Dr. Terri-Lynn MacKay and Dr. Lisa Petermann - Knowledge Translation in Gambling Research: A Public Health Approach
Dr. Terri-Lynn MacKay and Dr. Lisa Petermann
Assistant Research Professor, University of Nevada
Senior Consultant Clinical Engagement, Alberta Health Services
in Gambling Research
Terri-Lynn Mackay and Lisa Petermann
February 2nd, 2014
An RG training program is
delivered to casino employees and
researchers study whether
employee knowledge increased
A research team studies a sample
of patients in a treatment facility to
determine whether their treatment
protocol is effective in treating
You’re 30 yards
ground in a
You must be a
Because what you
told me is
You must be a
• Integration of research into a more concise overview
• Examples: systematic reviews, meta-analyses and practice
• Tailoring the message to meet the audience
• Examples: briefing notes, toolkits, and translating research in plain
language to stakeholder groups
• interaction between stakeholder groups
• Example: researchers and policy makers working collaboratively to
apply knowledge in real world setting.
Records identified through
(n = 1070)
identified through grey
literature search and via
(n = 93)
Knowledge transfer, knowledge exchange, knowledge translation, knowledge
mobilization, knowledge sharing, knowledge distribution, knowledge diffusion,
information sharing, diffusion of innovation, action research, audit and feedback,
communities of practice, knowledge broker, opinion leader, continuing education,
information dissemination, implementation research, research utilization, and evidence
gambling (search as gambl*), gaming, pathological gambling, and problem gambling
Tools and tactics
KT and Gambling: Moving the
1) What key areas in the gambling field are most ready for
2) What is one thing you can commit to doing that would
facilitate KT in your current work?
3) What are the potential barriers to successfully conducting
KT in the gambling field?
Acknowledgements & Contact Info
Terri-Lynn MacKay, Ph.D.
University of Nevada, Las Vegas
We would like to acknowledge:
The Alberta Gaming Research Institute
Ms. Christie Hurrell, Knowledge Resource Service, Alberta Health Services
Dr. David Hodgins, University of Calgary
Dr. Trudy Smit Quosai, Research, Knowledge Translation and Exchange, OPGRC
Lisa Petermann, Ph.D.
EXEP Consulting Inc.
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TL to do brief intro, what was impetus for study
Questions Is this KT? What makes it KT? How might this study be designed to optimize KT opportunities?
Lisa Jonathan Lomas has famously argued that the goal of health research ‘is to get the health service’s workforce, its employers, and its suppliers to have knowledge of facts and to use these facts in their practices, policies and products’ (pp. 129, Lomas, 2007). While this may be the goal, the reality has been a lag in mobilizing research to practice that has impeded the delivery of quality healthcare. In examining healthcare delivery in the United States, researchers have found that only 55% of patients receive recommended care with even less adherence when it comes to mental health conditions such as alcohol dependence, where a mere 10% of patients receive recommended care (McGlynn et al., 2003). Graham et al. (2006) recounted that research has shown 30-45% of patients do not receive empirically-based treatment and 20-25% of care is potentially detrimental.
In response to the delay in translating research evidence to best practice, there has been a rapidly growing interest in moving knowledge to action through the process of knowledge translation (KT). Beginning with the publication of the evidence-based medicine manifesto (Evidence-Based Medicine Working Group, 1992), there has been an explosion of related centers (e.g., Canadian Health Services Research Foundation), journals (e.g., Implementation Science) and resources (e.g., National Collaborating Center for Methods and Tools Repository of KT methods) dedicated to advancing KT in healthcare. Despite the sharp increase in interest, it has been illustrated that it takes an average of 17 years for research evidence to reach clinical practice (Morris, Wooding & Grant, 2011). Knowledge translation is particularly important in the wake of an era of rapidly advancing technological change, where information is abundant and accessible, but severely underutilized.
Research in the gambling field has increased exponentially in the past decade but application to practice has garnered less focus. The aim of this study was to provide an overview of the current state of knowledge translation (KT) in the gambling literature and offer recommendations for future direction
Lisa Knowledge Translation can be a confusing field to understand – there are multiple terms to describe all or part of the process; terms are often used interchangeably; some are used as nouns to describe the entire process that results in the use of knowledge by decision makers; others are used as verbs to represent actions or specific strategies taken to cause the uptake to occur…. For the purpose of the study we conducted, we used the CIHR definition : ‘‘a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge,….to provide more effective health services and products and strengthen the health care system’.
Lisa and TL TL examples from gambling
TL A search of these terms yielded 1070 results and 101 duplicates were removed. A manual review of the remaining citations was conducted and obviously irrelevant results (n=646) were removed by searching for keywords related to gambling.
Thirty-eight websites were included that primarily belonged to organizations involved in research and/or practice relating to gambling. Google and Google Scholar searches were truncated at 10 pages. Five results were excluded based on inactive weblinks and 74 remaining sources were reviewed.
A total of 416 records met criteria and were reviewed by three researchers. Records were excluded based on clear evidence of no thematic content of KT or gambling.
LP: You should do this as a nice conclusion to the study section. I like the alternating pattern in the next section as well.
