Knowledge Translation in HealthWestern Health Sciences

Current Projects

Kothari Projects

Accelerating public health systems research in Ontario: building an agenda

Team: Kothari, A. (Co-PI), Regan, S. (Co-PI), Garcia, J., Manson, H,. O'Mara, L,. and Valaitis, R.

Funder: Canadian Institutes of Health Research

Timeline: 2012-2013

Description: In the wake of SARS, Ontario has been engaged in a major public health systems renewal process. This age of restructuring provides a prime opportunity to strengthen, implement, and evaluate the public health services that play an important role in the delivery of public health programs. The purpose of this proposal is to hold an invitational Think Tank. We propose to bring together a group of key stakeholders with an interest and expertise in public health systems research to engage in discussion and debate about research priorities at the provincial level and develop a long-term research agenda. An environmental scan to identify external opportunities and challenges will be carried out in advance of the meeting. As well, an on-line survey will be conducted with an array of stakeholders to take into account broad input on public health systems research priorities. Both the scan and the survey findings will be distributed to participants as preparatory material for the Think Tank. Our team is composed of researchers from three Ontario universities, six public health units, a governmental Ministry and Public Health Ontario. We believe that the activities described in this proposal will be successful, and subsequently taken up for the longer term, precisely because the political climate related to public health restructuring is eager for rigorous models of collaboration and capacity building. We anticipate a high level of sustainability given our previous working relationship, the strong support from the relevant Ontario Ministry, the individual health units, and Public Health Ontario, and the roles that members of the research team continue to play in the public health system (i.e., related to research, policy, teaching, and practice).

Dissemination:

CIHR team in public health services renewal

Team:Hancock, T (Co-PI); MacDonald, M. (Co-PI), Pauly, B. (Co-PI), Best, A,. Bruce, T,. Dobbins, M., Eisler, G., George, A., Kothari, A., Mitton, C., O’Mara, L., Pennock, M., Regan, S., Riley, B., Sangster-Gormley, E., Valaitis, R., Wharf Higgins, J., Wong, S.

Funder: Canadian Institutes of Health Research

Timeline: 2009-2014

Description: The purpose of this program of research is to conduct a set of studies that compare the implementation and impact of the BC Core Public Health Functions framework and the Ontario Public Health Standards.

The specific objectives of our program of research are:

  1. To explore and understand the implementation of and contextual factors influencing public health renewal in BC and Ontario.
  2. To examine and understand the impact and outcomes of public health renewal at organizational, systems, and population levels in both BC and Ontario.
  3. To explore the implications of public health renewal for public health human resources planning related to workforce competency, skill development, and basic and continuing education.
  4. To apply and contribute to the development of new, innovative and appropriate methods for: a) mapping the context of public health renewal, b) identifying the complex causal processes that link public health renewal to outcomes, and c) analyzing and describing the relationships and collaborations between primary care and public health practitioners and systems.
  5. To assess the nature and extent to which an equity lens has been integrated into public health renewal policies and programs in BC and Ontario and to critically analyze the application of an equity lens in relation to the reduction of inequities drawing on previously developed analytic tools.
  6. To engage in an innovative knowledge translation and exchange (KTE) process to strengthen and improve services and their linkage with other health services in BC and Ontario.

 

Knowledge to action processes in SHRTN collaborative communities of practice

Team: Conklin, J. (Co-PI), Kothari, A. (Co-PI), Stolee, P. (Co-PI), Chambers, L., Forbes, D., and Le Clair, K.

Funder: Canadian Institutes of Health Research

Timeline: 2010-2013

Description: This research will help us to understand how a Community of Practice (defined as a group of people who work together to identify innovations, translate evidence and help implement changes to improve care) creates and shares knowledge in ways that improve quality of healthcare and quality of life for seniors. The investigators will work with the leaders and members of Ontario's Seniors Health Research Transfer Network Collaborative, which is a network of networks that includes the Seniors Health Research Transfer Network Knowledge Exchange, the Alzheimer Knowledge Exchange and the Ontario Research Coalition. The collaborative facilitates the sharing of knowledge through a library service, knowledge brokers, local implementation teams, collaborative technology, and, most importantly, Communities of Practice (CoPs). The research will help us to understand the types of activities and organizations that are most successful at bringing new innovations to the frontlines of Canadian healthcare. Over a three year period, the investigators will focus on at least nine detailed case studies that demonstrate how important new research findings and best practices are identified, confirmed, and then shared with frontline caregivers. By studying these cases, the research team will learn how to support the development of these communities of practice, and what factors are needed to support the adoption of better caregiving practices. They will also gain a better understanding of the importance of having everybody who participates in the creation of new innovations (researchers, policy makers, caregivers and others) involved throughout the knowledge generation process.

Dissemination:

 

West Virginia University Injury Control Research Center

Team: Coben, J. (PI), Kothari, A. (Co-I) and et. al.

