Making Science Stick:
Developing a KT Plan
Melanie Barwick, PhD, CPsych
Associate Scientist, Community Health Systems Resource Group, Learning Institute
Scientific Director Knowledge Translation, Child Health Evaluative Sciences Program, Research Institute.
Associate Professor, Psychiatry and Dalla Lana School of Public Health, University of Toronto.
February 23, 2011
3:00 pm Eastern
An online workshop/webcast sponsored by the
National Center for the Dissemination of Disability Research (NCDDR)
Funded by NIDRR, US Department of Education, PR# H133A060028
© Barwick 2011
Learning Objectives
1) KT plans as a proposal requirement
2) Basic components of a KT plan
3) Evidence-based KT strategies
4) Innovations
5) Stickiness
6) KT Planning Template
© Barwick 2011
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KT Plans as a Proposal Requirement
3
Implementation Science Funding Worldwide
Source: Tetroe et al., (2008). The Milbank Quarterly, 86(1),
125-155.
© Barwick 2011
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Health Research Funding Agencies’ Support &
Promotion of KT Internationally
Source: Tetroe et al., (2008). The Milbank Quarterly, 86(1),
125-155.
© Barwick 2011
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Basic Components of KT Planning
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Key Components of a KT plan
1)
What are your KT goals?
2)
Who is your target audience?
3)
How will you engage them?
4)
When will you engage them?
5)
What are your main messages?
6)
What KT strategies will you use?
7)
How will you implement your strategies?
8)
With what impact (evaluation strategy to determine success of KT plan and
impact on health)?
9)
What resources are required (budget, staffing, etc)
Resource: Barwick, M. (2008). KT Planning Template.
http://www.melaniebarwick.com/training.php
© Barwick 2011
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WHO is your audience?
•
Who needs to hear your message?
•
How well do you know your audience(s) ?
•
Is your audience prepared to make decisions based on the evidence – what is
their readiness for change?
•
What are the barriers for knowledge uptake in this case?
•
What existing networks or knowledge conduits already exist for this audience
that could be useful?
Source: Institute for Work & Health, Knowledge Transfer & Exchange Workbook
© Barwick 2011
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The Audience
•
One size-fits-all communication strategies are rarely successful
•
Tailor your main messages to your audiences, e.g., consumers, decision-
makers; policy developers; general public
•
Give people the information they need, not what you think they need
•
Listen to your audience – what issues are important to them?
•
Involve them in developing, discussing, and delivering
© Barwick 2011
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The Audience: Increasing Utilization
•
Format, style, and timeliness by themselves will not lead to utilization
•
Who provides the information is as important as what the information
actually is.
•
Readiness for change / readiness for knowledge use is an important
consideration
•
The message(s) and research-transfer activities must be audience-specific
© Barwick 2011
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Consider that Audiences sit in Organizations
Characteristics of
the Practice to be
Adopted
Relative advantage
Compatibility
Complexity
Trialability
Observability
© Barwick 2011
Characteristics of
the Exchange
between
Stakeholders
KT Strategies
Engagement
Characteristics of
the Setting
Social networks
influence diffusion
Early adopters
Characteristics of
the Adopting
Organization
Leadership
Motivation
Readiness
Competing Priorities
Preferences*
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Four Factor Model of KT for Practice Change
CIHR Emerging Team on KT for Child and Youth Mental Health (2009-2012) Melanie Barwick
(SickKids), Chuck Cunningham (McMaster), Bruce Ferguson (SickKids), Rhonda Martinussen (OISE),
Rosemary Tannock (OISE/SickKids), Peter Chaban (SickKids), Dean Fergusson (Ontario Institute for
Health Research)
Research
Evidence
Facilitation
Implementation of
EBP
Context
Readiness
Change
Preferences
See our research poster in the exhibit hall 
© Barwick 2011
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HOW will you engage them?

Your KTE strategies should fit the audience preferences

Regardless of who your audience is, remember that “active engagement”
works best
© Barwick 2011
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WHEN will you engage them?
Reducing scalds in children
http://www.sickkids.ca/SKCPublicPolicyAdvocacy/section.asp?s=Tap%20Water%20Scalds&sID=13747
© Barwick 2011
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Reducing Scalds
•
Yearly over 300 children, elderly people and people with disabilities are treated in hospital
annually across Canada for burn injuries caused by hot tap water. But hot tap water injuries
are predictable and preventable.
