Marc Lemire

Knowledge Exchange Processes in Organizations and Policy Arenas: A Narrative Systematic Review of the Literature

CONTEXT This article presents the main results from a large-scale analytical systematic review on knowledge exchange interventions at the organizational and policymaking levels. The review integrated two broad traditions, one roughly focused on the use of social science research results and the other focused on policymaking and lobbying processes. METHODS Data collection was done using systematic snowball sampling. First, we used prospective snowballing to identify all documents citing any of a set of thirty-three seminal papers. This process identified 4,102 documents, 102 of which were retained for in-depth analysis. The bibliographies of these 102 documents were merged and used to identify retrospectively all articles cited five times or more and all books cited seven times or more. All together, 205 documents were analyzed. To develop an integrated model, the data were synthesized using an analytical approach. FINDINGS This article developed integrated conceptualizations of the forms of collective knowledge exchange systems, the nature of the knowledge exchanged, and the definition of collective-level use. This literature synthesis is organized around three dimensions of context: level of polarization (politics), cost-sharing equilibrium (economics), and institutionalized structures of communication (social structuring). CONCLUSIONS The model developed here suggests that research is unlikely to provide context-independent evidence for the intrinsic efficacy of knowledge exchange strategies. To design a knowledge exchange intervention to maximize knowledge use, a detailed analysis of the context could use the kind of framework developed here.

Determinants of Internet use as a preferred source of information on personal health.

OBJECTIVE To understand the personal, social and cultural factors likely to explain recourse to the Internet as a preferred source of personal health information. DESIGN A cross-sectional survey was conducted among a population of 2923 Internet users visiting a firmly established website that offers information on personal health. Multiple regression analysis was performed to identify the determinants of site use. MEASUREMENT The analysis template comprised four classes of determinants likely to explain Internet use: beliefs, intentions, user satisfaction and socio-demographic characteristics. Seven-point Likert scales were used. An analysis of the psychometric qualities of the variables provided compelling evidence of the constructs validity and reliability. A confirmatory factor analysis confirmed the correspondence with the factors predicted by the theoretical model. FINDINGS The regression analysis explained 35% of the variance in Internet use. Use was directly associated with five factors: perceived usefulness, importance given to written media in searches for health information, concern for personal health, importance given to the opinions of physicians and other health professionals, and the trust placed in the information available on the site itself. CONCLUSION This study confirms the importance of the credibility of information on the frequency of Internet use as a preferred source of information on personal health. It also shows the potentially influential role of the Internet in the development of personal knowledge of health issues.

Internet use and the logics of personal empowerment in health

OBJECTIVES The development of personal involvement and responsibility has become a strategic issue in health policy. The main goal of this study is to confirm the coexistence of three logics of personal empowerment through health information found on the Internet. METHODS A theoretical framework was applied to analyze personal empowerment from the users perspective. A well-established Canadian Web site that offers information on personal health was used as a case study. A close-ended questionnaire was completed online by 2275 visitors and members of the Web site. RESULTS The findings confirm that the development of feelings of competence and control through Internet use is structured around three different logics. This implies three types of aptitudes that are fostered when the Internet is used to seek health information: doing what is prescribed (the professional logic), making choices based on personal judgment (the consumer logic), and mutual assistance (the community logic). CONCLUSIONS A recurring issue in three logics is the balance of roles and responsibilities required between the individual and the health provider.

Using Logic Analysis to Evaluate Knowledge Transfer Initiatives: The Case of the Research Collective on the Organization of Primary Care Services

Models that shift more responsibility onto researchers for the process of incorporating research results into decision-making have greatly gained in popularity during the past two decades. This shift has created a new area of research to identify the best ways to transfer academic results into the organizational and political arenas. However, evaluating the utilization of information coming out of a knowledge transfer (KT) initiative remains an enormous challenge. This article demonstrates how logic analysis has proven to be a useful evaluation method to assess the utilization potential of KT initiatives. We present the case of the evaluation of the Research Collective on the Organization of Primary Care Services, an innovative experiment in knowledge synthesis and transfer. The conclusions focus not only on the utilization potential of results coming out of the Research Collective, but also on the theoretical framework used, in order to facilitate its application to the evaluation of other knowledge transfer initiatives.

