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What is a knowledge broker?

In Uncategorized on May 1, 2012 by Centre for Evidence-based Health Care

Today I came across a new term.  Prof Lavis shed some light for me:  A knowledge broker, as I understand it, is a person who stands in the gap between policy-makers and researchers and connects the two.  This person should thus be familiar with the world of policy-making and with the world that researchers operate in. Although the person can work in a Research Unit, he/she is independent in the sense that the best current evidence is promoted, irrespective of who conducted the research.  Knowledge brokers can also be independent consultants.  Also, this person should of course have good people’s skills as well as networking skills.

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Day 2, 1 May 2012

In Uncategorized on May 1, 2012 by Centre for Evidence-based Health Care

Yesterday we ended with each working group (i.e. Centre/Unit) clarifying the problem that they are facing and for which they want decision-makers (policy-makers specifically for this workshop) to make an evidence-based informed decision. We have more than ten different working groups who are each determined (and I believe inspired!) to get their problem addressed in practice. The projects include from getting traditional medicine taken up in the Ethiopian Health System to introducing universal health insurance in Burkina Faso to addressing social aspects to reduce road accidents in Cameroon.

 

After a refreshing tea break Prof Lavis gave a presentation titled “What options are best suited to address the problem?”. To put this session in context, I should mention that there are three sub-processes (following on each other) that we are covering in this workshop. Together they are part of the bigger process of getting research evidence being taken up in practice. The three questions are:

  1.  What’s the problem, and how should one think it through to clarify and refine it?
  2. What options (interventions, actions, strategies) are best suited to address the problem?
  3. How can change be brought about (i.e. implementation)?

Today we addressed number 2. Again working in our working groups, we took our previous work a step further by answering the following questions for our problem:

  1. Has an appropriate set of options been identified to address the problem? – We had to identify three possible options that may solve or address the problem. – Ideally one would answer the questions below for each of the options, but for the sake of time we only chose one to unpack further.
  2. What benefits are important to those who will be affected and which benefits are likely to be achieved with each option? – Search for systematic reviews of effectiveness studies (search the relevant sources from the list that I mentioned yesterday).
  3. What harms are important to those who will be affected and which harms are likely to arise with each option? – Search for systematic reviews of effectiveness or if there aren’t any that addressed safety aspects as well, search for studies such as cohort studies (or systematic reviews of cohort studies!) that were specifically designed to asses harms.
  4. What are the local costs of each option and is there local evidence about their cost-effectiveness? – Search for economic evaluations conducted in similar settings from the same perspective (e.g. governmental healthy system, healthcare provider, payer). – Good sources for systematic reviews of cost-effectiveness are The Cochrane Library and Health Systems Evidence database. If you can’t find any, search for primary cost-effectiveness studies. If there aren’t any either, you will have to collaborate with people who can help you to make an expert estimation or simulation, or conduct a local cost-effectiveness study yourself (a nice learning opportunity for sure!).
  5. What adaptations might be made to any given option and might they alter its benefits, harms and costs? – Search for systematic reviews of process evaluations/qualitative studies. – Using PubMed’s “Topic specific queries” filter as I reported on yesterday will be a good start.
  6. Which stakeholders’ views, values, experiences and skills might influence the acceptability of an option and its benefits, harms and costs? – I would say a starting point here would be to have some ideas and start searching for those. However, don’t limit your search so much that you won’t retrieve studies on additional issues that you didn’t think of. – Ideally search for systematic reviews of qualitative studies.

P.S. If you cannot find systematic reviews that answer your questions and have to search for primary studies, McMaster PLUS database is a good start. Here you will find quality-appraised studies from the leading medical journals.

 

At the end of the day, the working groups had the opportunity to report back to the rest of the audience. Some of the groups triggered quite a lot of discussion (which is a good thing!) so that we had to call it a day. The remaining groups will stand over to tomorrow.

In addition to learning today about the approach one should take to unpack the different options to address your stated problem, I learned the following:

  • I practiced today how to search the health-evidence.ca and Health Systems Evidence databases (which I was not familiar with before and which I found extremely useful!);
  • Realised that what I am learning here at the workshop is not only limited to getting research evidence being taken up in the policy-making process, but that it will for sure help me to write better research proposals in future – especially in the sense of enhancing (or easing) the use of the research when it is done.

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What is a policy brief?

In Uncategorized on May 1, 2012 by Centre for Evidence-based Health Care

I’ve never read a policy brief before and for those of you who also haven’t here is an overview of what it should include:

  1. What do you know about the problem?  Sketch the context, including current practices.
  2. What are the options for addressing the specific problems?  For example, what are the possible interventions/strategies that can be followed and what is the evidence saying about these different options?
  3. Identify potential barriers that may hinder implementation (e.g. resources and infrastructure, number of staff and skills needed, patient values, etc.)
  4. Describe how implementation should be facilitated.

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Day 1, 30 April 2012

In Uncategorized on May 1, 2012 by Centre for Evidence-based Health Care

 

 

The workshop kicked off this morning with welcoming by Dr David Yondo after which workshop participants and presenters introduced themselves.  This group photo was taken in front of the workshop venue.  Participants are from a variety of African countries including Cameroon, Uganda, Nigeria, Burkina Faso, Ethiopia and South Africa.  A lot of participants are researchers already involved in writing policy briefs and influencing the policy-making process, whereas others such as me are there to absorb everything I can so that I can go back to my country and help to establish a system where we can get involved.  Many of the participants are also PhD students who want to make sure that they are on the right track in packaging their research optimally for decision-makers such as policy-makers.

