A Framework for
Disseminating Research
Evidence to Child Health
Clinicians & Policy Makers
Susan Jack, RN, PhD, McMaster University,
Hamilton, ON, Canada
Lil Tonmyr, MSW, PhD, Public Health Agency
of Canada, Ottawa, ON, Canada
1ST INTERNATIONAL SOCIETY FOR CHILD INDICATORS CONFERENCE, CHICAGO, IL
June 2007
Workshop Objectives
 Identify factors influencing the
utilization of research evidence by
decision-makers
 Develop a knowledge transfer &
exchange (KTE) strategy to
disseminate research findings
 Discuss a KTE strategy developed to
disseminate findings from the Canadian
Incidence Study of Reported Child
Abuse & Neglect (2003)
A Knowledge Transfer Story
….circa 1747
Time Elapsed from Lancaster to Adoption: 264 years
1497
1601
1747
1795
1865
Vasco da
Gama Rounds
Cape of Good
Hope to find
sea route to
India. Of the
160 crew, 100
die of scurvy
Captain
Lancaster
sails with 4
ships; Crew
#1 given
3tsps lemon
juice daily
Dr. James
Lind
conducts
random trial
of six
treatments
for scorbutic
sailors
British
Navy
orders
citrus fruit
in diet for
sailors
British Board
of Trade
orders citrus
on merchant
marine
vessels
Injury & Child Maltreatment Section
Public Health Agency of Canada
 Canadian Incidence Study of Reported Child
Abuse & Neglect
 National surveillance program
 5 year cycle of surveillance
Two cycles completed (1998 &
2003)
 Strong collaboration between ICMS,
Provincial/Territorial Directors of Child Welfare,
steering committee & the study team.
CIS-2003 Objectives




determine investigation and maltreatment
rates over time
assess the type and severity of
maltreatment
examine selected determinants of health
that may be associated with
maltreatment
monitor short-term investigation
outcomes
CIS-2003
 Data collected from investigating child
protection workers after completion of
investigation.
 Data collected during fall and then used
to develop weighted annual estimates
 Does not capture unreported cases,
cases only investigated by the police,
and reports about already open cases
National Child Health Surveillance
Data Analysis
&
Interpretation
Data
Collection/
Acquisition
Communication
of Information
for Action
adapted from McCarthy, 1992
Scope of CIS-2003
Knowledge Transfer and Exchange Framework
Knowledge
Persuasion
Knowledge
transfer
strategies
Decision
Implementation
Evidence-informed
Decision-making
Knowledge
Uptake
Adopt
Dissemination
strategies
Innovation
characteristics
Organizational
characteristics
Individual
characteristics
Environmental
characteristics
Confirmation
Outcomes
Reject
Decision-making
efforts
Implement
ation
strategies
Pt outcomes
resource
allocation
expenditures
organizational
performance
(Dobbins et al, 2002)
Knowledge Transfer and Exchange
Framework
Knowledge
Research
Dissemination
Persuasion
Decision
Evidence-informed
Decision-making
Implementation
Research
Utilization
Confirmation
Outcomes
(Dobbins, 2002)
Lesson # 1: You need a plan!
Framework for Knowledge Transfer
 What should be transferred to decision
makers?
 To whom should research knowledge be
transferred?
 By whom should research knowledge be
transferred?
 How should research knowledge be
transferred?
 With what effect should research knowledge
be transferred?
(Lavis et al., 2003; Reardon, Lavis &
Gibson, 2006)
Knowledge Transfer &
Exchange Models
1. Producer-Push Models
2. User-Pull Models
3. Exchange Models
 Relationships are built & nurtured
 Researchers help build capacity for
decision-makers to use research
 Decision-makers help identify relevance
of research & new research questions
Lesson #2: Put Together a Team!
 Communications sub-committee
 Stakeholder input & feedback





Social Development Canada
P/T Directors of Child Welfare
Centre of Excellence for Child Welfare
First Nations Child & Family Caring Society
CIS 2003 Steering Committee
 PHAC Internal Communications
 Develop ‘Dissemination’ & ‘Communication’
plans
Creating Key Messages
Type 1 Message
 Credible facts & ideas
Type 2 Message
 Due to strength or type of evidence, can’t
direct decisions, but can be used to
discuss issue
Type 3 Message
 A body of evidence, expressed as an
actionable idea, tailored to the decisionmakers needs
Key Messages
Type 1 Message
“The rate of substantiated child maltreatment
increased 125% between 1998 and 2003. These are
likely due to increased vigilance on the part of policy
makers, investigators, service providers, and the
general public.”
Type 2 Message
“Child maltreatment is an important health and social
concern that requires organizational collaboration to
prevent and treat”
Your Research: Create a
Message
What type of message can be
developed?
 Is there sufficient evidence to develop an
actionable message?
 Who is the message relevant for?
Reardon, Lavis & Gibson, 2006
Target Audiences
 A message’s target audience must be clearly
identified.
 Multiple audience-specific messages are
needed.
 Research knowledge alone may not impact
decisions.
The Challenge of Identifying
Specific Target Audiences!
1.
2.
3.
4.
Who can act on the basis of the available
research knowledge?
Who can influence those who can act?
With which of these target audience(s) can
we expect to have the most success?
Which messages pertain most directly to
them?
CIS-2003 Target Audiences

