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Reza Majdzadeh Professor of Epidemiology Tehran University of Medical Sciences

Concepts and definitions of knowledge translation. Reza Majdzadeh Professor of Epidemiology Tehran University of Medical Sciences. 47 Slides. Learning objectives:. Accept the necessity of knowledge translation (KT) activities, Explain some definitions and concepts of KT,

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Reza Majdzadeh Professor of Epidemiology Tehran University of Medical Sciences

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  1. Concepts and definitions of knowledge translation Reza Majdzadeh Professor of Epidemiology Tehran University of Medical Sciences 47 Slides TUMS-KTE group

  2. Learning objectives: Accept the necessity of knowledge translation (KT) activities, Explain some definitions and concepts of KT, Know the difference between dissemination and implementation, Explain Push, Pull and Exchange efforts, Become familiar with the characteristics of knowledge brokers, Explain five stages of research result delivery. 2/47 TUMS-KTE group

  3. Growth of output in selected countries in the region Source: National Science Indicators, 1981-2005 – standard version 3/47

  4. Regional ranking by impact (2001-2005) Source: National Science Indicators, 1981-2005 – standard version 4/47

  5. Background • Research is consistently producing new findings that may contribute to effective and efficient care, • The findings of such research will not change population outcomes unless health services and health care professionals adopt them in practice. Grimshaw, Ward, Eccles. Oxford Handbook of Public Health. TUMS-KTE group 5/47

  6. Rationale for knowledge translation • Creation of new knowledge often does not, by itself, lead to its widespread adoption or impact health • Increased emphasis on research governance and accountability even for the public. 6/47 TUMS-KTE group

  7. 7/47 TUMS-KTE group

  8. “Help it happen”i“Make it happen”Milbank Quarterly 2004;82:581-629. 8/47 TUMS-KTE group

  9. 9/47

  10. LUNG CANCER TREATMENTS SURGERY OR RADIATION THERAPY? SURGERY (/100) 90 survive surgery 68 alive after 1 year 34 alive after 5 years RADIATION THERAPY (/100) 100 survive therapy 77 alive after 1 year 22 alive after 5 years SURGERY (/100) 10 die during surgery 32 dead after 1 year 66 dead after 5 years RADIATION THERAPY (/100) 0 die during therapy, 23 dead after 1 year, 78 dead after 5 years Patients 84% Physicians 78% Patients 50% Physicians 60% McNeil, Pauker, Sox, & Tversky (1982) in Redelmeier et al (1993) 10/47 TUMS-KTE group

  11. Prospect Theory Curve Subjective value Prospect theory value function Losses Gains Reference point 11/47 TUMS-KTE group

  12. The Journal of Continuing Education in the Health Professions, Vol. 26 No. 1, Winter 2006 • DOI: 10.1002/chp. 12/47 TUMS-KTE group

  13. 13/47 TUMS-KTE group

  14. The Journal of Continuing Education in the Health Professions, Vol. 26 No. 1, Winter 2006 • DOI: 10.1002/chp. 14/47 TUMS-KTE group

  15. Data? Information? Knowledge? • Data: Raw facts • Information: Organized data • Knowledge: Meaningful information J Knowledge Management 2001;5:68-75. 15/47 TUMS-KTE group

  16. Knowledge translation • Knowledge utilization • Knowledge dissemination • Knowledge brokering • Knowledge transfer • Knowledge exchange 16/47 TUMS-KTE group

  17. Knowledge transfer A linear process through which research is first conceptualized and conducted, and the results are then handed over to the end-users. 17/47 TUMS-KTE group

  18. Knowledge transfer The unidirectional nature of knowledge transfer has been criticized and recent studies have demonstrated that such strategies “have not proven to be effective in encouraging the adoption and implementation of new research results 18/47 TUMS-KTE group

  19. Knowledge translation “The exchange, synthesis and ethically-sound application of research findings within a complex set of interactions among researchers and knowledge users. In other words, knowledge translation can be seen as an acceleration of the knowledge cycle; an acceleration of the natural transformation of knowledge into use.” 19/47 TUMS-KTE group

  20. Knowledge brokering “the human forces behind knowledge transfer…it helps build relationships and networks for sharing existing research and ideas and stimulating new work.” Knowledge brokering supports evidence- based decision-making by encouraging the connections that ease knowledge transfer. 20/47 TUMS-KTE group

  21. Policy Makers Politicians Board Members Managers Institutional CEOs Program Managers Service Professionals Physicians Nurses Researchers Mission Oriented In-house Employees Management Consultants Applied Research Institutes Insulated Academics Discovery Driven Decision Makers Solutions Problems 21/47 TUMS-KTE group

  22. Issues and Priorities Decision Makers Service Delivery Problems Policy Makers Managers Dx, Tx, Px Service Professionals Solutions Problems Incentives Researchers Mission Oriented Discovery Driven Researchable Questions Research Funders Applications Commercial R&D Grant Agencies Self-funding Discovery 22/47 TUMS-KTE group

  23. Issues and Priorities Decision Makers Research Funders Applications Discovery Service Delivery Problems Policy Makers Managers Dx, Tx, Px Service Professionals Solutions Problems Incentives Researchers Mission Oriented Discovery Driven Researchable Questions Knowledge Purveyors Stories Facts Ideas Best Practice Interventions Anecdotes Interests Wants Values Myths Evidences 23/47 TUMS-KTE group

