1. Reza Majdzadeh Professor of Epidemiology Tehran University of Medical Sciences TUMS-KTE group 47 Slides

2. TUMS-KTE group 2/ 47 Accept the necessity of knowledge translation (KT) activities, Explain some definitions and concepts of KT, Know the difference between dissemination and implementation, Explain Push, Pull and Exchange efforts, Become familiar with the characteristics of knowledge brokers, Explain five stages of research result delivery.

3. Source: National Science Indicators, 1981-2005 – standard version 3/ 47

4. Regional ranking by impact (2001-2005) Source: National Science Indicators, 1981-2005 – standard version 4/ 47

5. Research is consistently producing new findings that may contribute to effective and efficient care, The findings of such research will not change population outcomes unless health services and health care professionals adopt them in practice. Grimshaw, Ward, Eccles. Oxford Handbook of Public Health. TUMS-KTE group 5/ 47

6. 1. Creation of new knowledge often does not, by itself, lead to its widespread adoption or impact health 2. Increased emphasis on research governance and accountability even for the public. TUMS-KTE group 6/ 47

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9. ScienceTechnologyInnovation Knowledge creation Changing knowledge to a service and or a good Providing service and or a good to people 9/ 47

10. McNeil, Pauker, Sox, & Tversky (1982) in Redelmeier et al (1993) SURGERY (/100) 90 survive surgery 68 alive after 1 year 34 alive after 5 years RADIATION THERAPY (/100) 100 survive therapy 77 alive after 1 year 22 alive after 5 years LUNG CANCER TREATMENTS SURGERY OR RADIATION THERAPY? Patients 84% Physicians 78% SURGERY (/100) 10 die during surgery 32 dead after 1 year 66 dead after 5 years RADIATION THERAPY (/100) 0 die during therapy, 23 dead after 1 year, 78 dead after 5 years Patients 50% Physicians 60% TUMS-KTE group 10/ 47

11. Subjective value Reference point GainsLosses Prospect theory value function Prospect Theory Curve TUMS-KTE group 11/ 47

12. The Journal of Continuing Education in the Health Professions, Vol. 26 No. 1, Winter 2006 DOI: 10.1002/chp. TUMS-KTE group 12/ 47

13. TUMS-KTE group 13/ 47

14. The Journal of Continuing Education in the Health Professions, Vol. 26 No. 1, Winter 2006 DOI: 10.1002/chp. TUMS-KTE group 14/ 47

15. Data: Raw facts Information: Organized data Knowledge: Meaningful information J Knowledge Management 2001;5:68-75. TUMS-KTE group 15/ 47

16. Knowledge translation Knowledge utilization Knowledge dissemination Knowledge brokering Knowledge transfer Knowledge exchange TUMS-KTE group 16/ 47

17. A linear process through which research is first conceptualized and conducted, and the results are then handed over to the end-users. TUMS-KTE group 17/ 47

18. The unidirectional nature of knowledge transfer has been criticized and recent studies have demonstrated that such strategies “have not proven to be effective in encouraging the adoption and implementation of new research results TUMS-KTE group 18/ 47

19. “The exchange, synthesis and ethically-sound application of research findings within a complex set of interactions among researchers and knowledge users. In other words, knowledge translation can be seen as an acceleration of the knowledge cycle; an acceleration of the natural transformation of knowledge into use.” TUMS-KTE group 19/ 47

20. “the human forces behind knowledge transfer…it helps build relationships and networks for sharing existing research and ideas and stimulating new work.” Knowledge brokering supports evidence- based decision-making by encouraging the connections that ease knowledge transfer. TUMS-KTE group 20/ 47

21. Policy Makers Politicians Board Members Managers Institutional CEOs Program Managers Service Professionals Physicians Nurses Decision Makers Solutions Problems Researchers Mission Oriented In-house Employees Management Consultants Applied Research Institutes Insulated Academics Discovery Driven TUMS-KTE group 21/ 47

22. Policy Makers Managers Service Professionals Decision Makers Solutions Problems Researchers Mission Oriented Discovery Driven Research Funders Applications Commercial R&D Grant Agencies Self-funding Discovery Issues and Priorities Service Delivery Problems Dx, Tx, Px Incentives Researchable Questions TUMS-KTE group 22/ 47

23. Policy Makers Managers Service Professionals Decision Makers Solutions Problems Researchers Mission Oriented Discovery Driven Research Funders Applications Discovery Issues and Priorities Service Delivery Problems Dx, Tx, Px Incentives Researchable Questions Knowledge Purveyors Stories Facts Ideas Best Practice Evidences Anecdotes Interests Wants Values Myths Interventions TUMS-KTE group 23/ 47

24. Policy Makers Managers Service Professionals Decision Makers Solutions Problems Researchers Mission Oriented Discovery Driven Research Funders Applications Discovery Issues and Priorities Service Delivery Problems Dx, Tx, Px Incentives Researchable Questions Knowledge Purveyors Stories Public Relations Media Think Tank Conferences Journals Books Facts Ideas Best Practice Evidences Personal Experiences Anecdotes Interests Wants Values Myths Assumptions Interventions TUMS-KTE group 24/ 47

