Knowledge Translation and Equity for Information in Health Sciences relevant to this session on :

1. Knowledge Translationand Equity for Information in Health Sciences relevant to this session on : Research, Communication and Decision Making

2. Canadian Institutes of Health Research [CIHR] New role in Communication and Decision Making • A Unique Mandate: • The Canadian Govt has revitalised its Health Research • mandate through the establishment of 13 virtual health institutes. • The parliamentary act states : • The objective of the CIHR is to excel, according to • internationally accepted standards of scientific excellence, • in the creation of newknowledgeand itstranslationinto: • improved health …. • more effective services and products.. • a strengthened health care system.. • [CIHR Act; April 2000]

3. Canadian Global Health Research Initiative2001 • CIHR – IDRC – CIDA - Health Canada • International Development Research Centre (IDRC) • Experience fostering research in developing countries; • Program in Equity and Knowledge Transfer • Health Canada (HC) • Considerable networks, knowledge base and recognized • leadership; • Canadian International Development Agency (CIDA) • Considerable development experience • and its emphasis onevidencebased health development; • Canadian Institutes of Health Research (CIHR) • Strong tradition of excellence in research through the • peer-review process; new commitment to research transfer • & knowledge exchange.

4. Canadian Global Health Research Coalition: Vision: • Equity-oriented focus • Knowledge Generation and Knowledge Translation • Balanced approach • Putting Southern countries first • Inclusive partnerships • Mentoring • Link to international development agenda

5. Draft Framework:Knowledge Translation ‘ Cube’ Policy Makers Health Providers Consumers Uses of Health Knowledge KT6 KT5 KT4 Media Stage of KT Research Cycle KT3 KT2 Researchers KT1 1 2 3 4 Research Pillars Sources of Knowledge

6. Draft Framework:Knowledge Translation ‘ Cube’ Policy Makers Health Providers Consumers Uses of Health Knowledge KT6 KT5 KT4 Media Stage of KT Research Cycle KT3 KT2 Researchers KT1 1 2 3 4 Research Pillars Sources of Knowledge

7. Knowledge Translation Research Cycle Evidence implementation Evidence generation Define the health problem 6. Measure variations in utilization & outcomes 1.Generate new information 5. Develop measures of utilization & outcomes 2.Summarize existing evidence 3. Combine evidence on benefits, harm, costs & preferences 4. Create evidence-based messages and performance criteria

8. Draft Framework:Knowledge Translation ‘ Cube’ Policy Makers Health Providers Consumers Uses of Health Knowledge KT6 KT5 KT4 Media KT3 Stage of KT Research Cycle KT2 Researchers KT1 1 2 4 3 Population Basic Clinical Research Pillars -Sources of Knowledge

9. Draft Framework:Knowledge Translation ‘ Cube’ Policy Makers Health Providers Consumers Uses of Health Knowledge KT6 KT5 KT4 Media Stage of KT Research Cycle KT3 KT2 Researchers KT1 1 2 3 4 Research Pillars Sources of Knowledge

10. Knowledge Translation Cube Policy Makers Health Providers Consumers Uses of Health Knowledge KT6 KT5 KT4 Media KT3 Stage of Research Cycle KT2 Researchers KT1 1 2 3 4 Research Pillars Sources of Knowledge

11. Knowledge Translation relevant to Policy Makers • They need the Evidence on which interventions in health actually do more good than harm! • Example: Web-Based Cochrane Library www.Cochrane.org VHL Version for Latin America and Caribbean- Stay tuned for Dr Abel Packer!

12. Cochrane Collaboration Objectives To help people make well informed decisions by preparing, maintaining and promoting access to systematic reviews of studies on the effects of health and health care practices and policies. Www.Cochrane.org

13. Campbell Collaboration Objectives To help people make well informed decisions by preparing, maintaining and promoting access to systematic reviews of studies on the effects of -----------, -----, and ------ interventions upon health.