•
Turning this knowledge into action in Canada has been a slow process. Despite numerous
public education campaigns to reduce risks through behaviour change (i.e. getting
consumers to lower the temperature setting of their hot water heaters and/or to be cautious
in using hot tap water), the rates of tap water scald injury in this country have remained
virtually unchanged in the past two decades.
•
Tap water scalds can be prevented most effectively through a combination of public
education, environmental changes, and enforcement of necessary regulations. Individual
action is an unreliable way to protect a population. It is more effective in the long run to
“build in” safety into Canadian homes. This can be done through:
•
changes to building and plumbing codes •
Ontario’s Building Code now requires hot tap water to be a maximum of 49°C.
© Barwick 2011
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Measuring Health Impact
LEVEL 4
Impact on Health
Outcomes
LEVEL 3
Impact on Clinical Practice
LEVEL 2
Impact on Health Policies & Services
LEVEL1
Impact on Healthcare Research Base & Future Research
Stryer, Tunis, Hubbard & Clancy. (2000). Health Services Research 35:5 Part 1
© Barwick 2011
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Monitoring and Evaluating Health Information
Products and Services
Sullivan, T.M., Strachan, M., and Timmons, B.K. Guide to Monitoring and Evaluating Health Information Products and Services.
Baltimore, Maryland: Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health; Washington, D.C.:
Sullivan, T.M., Strachan, M., and Timmons, B.K. Guide to Monitoring and Evaluating Health Information Products and Services. Baltimore, Maryland: Center for Communication
Programs, Johns Hopkins Bloomberg School of Public Health; Washington, D.C.: Constella Futures; Cambridge, Massachusetts: Management Sciences for Health, 2007.
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1. Indicators for Monitoring and
Evaluation of Health Products
REACH INDICATORS
Area 1: Primary Distribution (Push)
Number of copies of a product initially distributed to existing lists
Number of copies of a product distributed by a publisher through additional
distribution
Area 2: Secondary Distribution (Pull)
Numbers of products distributed in response to orders
Number of file downloads in a time period
Number of times a product is reprinted by recipients
Number of people reached by media coverage of the material or generated by it
Area 3: Referrals
Number of instances that products indexed or archived in bibliographic databases
Number of postings by other Web sites or links to products from other Web sites
Number of instances that products are selected for inclusion in a library
Percentage of users who share copies or transmit information verbally to colleagues
Sullivan, T.M., Strachan, M., and Timmons, B.K. Guide to Monitoring and Evaluating Health Information
Products and Services. http://www.infoforhealth.org/hipnet/MEGuide/MEGUIDE2007.pdf
© Barwick 2011
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2. Indicators for Monitoring and
Evaluation of Health Products
USEFULNESS INDICATORS
Area 1: User Satisfaction
Percentage of those receiving a product or service that read or browsed it
Percentage of users who are satisfied with a product or service
Percentage of users who rate the format/presentation of a product as usable
Percentage of users who rate the content of a product or service as useful
Number/percentage of users who report knowledge gained from product or service
Number/percentage of users who report that product or service changed their views
Area 2: Product or Service Quality
Number and quality assessment of reviews of a product in periodicals
Number and significance of awards given to a product or service
Number of citations of a journal article or other information product
Journal impact factor
Number/percentage of users who pay for a product or service
© Barwick 2011
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3. Indicators for Monitoring and
Evaluation of Health Products
USE INDICATORS
Number/percentage of users intending to use an information product or service
Number/percentage of users adapting information products or services
Number/percentage of users using an information product or service to inform
policy and advocacy or to enhance programs, training, education, or research
Number/percentage of users using an information product or service to improve
their own practice or performance
© Barwick 2011
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4. Indicators for Monitoring and
Evaluation of Health Products
COLLABORATION & CAPACITY BUILDING INDICATORS
Area 1: Collaboration
Number of instances of products or services developed or disseminated with
partners
Number of instances of South-to-South or South-to-North information sharing
Area 2: Capacity Building
Number and type of capacity-building efforts
www.partnershiptool.ie/
Partnership Evaluation Tool
Ireland Public Health
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Moving Beyond Academic Currency
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How many journal articles would you have to
read per day to stay up to date?
a)
5
b) 10
c)
15
d) 20
e)
25
f)
30
Source: Shaneyfelt (JAMA 2001)
Estimate only; not empirical data!
