Kenniscentrum Revalidatiegeneeskunde Utrecht Knowledge Brokers – getting knowledge from researchers to practitioners Marjolijn Ketelaar
Clinical practice Research Bridging the gap. HOW?
Knowledge Brokers: What are they and how can they help move research into clinical practice? CP 2009 Conference Saturday February 21, 2009
Dianne Russell Peter Rosenbaum Jan Willem Gorter CanChild Centre for Childhood Disability Research McMaster University, Hamilton, ON. Canada Johanna Darrah University of Alberta, Edmonton, Alberta, Canada Lori Roxborough Sunnyhill Health Centre for Children, Vancouver, BC Canada Dianne Cameron Centre for Ability, Vancouver, BC Canada Marjolijn Ketelaar RC De Hoogstraat NetChild PERRIN
Objectives of the workshop • To share our experiences with knowledge translation and Knowledge Brokering
What do we mean by knowledge translation anyway? • Research transfer • Knowledge transfer • Knowledge exchange • Knowledge mobilization • Utilization and diffusion • Knowledge transfer and exchange
CIHR definition of Knowledge Translation A dynamic, iterative process that includes synthesis, dissemination, exchange, and ethically-sound application of knowledgeto improve the health of people, provide more effective health services and products and strengthen the health care system.
Do you think there is a gap between knowing and doing? Evidence that research is not being translated into clinical practice • 20-25% of patients get care that is not needed or potentially harmful • 30-40% of patients do not get treatments of proven effectiveness Schuster, McGlynn, Brook (1998); Grol (2001)
Talk to the person on either side of you (3 minutes) and answer this question • I’d use evidence from research in my practice but…..
Barriers • Huge amount of information • Lack of time • We’re not doing he wrong things • Trust all information that is coming up? • Changing yourself is not enough • Changing attitude
Talk to the person on either side of you (3 minutes) and answer this question • What are some possible supports to implementing evidence into practice?
Supports • Way results are presented • Back to earth • Presentations • Money • E.g., Buy instruments • Good, easy to use instruments • Contact to people with experience • Leadership – decide what to do • Group process
Traditional methods of KT have focused on publication of journal articles and conference presentations Suggested reading
Papers published in last 30 days 538!! Pubmed.com rehabilitation OR therapy OR intervention: 5113 hits child* OR pediatric: 3426 hits
PERRIN PEdiatric Rehabilitation Research In the Netherlands A national research program Stichting Bio Kinderrevalidatie KinderrevalidatieFonds AdriaanStichting
Why PERRIN? Questions..... • Parents • Children, adolescents, young adults • Health and care professionals Themes: • development • prognosis • processes of care
Develop instruments Insight in development and determinants Goals of PERRIN Cerebral Palsy Activities and participation
Started in 2001 Development and prognosis CP 0-5 CP 5-9 CP 9-16 CP 16-24 ProCP Instruments GMFM GMFCS MPOC VABS TP etc PEDI
Knowledge Transfer • Papers in scientifc journals • Papers in professional journals • Factsheets • www.perrin.nl
Heard about Experience with
One step further-Workshops Interactive workshops were more successful than more “traditional” other strategies, such as • peer-reviewed publications • presentations • posting information on web sites Phys & Occ Ther in Pediatrics 2008; 28: 191-206 BUT
What do we know about effective KT strategies? • Passive dissemination strategies are useful to increase awareness and knowledge but do not lead to substantial changes in practice
Knowledge transfer • It involves • Getting the right information • To the right people • In the right form • At the right time • For the right impact (Julie Gilbert, KT manager, The Change Foundation)
What works to promote evidence-based practice?....data from 93 studies • Ongoing dissemination of information • Interaction between research and users • Social influence (power of influential people to persuade) • Facilitation (provision of technical, financial, organizational and emotional support) • Reinforcement (reminders, rewards for collaborative behaviour) Walter, Nutley & Davis. Evidence & Policy 2005; 1: 335-631
What do we know about effective KT strategies? • Emerging evidence that Knowledge Brokers who are located at each site and understand the local context (supports & barriers) are helpful in moving evidence into practice
Knowledge Brokering “bringing people together to help build relationships, uncover needs, and share ideas and evidence that will let them do their jobs better” Canadian Health Services Research Foundation (CHSRF) “Local champions” “Opinion leaders” “Change agents”
Talk to the person on either side of you (3 minutes) and answer this question • What skills would be important for a Knowledge Broker to have?
Researcher competent • Meet colleagues – time & money • Excited by the subject • Communicative • Enthusiasm • Leader that is supportive • Flexible – new ideas – tru out new things • Open minded – live with your own past • Respect clinicians and researchers – get respect • Hold on – be strong! • Convincing person – formal and informal leadership!
KB-projectsCanadaNetherlands Research Clinical practice Knowledge Brokers
Knowledge Brokers PERRIN Network of “influential” therapists Pilot with: • 4 rehabilitation centers • 6 instruments (a.o. GMFCS and GMFM) Purpose: From “knowing” to “doing”
KB-projectsCanadaNetherlands Research Clinical practice Researchers Professionals working in clinical practice Knowledge Brokers Broker to the Brokers
Knowledge Brokers“Brokers to the Brokers”and Researchers Lessons Learned
Lessons Learned • KB as facilitator (rather than expert) should be: • Reflective and flexible • Able to respond in a timely manner • Able to explain KB-role to others • Should have: • Designated time • Resources to support the KB role (responsibility of researchers?)
Lessons Learned Crucial aspects: • “Broker to the Broker” (linking researchers with KBs) • Convincing stakeholders • Responsibility to children and families – evidence based practice • What knowledge should be brokered and who decides, based on what?(Challenge: Finding enough strong evidence)
Lessons Learned • Great experiences: • Use of instruments increased! • Professionals felt more confident in choosing instruments • KBs enthusiasm – job satisfaction • Network of KBs – creativity, enthusiasm, learn from each other • Spill over to others not “formally” involved Russell et al, in preparation Rivard et al, in preparation www.canchild.ca – Knowledge brokering
One of the creative ideas A flyer with measures
Take home message • Create ways for researchers and research users to get together • Create a climate in service delivery organizations conducive to research uptake • Multi-faceted strategies to promote use are more likely to be successful than single interventions.