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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
CPHA 2014 2
Maureen Dobbins, PhD
Robyn Traynor, MSc
Lori Greco, MPH
Reza Yousefi Nooraie, MSc, PhD (candidate)
Jennifer Yost, PhD
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
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
Tailored Interventions
CPHA 2014 5
KB
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
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
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
Response Rate
CPHA 2014 9
Response Rate
CPHA 2014 10
Demographics
CPHA 2014 11
Gender
Public Health
Experience
Highest Degree
Earned
● Diploma
● Bachelors
Masters
● Doctorate
20
15
10
5
0
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
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
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
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
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
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
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
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
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
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
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
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
Overall Conclusions
CPHA 2014 24
• 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
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
Thank you!
Contact us:
info@healthevidence.org
CPHA 2014 27

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CPHA 2014: Partnerships for Health System Improvement

  • 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. CPHA 2014 2 Maureen Dobbins, PhD Robyn Traynor, MSc Lori Greco, MPH Reza Yousefi Nooraie, MSc, PhD (candidate) Jennifer Yost, PhD
  • 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. 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
  • 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. 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. 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
  • 11. Demographics CPHA 2014 11 Gender Public Health Experience Highest Degree Earned ● Diploma ● Bachelors Masters ● Doctorate 20 15 10 5 0
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
  • 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. 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