14. Campbell Collaboration Objectives To help people make well informed decisions by preparing, maintaining and promoting access to systematic reviews of studies on the effects of educational, legal and social interventions upon health. www.campbellcollaboration.org

15. The Cochrane Collaboration Knowledge Translation (KT) KT: Evidence synthesis KT: Dissemination Primary studies KT: policymakers practitioners consumers KT:Informed decisions

16. Knowledge Translation for Policy Makers Cochrane reviews being undertaken relevant to the ten projected leading causes of Disability-Adjusted Life Years in 2020, DEVELOPED REGIONSIschaemic heart disease YesCerebrovascular disease YesUnipolar major depression Yes Trachea, bronchus and lung cancers YesRoad traffic accidents YesAlcohol use YesOsteoarthritis YesDementia YesChronic obstructive lung disease YesSelf-inflicted injuries Yes

17. Knowledge Translation for Policy Makers Cochrane reviews being undertaken relevant to the ten projected leading causes of Disability-Adjusted Life Years in 2020, IN DEVELOPING REGIONS Unipolar major depression Yes Road traffic accidents Yes Ischaemic heart disease Yes Chronic obstructive lung disease Yes Cerebrovascular disease Yes Tuberculosis Yes Lower respiratory tract infections Yes War injuries Yes Diarrhoeal diseases Yes HIV Yes

18. Title of this talk emphasised Equity Knowledge Translationand Equity for Information in Health Sciences relevant to this session on : Research, Communication and Decision Making

19. New Cochrane-Campbell Project-Apply the ‘Equity Lens’ to all Cochrane and Campbell Reviews • Document whether the .Cochrane [Health] Interventions .Campbell [Educational,Legal,Social] Interventions do they work in the disadvantaged?

20. Equity: Do therapies that work in the Rich also work in the Poor Aspects? • In many situations probably not! Poor access Poor healthcare Poor Compliance • Recognised Need for a VHL Database for the ‘Poor’

21. Strategies for tackling health inequalities We need international exchange of experiences with developing and implementing interventions and policies to reduce socioeconomic inequalities in health in order to increase learning speed in this field J P Mackenbach BMJ 2002;325:1029–32 U of O IPH is Co-Convening with U of Aberdeen in UK , a joint Methods Gp in Equity Interventions within Campbell and Cochrane Collaborations

22. New Cochrane/Campbell Group:Systematic reviews of Interventions to reduce socioeconomic inequalities in healthAustralia, Canada, Norway, South Africa, UK, USA Please join us!

23. New Cochrane/Campbell Equity GroupObjectives: • To apply the ‘Equity Lens’ to all Cochrane/Campbell Reviews to identify interventions that improve health status in the disadvantaged and reduce health inequities • Series of systematic reviews on effective interventions • Link this into Virtual Health Libraries

24. What does applying the Equity Lens to Cochrane /Campbell Reviews mean? Disadvantaged is not just Socio-economic Status! What other groupings of disadvantaged should one consider?

25. Equity Gradients -Not just Socio-economic Status! • ‘PROGRESS’ [Evans and Brown]. • Place of Residence • Race/ethnicity • Occupation • Gender • Religion • Education • SES • Social networks/resources

26. Current Project with Library Scientists: How do we search the literature including Cochrane and Campbell databases for the different groups of Disadvantaged?

27. Search terms for Equity • TermMeSHKeywordsEquityequit$ or inequit$ Inequalityequalit$ or inequalit$ • P - Place of residence (urban vs. rural)Urban population/ or rural population/ or Rural or urban or inner city or residence • R – Race/ethnicity Exp Ethnic Groups or eh.fs. (ethnology sub-heading)Ethnic$ or ethnol$ or Aborigines or Arabs or Asian Americans or Blacks or Eskimos or Gypsies or Hispanic Americans or Indians, or Jews or Whites or racism or segregation • O – Occupation Occupations/ (this is a term under socioeconomic factors) or employmentVocation$ or occupation$ or job or profession or career or employment • G – Gender Male/ of female/ or prejudice (for bias)Male or female or gender or sexism or discrimination • R – Religion Exp ReligionReligion or religious or prayer or meditate$ (add specific religions?) • E – Education (educational level)Exp educationEducation or school$ or college or university$ or degree (may bring too many off-focus articles) or certificate or certified or professional • S – Socioeconomic status Exp Socioeconomic factors/Socioeconomic or poverty or standard$ of living or high-income population or low-income population • S – Social capital/resources *Culture/Social values, custom$, belief$ Project: 10% sample to establish a baseline

