KNOWLEDGE TRANSLATION IN HEALTH PROMOTION: FUTURE PERSPECTIVES

1. First National Health Promotion Conference March 30-April 1 2013 Sujan Babu Marahatta, PhD, Member of American College of Epidemiology (MACE) Associate, Institute of Public Health Calgary University CANADA Associate Professor, Manmohan Memorial Medical College/MMIHS KNOWLEDGE TRANSLATION IN HEALTH PROMOTION: FUTURE PERSPECTIVES

2. Knowing is not enough; we must apply Willing is not enough; we must do Goethe

3. Doesn’t all health research have an impact? Consistent evidence of failure to translate research findings into clinical practice 30-45% patients do not get treatments of proven effectiveness 20–25% patients get care that is not needed or potentially harmful (McGlynn et al, 2003; Grol R, 2001; Schuster, McGlynn, Brook, 1998;) Cancer outcomes could be improved by 30% with optimum application of what is currently known 10% reduction in cancer mortality with widespread use of available treatment (CSCC 2001; Ford et al, 1990)

4. This is Not a New Problem :The Case of Scurvy 1601 : Lancaster shows that lemon juice supplement eliminates scurvy among sailors 1747 : Lind shows that citrus juice supplement eliminates scurvy 1795 : [ 194 years after discovery ] British Navy implements citrus juice supplement Science l981; 221: 881

5. Knowledge translation ‘All breakthrough, no follow through’ Woolf (2006) Washington Post op ed • The benefits of the US $100 billion/year worldwide investment in biomedical and health research are not optimally achieved because of knowledge translation failures

6. Knowledge Translation is the bridge between discovery and impact KNOWLEDGE TRANSLATION RESEARCH INPUT RESEARCH IMPACTS

7. Knowledge Translation: Definition The synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health CIHR Definition

8. What is Knowledge Translation? Ethically sound application of knowledge • The contextualization and integration of research findings of individual research studies within the larger body of knowledge on the topic. • Synthesis is a family of methodologies for determining what is known in a given area or field and what the knowledge gaps are. Knowledge synthesis • Involves identifying the appropriate audience for the research findings, and tailoring the message and medium to the audience. Dissemination • Refers to the interaction between the knowledge user and the researcher resulting in mutual learning, it encompasses the concept of collaborative or participatory, action oriented research where researchers and knowledge users work together as partners to conduct research to solve knowledge users’ problems (Integrated KT). Knowledge exchange • The iterative process by which knowledge is actually considered, put into practice or used to improve health and the health system. • KT activities must be consistent with ethical principles and norms, social values as well as legal and other regulatory frameworks

9. What is Knowledge Translation? Knowledge translation is about: Making users aware of knowledge and facilitating their use of it to improve health and health care systems Closing the gap between what we know and what we do (reducing the know-do gap) Moving knowledge into action Knowledge translation research (KT Science) is about: Studying the determinants of knowledge use and effective methods of promoting the uptake of knowledge

10. So What are Key Characteristics of KT? Knowledge is connected to research Actively connected to user/beneficiary group(s) Inclusive of all activities from generation of new knowledge to its use 10

11. Two broad categories of KT The researcher develops and implements a plan for making knowledge users aware of the knowledge generated through a research project End of grant KT The researcher engages potential knowledge users as partners in the research process. This requires a collaborative or participatory approach to research that is action oriented and is solutions and impact focused. Integrated KT

12. Health promotion ……. “is the process of enabling people to increase control over and to improve their health” (Ottawa Charter ’86) “involves the facilitation of skills in individuals and change in environments which impact positively on health” (VicHealth 2005) “is everyone’s business” (CEO DHCS 2004)

13. Health Promotion Focus on the whole population. Use a number of interventions simultaneously. Support people to make a ‘healthy’ choice. Historically has been skewed towards education, need all strategies and approaches, not just one

14. The Ottawa Charter for Health Promotion • Build healthy public policy • Create supportive environments • Strengthen community action • Develop personal skills • Re-orient health services

15. Challenges of Evidence-Based Health Promotion • Defining what it means • Finding the relevant evidence • Assessing the evidence • Using the evidence appropriately • Creating new evidence • Sharing the evidence

16. Social model of health/ life course Lynch 2000

17. Increasing the use of health promotion evidence in policy and practice CURRENT HEALTH PROMOTION POLICY AND PRACTICE Evidence Based Interventions EVIDENCE Health promotion policy and practice Evidence based interventions

18. Shifting Paradigms . . . Old Paradigm -Researchers do research -They communicate it effectively -Recipients use the results . . . One way knowledge transfer • New Paradigm • Researchers and users select topic, questions • Researchers and users bring different expertise • Joint interpretation, application • in specific context Knowledge translation Multi-directional, and multiple inputs from research, practice, experience and culture

19. Knowledge Inquiry Tailoring Knowledge Synthesis Products/ Tools Monitor Knowledge Use Select, Tailor, Implement Interventions Evaluate Outcomes KNOWLEDGE CREATION Assess Barriers/Facilitators to Knowledge Use Sustain Knowledge Use Adapt Knowledge to Local Context ACTION PHASES Identify Problem Identify, Review, Select Knowledge Defining Knowledge translation Straus et al. CMAJ 181:165-168,2009 Knowledge-to-action process

20. Knowledge Translation Process Source: Nieva VF, et al. From Science to Service: A Framework for the Transfer of Patient Safety Research into Practice, Advances in Patient Safety, Vol 2. p.441-453

21. Some general KT principles for achieving impact 1.Researchers need to do the right research need for synthesis to determine what we already know (or should know if we were to summarize the existing knowledge) need to determine where there is a strong evidence base and move that evidence into action today's health problems are complex and interdisciplinary and require mixed methods to solve primary research needs to be targeted to fill the known gaps in our knowledge base primary research needs to be solutions-based

22. Some general KT principles for achieving impact Theright people need to be involved from the beginning need applied, collaborative, interdisciplinary research (in other words: integrated KT) users of the research need to be helping to set the research agenda and define the research questions to ensure relevance and greater likelihood of uptake of the results when they become available

23. Some general KT principles for achieving impact Knowledge-users need to make the research rightfor their own context research is not used like a can opener knowledge-users need to adapt, contextualize and take ownership of knowledge for local use as research producers, this means we need to help them sufficiently understand our work so that they are able to put it to use

24. Achieving impact:closing the gap between evidence and action How to close the gap between evidence and action: shift attention from individual adopters to the organizational and environmental context for change set targets for change monitor uptake of the research and evaluatethe health and system outcomes/impact keep it simple focus on a few important targets, practical indicators

25. Practical ingredients for success in health promotion • Researcher community collaboration • Role of credible champions • Aligning with larger policy trajectories • Linking with existing organizational activities • Addressing concerns of decision makers • Using effective communication strategies

27. TAKE HOME MESSAGE Making users aware of knowledge and facilitating their use of it Closing the gap between what we know and what we do Moving knowledge into action

28. THANK YOU FOR ATTENTION sujanmarahatta@gmail.com