Broad spectrum of stakeholders:
 policy makers
 professionals
 civil society organizations
 women’s shelters
 academics & researchers
 media & general public



Decision-makers in these sectors:
 Social Development (Child Welfare), Public
Health, Health, Education, Justice, Indian &
Northern Affairs Canada
Aboriginal populations
Youth populations
Understand Your Audience
 What decisions does the audience own
that this evidence might influence?
 Who is a credible messenger to this
audience?
 Is the audience connected to existing
knowledge pathways?
Identify Barriers & Facilitators
 For the audience, what is the magnitude
of change suggested by the message?
 Is there a cost to this change?
 Does the change require resources or
expertise?
Messengers
 Credibility of messenger is important
 Who is perceived to be credible varies
by target audience
 Researchers, with skills & experience, to
act as messenger viewed as credible.
 Time consuming and skill-intensive
process
 Work with & through trusted
intermediaries
Lesson #3: Identify the right people when
targeting specific audiences
 ICMS
 Study team
 CIS Steering committee
 P/T Directors of Child Welfare
 Representatives from Aboriginal &
Youth Stakeholder Groups
Process of Knowledge
Transfer
If goal is uptake & utilization:
 Passive processes are ineffective
 Interactive engagement most effective
 Interaction between researchers & target
audience is important
 Supporting infrastructure can augment
interactive efforts
Target to clearly identified audience
General information in searchable form
Grol & Grimshaw, 1999
KTE Strategies
1. Generally effective




Academic detailing/ education outreach
Interactive education sessions
Reminder prompts or messages
Interventions tailored to overcome
identified barriers
(Grimshaw, 2001)
KTE Strategies
2. Variable Effectiveness
 Audit & feedback
 Opinion leaders
 Formal opinion leaders
 Informal opinion leaders
 Patient-mediated intervention
(Grimshaw, 2001)
KTE Strategies
3. Generally Ineffective as ‘stand alone’
 Lectures
 Educational materials
4. No evidence of effectiveness
 Electronic communication
 Media
Process of Knowledge Transfer
Communication Strategy

National launch; media & communication
strategy
Dissemination Strategies
1.
2.
3.
Producer Push: Conference presentations, broad
distribution of report, submission to peer reviewed
journals
Exchange Model: Discussion of findings, facilitated by
study team, at all study centre sites
User Pull Model: Development of CIS-2003 web-pages
Transfer Mechanisms
For different transfer mechanisms,
assess:
 Availability
 Resources
 Feasibility
Lesson #4: Effective transfer takes
time and resources
 Resources required to develop strategies
 Messengers & financial resources required to
support interactive transfer strategies
 Identify existing personal relationships between
‘messengers’ and members of ‘target
audience’…encourage integration of CIS-2003
findings into discussions
 Issue of child maltreatment will continually
arise….keep evidence readily available
Evaluate the KTE Impact
Indirect use
 Changes in knowledge, awareness or
attitudes
Direct use
 Behavioural changes
Tactical use
 Validation or legitimization of decision that
is already made
Acknowledgments
 Injury & Child Maltreatment Section,
Public Health Agency of Canada
 During this work, Dr. Jack was supported
through a Canadian Health Services
Research Foundation Post Doctoral
Fellowship
Contacts
Dr. Susan Jack
jacksm@mcmaster.ca
Dr. Lil Tonmyr
Lil_tonmyr@phac-aspc.gc.ca
References
Dobbins, M., Ciliska, D., & DiCenso, A. (2002). Dissemination and use of research
evidence for policy and practice. Online J Knowledge Synthesis Nurs, 9,
Document 7.
Grimshaw, J. et al. (2001). Changing provider behaviour: An overview of systematic
reviews of interventions. Medical Care, 38, 8, Supp 2.
Grol, R., & Grimshaw, J. (1999). Evidence-based implementation of evidence-based
medicine. Journal of Quality Improvement, 25(10), 503-513.
Lavis, J., N., Robertson, D.M., Woodside, J.M., McLeod, C.B., Abelson, J., & the
Knowledge Transfer Study Group (2003). How can research organizations more
effectively transfer research knowledge to decision makers? The Milbank
Quarterly, 81(2), 221-248.
McCarthy B. The risk approach revisited: a critical review of developing country
experience and its use in health planning. In: Liljestrand J, Povey WG (Eds).
Maternal Health Care in an International Perspective. Proceedings of the XXII
Berzelius Symposium, 1991 May 27-29, Stockholm, Sweden. Sweden: Uppsala
University, 1992:107-24.
Reardon, R., Lavis, J., & Gibson, J. (2006). From research to practice: A knowledge
transfer planning guide. Toronto, ON: Institute for Work and Health. www.iwh.on.ca
Trocmé, N., Fallon, B., MacLaurin, B., Daciuk, J., Felstiner, C., Black, T., Tonmyr, L.,
Blackstock, C., Barter, K., Turcotte, D., & Cloutier, R. Canadian Incidence Study of
Reported Child Abuse and Neglect, CIS-2003: Major Findings Report. Ottawa:
Minister of Public Works and Government Canada, 2005.