Myriam Hivon

Creating a new articulation between research and practice through policy? The views and experiences of researchers and practitioners

Objectives In 1990, the Quebec Social Research Council - a body financing social research in Quebec, Canada -launched a new policy encouraging the development of social research units within health care organizations. Through financial incentives, it encouraged the implementation of long-term collaborations between researchers and practitioners with the purpose of transforming both scientific knowledge production and professional practices. This paper examines the perceptions of researchers and practitioners regarding the attributes and the usefulness of this collaborative research policy. Methods A self-administered survey was sent to all the researchers (n = 146; response rate 78.1%) and practitioners (n = 204; response rate 44.1%) involved in the 21 collaborative research teams funded in 1998. T-tests were performed in order to assess the difference between the perceptions of researchers and practitioners in five key dimensions of collaborative research. Results The results showed that, contrary to expectations, researchers and practitioners shared fairly similar views regarding the various dimensions of collaborative research. They both agreed that their involvement within collaborative research teams had contributed to the development of new skills and practices but had not facilitated their participation in external activities nor their involvement in networks and organizations that influence environments in which public policies and practices are deployed. They also both encountered some difficulties in putting the dimensions that they highly valued into practice. Conclusions Collaborative research within health care organizations succeeded in fostering the implementation of new modes of knowledge production and intervention. Nevertheless, special attention needs to be given to the development of strategies to reduce the discrepancies between values and practices.

Dissemination of health technology assessments: identifying the visions guiding an evolving policy innovation in Canada.

Health technology assessment (HTA) has received increasing support over the past twenty years in both North America and Europe. The justification for this field of policy-oriented research is that evidence about the efficacy, safety, and cost-effectiveness of technology should contribute to decision and policy making. However, concerns about the ability of HTA producers to increase the use of their findings by decision makers have been expressed. Although HTA practitioners have recognized that dissemination activities need to be intensified, why and how particular approaches should be adopted is still under debate. Using an institutional theory perspective, this article examines HTA as a means of implementing knowledge-based change within health care systems. It presents the results of a case study on the dissemination strategies of six Canadian HTA agencies. Chief executive officers and executives (n = 11), evaluators (n = 19), and communications staff (n = 10) from these agencies were interviewed. Our results indicate that the target audience of HTA is frequently limited to policy makers, that three conflicting visions of HTA dissemination coexist, that active dissemination strategies have only occasionally been applied, and that little attention has been paid to the management of diverging views about the value of health technology. Our discussion explores the strengths, limitations, and trade-offs associated with the three visions. Further efforts should be deployed within agencies to better articulate a shared vision and to devise dissemination strategies that are consistent with this vision.

Examining the ethical and social issues of health technology design through the public appraisal of prospective scenarios: a study protocol describing a multimedia-based deliberative method.

BackgroundThe design of health technologies relies on assumptions that affect how they will be implemented, such as intended use, complexity, impact on user autonomy, and appropriateness. Those who design and implement technologies make several ethical and social assumptions on behalf of users and society more broadly, but there are very few tools to examine prospectively whether such assumptions are warranted and how the public define and appraise the desirability of health innovations. This study protocol describes a three-year study that relies on a multimedia-based prospective method to support public deliberations that will enable a critical examination of the social and ethical issues of health technology design.MethodsThe first two steps of our mixed-method study were completed: relying on a literature review and the support of our multidisciplinary expert committee, we developed scenarios depicting social and technical changes that could unfold in three thematic areas within a 25-year timeframe; and for each thematic area, we created video clips to illustrate prospective technologies and short stories to describe their associated dilemmas. Using this multimedia material, we will: conduct four face-to-face deliberative workshops with members of the public (n = 40) who will later join additional participants (n = 25) through an asynchronous online forum; and analyze and integrate three data sources: observation, group deliberations, and a self-administered participant survey.DiscussionThis study protocol will be of interest to those who design and assess public involvement initiatives and to those who examine the implementation of health innovations. Our premise is that using user-friendly tools in a deliberative context that foster participants’ creativity and reflexivity in pondering potential technoscientific futures will enable our team to analyze a range of normative claims, including some that may prove problematic and others that may shed light over potentially more valuable design options. This research will help fill an important knowledge gap; intervening earlier in technological development could help reduce undesirable effects and inform the design and implementation of more appropriate innovations.

Marginal voices in the media coverage of controversial health interventions: how do they contribute to the public understanding of science?