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26. Lavis, J; Roberston, D.; Woodside, J.; McLeod, C.B.; Abelson; J. (2003). « How Can Research Organizations More Effectively Transfer Research Knowledge to Decision-Makers »; The Milbank Quarterly, 81 (2) : 221-248. TUMS-KTE group 26/ 47

27. 1. Message (WHAT?) 2. Target Audience (WHO?) 3. Messenger (BY WHOM?) 4. Knowledge transfer process and support system (HOW?) 5. Evaluation (with what EFFECT should it be transferred?) Lavis, J; et al. (2003). « How Can Research Organizations More Effectively Transfer Research Knowledge to Decision-Makers »; The Milbank Quarterly, 81 (2) : 221-248. TUMS-KTE group 27/ 47

28. Information: Organized data Knowledge: Meaningful information J Knowledge Management 2001;5:68-75. TUMS-KTE group 28/ 47

29. The first published study on a scientific question may find the most exaggerated effect size and that as further evidence is gathered, effect sizes tend to diminish. Ioannidis, J. (2006). PLOS Clinical Trials 1(7. ); 29/ 47

30. Thousands of observations are required before estimates of gene disease associations became stable. 30/ 47

31. “Actionable messages” are preferable to single research reports or the results of single studies. Actionable message Synthesis of research knowledge Individual studies, articles and reports Basic, theoretical and methodological innovations Music Noise 31/ 47

32. 2. Target Audience (WHO?) – The types of decisions being made and the types of decision- making environment at hand need to be considered (organizational and political factors cannot be neglected). When selecting a target audience, one should consider who will be able to act on the basis of the research, which can influence those who act, and with which audience can the most success be expected. TUMS-KTE group 32/ 47

33. When selecting a target audience, one should consider: 1) who will be able to act on the basis of the research, 2) which can influence those who act, and 3) with which audience can the most success be expected. 33/ 47

34. 3. Messenger (BY WHOM?) – The key here is credibility. TUMS-KTE group 34/ 47

35. G085 G095 G086 G087 G033 G032 G128 G078G116 G090 G027 G147 G150 G049 G069 G140 G051 G050 G099 G047 G048 G053 G007 G141 G013 G009 G001 G005 G123 G100 G098 G111 G112 G113 G065 G062 G017 G064 G071 G011 G015 G004 G114 G139 G089 G115 G074 Gynaecologists’ social network 35/ 47

36. TUMS-KTE group 36/ 47 Psychiatrists’ social network in TUMS

37. Use of providers nominated by their colleagues as ‘educationally influential’. The investigators must have explicitly stated that their colleagues identified the opinion leaders. Local opinion leaders Up-to-date Good communicators Humanistic TUMS-KTE group 37/ 47

38. 4. Knowledge transfer process and support system (HOW?) Passive processes are widely recognized as ineffective, and interactive engagement is preferred. Two-way exchanges can, in the long term, produce beneficial cultural shifts. TUMS-KTE group 38/ 47

39. Type of activityObjectiveProcess DiffusionAwarenessPassive DisseminationAwareness + Attitude change Active ImplementationAttitude change + Behavior change Active+++ Lomas (1993) TUMS-KTE group 39/ 47

40. Peer reviewed publication Conference presentation Final report to funders Summary to agency Non-peer reviewed publication Website posting Graham I. KT ICEBeRG Symposium 2005 40/ 47

41. Stakeholder involvement Media involvement Educational sessions with decision makers Use of knowledge brokers Graham I. KT ICEBeRG Symposium 2005 41/ 47

42. Educational materials (1) Educational meetings (1) Educational outreach (1) Audit and feedback (2) Opinion leaders (1) Mass media (1) Reminders – general (4) Reminders – Computer assisted drug dosage (3) Reminders – CPOE (1) Tailored interventions (1) Prescribing – general (10) Prescribing - safety (2) Changing roles – nursing (1) Changing roles – pharmacy (7) Financial (4) Regulatory (1) General (10) 42/ 47

43. Most approaches to changing practice are more often based on beliefs than on scientific evidence ‘Evidence based medicine should be complemented by evidence based implementation’ Grol (1997). British Medical Journal. 43/ 47

44. 5. Evaluation (with what EFFECT should it be transferred?) – Judgments about the success of an initiative depend on the objective: are we looking for a change in behavior. An increase in awareness. Introduction of the issue into a debate. TUMS-KTE group 44/ 47

45. Message (WHAT?) Target Audience ( To WHOM?) Messenger (BY WHOM?) Evaluation (with what EFFECT should it be transferred?) Knowledge transfer process and support system (HOW?) 45/ 47

46. TUMS-KTE group 46/ 47 Accept the necessity of knowledge translation (KT) activities, Explain some definitions and concepts of KT, Know the difference between dissemination and implementation, Explain Push, Pull and Exchange efforts, Become familiar with the characteristics of knowledge brokers, Explain five stages of research result delivery.

47. Willing is not enough; we must do.” - Goethe TUMS-KTE group