Shannon L. Sibbald

Research funder required research partnerships: a qualitative inquiry

BackgroundResearchers and funding agencies are increasingly showing interest in the application of research findings and focusing attention on engagement of knowledge-users in the research process as a means of increasing the uptake of research findings. The expectation is that research findings derived from these researcher-knowledge-user partnerships will be more readily applied when they became available. The objective of this study was to investigate the experiences, perceived barriers, successes, and opinions of researchers and knowledge-users funded under the Canadian Institutes of Health Research’s integrated Knowledge Translation funding opportunities for a better understanding of these collaborations.MethodsParticipants, both researchers and knowledge-users, completed an online survey followed by an individual semi-structured phone interview supporting a mixed methods study. The interviews were analyzed qualitatively using a modified grounded theory approach.ResultsSurvey analysis identified three major partnership types: token, asymmetric, and egalitarian. Interview analysis revealed trends in perceived barriers and successes directly related to the partnership formation and style. While all partnerships experienced barriers, token partnerships had the most challenges and general poor perception of partnerships. The majority of respondents found that common goals and equality in partnerships did not remove barriers but increased participants’ ability to look for solutions.ConclusionsWe learned of effective mechanisms and strategies used by researchers and knowledge-users for mitigating barriers when collaborating. Funders could take a larger role in helping facilitate, nurture, and sustain the partnerships to which they award grants.

Evaluation of partnerships in a transnational family violence prevention network using an integrated knowledge translation and exchange model: a mixed methods study

BackgroundFamily violence is a significant and complex public health problem that demands collaboration between researchers, practitioners, and policymakers for systemic, sustainable solutions. An integrated knowledge translation network was developed to support joint research production and application in the area. The purpose of this study was to determine the extent to which the international Preventing Violence Across the Lifespan (PreVAiL) Research Network built effective partnerships among its members, with a focus on the knowledge user partner perspective.MethodsThis mixed-methods study employed a combination of questionnaire and semi-structured interviews to understand partnerships two years after PreVAiL’s inception. The questionnaire examined communication, collaborative research, dissemination of research, research findings, negotiation, partnership enhancement, information needs, rapport, and commitment. The interviews elicited feedback about partners’ experiences with being part of the network.ResultsFive main findings were highlighted: i) knowledge user partner involvement varied across activities, ranging from 11% to 79% participation rates; ii) partners and researchers generally converged on their assessment of communication indicators; iii) partners valued the network at both an individual level and to fulfill their organizations’ mandates; iv) being part of PreVAiL allowed partners to readily contact researchers, and partners felt comfortable acting as an intermediary between PreVAiL and the rest of their own organization; v) application of research was just emerging; partners needed more actionable insights to determine ways to move forward given the research at that point in time.ConclusionsOur results demonstrate the importance of developing and nurturing strong partnerships for integrated knowledge translation. Our findings are applicable to other network-oriented partnerships where a diversity of stakeholders work to address complex, multi-faceted public health problems.

Knowledge flow and exchange in interdisciplinary primary health care teams (PHCTs): an exploratory study

OBJECTIVE Improving the process of evidence-based practice in primary health care requires an understanding of information exchange among colleagues. This study explored how clinically oriented research knowledge flows through multidisciplinary primary health care teams (PHCTs) and influences clinical decisions. METHODS This was an exploratory mixed-methods study with members of six PHCTs in Ontario, Canada. Quantitative data were collected using a questionnaire and analyzed with social network analysis (SNA) using UCINet. Qualitative data were collected using semi-structured interviews and analyzed with content analysis procedures using NVivo8. RESULTS It was found that obtaining research knowledge was perceived to be a shared responsibility among team members, whereas its application in patient care was seen as the responsibility of the team leader, usually the senior physician. PHCT members acknowledged the need for resources for information access, synthesis, interpretation, or management. CONCLUSION Information sharing in interdisciplinary teams is a complex and multifaceted process. Specific interventions need to be improved such as formalizing modes of communication, better organizing knowledge-sharing activities, and improving the active use of allied health professionals. Despite movement toward team-based models, senior physicians are often gatekeepers of uptake of new evidence and changes in practice.