28. CIHR KT Cube Policy Makers Health Providers Consumers Uses of Health Knowledge KT6 KT5 KT4 Media KT3 Stage of Research Cycle KT2 Researchers KT1 1 2 3 4 Research Pillars Sources of Knowledge

29. The Cochrane Collaboration Knowledge Translation (KT) KT: Evidence synthesis KT: Dissemination Primary studies KT: policymakers practitioners consumers KT:Informed decisions

30. Knowledge Translation relevant to Clinicians and Health Practitioners • They need the Evidence on which interventions in health actually do more good than harm! • Example: Web-Based Cochrane Library www.Cochrane.org VHL Version for Latin America and Caribbean- Stay tuned for Dr Abel Packer!

31. Mexican Cochrane Centre/Information Center for Decisions in Health (CENIDS) of the National Institute for Public Health (INSP). Dr Gladys Faba et al Project on evidence-based, user-friendly bulletins for primary care physicians, nurses and health care administrators. • The content is based on up-to-date Cochrane reviews of the evidence and includes information on etiology, management, prevention and diagnosis. • The Ministry of Health is actively engaged in the project by suggesting priority health areas and supporting implementation. • Evaluation to date has very positive, focusing on health practitioner satisfaction and self-reported use of the bulletins. • Equity: Because these bulletins are directed towards primary care needs and distributed to rural practitioners serving the poorest communities and with little access to continuing medical education, it will be great interest to assess whether these bulletins will help reduce socioeconomic inequities in health.

32. CIHR KT Cube Policy Makers Health Providers Consumers Uses of Health Knowledge KT6 KT5 KT4 Media KT3 Stage of Research Cycle KT2 Researchers KT1 1 2 3 4 Research Pillars Sources of Knowledge

33. Health Consumers • They also need the Evidence on which interventions in health actually do more good than harm! • Example: Web-Based Cochrane Library www.Cochrane.org VHL Version for Latin America and Caribbean- Stay tuned for Dr Abel Packer!

34. Cochrane Reviews for Consumers on the Internet www. cochrane.org www. cochraneconsumer.com

35. Knowledge Translation Consumer Projects using Cochrane for research, communication and decision-making.

36. The ‘expert consumer.’KT Project CIHR 2003 • Cochrane/Campbell Evidence for the 4 characteristics of an ‘effective consumer’. • Ability to understand health condition and their benefits and harms. • Ability to clarify personal values for options, benefits and harms. • Ability to negotiate chosen role in care. • Ability to negotiate and achieved preferred health options Please join us if you are interested !

37. Shared Decision Making and the Health Coach Concept • Goal: Improve evidence-based decision making capacity of women and girls (gatekeepers to the health of families) • Strategies • Decision support tools • Health coaches

38. Health Coaching in Chile • Project Partners • University of Ottawa • Pontificia Universidad Católica de Chile • Comuna of La Pintana • A CIDA funded project

39. Finally.. Next Steps • Equity and Knowledge Translation are priority areas in Canada. • Plans for follow-up grants for global networks and centres linked to international development agenda • Need Inclusive Knowledge Translation Partnerships • Health Science Libraries and Virtual Health Libraries will be essential to the success of this!

41. Research Transfer/ Knowledge Exchange Partnerships are the key: • Researchers -- research “producers” • in universities, institutes, government departments • Research users” – the “four P’s”: • Program administrators • Policy makers • Practitioners – clinical/public health • Public – including NGOs/”civil society” organizations • Unlimited potential and synergy in pursuing opportunities!