Lisa Consensus building is defined as the transfer of knowledge in non-hierarchical ways so that new, relevant and specific knowledge is co-created by all interested parties (Broner, Franczak, Dye, & McAllister, 2001). Consensus building recognizes that diverse stakeholders hold different kinds of knowledge, all of which are required to develop effective policies and programs to address health issues. Nearly 40% of the articles in the review were concentrated in this category and utilized KT principles to build consensus, develop strategic position statements, or define best practices. The literature was stronger in highlighting the role of multi-stakeholder engagement in the development process versus outlining collaborative practice as part of the execution of the resultant recommendations. Consensus building is mainly occurring in the form of strategic planning documents (e.g., Department of Education and Children’s Services, 2004; Responsible Gambling Strategy Board, 2009) or in the form of guidelines or agreement on best practices (e.g., Blaszczynski, et al., 2011; Productivity Commission, 2010).
TL Example: A panel comprised of researchers and experts in the field of gambling treatment and prevention produce a document that identifies key priorities and actionable recommendations.
Lisa Nearly one third of the articles incorporated co-design or collaboration as key elements. These collaborations often took the form of adapting an original research hypothesis based on end user feedback during implementation, or challenging built in assumptions after preliminary investigation. Some of the literature included an ongoing collaboration with integrated guidance or co-design (e.g., King & Hardy, 2006; Community Links, 2010; Korn et al., 2006), while some of the literature included collaborative input or guidance at a specific point in time (e.g., Lee & Awosoga, 2014; Macdonald, Turner & Somerset, 2013; Thompson et al., 2009; Wood & Griffiths, 2007; Wood et al., 2010). Co-design and collaboration occurred with a variety of end-users including practitioners, problem gamblers, or multiple stakeholder groups involved in a collective project.
TL Website designed for youth by youth YouthBet.net is a youth engagement gambling project run out of the YMCA Youth Gambling Awareness Program. YouthBet.net works provincially to involve young people from diverse backgrounds in gambling issue identification, community action, and gambling education/prevention. The aim of the project is to develop, implement, and evaluate the use of information technology (Internet) for youth gambling prevention and intervention. Our program seeks to specifically: Promote informed and balanced attitudes and behaviours towards youth gambling; Prevent youth gambling-related health problems; and Protect at-risk youth from gambling related harm. YouthBet.net seeks to promote Youth Engagement, Expression, Empowerment, and Exchange through youth-driven media and participatory research. This “youth in action” approach combines youth engagement, youth media, eHealth, and knowledge exchange through evidence-based resources and best practices.
Lisa This theme includes literature in which the application of KT supported skill development or enhanced knowledge sharing and exchange. Literature identified in this category was generally related to tailored messages for key stakeholders, or creating tools to cultivate new skills. Example research investigated tailored messaging for people experiencing problems with gambling, concerned significant others, and specific population segments (e.g., Calderwood & Wellington, 2013; Dyall, Hawke, Herd & Nahi, 2012). It is noted that several problem gambling toolkits are available (e.g., Substance Abuse and Mental Health Service Administration Problem Gambling Toolkit) and various tools and tactics have been developed by individual problem gambling agencies throughout the world. These tools are valid forms of disseminating knowledge but were not included here because they were not identified by the search strategy or did not meet the inclusion criteria for multiple stakeholder group involvement.
TLExample: A problem gambling research group and a business/marketing professor designed billboards to promote a local PG service based on feedback from problem gamblers and family members of PG family members (to make sure effective; not triggering; not stigmatizing; reputable agency; does it increase admissions?).
Lisa Trans-disciplinary translation involves the application of verified empirical knowledge from one field or discipline to another. Trans-disciplinary translation literature identified in the review primarily included the application of knowledge from the addiction field (e.g., Byrne et al., 2003; Currie et al., 2008; Dickson, Derevensky & Gupta, 2002). Translation from the addiction field is logical, particularly in light of the categorization of Pathological Gambling with other addictive disorders in the Diagnostic and Statistical Manual (American Psychiatric Association, 2013). Although the gambling field has drawn from research conducted in other fields (e.g., mental health), the application of knowledge from other related disciplines was not generally explicit in the literature.
TLStudy sought expert opinion on low risk gambling limits (application of low risk alcohol consumption) from researchers, clinicians and policy makers.
TL to talk about recommendations from the study
LP: Ottawa Model for Smoking Cessation: Research illustrated that: Receiving support from a healthcare practitioner has been shown to increase a patient’s motivation to stop smoking. Smokers who try to quit with the help of best practice counseling, cessation medications, and follow-up, experience double or triple the success rate with quitting long term
Clinical Application: The OMSC is an institutional program that systematically identifies, provides treatment, and offers follow-up to all smokers seen in clinical practice – based on the findings of the research.
KT Process: A key component to the success of the OMSC is best attributed to its personnel, which includes expert Outreach Facilitators. Our facilitators work directly with participating sites to adapt their clinical practices to implement the 10 best practices for effective tobacco dependence treatment using a detailed implementation Workplan.
Scale and Spread: Since 2009, nearly 180 healthcare sites across Canada have joined the Ottawa Model for Smoking Cessation Network and are all using a common approach to treat tobacco users in their institutions. To better serve the growing number of healthcare settings in our network, 3 Centres of Excellence for Tobacco Dependence Treatment have been established - one in Ontario (the University of Ottawa Heart Institute), one in British Columbia (within Vancouver Coastal Health), and one in New Brunswick (within Horizon Health Network).
Recommendations for the future.
THIS IS AN OPPORTUNITY FOR A FACILITATED EXERCISE. Potential question:
What key areas in the gambling field are most ready for KT? What is one thing you can commit to doing that would facilitate KT in your current work? What are the potential barriers to successfully conducting KT in the gambling field?