INFORM
BEHAVIOUR
© Barwick 2011
 CHANGE
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Evidence-Based and Innovative KT
Strategies
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Current State of Evidence


MOSTLY EFFECTIVE
Participatory research
Interactive small groups
Educational outreach
Reminders
Computerized decision
support
Use of computers in
practice
Multi-disciplinary
collaboration
Mass media campaign
Financial intervention /
incentive
Combined interventions
Substitution of Tasks
MIXED EFFECTIVENESS
Conferences, courses
Opinion leaders
Champions
Educational materials
Patient-mediated
interventions
Performance feedback
Educational strategies –
dependent on combination
of strategies

LIMITED EFFECTIVENESS
Total quality management
Continuous quality
improvement
Didactic meetings

NOT SYSTEMATICALLY
REVIEWED AS YET
Press release
Patent license
Social marketing
Arts-based KT
Grol, R. & Grimshaw, J. 2003, The Lancet, 362.
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Role Based KT Strategies
Knowledge
Broker
Opinion Leaders
Champions
© Barwick 2011
Consultants
Substitution of
Tasks
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Knowledge Broker
An individual who links decision-makers and researchers,
facilitating their interaction to better understand each
other’s goals and professional cultures, influence each
other’s work, forge new partnerships, and promote the
use of research-based evidence in decision-making.
No systematic reviews
© Barwick 2011
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Opinion Leader
Peers or experts that are well-connected, credible, and
persuasive. They are considered knowledgeable,
trustworthy, accessible and approachable and they
have a willingness to share their knowledge.
Champions are typically from within the organization.
Opinion leaders may be from outside the
organization.
• 3 reviews of 3-6 studies
• Mixed effects
• The feasibility of identifying opinion
leaders in different settings is uncertain.
© Barwick 2011
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Substitution of Tasks
Expanding the role of a healthcare practitioner, e.g.,
pharmacists who package and dispense prescription
and over the counter medications, begin to advise
about them, and work with other health care
professionals and the public.
• 6 reviews of 2-14 studies
• Pharmacists’ effects on prescribing
• Results of a review on delegation of tasks
to nurses showed no relevant effect
© Barwick 2011
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Organizational KT Strategies
Leadership
Continuous Quality
Improvement
Financial Incentives
© Barwick 2011
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Continuous Quality Improvement
Total Quality Management
A management approach to improving and maintaining
quality that emphasizes internally driven and
continuous assessments of potential causes of quality
defects, followed by action aimed either at avoiding
decrease in quality or else correcting it at an early
stage.
• 1 review of 55 studies.
• Limited effects
• Results of single-site studies showed
positive results on clinical performance,
but RCTs did not.
© Barwick 2011
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Financial Incentives
Compensation to the healthcare provider that is based in
part on practice / service quality measures.
• 6 reviews
• Fund-holding had an effect on prescribing
• Providing budgets instead of fees
reduced drug costs & number of days in
hospital
© Barwick 2011
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Educational KT Strategies
Media
Patient Mediated
© Barwick 2011
Patient
Education
Audit and
Feedback
Policy Brief
Clinical Practice
Guideline
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Educational Materials
Print, CD-ROM, video or graphic materials intended to
inform, promote behaviour change, or practice change.
• 9 reviews of the distribution of
educational materials to professionals,
3-37 studies
• Limited effects due to problems with
power and analysis
• Mixed effects
© Barwick 2011
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Academic Detailing
A trained person who meets with providers in the
practice setting to provide information with the intent
of changing the provider’s performance.
• 8 reviews
• Especially effective for improving
prescribing behaviour
© Barwick 2011
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Policy Brief
A document that outlines the rationale for choosing a
particular policy direction. It is commonly produced in
response to a request directly from a decision-maker, or
within an organization that intends to advocate for the
position detailed in the brief.
© Barwick 2011
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Clinical Practice Guidelines
Guidelines developed from systematic reviews to help
health care professionals and patients make decisions
about screening, prevention, or treatment of a specific
health condition.
