How to transfer

1. How to transfer Jaleh Gholami Eshlaghi MD. MPH. PhD Candidate in Epidemiology

2. اهداف آموزشی این بخش • آشنایی با اصول کلی که در هنگام انتقال دانش باید در نظر گرفت • آشنایی با برخی از روش های انتقال دانش برای گروه های متفاوت مخاطبین • آشنایی با روش های موثر انتقال دانش • توجه به اثربخشی روش های انتقال هنگام تدوین استراتژی انتقال

3. Review Message (WHAT?) Level of Evidence Target Audience ( To WHOM?) Messenger (BY WHOM?) Barriers Knowledge transfer process and support system (HOW?) Evaluation (with what EFFECT should it be transferred?)

4. Consider the audience • Knowledge sharing requires an understanding of the problems audiences face, the level of detail they need, and the style of thinking they use. • The message must be one that is valuable to an audience based on their needs, delivered by a messenger they can trust, in language they are comfortable with.

5. Use Plain Language • Researchers, service providers, and policymakers may talk about their work in diverse ways. Researchers may communicate with one another in highly technical terms, whereas service providers may discuss similar issues in language based on their daily work, and policymakers in political jargon. If a community of people sharing knowledge spans several disciplines and contexts, a common language is needed.

6. Example • مرور نظام مند و متاآناليز كارازمايي هاي باليني شاهد دار تصادفي شده نشان مي دهد كه ميزان خطر نسبي شكستگي ران براي مصرف ويتامين D به تنهايي 1.1 (با حدود اطمينان 95% 0.89-1.36) مي باشد در حالي خطر نسبي شكستگي ران در صورت مصرف ويتامين D و مكمل كلسيم برابر با 0.82 (با حدود اطمينان 95% 0.71, 0.94) مي باشد. • ويتامين D در صورت مصرف مكمل كلسيم باعث كاهش خطر شكستگي ران مي شود در صورتي كه مصرف ويتامين D‌ به تنهايي اين تاثير را ندارد.

7. Evidence based medicine should be complemented by evidence based implementation. Richard Grol

8. professional behavior change strategies • Printed Educational material (Clinical Practice Guideline, audio-visual materials, and electronic publications) • Educational Meeting • Didactic meeting (Lectures, Conferences) • Interactive Educational Meeting (workshop) • Educational Outreach (Prescribing behavior) • Local opinion leaders (Educationally influential providers) • Audit and feedback (Any summary of Clinical performance) • Reminders (Patient or encounter specific information)

9. Clinical Practice Guideline • Evidence-based clinical practice guidelines are knowledge tools defined as systematically developed statements that help clinicians and patients make decisions about appropriate health care for specific clinical circumstances. • clinical practice guidelines should facilitate high-quality practice informed by evidence,

10. How are clinical practice guidelines developed? essential elements • Establish multidisciplinary guideline team • Identify clinical question that explicitly defines the patients, intervention/exposure, comparisons (if relevant), outcomes of interest and setting • Conduct a systematic review of evidence • Appraise and interpret evidence and come to consensus on its meaning • Draft guideline recommendations that align with evidentiary base • Complete an external review of draft report among intended users and key stakeholders • Revise the guidelines in response to external review • Read the final guideline report for distribution and dissemination • Prepare implementation strategy

11. How do we determine the quality of clinical practice guidelines? • Appraisal of Guidelines Research and Evaluation(AGREE) • Guideline Implementability Assessment (GLIA) tool • The ADAPTE tool that provides criteria to evaluate the clinical fidelity of recommendations and their link to evidence.

12. Local opinion leaders • local opinion leaders are “providers nominated by their colleagues as educationally influential”. • Opinion leadership is the degree to which an individual is able to influence other individuals’ attitudes or overt behavior informally in a desired way with relative frequency.

13. Local opinion leaders This informal leadership is not a function of the individual’s formal position or status in the system, it is earned and maintained by the individual’s • Technical competence, • social accessibility, and • conformity to the systems norms. opinion leaders have more: • external communication, • higher social status, • innovative.