Dissemination of performance information and continuous improvement

PURPOSE Developing a performance measure and reporting the results to support decision making at an individual level has yielded poor results in many health systems. The purpose of this paper is to highlight the factors associated with the dissemination of performance information that generate and support continuous improvement in health organizations. DESIGN/METHODOLOGY/APPROACH A systematic data collection strategy that includes empirical and theoretical research published from 1980 to 2010, both qualitative and quantitative, was performed on Web of Science, Current Contents, EMBASE and MEDLINE. A narrative synthesis method was used to iteratively detail explicative processes that underlie the intervention. A classification and synthesis framework was developed, drawing on knowledge transfer and exchange (KTE) literature. The sample consisted of 114 articles, including seven systematic or exhaustive reviews. FINDINGS Results showed that dissemination in itself is not enough to produce improvement initiatives. Successful dissemination depends on various factors, which influence the way collective actors react to performance information such as the clarity of objectives, the relationships between stakeholders, the systems governance and the available incentives. RESEARCH LIMITATIONS/IMPLICATIONS This review was limited to the process of knowledge dissemination in health systems and its utilization by users at the health organization level. Issues related to improvement initiatives deserve more attention. PRACTICAL IMPLICATIONS Knowledge dissemination goes beyond better communication and should be considered as carefully as the measurement of performance. Choices pertaining to intervention should be continuously prompted by the concern to support organizational action. ORIGINALITY/VALUE While considerable attention was paid to the public reporting of performance information, this review sheds some light on a more promising avenue for changes and improvements, notably in public health systems.

What can be expected of information and communication technologies in terms of patient empowerment in health

PURPOSE Implementing information and communication technologies (ICT) is often mentioned as a strategy that can foster public involvement and responsibility in health. The purpose of this paper is to provide a better understanding of the possibilities and issues afforded by the social uses of ICT for personal empowerment in health. DESIGN/METHODOLOGY/APPROACH The paper discusses evidence from four case studies that characterize current computerization and networking processes in health. The studies shared a global framework comprising four interpretative paradigms of personal empowerment: the professional, technocratic, consumerist and democratic paradigms. FINDINGS The results show the coexistence of four empowerment logics in ICT use. Two trends proved dominant: a strengthening of the control and standardization processes tied to the typical power relationships in health, and a reinforcement of personal autonomy and self-assertion processes, either through commercial relationships or through the social relationships that are also present. PRACTICAL IMPLICATIONS The paper supports the argument that in order to understand the opportunities for personal empowerment offered by ICT the logic underlying user practices in their respective contexts must be examined. ORIGINALITY/VALUE The paper uses data from four case studies to illustrate the contradictory logics shaping the personal empowerment process. Under these logics, an ICT user may play roles as patient, client, consumer, or citizen.

Internet as a Source of Health Information and its Perceived Influence on Personal Empowerment

The primary aim of this study is twofold. First, the authors seek to identify the factors that influence members of the general public to conduct Internet searches for health information. Their second intent is to explore the influence such Internet use has on three types of personal empowerment. In the summer of 2007 the authors conducted a household sample survey of a population of Canadian adults. A total of 261 self-administered questionnaires were returned to the researchers. Our findings indicate that use of the Internet as a source of health information is directly related to three main factors: sex, age and the individual’s perceived ability to understand, interpret and use the medical information available online. Further, their results lend support to the notion that using the Internet to search for information about health issues represents a more consumer based and participative approach to health care. This study is one of the first to relate Internet use to various forms of personal empowerment. This area appears to have great potential as a means by which consumers can become more empowered in managing personal health issues.