Funder: Centers for Disease Control and Prevention

Timeline: 2012-2017

Description: This research purports to explore knowledge translation and partnerships among members of the 'INJURY CONTROL RESEARCH CENTER' over a 5 year period through the administration of (1) a questionnaire that contains network indicators. The questionnaire will be administered annually and followed by semi-structured interviews. (2) A focus group that assesses the partner organizations’ ability to acquire and utilize research.

Wathen Projects

PreVAiL: The Preventing Violence Across the Lifespan Research Network

Team: MacMillan, H. L., Stewart, D. E., Wathen, C. N., Coben J., and Herrman, H. (co-principal investigators)

Funder: Canadian Institutes of Health Research - Centres for Research Development in Gender, Mental Health and Addictions

Timeline: 2009-Present

Website: http://www.prevailresearch.ca/

Description: Although exposure to violence is recognized as a critical factor in determining mental health outcomes, there has been little opportunity for investigators in mental health and addictions, child maltreatment and intimate partner violence (IPV) to collaborate to develop and test approaches to reduce violence and associated impairment. As a result, there is a paucity of research evidence about effective interventions for family violence. Our international team of over 50 collaborating investigators and policy partners has been funded for 5 years by the Canadian Institutes for Health Research (CIHR) to establish the PreVAiL Research Network, a Centre for Research Development in Gender, Mental Health and Violence Across the Lifespan.

PreVAiL has three main objectives:

  1. To increase understanding and knowledge about the links between mental health impairment, gender and exposure to child maltreatment and IPV, both in Canada and internationally
  2. To develop interventions to prevent or reduce child maltreatment, IPV and subsequent mental Thealth problems;
  3. To develop and promote an integrated research and knowledge translation and exchange (KTE) agenda among a network of established, new and emerging researchers and key stakeholders.

Dissemination:

Development and evaluation of an intervention for intimate oartner violence in the context of nurse home visits (phase 2)

Team: Jack, Susan M., Marilyn Ford-Gilboe, C. Nadine Wathen, Danielle M. Davidov, Diane B. McNaughton, Jeffrey H. Coben, David L. Olds, and Harriet L. MacMillan

Funder: Centers for Disease Control and Prevention: Injury Prevention Center Grant

Timeline: 2007-Present

Description: The self-reported prevalence of intimate partner violence (IPV) among clients enrolled in the NFP program is higher compared to rates in the general population. The presence of severe IPV attenuates the NFP’s impact on reducing child abuse among participant families. NFP nurse home visitors have identified that IPV in the home makes delivering the NFP difficult and a survey of NFP nurses indicated that many perceive that they have received insufficient knowledge and training to address IPV.

To better support nurses’ work with clients exposed to IPV, an international team of researchers in collaboration with Dr. David Olds, has developed a comprehensive intervention to support nurses in identifying IPV, responding to IPV disclosures and delivering tailored interventions to support women and their children and to increase their levels of safety in relationships. As part of the intervention, nurses and supervisors participate in a comprehensive training program on identifying and responding to IPV. Supports for supervisors and a checklist for organizational readiness to respond to IPV have also been integrated into the IPV intervention.

This intervention has been informed by:

  1. Current research evidence about what is known to be effective in addressing IPV
  2. The theoretical foundation of the NFP and current program guidelines
  3. Qualitative data collected from NFP nurses, clients and community partners from four NFP sites during Phase 1 of this study

Phase 2 is evaluating whether the NFP + the enhanced IPV curriculum intervention improves women’s quality of life and reduces violence compared to delivering the current NFP program alone using a cluster randomized controlled trial in 15 US-based NFP sites. This means that ½ the sites deliver the NFP + IPV and the remaining ½ of the sites are the control sites and continue to deliver the NFP following the regular protocol. Results of this trial are expected in 2013.

Effectiveness of an internet-based decision Aid in enhancing safety behaviors, reducing exposure to violence and improving mental health among women experiencing intimate partner violence

Team: Varcoe, C. (PI), Ford-Gilboe, M. (PI), Wuest, J.(PI); Currie, L., Glass, N., Hodgins, M., MacMillan, H., Neal, D., Noh, M., Scott-Storey, K., and Wathen, N.