14. Local opinion leaders characteristics in Iran • 1) High level of knowledge • 2) Communication skills • 3) Taking into account stakeholders • 4) Professional ethics

15. 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 15/47 G049 G114

16. Effectiveness of professional behavior change strategies • Printed Educational material (Clinical Practice Guideline, audio-visual materials, and electronic publications) • Educational Meeting • Didactic meeting (Lectures, Conferences) • Interactive Educational Meeting (workshop) • Educational Outreach (Prescribing behavior) • Local opinion leaders (Educationally influential providers) • Audit and feedback (Any summary of Clinical performance) • Reminders (Patient or encounter specific information)

17. strategies focusing on patients • Patient decision aids • Personalized risk communication (Uptake for screening test) • Interactive Health Communication Applications (Information packages for patients that combine health information with at least one of social support, decision support, or behavior change support) • Interventions to enhance medication adherence (Instruction, Automated telephone monitoring and counseling, manual telephone follow-up, Reminders, special ‘reminder’ pill packaging, dose-dispensing units and medication charts, appointment and prescription refill reminders, direct observation of treatments, …)

18. Patient Decision Aids A review of 2500 treatments found that only 17% had adequate scientific evidence to be classified as black or white; the majority were “grey” either because of insufficient evidence or because the balance between benefits and harms was close. • birth control, • options for menopause symptoms, • back pain, • osteoarthritis, • end-of-life care, • genetic testing, • breast and prostate cancer treatment,

19. What are patient decision aids? Patient decision aids translate evidence into patient-friendly tools to inform patients about their options, help them clarify the value they place on benefits versus harms, and guide them in the process of decision making. Formats for decision aids are: • paper-based booklets, • video/DVDs, • decision boards, • and internet-based materials

20. presentation of outcome probabilities

21. clarify patients’ values for outcomes

23. Ottawa Hospital Research Institute (OHRI)

24. How do we determine the quality of patient decision aids?

25. Effectiveness of knowledge translation strategies focusing on patients • Patient decision aids • Personalized risk communication (Uptake for screening test) • Interactive Health Communication Applications (Information packages for patients that combine health information with at least one of social support, decision support, or behavior change support) • Interventions to enhance medication adherence (Instruction, Automated telephone monitoring and counseling, manual telephone follow-up, Reminders, special ‘reminder’ pill packaging, dose-dispensing units and medication charts, appointment and prescription refill reminders, direct observation of treatments, …)

26. Do patient decision aids work? PDAs improve: • patients’ participation in decision making, • knowledge of options, • agreement between patients’ values and the subsequent treatment or screening decisions. • realistic expectations of the chances of benefits, harms, and side effects • More use of conservative options, • without apparent adverse effects on health outcomes or anxiety.

27. Effectiveness of knowledge translation strategies focusing on policy makers and senior health service managers • In contrast to the substantial evidence base on the effectiveness of knowledge translation strategies targeting health care professionals and patients, we are not aware of any experimental studies evaluating the effects of knowledge translation research that focused on policy makers or senior health service managers.

29. “Reader Friendly Writing” Writing for health policy makers, planners and managers(Canadian Health Service Research Foundation) 1:3:25 1: Main message 3: Executive Summary 25: The Report

30. 1 صفحه: پيام اصلي (قلب گزارش) • چه كسي است این گزارش را می خواند؟ • لازم است چه مطلبي را در مورد اين پژوهش بداند؟ • چه چيز از يافته هاي اين مطالعه بر مي آيد؟ • كنار گذاشتن كليه متون • نكاتی كه مخاطب بايد از آن آگاه شود به صورت فهرست وار • ذكر خلاصه نتايج ممنوع • لازم نيست پيام شما حاوي توصيه هاي مشخص باشد، اگر نمي توان نتيجه گيري قطعي نمود سوال مشخصي را كه بايد به آن پاسخ داد به صورت واضح مطرح نماييد و از نوشتن “پژوهش هاي بيشتري مورد نياز است” بپرهيزيد.

