Integrated vs. End of Grant Knowledge Translation Approaches Ian D Graham Vice President Knowledge Translation and Public Outreach Canadian Institutes of Health Research & Sharon Straus Director, Knowledge Translation Program, Li Ka Shing Knowledge Institute at St. Michael’s Hospital and University of Toronto KTE: Doing What We Know, Knowing What to Do February 2-3 2011 Two kinds of KT/KT&E Integrated KT Research  Research approaches that engage potential knowledge-users as partners in the research process.  requires a collaborative or participatory approach to research that is action oriented and is solutions and impact focused (Mode 2).  For example, the researcher(s) and knowledge-user partner(s) jointly define the research question, and are involved in interpreting and applying the findings  The researcher develops and implements a End of grant KT plan for making knowledge users aware of the knowledge generated through a research project What is integrated KT research? • a way of doing research • collaborative, participatory, action-oriented, community based research, co-production of knowledge, mode 2 research • involves engaging and integrating knowledge users into the research process • Knowledge users can be: – Policy- and decision-makers from the community to the federal level, researchers, the public, industry, clinicians, the media – Investigators from different disciplines, teams, countries What is integrated KT research? Knowledge users and researchers (knowledge creators) work together to:  shape the research questions  interpret the study findings and craft messaging around them  move the research results into practice In our view – this is the minimum requirement for conducting integrated KT What is integrated KT research? In addition, knowledge users and researchers (knowledge creators) can work together to:  shape the research questions  decide on the methodology  help with data collection, tools development, selection of outcome measures  interpret the study findings and craft messaging around them  move the research results into practice  widespread dissemination and application Why integrated KT research? Through partnerships, the research is strengthened: • research can be more solutions-based because there is an end-user involved in developing the research question • research can have more impact because the enduser is engaged and interested, ready for results and willing to move those results into practice because they are of direct relevance to their day-to-day lives What is integrated KT? • We have an educational module on participatory research (Ann Macaulay, McGill http://pram.mcgill.ca/) • Available on the CIHR website: http://www.cihrirsc.gc.ca/e/39128.html#Guide • Includes advice/discussion about how to manage research of this sort: negotiating roles and responsibilities ahead of time, dealing with IP, dealing with disagreements; guidance as to how to be mutually respectful, etc Review implications of integrated KT By requiring both researchers and knowledge users to be part of the research team, integrated KT requires merit review: • Both knowledge users and researchers on the review panel • Each proposal scored on impact/relevance as well as scientific merit • Panellists often need orientation materials explaining the process as well as worksheets to apply the criteria • Both “types” of panel members have a voice End-of-grant KT  Typical dissemination and communication activities undertaken by most researchers:  KT to peers such as conference presentations and publications in peer-reviewed journals  End of grant KT can involve  more intensive dissemination activities that tailor the message and medium to a specific audience  more interactive approaches to application such as educational sessions with patients, practitioners and/or policy makers What are the goals? Dissemination: share the results  Implementation: use the results to promote change, influence decision making  Framework for more interactive dissemination and application:        Who are the end users of the research and who will be interested in knowing the results? What are the key messages? Who are the principal target audiences for each of these messages? Who is the most credible messenger for these messages and how do we engage them in communicating these messages? What are the barriers and facilitators to uptake? What KT strategy will we use? What resources are necessary? An example  Project to explore impact of mentorship for clinician scientists  Completed systematic reviews of mentorship interventions and of factors influencing academic career choice, and a qualitative study of mentorship   JCEHP 2008;28(3):117-22; Acad Med 2009;84(1):135-9; JAMA 2006;296;1103-15; JGIM 2006;:845-8; JGIM 2009;84:135-9. Objectives: to disseminate the results to interested audiences and to develop a mentorship strategy for academic HSC  Rationale for strategy  Body of evidence including systematic reviews that could inform development of mentorship strategies or modify current approaches to mentorship at relevant academic health science centres  Who would be interested in these results?  Research funders, Department Chairs, University Admin, Researchers, Trainees What are the key messages?   