While the media are a significant source of information for the public on science and technology, journalists are often accused of providing only a partial picture by neglecting the points of view of vulnerable stakeholders. This paper analyzes the press coverage of four controversial health interventions in order to uncover what voices are treated marginally in the media and what the relative contributions of these voices are to the stories being told. Our empirical study shows that: 1) patterns of source utilization vary depending on the health intervention and less dominant stakeholders are in fact represented; and 2) the use of marginal voices fills certain information gaps but the overall contribution of such voices to the controversies remains limited. In order to strengthen the media coverage of science and technology issues, we suggest that further research on journalistic practices: 1) move beyond the dichotomy between journalists and scientists, and 2) explore how different categories of readers appraise the meaning and relevance of media content.

How do medical device manufacturers' websites frame the value of health innovation? An empirical ethics analysis of five Canadian innovations.

While every health care system stakeholder would seem to be concerned with obtaining the greatest value from a given technology, there is often a disconnect in the perception of value between a technology’s promoters and those responsible for the ultimate decision as to whether or not to pay for it. Adopting an empirical ethics approach, this paper examines how five Canadian medical device manufacturers, via their websites, frame the corporate “value proposition” of their innovation and seek to respond to what they consider the key expectations of their customers. Our analysis shows that the manufacturers’ framing strategies combine claims that relate to valuable socio-technical goals and features such as prevention, efficiency, sense of security, real-time feedback, ease of use and flexibility, all elements that likely resonate with a large spectrum of health care system stakeholders. The websites do not describe, however, how the innovations may impact health care delivery and tend to obfuscate the decisional trade-offs these innovations represent from a health care system perspective. Such framing strategies, we argue, tend to bolster physicians’ and patients’ expectations and provide a large set of stakeholders with powerful rhetorical tools that may influence the health policy arena. Because these strategies are difficult to counter given the paucity of evidence and its limited use in policymaking, establishing sound collective health care priorities will require solid critiques of how certain kinds of medical devices may provide a better (i.e., more valuable) response to health care needs when compared to others.

What medical specialists like and dislike about health technology assessment reports

Objective: To examine how medical specialists view health technology assessment (HTA) and its role in policy-making. Methods: Semi-structured interviews with 28 medical specialists practising in Quebec and Ontario (Canada) to examine their views on an HTA report relevant to their specialty (prostate-specific antigen screening, electroconvulsive therapy and prenatal screening for Downs syndrome). Results: Medical specialists represent a particularly demanding audience for HTA producers because they are knowledgeable about current studies in their field and often contribute to the evidence base that HTA seeks to synthesize. In all three cases, specialists not only challenged specific points in the content of the HTA reports but also offered different and sometimes conflicting appraisals of the clinical relevance and policy implications. More than just the timeliness and usefulness of HTA findings are at issue. The views of specialists are grounded in a clinical understanding of what counts as evidence and how decisions should be made, a view that contrasts with the societal perspective of HTA. Conclusions: HTA producers cannot afford to overlook medical specialists who play a key role in the adoption of health technologies. Establishing a transparent dialogue between producers and users of HTA reports could enrich policy recommendations.

Building Business Relationships Through the Web: How Medical Technology Companies Enroll Stakeholders in Innovation Development and Uptake

Abstract: Websites are perceived as an additional communication space where public and private institutions and their stakeholders can interact and develop sustainable relationships. Although public relations scholars argue that both companies and consumers may benefit from virtual interactions, the growing online direct-to-consumer advertising and sale of health-related products has raised social and ethical concerns. Our study seeks to clarify the scope and nature of the virtual relationships that are specific to medical devices companies. Through a qualitative analysis of website, we show how four Canadian medical technology companies sought to enroll three types of stakeholders into their innovation development and commercialization strategies: investors, healthcare providers and patients. Our findings show that by reinforcing stereotypical relationships with investors, the websites maintain certain disconnect between the worlds of business and healthcare, and by creating proactive roles for healthcare providers and patients, they contribute to forge ethically convoluted relationships.

A six-minute video-clip to ponder the values fostered by health technology.

As part of our research teams knowledge transfer and exchange (KTE) initiatives, we developed a six-minute video-clip to enable productive deliberations among technology developers, clinicians and patient representatives. This video-clip summarises in plain language the valuable goals and features that are embedded in health technology and raises questions regarding the direction that should be taken by health care innovations. The use of such video-clips creates unique opportunities for face-to-face deliberations by enabling participants to interact and debate policy issues that are pivotal to the sustainability of health care systems. In our experience, we found that audiovisual-elicitation-based KTE initiatives can fill an important communication gap among key stakeholders: pondering, from a health care system perspective, why and how certain kinds of medical technologies bring a more valuable response to health care needs when compared to others.