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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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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

TUMS-KTE group


Learning objectives

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.

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Growth of output in selected countries in the region

Growth of output in selected countries in the region

Source: National Science Indicators, 1981-2005 – standard version

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

Regional ranking by impact (2001-2005)

Source: National Science Indicators, 1981-2005 – standard version

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Background

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.

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Rationale for knowledge translation

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.

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

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Help it happen i make it happen milbank quarterly 2004 82 581 629

“Help it happen”i“Make it happen”Milbank Quarterly 2004;82:581-629.

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

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)

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

Prospect Theory Curve

Subjective value

Prospect theory

value function

Losses

Gains

Reference point

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

  • The Journal of Continuing Education in the Health Professions, Vol. 26 No. 1, Winter 2006 • DOI: 10.1002/chp.

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

  • The Journal of Continuing Education in the Health Professions, Vol. 26 No. 1, Winter 2006 • DOI: 10.1002/chp.

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Data information knowledge

Data? Information? Knowledge?

  • Data: Raw facts

  • Information: Organized data

  • Knowledge: Meaningful information

    J Knowledge Management 2001;5:68-75.

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

  • Knowledge translation

  • Knowledge utilization

  • Knowledge dissemination

  • Knowledge brokering

  • Knowledge transfer

  • Knowledge exchange

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Knowledge transfer

Knowledge transfer

A linear process through which research is first conceptualized and conducted, and the results are then handed over to the end-users.

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Knowledge transfer1

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

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Knowledge translation

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.”

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Knowledge brokering

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.

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

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

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

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

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

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

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

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

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

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.

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A five step approach to knowledge transfer

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.

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Knowledge

Knowledge?

  • Information: Organized data

  • Knowledge: Meaningful information

    J Knowledge Management 2001;5:68-75.

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

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.

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Ioannidis, J. (2006). PLOS Clinical Trials 1(7. );


Reza majdzadeh professor of epidemiology tehran university of medical sciences

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

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Message what

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

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

  • 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.

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Target audience who

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.

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

3. Messenger (BY WHOM?) – The key here is credibility.

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

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

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G049

G114


Reza majdzadeh professor of epidemiology tehran university of medical sciences

Psychiatrists’ social network

in TUMS

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Local opinion leaders

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

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

  • 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.

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How should it be transferred

How should it be transferred?

Lomas (1993)

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Examples of diffusion activities

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

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Examples of implementation activities

Examples of “Implementation” Activities

  • Stakeholder involvement

  • Media involvement

  • Educational sessions with decision makers

  • Use of knowledge brokers

    Graham I. KT ICEBeRG Symposium 2005

Interaction

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Overview of reviews

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

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Towards evidence based implementation

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.

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

  • 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.

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Reza majdzadeh professor of epidemiology tehran university of medical sciences

Message (WHAT?)

Target Audience ( To WHOM?)

Messenger (BY WHOM?)

Knowledge transfer process and support system (HOW?)

Evaluation (with what EFFECT should it be transferred?)

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Learning objectives1

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.

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TUMS-KTE group


Knowing is not enough we must apply

“ Knowing is not enough; we must apply.

Willing is not enough; we must do.”- Goethe

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