• 4 RCTs showed median improvement of 8%
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Audit and Feedback
A summary of clinical performance over a specified period
of time, e.g., average number of diagnostic tests ordered.
The summary may also include recommendations for
clinical care.
• 16 reviews
• Effective when targeting test ordering and
prevention
• Effect size moderated by type of feedback,
source and format, frequency and intensity
of presentation
• Recommended in combination with
education, outreach visits, or reminders
© Barwick 2011
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Mass Media
Use of television, radio, print to ‘advertise’ the
message, or attracting the media’s participation
with the message as the ‘news story.’ e.g. public
awareness campaigns on bike helmet safety.
Grilli reviewed the effects of 22 studies
of mass media on health-service use
and reported that all studies showed
improvements in care.
© Barwick 2011
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Technologically Supported KT
© Barwick 2011
Social Media
Reminders
Patient Mediated Tools
Clinical Decision
Supports
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Reminders
Any intervention that prompts the healthcare
provider to perform a patient action or encounterspecific action.
• 14 reviews of 4-68 studies
• Mostly effective, particularly for prevention
(vaccination and cancer screening)
© Barwick 2011
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Social Media
Social media is the use of technology combined with
social interaction to create or co-create knowledge.
• 1 review of 22 studies
• Mostly effective
© Barwick 2011
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Social Media in Hospitals
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Hospitals Using Social Media
http://ebennett.org/hsnl/data/
© Barwick 2011
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Small Groups & Networks
Interactive
Workshops
Community of
Practice
Conferences
Continuing
Medical
Education
In-Service
Training
Networks
© Barwick 2011
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Networks
Professional relationships between individuals that
represent both a collection of ties between people and the
strength of those ties. Networks are a useful mechanism for
knowledge exchange.
© Barwick 2011
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Community of Practice
A social learning process whereby a group of people with
common interest come together to share, develop, and
advance a knowledge base. This informal social setting
serves as a forum for the sharing of tacit knowledge.
Getting to Uptake: Do Communities of
Practice Support the Implementation of
Evidence-Based Practice? Melanie A.
Barwick; Julia Peters; Katherine Boydell
J Can Acad Child Adolesc Psychiatry
18:1 February 2009
© Barwick 2011
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Interactive Small Group
An educational seminar or series of meetings emphasizing
interaction and exchange of information among a small
number of participants.
• 4 reviews of 2-6 studies
• Positive effects
© Barwick 2011
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Multi-Professional Collaboration
Collaborative practice designed to promote the active
participation of each discipline in providing quality patient
care.
• 5 reviews of 2-22 studies
• Range of effects in chronic patients
(cancer, stroke, mental health, geriatric
care), resulting in shorter stay in hospital,
reduction of costs, or more patient
satisfaction.
© Barwick 2011
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Arts Based KT
Knowledge Creation
© Barwick 2011
Knowledge Transfer
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Arts Based KT
Arts-informed KT brings together the systematic and
rigorous qualities of scientific inquiry with the artistic and
imaginative qualities of the arts to reach out beyond
academia.
© Barwick 2011
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Business Related KT Strategies
Patent
© Barwick 2011
Commercialization
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Stickiness
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Stickiness
6 Principles of Sticky Ideas – Chip & Dan Heath
A sticky idea is one that is easily understood, remembered, and that
changes opinions, behaviors, or values, and has a lasting impact.
1.Simplicity – Isolate your core message and convey it succinctly
2.Unexpectedness – Surprise and intrigue with leaps of thought
3.Concreteness – Make it real and recognizable
4.Credibility – Use details that symbolize and support your core idea
5.Emotions – Evoke feelings about what matters
6.Stories – Connect the dots
Heath, C., & Heath, D. (2008). Made to stick: why some ideas
survive and others die. New York: Random House.
© Barwick 2011
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Implementation
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The Three Implementation Gaps
Science to Service Gap
1) What is known is not what is adopted to help children, families, and
caregivers
Implementation Gaps
1) What is adopted is not used with fidelity and good outcomes for
consumers.
2) What is used with fidelity is not sustained for a useful period of time.
3) What is used with fidelity is not used on a scale sufficient to impact social
problems.
