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.
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
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
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
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
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