31. 3 صفحه: خلاصه اجرايي • نكات داراي اهميت بيشتر در ابتداي متن و نكات كم اهميت تر در ادامه • نگارش با زبان شفاف و روشن ولي غيرعاميانه به گونه اي كه فرد ناآشنا به پژوهش آن را كاملا درك نمايد • اشاره به موضوع مورد بررسي و پاسخ هاي بدست آمده • يافته هاي طرح به صورت فشرده • روش اجرا و جزئيات تكنيكي در حد 2-1 سطر

32. 25 صفحه: گزارش • زمينه و سابقه Context: سوال پژوهش، پژوهش هاي قبلي و سهم اين پژوهش در پاسخ به سوال • مفاهيم Implications: مفهوم يافته ها براي مدير يا سياست گذار، ذكر گستره تعميم نتايج، تفكيك پيام ها • رويكرد Approach: طراحي مطالعه، روش ها، منبع داده ها، جزئيات نمونه گيري، تكنيك هاي آناليز و ... • نتايج Results: نگارش نتايج به صورت خلاصه و پررنگ نمودن پيام ها، استفاده از جداول و نمودارها • منابع اضافي Additional Resources: ساير منابع كه براي سياست گذار مي تواند مفيد باشد • پژوهش هاي بيشتر Further Research: فهرست نمودن شكاف هاي موجود، طرح پرسش هاي مشخص • مراجع و كتابشناسي References and Bibliography: مشخص نمودن مواردي كه مفيدتراست • پيوست: يافته هايي كه مستقيما به نتيجه گيري ارتباط ندارند، مواد و روش هاي تكنيكي، مراجعي کامل

34. Effect sizes of multifaceted interventions by number of interventions

35. رسانه های گروهی • در یک پژوهش در شهر تهران نزديک به 50% از مردم اعلام کردند ازطريق صدا و سيما اطلاعات بهداشتي وپزشکي خود راکسب مي کنند. در حالی که 16درصد پاسخگويان از«پزشکان»، 11درصد از«کتاب ها» 9درصد از«افراد عادي» (آشنايان واقوام) و 6 درصد از«مطبوعات» اطلاعات بهداشتي وپزشکي خود راکسب مي کنند. • در مطالعه ای 58% مردم اعلام داشتند که اخبار سلامت کسب شده از طریق رسانه، موجب تغییر رفتار و نگرش آنها نسبت به مسائل سلامت شده است. برخی بیماران تحت تاثیر اخباری که پخش می شود حتی نحوه درمان خود را تغییر می دهند.

36. منبع اطلاعات پزشكان و مردم در زمينه بيماري آنفلوانزاي خوكي 2 ماه پس از آغاز پاندمی بيماري 75/6% پزشكان و 80/1% مردم اطلاعات خود را در زمينه بيماري آنفلوانزاي خوكي از تلويزيون و يا روزنامه ها و مجلات عمومي بدست آورده بودند.

37. ارزش هاي خبري از نگاه خبرنگاران • تازگی خبر • موضوع روز • موضوعات در مورد مسائل مهم • فراگير بودن (جمعيتي مخاطب بزرگتر باشد) • عدد بزرگ • شهرت بیان کننده خبر • مجاورت (كشورهاي همسايه) • استثنا بودن خبر • اخبار در زمینه يك برخورد يا چالش

38. در مطالعه ای که در مرکز تحقیقات بهره برداری از دانش سلامت در سال 1387 صورت گرفت مشاهده شد که حدود 18% اخبار سلامت درج شده در روزنامه های عمومی از نظر شواهد علمی فاقد صلاحیت انتشار می باشند.

39. معيارهای ارزيابي اخبار درمان معيارهای ارزيابي اخبار مربوط به درمان در امریکا: • بحث در مورد هزینه ها • سنجش فواید • سنجش زیان ها • اشاره به دیگر گزینه های موجود • جستجوي منابع و توجه به تعارض منافع در منبع خبر • اجتناب از استفاده تجاری از بیماریها • کیفیت شواهد • جدید بودن موضوع مورد بررسی • بررسي در دسترس بودن روش • بررسی های فراتر Gary Schwitzer. How Do US Journalists Cover Treatments, Tests, Products, and Procedures? An Evaluation of 500 Stories.PLoS Medicine. May 2008, 5(5).

40. Key Messages • Knowledge sharing requires an understanding of the problems audiences face, the level of detail they need, and the style of thinking they use. • Evidence based medicine should be complemented by evidence based implementation. • Interactive or mixed/interactive educational meetings were generally • effective resulting in moderate. In contrast, didactic meetings were largely ineffective. • There is not any evidence of the effects of knowledge translation strategies that focused on policy makers or senior health service managers.