Exploring the uptake and framing of research evidence on universal screening for intimate partner violence against women: a knowledge translation case study

BackgroundSignificant emphasis is currently placed on the need to enhance health care decision-making with research-derived evidence. While much has been written on specific strategies to enable these “knowledge-to-action” processes, there is less empirical evidence regarding what happens when knowledge translation (KT) processes do not proceed as planned. The present paper provides a KT case study using the area of health care screening for intimate partner violence (IPV).MethodsA modified citation analysis method was used, beginning with a comprehensive search (August 2009 to October 2012) to capture scholarly and grey literature, and news reports citing a specific randomized controlled trial published in a major medical journal on the effectiveness of screening women, in health care settings, for exposure to IPV. Results of the searches were extracted, coded and analysed using a multi-step mixed qualitative and quantitative content analysis process.ResultsThe trial was cited in 147 citations from 112 different sources in journal articles, commentaries, books, and government and news reports. The trial also formed part of the evidence base for several national-level practice guidelines and policy statements. The most common interpretations of the trial were “no benefit of screening”, “no harms of screening”, or both. Variation existed in how these findings were represented, ranging from summaries of the findings, to privileging one outcome over others, and to critical qualifications, especially with regard to methodological rigour of the trial. Of note, interpretations were not always internally consistent, with the same evidence used in sometimes contradictory ways within the same source.ConclusionsOur findings provide empirical data on the malleability of “evidence” in knowledge translation processes, and its potential for multiple, often unanticipated, uses. They have implications for understanding how research evidence is used and interpreted in policy and practice, particularly in contested knowledge areas.

Into the gray: a modified approach to citation analysis to better understand research impact.

Academic authors and funders often want to know the “impact” of their publications, and this impact is generally judged by how and where the paper is cited in other academic works. This limited appraisal has been expanded in recent years as many are beginning to argue that nonacademic publishing venues should be included in assessing the impact of academic publications. This is an issue of particular concern with the growing emphasis on “knowledge translation” from the scientific literature to policy and practice applications 1–3 and to sources other than the traditional peer-reviewed and indexed venues, in other words, translation into the “gray literature” 4. In this comment and opinion piece, the authors describe the process of developing and applying a “modified citation analysis” that builds on existing methods of examining a research papers impact in two key ways: (1) by deliberately including gray literature in the citation analysis search process, and (2) by including quantitative and qualitative methods of analysis to gain a better understanding of how a research paper was used. By broadening the search and deepening the level of analysis, we suggest this new approach can better assess the impact of a given research paper—both within and outside of traditional peer-reviewed venues. We begin with a review of gray literature and then describe current methods for analyzing the impact of a research paper. Finally, we use a specific example to describe our new approach, highlight its potential for evolving the field of citation and impact analysis, and discuss future refinements and evaluation.

Creating a Knowledge Translation Trainee Collaborative: From Conceptualization to Lessons Learned in the First Year

Trainees (e.g., graduate students, residents, fellows) are increasingly identifying knowledge translation as their research discipline. In Canada, a group of trainees have created a trainee-initiated and trainee-led national collaborative to provide a vehicle for trainees to examine the diversity of knowledge translation research and practice, and to link trainees from diverse geographical areas and disciplines. The aim of this paper is to describe our experience and lessons learned in creating the Knowledge Translation Trainee Collaborative. In this meeting report, we outline the process, challenges, and opportunities in planning and experiencing the collaboratives inaugural meeting as participant organizers, and present outcomes and learnings to date.

Communities of practice for supporting health systems change: a missed opportunity

BackgroundCommunities of practice (CoPs) have been used in the health sector to support professional practice change. However, little is known about how CoPs might be used to influence a system that requires change at and across various levels (i.e. front line care, organizational, governmental). In this paper we examine the experience of a CoP in the Canadian province of Ontario as it engages in improving the care of seniors. Our aim is to shed light on using CoPs to facilitate systems change.MethodsThis paper draws on year one findings of a larger multiple case study that is aiming to increase understanding of knowledge translation processes mobilized through CoPs. In this paper we strategically report on one case to illustrate a critical example of a CoP trying to effect systems change. Primary data included semi-structured interviews with CoP members (n = 8), field notes from five planning meetings, and relevant background documents. Data analysis included deductive coding (i.e. pre-determined codes aligned with the larger project) and inductive coding which allowed codes and themes to emerge. A thorough description of the case was prepared using all the coded data.ResultsThe CoP recognized a need to support health professionals (nurses, dentists) and related paraprofessionals with knowledge, experience, and resources to appropriately address their clients’ oral health care needs. Accordingly, the CoP led a knowledge-to-action initiative that involved a seven-part webinar series meant to transfer step-by-step, skill-based knowledge through live and archived webinars. Although the core planning team functioned effectively to develop the webinars, the CoP was challenged by organizational and long-term care sector cultures, as well as governmental structures within the broader health context.ConclusionThe provincial CoP functioned as an incubator that brought together best practices, research, experiences, a reflective learning cycle, and passionate champions. Nevertheless, the CoP’s efforts to stimulate practice changes were met with broader resistance. Research about how to use CoPs to influence health systems change is needed given that CoPs are being tasked with this goal.