We brought together a stakeholder group to discuss the results of the research and develop key messages 1.5 day workshop with funders, university administrators, clinician scientists at various stages of their career, experts in mentorship  Funded  by AHFMR Discussion groups focused on contextualising the evidence and discussing barriers to use in the local setting Key messages  Mentorship strategies     Educational interventions   Academic institutions need to establish a format to find a mentor Department Chairs should support the creation of mentorship facilitators/champions Team mentorship (including mentorship at a distance) should be considered For mentors and mentees to be implemented by facilitators Role of AHFMR   Should enhance accountability of ‘mentorship’ component of the career awards Should include mentorship in all career awards Who are the principal target audiences for each message? Administrators at Universities, VP Research  Department Chairs  Researchers (mentors and mentees)  Chairs of Research Institutes  AHFMR  Who is the most credible messenger for each message?  University administrators – we had a Vice Dean in our group who tackled this 2   of us also met with the VP Research Department chairs – we identified local champions for mentorship amongst department chairs AHFMR assisted with this process and worked to engage administrators Examples of our strategies Target Audience Barriers KT Strategy Administrators (VPs of Research) Lack of time Written summary of key messages; academic detailing conducted in person by researchers Department Chairs Lack of capacity Identify local champions/opinion leaders; academic detailing Researchers (mentors/mentees) Lack of time Lack of capacity Lack of tools Mass media: use of existing university newsletters, electronic magazines, websites; Creation of workshops Examples of toolkits Created mentorship cases for a communication workshop for mentors and mentees  Adapted mentorship checklist and individual development plan created by Dr. M. Feldman, UCSF  Evaluation of impact  Series of interviews with stakeholders across academic health science centres  Analysis  underway Created a survey for academic institutions to use with faculty members to evaluate impact of mentorship strategy Example 2: FORCE FORCE Study   Local public health agency in Sault Ste. Mari was working with the home care agency and a patient advocacy group because they noticed a problem with admissions to hospital in older adults with falls and fractures. Existing evidence for management of osteoporosis available   Ciaschini P, Straus SE, Dolovich L et al. Age and Ageing 2009;38:723-30 Ciaschini P, Straus SE, Dolovich L et al. BMC Geriatr. 2010 Aug 27;10:60. FORCE Study They engaged primary care clinicians, general internists, pharmacists and rehabilitation therapists  They did a local study showing that less than 40% of these people get assessed for osteoporosis or falls risk  Identified barriers and facilitators to adaptation of the evidence  ◦ Lack of primary care clinicians; lack of referral to specialists, lack of knowledge of significance of OP… FORCE Study Randomised trial of a multi-component educational intervention aimed at enhancing implementation of falls and osteoporosis management strategies for high-risk patients  Randomised 201 patients to immediate intervention or delayed intervention  Patients in the delayed intervention group were offered the intervention at 6 months  Results  Appropriate OP therapy  56% of IP group vs. 27% of DP group at 6 months (RR 2.09 [95% CI 1.29 to 3.40])  At 12 months, there was no difference between the 2 groups  Number of falls in IP group was greater at 12 months  (RR  2.07 [95% CI 1.07 to 4.02]) Quality of life enhanced in intervention group End of Grant KT Strategy Focus in this example is on dissemination  Rationale for strategy:   It is a single, small study that should inform local implementation efforts  Does not need a complex, multicomponent strategy  The results can also inform future KT research initiatives Dissemination  Published protocol for trial in open access journal (Trials. 2008 Nov 4;9:62)  Published results of trial in Age and Ageing  Local members of research team (Carol Wood, Patricia Ciaschini) presented results of project at local, regional and provincial meetings  Used the results to inform the development of a self management intervention for patients with osteoporosis  This was based on feedback from the research team and relevant stakeholders • • • • • Writing the End of Grant KT Section Goals Audience Strategies Expertise Resources Key word: Appropriateness Judicious KT For all KT activities the most important consideration is appropriateness. Each discipline, research project, and knowledge-user community is different. When there are limitations on the validity or generalizability of the results with few potential knowledge-users, a modest approach is most appropriate. The key to a successful plan is to ensure that there is a match between the expected research findings, the targeted knowledge-users and the KT strategies selected. Note: The application of the results of a single study is usually not appropriate. Synthesized evidence is robust and mature, constituting the best knowledge for application. For more information, visit our web page: http://www.cihr-irsc.gc.ca/e/29418.html http://www.cihr-irsc.gc.ca/f/29418.html [email protected] Thank you