Maureen Dobbins RN, PhD Kara DeCorby, MSc Paula Robeson RN, MScN Donna Cilisaka, RN, PhD

1. The Power of Tailored Messaging: Preliminary results from Canada’s first knowledge brokering trial Maureen Dobbins RN, PhD Kara DeCorby, MSc Paula Robeson RN, MScN Donna Cilisaka, RN, PhD Helen Thomas, RN, MSc Steve Hanna, PhD Steve Manske, PhD Shawna Mercer, PhD Linda O’Mara Roy, Cameron, PhD

2. Research Objectives • evaluate the effectiveness of knowledge transfer and exchange (KTE) strategies • promote evidence-informed decision making (EIDM) in public health • evaluate the usefulness of health-evidence.ca Canadian Health Libraries Association May 31, 2007

3. Rationale • a KTE strategy is needed to move effective research into public health policies and programs • the promotion of healthy body weight (HBW) is a priority in the Canadian health care system • the feasibility and impact of a knowledge broker (KB) needs further exploration within the health care sector Canadian Health Libraries Association May 31, 2007

4. Study Design • RCT • Canadian health units (n=108) • unit of analysis – organization • study participants - person most responsible and actively involved in decisions related to HBW program/policy Canadian Health Libraries Association May 31, 2007

5. Intervention 3 intervention groups • Control • Access to an online registry of effectiveness evidence at health-evidence.ca • Tailored Messaging • Registry access + targeted messages containing summaries and full text to 8 systematic reviews • Knowledge Brokering • Registry access + targeted messages + one-to-one interaction with a knowledge broker Canadian Health Libraries Association May 31, 2007

6. Hypotheses •  KTE strategy intensity ⇒incorporation of evidence • specific organizational characteristics will explain variation between health units •  level of interaction in the KTE strategy ⇒  DM satisfaction with the intervention Canadian Health Libraries Association May 31, 2007

7. Health-evidence.ca • accessible online registry • appraised reviews of effectiveness of interventions (~800) • registered users (2,000) • Canadian (~80%) • U.S., Australia, & U.K. (20%) • largest user groups are • public health nurses, program managers, health promotion workers, researchers, & program coordinators • librarians, dieticians, medical officers of health, & nutritionists. Canadian Health Libraries Association May 31, 2007

8. Scope of brokering activities • support • mentoring • knowledge & skill development • resource development • dissemination • facilitating KTE activities within organizations Canadian Health Libraries Association May 31, 2007

9. Timeline • Fall 2004 – baseline survey & re-survey • Fall/Winter 2004 – document collection • October 2004 – KB hiring & orientation • Jan-Dec 2005 – KTE intervention implemented • February 2006 – post-intervention survey • January 2007 – one-year follow-up & qualitative interviews Canadian Health Libraries Association May 31, 2007

10. Knowledge utilization survey • specific outcome measures include • incorporation of results of the disseminated reviews into policy and/or programming decision making processes • impact of results of the systematic reviews on actual HBW policy/program • decision-making process itself • decision makers’ satisfaction with KTE strategy Canadian Health Libraries Association May 31, 2007

11. Data Analysis • survey data analyzed using SPSS 15.0 • qualitative data analysis by two reviewers using Nvivo 7.0 • data sources • health unit documents • broker’s daily reflective journal • in-depth interviews Canadian Health Libraries Association May 31, 2007

12. Quantitative results • 76% participation rate • No significant differences between groups at baseline • 81.5% follow-up rate (post intervention) • Tailored messaging was significantly more effective in promoting EIDM compared to knowledge brokering or control (p<.009) • Extent to which organization valued research evidence moderated treatment effect Canadian Health Libraries Association May 31, 2007

13. Canadian Health Libraries Association May 31, 2007

14. Qualitative Results • +ve effect of the KB on incorporation of research results into decision making, including: •  value placed on EIDM • knowledge & skill development in the evidence-based process •  value placed on KB’s role in overcoming barriers Canadian Health Libraries Association May 31, 2007

15. Knowledge broker reflections • common issues & needs • identification of needs • early personal contact •  knowledge & skill development •  organizational change efforts • development of supportive networks •  access to practical quality resources •  use of systematic reviews Canadian Health Libraries Association May 31, 2007

16. Implications Policy and Practice • unclear why these results were observed & how to interpret • EIDM process is slow • impact of knowledge brokering • much more complex than previously considered • very difficult to measure objectively • continued PHDM capacity development needed Canadian Health Libraries Association May 31, 2007

17. Implications Evaluation and Research • objective measurement of KB impact is challenging • more empirical research on the impact of knowledge brokers is needed • long term outcome measurement needed Canadian Health Libraries Association May 31, 2007

18. Looking ahead • currently analyzing qualitative interviews to help explain quantitative results • submitted a multi-year grant to continue to evaluate the impact of brokering and tailored messaging in the long-term • expanding focus to measure organizational characteristics (precursors to EIDM) Canadian Health Libraries Association May 31, 2007

19. Acknowledgements The research project gratefully acknowledges the support of: • Canadian Institutes of Health Research (CIHR) • City of Hamilton Public Health Research, Education and Development (PHRED) Program • McMaster University, Faculty of Health Sciences Canadian Health Libraries Association May 31, 2007