Ontario primary care reform and quality improvement activities: an environmental scan

BackgroundQuality improvement is attracting the attention of the primary health care system as a means by which to achieve higher quality patient care. Ontario, Canada has demonstrated leadership in terms of its improvement in healthcare, but the province lacks a structured framework by which it can consistently evaluate its quality improvement initiatives specific to the primary healthcare system. The intent of this research was to complete an environmental scan and capacity map of quality improvement activities being built in and by the primary healthcare sector (QI-PHC) in Ontario as a first step to developing a coordinated and sustainable framework of primary healthcare for the province.MethodsData were collected between January and July 2011 in collaboration with an advisory group of stakeholder representatives and quality improvement leaders in primary health care. Twenty participants were interviewed by telephone, followed by review of relevant websites and documents identified in the interviews. Data were systematically examined using Framework Analysis augmented by Prior’s approach to document analysis in an iterative process.ResultsThe environmental scan identified many activities (n = 43) designed to strategically build QI-PHC capacity, identify promising QI-PHC practices and outcomes, scale up quality improvement-informed primary healthcare practice changes, and make quality improvement a core organizational strategy in health care delivery, which were grouped into clusters. Cluster 1 was composed of initiatives in the form of on-going programs that deliberately incorporated long-term quality improvement capacity building through province-wide reach. Cluster 2 represented activities that were time-limited (research, pilot, or demonstration projects) with the primary aim of research production. The activities of most primary health care practitioners, managers, stakeholder organizations and researchers involved in this scan demonstrated a shared vision of QI-PHC in Ontario. However, this vision was not necessarily collaboratively developed nor were activities necessarily strategically linked.ConclusionsWithin the scope of this research, the scan affirmed that there is currently no province-wide, integrated, and measured quality improvement program for the primary healthcare sector in Ontario. This could be improved by the development of a coordinated plan, an accompanying accountability framework, and an appropriate sustainable funding envelope for QI-PHC at the provincial level.

An empirically based model for knowledge management in health care organizations.

Background: Knowledge management (KM) encompasses strategies, processes, and practices that allow an organization to capture, share, store, access, and use knowledge. Ideal KM combines different sources of knowledge to support innovation and improve performance. Purposes: Despite the importance of KM in health care organizations (HCOs), there has been very little empirical research to describe KM in this context. This study explores KM in HCOs, focusing on the status of current intraorganizational KM. The intention is to provide insight for future studies and model development for effective KM implementation in HCOs. Methodology/Approach: A qualitative methods approach was used to create an empirically based model of KM in HCOs. Methods included (a) qualitative interviews (n = 24) with senior leadership to identify types of knowledge important in these roles plus current information-seeking behaviors/needs and (b) in-depth case study with leaders in new executive positions (n = 2). The data were collected from 10 HCOs. Our empirically based model for KM was assessed for face and content validity. Findings: The findings highlight the paucity of formal KM in our sample HCOs. Organizational culture, leadership, and resources are instrumental in supporting KM processes. An executive’s knowledge needs are extensive, but knowledge assets are often limited or difficult to acquire as much of the available information is not in a usable format. We propose an empirically based model for KM to highlight the importance of context (internal and external), and knowledge seeking, synthesis, sharing, and organization. Participants who reviewed the model supported its basic components and processes, and potential for incorporating KM into organizational processes. Discussion: Our results articulate ways to improve KM, increase organizational learning, and support evidence-informed decision-making. Practice implications: This research has implications for how to better integrate evidence and knowledge into organizations while considering context and the role of organizational processes.

Process evaluation of implementing knowledge management tools in public health

Translating formal and informal knowledge into public health (PH) action is essential given that PH professionals rely on up-to-date and context-specific information for effective programme planning, implementation, and evaluation. Knowledge management (KM) provides possible solutions to this challenge. We conducted an evaluation of a pilot implementation of four KM tools: (1) After Action Review; (2) Communities of Practice; (3) Peer Assist and; (4) Organizational Yellow Pages. The evaluation focused on fidelity, feasibility, and acceptability of the tools. Three main messages emerged from the study findings: (1) KM tools can be implemented in a PH context for the sharing of explicit and tacit knowledge, (2) enabling organizational environments were important for implementation, and (3) the provision of a facilitator during the implementation period was also important and appreciated by study participants.