmyr Lil_tonmyr@phac-aspc.gc.ca
    34. 34. References Dobbins, 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.