Funder: Canadian Institutes of Health Research - Operating Grant

Timeline: 2012-2017

Description: Intimate partner violence (IPV), a pattern of physical, sexual, and psychological abuse directed toward a woman by her current or ex-partner, affects 1 in 4 Canadian women in their lifetimes and threatens women’s physical and emotional safety (Du Mont et al., 2005). In addition to increased risk of injury, physical health problems and health risk behaviors, IPV has also been associated with increased rates of mental health problems, particularly depression, anxiety and post-traumatic stress disorder (PTSD). Poor mental health makes it more difficult for women to create a new life after separation (Wuest et al, 2003) and increases their risk of returning to an abusive partner (Alahal, Ford-Gilboe & Regan 2011; Ford-Gilboe et al, 2011). Among women who have experienced IPV, safety behaviors, such as protection orders, enhance formal and informal support and reduce risk of re-abuse (Wathen & MacMillan, 2003), and better social support and less severe violence are associated with better mental health (Ford-Gilboe, et al, 2009). Qualitative studies portray women’s responses to IPV as complex processes in which the woman faces the difficult task of deciding how to improve her physical and emotional safety and that of her family (Anderson & Saunders, 2003; Wuest & Merritt-Gray, 1999). The options women identify for addressing IPV, and the strategies they employ, are shaped by conflicting feelings of stigma, fear, love or concern for the abusive partner, and the wider social context, including internalized gender role expectations for “good” mothers or partners, and gender-based structural inequities which shape women’s economic dependence. Gender- and context-specific, culturally competent interventions urgently are needed to improve the negative health and social consequences of IPV. Safety planning is widely recommended for reducing the impacts of IPV (Goodkind et al, 2004). Fewer than 1 in 5 Canadian women access support from violence services (Barrett & St. Pierre, 2011). Rural, Aboriginal, and women with same-sex partners face particular barriers to accessing information and support for safety decision-making (Riddell et al, 2009; Wiesz, 2005; Yoshihama, 2002). Effective, accessible and personalized tools are needed to enhance decision-making and support women’s healing. A Cochrane review of 86 decision aid trials supported their effectiveness in improving knowledge and active participation in decision-making and resolving decisional conflict (Stacey et al, 2011). Recently, US researchers developed and tested the first interactive, internet-based decision aid for women exposed to IPV. Preliminary findings suggest that the aid provides women with an acceptable, private way to assess danger in their relationships and to consider personalized safety options. Although promising, the effectiveness of such a decision aid among Canadian women is not known.

An evaluation of shelters as service navigation hubs for abused women

Team: Hansen, M., Wathen, N., Ense, L., Freeman, C., Wiggins, K., Ford-Gilboe, M., Harris, R., and MacQuarrie, B.

Funder: Ontario Trillium Foundation – Provincial Grants

Timeline: 2009-2011

The difficulties that abused women experience in ‘navigating’ the various health and social service systems to get help for themselves and their children should not be underestimated. Many women report difficulty in getting support from formal systems. This project focused on identifying:

  • what shelters do, both with respect to short-term residential services, but also in terms of ongoing outreach and “navigation/linkage” work to ensure women get the help they need;
  • how other social service sectors perceive and understand the work done by shelters
  • factors at the system, community & organizational level that influence service delivery
  • indicators of success, in other words, the outcome measures that should be used to determine the impact of shelter services on the lives of abused women and their children

Dissemination:

EQUIP: equity-oriented primary healthcare interventions for marginalized populations addressing structural inequities and structural violence

Team: Browne, A. J., Ford-Gilboe, M., Herbert, C., Lavoie, J., McDonald, M., Pauly, B., Smye, V., Tu, D., Varcoe, C., Wathen, N., and Wong, S.

Funder: CIHR - Programmatic Grants to Tackle Health and Health Equity

Timeline: 2011-2016

Description: Many challenges exist in public and population health, including health inequities and health disparities. The Canadian Institutes of Health Research Programmatic Grants to Tackle Health and Health Equity support research that addresses these and other challenges in order to improve the health of the Canadian population and promote health equity for all.

In Canada and other nations, primary health care (PHC) renewal continues to be identified as a key pathway to achieve health equity, with particular implications for marginalized populations. Current research and existing literature show that structural inequities and structural violence have profound negative health effects; however, little is known about how to address these issues. In this research, the term “marginalized” refers to the inequitable social conditions that result in a disproportionate burden of ill health and social suffering among particular groups or individuals, as well as peoples’ agency, resistance and resilience in the face of these challenges.

This research program brings together an interdisciplinary team of researchers and knowledge users from nursing, medicine, population and public health, community health sciences, and information and media studies, and leaders in Aboriginal health, women’s health, and the PHC sector. Key partnerships are with the Public Health Agency of Canada, the Aboriginal Health Program of the BC Provincial Health Services Authority, Aboriginal health organizations, Echo: Improving Women’s Health in Ontario, and PHC agencies in BC and Ontario.

This project builds and expands on the team’s prior research in PHC for marginalized populations, interventions for women experiencing violence, health equity for Aboriginal people, health policy ethics, and research in knowledge translation in relation to gender and violence. For example, our current research conducted in partnership with two Urban Aboriginal Health Centres in British Columbia, and ongoing research on the health effects of violence for women, show that people affected by structural inequities and violence have higher rates of chronic pain and other chronic illnesses, and higher rates of emergency department visits and preventable hospital admissions. These studies also show that healthcare system responses to these negative health effects are lacking.

The overarching goal of the newly funded research program is to contribute new knowledge about innovative PHC interventions that mitigate the effects of structural inequities and structural violence for marginalized populations, and the policy environments needed to support such programming.

Dissemination: