Innovations and Knowledge
Translations
Frontiers of Tomorrow
Orienting Questions...
• What does the emerging science and
practice of KT ask of us as nurses, as
health care professionals, as health care
educators?
• How do we bring our (nursing) research
findings into sustainable practices that
make differences that matter for the
health care of all Canadians?
A Call For New Approaches in KT
• Methods used to promote practices are not
often evidence-informed
• Dearth of information on which interventions
actually work and under what circumstances
• Shift efforts “from development of new
interventions to consistently deliver what is
already known to work”
• Shift toward Action or Utilization component
of KT
• The interplay with setting, context,
environment as active participant
Innovators and Knowledge
Translators
Participators, Designers, and
Researchers .....
Graham, Logan, Harrison
et al. (2006)
What is "knowledge translation"?
Knowledge translation research (KT Science)
is about:
• determinants of knowledge use
• promoting the uptake of knowledge
Knowledge translation (KT) is about:
• Making users aware of knowledge
• Facilitating their use of it
• Closing the know-do gap
• Moving knowledge into action
Strauss, Tetroe, & Graham
(2009)
Knowledge translation at CIHR:
Definition
• dynamic and iterative process
• synthesis, dissemination, exchange and
ethically sound application of knowledge
• complex system of interactions between
researchers and knowledge users
• may vary in intensity, complexity and level
of engagement depending on
– the nature of the research and the findings
– the particular knowledge user.
Two broad types of KT at CIHR
End-of-grant KT
• making knowledge users aware of the
knowledge generated through a research project
Integrated KT
• engages potential knowledge users as partners
in the research process
• a collaborative or participatory approach to
research that is action oriented and is solutions
and impact focused
Where are the Future
Frontiers?
Future Design Considerations:
It’s about
• Processes & Participation
• Engaging multiple audiences – not a unidisciplinary venture
– Active Citizenship engagement
– Partnerships & Networks – practice, education,
research
• Context as a complex active participant
• Armamentarium of maps
• Economics – cost analysis and utility
Responding to the
Frontier Challenges...
• New statistical modelling
• Community based opportunities and participatory
action research designs (Patrick McGrath, Patricia LingleyPottie, Debbie Emberly, Cathy Thurston, &Cathy McLean)
• Evidence informed policy and practice pathway
(Shelley Bowen & Anthony Zwi, 2005)
• Clinical Networks (SCN) interfaced with
curriculum initiatives & Educator Networks
(CASN)
Integrated KT
(McGrath et al. 2009)
Collaborative, participatory, actionoriented way of conducting research
Results in:
1. co-creation of knowledge(s) by
researchers and knowledge users.
2. integration of research findings into
practice in a more structured, efficient,
expedient, and effective health service.
Community & Participatory based
Principles
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•
•
•
•
•
•
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Community as a unit of identity and of analysis
Collaborative partnerships & long-term commitments
Strengths & resources within the community
Integrates knowledge & action for mutual benefit
Co-learning and responsive empowering processes
Health focus on capabilities
Responsive to settings
Disseminates findings & knowledge gained to all partners
(Israel, Schulz, Parker & Becker, 2001;
Garrison & Vaughan, 2008; Dopson, 2007)
Integrated KT
Plan and Implementation
• Time 1: Informing the Design
– Panel of international, interdisciplinary experts
and health professionals
– Material development
• Time 2: During the Research
– Study Management Team
– Advisory Committee
– Regular reporting to stakeholders
• Time 3: Following Completion of the study
phase
– From research recruitment to service promotion
and awareness
Community-based research
with impact:
Supportive Environments for
Moms Living with PPD
Nicole Letourneau
Norlien/ACHRI Chair in Parent-Infant Mental
Health
What is PHSI?
“The PHSI program supports teams of
researchers and decision makers interested
in conducting applied and policy-relevant
health systems and services research that
responds to the needs of health care
decision makers and strengthens the
Canadian health care system.”
http://www.cihr.ca/e/36327.html
It’s all about impact
“With PHSI, you can make a difference.
Research is more likely to be used in
policy and practice when researchers
work hand-in-hand with decision
makers.”
http://www.cihr.ca/e/36327.html
Evidence-informed Policy and Practice Pathway
Bowen & Zwi, 2005
The Importance of Settings for
Health Promotion:
The analytic framework comprises
three parts:
(a) understanding settings,
(b) changing settings, and
(c) knowledge development and
knowledge translation.
Blake Poland, Gene Krupa & Douglas McCall (2009). Settings for Health Promotion: An
Analytic Framework to Guide Intervention Design and Implementation
Sustainable Telephone-Based
Support for Mothers with
Postpartum Depression
Funded by CIHR and the
NBHRF
Benefits
• Integrated KT (but not an end in itself)
• Greater buy-in – sustained ‘community’
& service
• Increased chance for impact
– On health care program delivery (↑
services for mothers with PPD)
– On health care system efficiency (↓ wait
times and emergency room visits)
– Client health outcomes (↓ s/s PPD)
MMT
MOMS
MMT
MOMS
StudyStudy
Supporting Mother’s Engagement in
Community-based Methadone Treatment
MMT MOMS Study
PURPOSE:
Examine women’s and service
providers’ perspectives on the
characteristics of parenting supports
and resources that could facilitate
mothers’ engagement in MMT
MMTDetermine
MOMS Studythe influence of MMT on
mothers’ parenting
MMT MOMS Study
I was kind of scared when I had
him, that he was going to be sick
because some kids are sick and
have to have Morphine and stuff
like that, but I made sure he
breastfed so he was still getting
some Methadone for the first
three months of his life. So when I
MMT MOMS
did wean
him Study
off my breast milk, I
done it very slowly so that he
wasn’t sick. [MMT 05]
Current Project: Addiction and
Mental Health Research Network
• Integrated KT approach to build a
research team and a program of
research
• Research Focus:
Attachment/relationship interventions
with maternal addiction (triadic
relations)
• Four phases proposed
Minding the Baby
• A COLLABORATION -Yale Child Study Center,
Yale School of Nursing, Fair Haven Community
Health Center, Cornell Scott Hill Health Center
• Minding the Baby (MTB)
– intensive home visiting program working with firsttime young mothers and their families
– First developed in 2002
– program is interdisciplinary
– home visiting team including a pediatric nurse
practitioner and a licensed clinical social worker
– promote positive health, mental health, life course,
and attachment outcomes in babies, mothers, and
their families.