Knowledge Translation in HealthWestern Health Sciences

Past 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.

Advancing knowledge translation: can community networks support the use of research and knowledge in public health?

Team: Kothari, A. (PI), Cohen, B., Dobbins, M., Kloseck, M., MacDonald, M., McPherson, C., and Sibbald, S.

Funder: Canadian Institutes of Health Research

Timeline: 2010-2011

Description: Health issues are becoming more and more complex, and require community agencies to work together for lasting solutions. For example, ensuring food safety requires local food producer groups, retailers, public health inspectors and others to work collaboratively to identify the best policies to safeguard the public. In fact, public health units are taking on new roles as coordinators of various community agency collaborations; these collaborations or networks ought to be structured effectively so that research and other information can be easily shared among network members. The goal of this study is to determine the extent to which networks are effective structures for research and knowledge sharing and utilization. To accomplish this we will recruit, through public health units, three community networks. Our methods are based on the assumption that relationships within the networks - for example, who goes to whom for expert advice - form regular patterns. For each network we will identify the patterns of information relationships, and measure the extent of knowledge utilization. This study will begin to show if networks can support the use of research and knowledge for evidence-based collaborative decision-making, and thus demonstrate public value.

Dissemination:

 

The quality improvement in primary care

Team: Kothari, A. (PI), MacPhearson, C., and Sibbald, S.

Funder: Quality Improvement and Innovation Partnership

Timeline: 2010

Description: This environmental scan and capacity map project was commissioned by a Planning Group of stakeholders to determine the nature and extent of quality improvement in primary health care (QI-PHC1) activity in Ontario and to map the related human resource capacity for QI-related work in this sector. Individual interviews of 20 strategically identified PHC stakeholders were undertaken during February and March 2010. A review of documents and other related online resources also supported collection and analysis of the scan data.

The results of this exercise provide background details regarding 43 identified QI-PHC activities in Ontario. Key aspects for each activity were identified, including funding, human resources/expertise, tools associated with the activity, and the available evidence regarding the activity impact.

Dissemination:

 

Development and evaluation of an intervention for intimate partner violence in the context of nurse home visits (phase 1)

Team: Jack, S. M., Ford-Gilboe, M., Wathen, N., Davidov, D. M., McNaughton, D., Coben, J. H., Olds, D. L., and MacMillan, H. L.

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

Timeline: 2007-2012

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
In Phase 1 we explored:
  1. The challenges of identifying and addressing IPV within the context of home visitation
  2. What NFP clients who are exposed to IPV need and require from their home visitors
  3. An analysis of current nursing, supervisor and community partner clinical practices. This information has been essential for creating an intervention that is specific to the home visiting environment and that can be seamlessly integrated into the NFP guidelines

Phase 1 Publication:

Jack, S.M., Ford-Gilboe, M., Wathen, C. N., Davidov, D. M., McNaughton, D. B., Coben, J., Olds, D. L., MacMillan, H. L. (2012). Development of a nurse home visitation intervention for intimate partner violence. BMC Health Services Research, 12:50. doi:10.1186/1472-6963-12-50.

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.

A tailored, collaborative strategy to develop capacity and facilitate evidence-informed public health decision making

Team: Dobbins, M. (Co-PI), Kyle, J. (Co-PI), Timmings, C. (Co-PI), Ward, M. (Co-PI), Akhtar-Danes, N., Cava, M., Clarke, C., Jack, S., Kothari, A., Lemieux-Charles, L., McKibbon, A.., Peirson, L., Pietrusiak, M., and Sibbald, S.

Funder: Canadian Institutes of Health Research

Timeline: 2010-2013

Description: The goal of public health is to promote health and reduce the amount of disease, premature death, and pain and suffering in the population, through health promotion, disease and injury prevention, and health protection. The following example illustrates how public health services directly impact the broader health system with respect to patient outcomes and expenditures. In 2005, chronic diseases such as cardiovascular disease (CVD), cancer, emphysema, and diabetes accounted for 35 million deaths worldwide (10) and in 2002, the economic burden of CVD and cancer alone in Canada was $32.7 billion. Overweight and physical inactivity are recognized risk factors for chronic diseases. Public health in Canada has a mandate to reduce overweight and increase physical activity in the population. Canadian data suggests a 10% decrease in sedentary behaviour would result in health savings of $150 million per year. Therefore this is crucial that public health decision makers and health departments are equipped with the necessary knowledge, skills and capacity to incorporate the best evidence on what works in promoting healthy lifestyles into policy and practice. Currently we know there are significant gaps in the use of evidence in public health decision making, and that knowledge, skills and capacity to use evidence are lacking in public health settings. The goal of this research is to work collaboratively with health departments to enhance capacity for evidence-informed decision making. The knowledge gained from this study will be useful for several audiences including health departments; public health organizations (e.g. Public Health Agency of Canada); research fundings, and other health care professionals and settings.

Identifying violence against women (VAW) in health care settings

Team: Wathen, N., and MacMillan, H.

Funder: Ontario Women’s Directorate

Timeline: 2003-2008

Description:

  • Intimate partner violence against women (VAW) is a serious health care issue that can result in physical and psychological harm for women and their children.
  • Current evidence does not give clear guidance to health care providers about whether, and when, they should ask women about abuse
  • Both universal screening and case-finding can identify women exposed to violence, but current evidence does not identify effective interventions to which women can be referred
  • The McMaster VAW Research Program (2003 – 2008) provided evidence to answer the question “is screening for woman abuse effective in preventing subsequent violence and improving quality of life?”
  • A number of projects, including two that asked women and their health providers how best to identify woman abuse in health care settings, informed the development of two randomized trials to assess 1) the best approaches to screening, and 2) the effectiveness of universal screening vs no screening in 4 types of health settings