Integrated vs. End of Grant Knowledge Translation Approaches & Ian D Graham

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
Ian.graham@cihr-irsc.gc.ca
Thank you