  24. Issues and Priorities Decision Makers Research Funders Applications Discovery Service Delivery Problems Policy Makers Managers Dx, Tx, Px Service Professionals Solutions Problems Incentives Researchers Mission Oriented Discovery Driven Researchable Questions Knowledge Purveyors Stories Public Relations Media Think Tank Conferences Journals Books Facts Ideas Best Practice Interventions Personal Experiences Anecdotes Interests Wants Values Myths Assumptions Evidences 24/47 TUMS-KTE group

  25. 25/47

  26. Lavis, J; Roberston, D.; Woodside, J.; McLeod, C.B.; Abelson; J. (2003). « How Can Research Organizations More Effectively Transfer Research Knowledge to Decision-Makers »; The Milbank Quarterly, 81 (2) : 221-248. 26/47 TUMS-KTE group

  27. A five-step approach to knowledge transfer • Message (WHAT?) • Target Audience (WHO?) • Messenger (BY WHOM?) • Knowledge transfer process and support system (HOW?) • Evaluation (with what EFFECT should it be transferred?) Lavis, J; et al. (2003). « How Can Research Organizations More Effectively Transfer Research Knowledge to Decision-Makers »; The Milbank Quarterly, 81 (2) : 221-248. 27/47 TUMS-KTE group

  28. Knowledge? • Information: Organized data • Knowledge: Meaningful information J Knowledge Management 2001;5:68-75. 28/47 TUMS-KTE group

  29. The first published study on a scientific question may find the most exaggerated effect size and that as further evidence is gathered, effect sizes tend to diminish. 29/47 Ioannidis, J. (2006). PLOS Clinical Trials 1(7. );

  30. Thousands of observations are required before estimates of gene disease associations became stable. 30/47

  31. Message (WHAT?) • “Actionable messages” are preferable to single research reports or the results of single studies. Music Actionable message Synthesis of research knowledge Individual studies, articles and reports Basic, theoretical and methodological innovations Noise 31/47

  32. 2. Target Audience (WHO?) – The types of decisions being made and the types of decision-making environment at hand need to be considered (organizational and political factors cannot be neglected). When selecting a target audience, one should consider who will be able to act on the basis of the research, which can influence those who act, and with which audience can the most success be expected. 32/47 TUMS-KTE group

  33. Target Audience (WHO?) • When selecting a target audience, one should consider: 1) who will be able to act on the basis of the research, 2) which can influence those who act, and 3) with which audience can the most success be expected. 33/47

  34. 3. Messenger (BY WHOM?) – The key here is credibility. 34/47 TUMS-KTE group

  35. G001 G005 G011 G015 Gynaecologists’ social network G085 G004 G009 G095 G013 G089 G086 G007 G078 G116 G115 G090 G113 G098 G087 G048 G140 G112 G033 G074 G100 G150 G047 G051 G111 G123 G027 G099 G032 G069 G147 G141 G050 G065 G062 G017 G128 G139 G053 G071 G064 35/47 G049 G114

  36. Psychiatrists’ social network in TUMS 36/47 TUMS-KTE group

  37. Local opinion leaders • Use of providers nominated by their colleagues as ‘educationally influential’. The investigators must have explicitly stated that their colleagues identified the opinion leaders. • Local opinion leaders • Up-to-date • Good communicators • Humanistic 37/47 TUMS-KTE group

  38. 4. Knowledge transfer process and support system (HOW?) Passive processes are widely recognized as ineffective, and interactive engagement is preferred. Two-way exchanges can, in the long term, produce beneficial cultural shifts. 38/47 TUMS-KTE group

  39. How should it be transferred? Lomas (1993) 39/47 TUMS-KTE group

  40. Examples of “Diffusion” Activities • Peer reviewed publication • Conference presentation • Final report to funders • Summary to agency • Non-peer reviewed publication • Website posting Graham I. KT ICEBeRG Symposium 2005 40/47

  41. Examples of “Implementation” Activities • Stakeholder involvement • Media involvement • Educational sessions with decision makers • Use of knowledge brokers Graham I. KT ICEBeRG Symposium 2005 Interaction 41/47

  42. Educational materials (1) Educational meetings (1) Educational outreach (1) Audit and feedback (2) Opinion leaders (1) Mass media (1) Reminders – general (4) Reminders – Computer assisted drug dosage (3) Reminders – CPOE (1) Tailored interventions (1) Prescribing – general (10) Prescribing - safety (2) Changing roles – nursing (1) Changing roles – pharmacy (7) Financial (4) Regulatory (1) General (10) Overview of reviews 42/47

  43. Towards evidence based implementation • Most approaches to changing practice are more often based on beliefs than on scientific evidence • ‘Evidence based medicine should be complemented by evidence based implementation’ Grol (1997). British Medical Journal. 43/47

  44. 5. Evaluation (with what EFFECT should it be transferred?) – Judgments about the success of an initiative depend on the objective: are we looking for a change in behavior. An increase in awareness. Introduction of the issue into a debate. 44/47 TUMS-KTE group

  45. Message (WHAT?) Target Audience ( To WHOM?) Messenger (BY WHOM?) Knowledge transfer process and support system (HOW?) Evaluation (with what EFFECT should it be transferred?) 45/47

  46. Learning objectives: Accept the necessity of knowledge translation (KT) activities, Explain some definitions and concepts of KT, Know the difference between dissemination and implementation, Explain Push, Pull and Exchange efforts, Become familiar with the characteristics of knowledge brokers, Explain five stages of research result delivery. 46/47 TUMS-KTE group

  47. “ Knowing is not enough; we must apply. Willing is not enough; we must do.”- Goethe TUMS-KTE group

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