© Barwick 2011
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Implementation
Intervention
Effectiveness
Implementation Team
No Implementation Team
80% 3 years
14% 17 years
Application of
implementation science and
practice
Diffusion and dissemination
Balas & Boren 2000
Fixsen et al., 2007
Fixsen, Blase, Timbers & Wolf (2007). In search of program implementation – 792 replications
of the teaching-family model. The Behavior Analyst Today, 8(1), 96-110.
Balas EA, Boren SA. In: Yearbook of Medical Informatics 2000: Patient-Centered Systems.
Stuttgart: Schattauer; 2000:65-70.
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Staff Development
OUTCOMES
(% of participants who DEMONSTRATE KNOWLEDGE;
DEMONSTRATE NEW SKILLS in a practice setting; and USE
NEW SKILLS in the Classroom
Training Components
Knowledge
Skill Demonstration
Use in the
Classroom
Theory & Discussion
10%
0%
0%
+ Demonstration &
Training
30%
20%
0%
+ Practice & Feedback
in Training
60%
60%
5%
+ Coaching in the
Classroom
95%
95%
95%
© Barwick 2011
Joyce, B., & Showers, B. (2002). Student achievement through
staff development. Alexandria, VA: Association for Supervision and
Curriculum Development.
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Implementation Science
INTERVENTION
IMPLEMENTATION
Effective
Not Effective
Effective
Not Effective
ACTUAL BENEFITS
Inconsistent
Non Sustainable
Poor Outcomes
Poor Outcomes
Poor Outcomes
Sometimes Harmful
Source: Dean Fixsen [Institute of Medicine 2000,2001.,2009; New Freedom Commission on
Mental Health, 2003; National Commission on Excellence in Education, 1983; Dept of Health
and Human Services, 1999]
© Barwick 2011
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Exploration & Adoption
Full Operation
Fixsen et al 2005
Program Installation Initial Implementation
Innovation
Sustainability
© Barwick / SickKids
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KT Planning Template
www.melaniebarwick.com
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Your Research Partners
© Barwick 2011
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Partner Engagement
© Barwick 2011
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KT Expertise on Your Team
© Barwick 2011
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Main Messages, Audience, Goals
© Barwick 2011
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Methods, Process, Impact
© Barwick 2011
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Partners, Resources, Budget
© Barwick 2011
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Partners, Resources, Budget
© Barwick 2011
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Example: Pain Management during Childhood Immunization (Taddio et al)
Who is the
target audience
How will they be
engaged and
when?
Government
(including but not
limited to:
Councils of
Medical Officers
of Health,
Provincial
Ministry of
Health, Public
Health Agency of
Canada, CIHR,
Health Canada)
At the outset, as
collaborators
advisory members
Throughout using
relationship building,
meetings,
workshops
At the end via
meetings,
presentations,
workshops
- Pain management
during routine needles
and immunization is
important yet
underutilized
- Strategies to prevent
pain
- Fact sheets, pamphlets, and guidelines to
federal and provincial government, CCIAP and
study
website; British Columbia Centre for Disease
Control (CDC)
- Immunization Competencies posted by Public
Health Agency of Canada
- Presentations at meetings
- Dissemination of 1-3-25 report
Academics
(might also
include
practitioners as
audience)
At the outset, as
collaborators
advisory members
Throughout using
relationship building,
meetings,
conferences
workshops, etc
At the end via
journal articles,
conferences,
workshops, etc
-Pain management
during routine needles
and immunization is
important
- Strategies to prevent
pain
- Additional research
needed in the area
- Presentations at discipline-specific annual
meetings, workshops (e.g. paediatric
associations,
pharmacy associations, nursing associations)
- Journal publication of systematic reviews (in
Clinical Therapeutics) and practice guidelines
(in Paediatrics & Child Health)
- Other relevant peer reviewed journal
publications
© Barwick 2011
Main message
KT strategy
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Pain Management during Childhood Immunization (Taddio et al) (Cont.)
Who is the target
audience
How will they be
engaged and when?
Main Message
KT strategy
Physicians and
Nurses
(including but not
limited to family
practice physicians,
pediatricians)
At the outset, as
collaborators
advisory members
Throughout using
relationship building,
meetings, workshops,
rounds, networks
At the end using
networks and
governing bodies,
presentations,
workshops, etc
- Pain management
during routine needles
and immunization is
important and within
the scope of clinical
practise
- Strategies to prevent
pain
- Patient education is
important
- Fact sheets, pamphlets, newsletters articles, and
guidelines circulated to physician offices, clinics
through nursing and paediatric governing bodies
- Presentations at discipline-specific rounds, continuing
education meetings; train the trainer workshops
- Journal publication of systematic reviews (in Clinical
Therapeutics) and practice guidelines
(in Paediatrics & Child Health)
- Academic detailing (through government site visits)
-Medical resident teaching
- Link on discipline specific websites to CCIAP partner
website
- Transportable learning modules and educational materials
including video clips on strategies for
delivering vaccines that minimize pain
- Recommendation for CPS position statement
Pharmacists
At the outset, as
collaborators
advisory members
Throughout
relationship building,
meetings, workshops,
rounds, networks
At the end using
networks and
governing bodies,
presentations,
workshops, etc
-The benefits of
analgesics in pain
management
- Strategies and
products to reduce
pain
- The benefits of client
education
- Fact sheets, educational materials, guidelines, articles,
main messages to be included in vaccine
shipments and sent via mailings to pharmacists by
governing bodies
- Article in Canadian Pharmaceutical Association journal
- Links on discipline specific websites to CCIAP partner
website
-Posters and pamphlets to be sent for display to pharmacies
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Pain Management during Childhood Immunization (Taddio et al) (Cont.)
Who is the
target
audience
How will they be
engaged and
when?
Main message
Society at
large
(including but
not limited to
Parents and
Children)
At the end using
media, products
developed (e.g.
children's books),
networks
- Vaccines are
good
- Pain can and
should be
managed
- What a parent
can do to ensure
their child does
not suffer
unnecessary pain
during needles
- How doctors and
pharmacists can
help
KT strategy
- Fact sheets and posters distributed to family resource
centers, libraries, daycares, schools
- Study website and partners (The Hospital for Sick
Children media press release and ‘aboutkidshealth.ca’,
Canadian Pain Society)
- Children’s handbook (distributed in pharmacies, hospital
gift shop, retail outlets)
- Chapter in Your Child’s Best Shot: A Parent’s Guide to
Vaccination
- Column in parenting magazine (Today’s Parent)
- Fact sheets, teaching/presentations and telephone
counseling (disseminated during prenatal classes,
maternal-infant hospitalization after delivery, and after
hospital discharge) by physicians, nurses, educators,
public health
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Scientist Knowledge
Translation Training™
External (non-SickKids) – March 24-25 2011 Toronto - $450
Graduate Students – 1 day workshop – May 18 2011 - $30
A well-developed knowledge translation (KT) plan is emerging as a proposal requirement for
health research in Canada and abroad, and there is greater attention to research
utilization and research impact. The SKTT™ training course was developed on the
premise that scientists are agents of change in creating research impact, promoting
research utilization, and ensuring their research findings reach the appropriate
audiences. There is a skill set surrounding KT practice, and it is these competencies that
the training course was designed to impart.
Intended Audiences: Researchers across all pillars, Educators, KT practitioners
For more information or to register, contact sarah.bovaird@sickkids.ca
© Barwick 2011
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Knowledge Translation
Professional Certificate™
SKTT – October 17-21 2011 Toronto
KTPC is a 5 day professional development course and the only course of its kind in North
America. The curriculum, presented as a composite of didactic and interactive teaching,
exemplars, and exercises, focuses on the core competencies of KT work in Canada, as
identified by a survey of KT Practitioners (Barwick et al., 2010). This one-of-a-kind
opportunity for professional development and networking.
The KTPC course is aimed at developing the competencies of KT practitioners working
across all disciplines – not limited to: health, education, prevention/promotion, and
agriculture. Whether you call yourself a knowledge broker, KT specialist or work by some
other name, this event is of great importance to helping us close the research to practice
gap. However you identify yourself professionally, this course is for you if you serve an
intermediary role between science and practice. We invite active participation of your
employer to help build organizational culture for KT.
© Barwick 2011
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“A little knowledge that acts
is worth infinitely more
than much knowledge that is idle.”
Kahlil Gibran (1883-1931)
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Melanie Barwick
Ph
Email
Web
001-416-813-1085
melanie.barwick@sickkids.ca
www.melaniebarwick.com