We are privileged to have an international expert in the field of knowledge translation, Prof John Lavis from Canada, as the lead presenter of the workshop.  A short description of him and the other two presenters are below:

  • Prof John Lavis is the Director of the McMaster University Hospital Forum, a WHO collaborating Centre for Evidence-Informed Policy.  He is also a Professor of Health Policy in the Development of Clinical Epidemiology at McMaster University in Hamilton, Canada.
  • Dr Pierre Ongolo-Zogo is the head of the Centre for of Best Practices in Health and Knowledge Translation Unit (Cameroon) which was created in 2008 to build capacity for knowledge translation in the Central Hospital Africa.  They also provide evidence syntheses to policy-makers.
  • Prof Nelson Sewankambo is the Principal of the College of Health Sciences at Makerere University in Kampala, Uganda.  He is one of the leaders of the REACH Policy Initiative which is a knowledge translation entity of the regional East African community.

 

As this is a workshop and not a seminar, participants are encouraged to interact with the presenter during presentations.  Furthermore, the presentations take the form of sets of questions that guides you to reflect and assess your Unit’s/Centre’s current situation and capacity to find and use research evidence.  In this way one doesn’t only obtain knowledge but also gets to build skills – very hands-on indeed!

The programme of the day started with a pre-test.  Each participant got to answer the following questions:

  1. Can your Unit/Centre find and obtain research evidence on high-priority health systems?  This includes evaluating current staff skills and capacity; whether there is dedicated time, incentives and resources; and whether you are/can collaborate with experts to fill the gaps where your Unit/Centre is lacking.
  2. Is your unit looking for research evidence in the right places?
  3. Can your unit tell if the available research evidence warrantee serious consideration?  This includes assessing quality of research and evaluating applicability of the evidence.
  4. Can your Unit/Centre present research evidence to policy-makers in a useful way?  This includes having communicating skills to convey research findings precisely and in an accessible (plain) language.
  5. Does your Unit/Centre lead by example and show how it values the use of research evidence?  This should address whether knowledge translation is a priority in your Unit/Centre and whether you have resources and dedicated time to do it.
  6. Do the policy-making processes in your country/province have a place for research evidence?  Therefore you must be familiar (or become familiar!) with the policy-making processes in your region.  The ideal is that policy-makers understand the importance and the principles of evidence-based health care so that they can know to ask for research evidence, and for whom or where to ask.

 

Having done a brief stock-taking of your Unit/Centre, it is useful to recognise that before starting with a project, researchers should be clear on what they are trying to achieve:

  1. What role are you trying to play in the policy-making process?  For example, are you writing a policy brief or are you providing relevant evidence for use by policy-makers?
  2. What steps in the policy-making process are you trying to inform?  The steps include (a) agenda setting, (b) the policy choice, (c) policy implementation, and (d) policy evaluation.
  3. Can you situate your data or study in the context of a systematic review?
  4. Do you have the time and resources to inform other steps in the policy-making process and at the same time using systematic reviews?

 

One must also be realistic about the fact that the process of getting evidence to be used in policy-making and practice will only be successful if you acknowledge and address the potential barriers that my hinder the uptake of research by decision-makers.  Below is a summary of the different types of barriers:

  1. The research isn’t valued as an information input, i.e. decision-makers do not appreciate the importance of using evidence to inform practice.
  2. The research isn’t relevant, i.e. irrelevant research are produced and/or priority questions are not addressed.
  3. The research is in a format that is not easy to use by decision-makers.  Therefore it should be translated from scientific language to a language that is understood by the decision-makers.  This can be done by one or more of the following knowledge translation strategies:
    1. PUSH – where the researcher produces evidence assessments and feed them to decision-makers, hoping that it will be used.
    2. Facilitate PULL – building capacity among policy-makers to make them want to ask for translated research findings to inform decision-making.
    3. PULL – where decision-makers are asking for translated research findings.
    4. Exchange – where both researchers and policy-makers are working and learning together throughout the process of producing research and writing policies.

In an ideal world you will have all of these strategies going on to make sure that nothing hinders the uptake of research in the healthcare decision-making process.  In this workshop however, the main focus will be on the PUSH strategy.

Knowing where you are aiming, having identified potential barriers and decided on a knowledge translation strategy, you must know how to formulate the question that the policy wants to answer.  Without a clear question one surely cannot find answers!  Consequently, you must search for research that addressed your specific question.  Searching for systematic reviews is the best approach. The most important sources to search are as follows:

  1. If you want to find systematic reviews about the effects of interventions on patient level, search The Cochrane Library.
  2. If you want to find systematic reviews about the effects of public health programmes and services, search www.health-evidence.ca .
  3. If you want to find systematic reviews about health systems implementation strategies, search Health Systems Evidence (www.mcmasterhealthforum.org/healthsystemsevidence-en).
  4. If you want to find systematic reviews of consumer- and healthcare provider-targeted implementation strategies, search the ‘Rx for change’ database.
  5. If you want cannot find any systematic reviews to address your question, you can search:
    1. McMaster PLUS database which contains quality-appraised studies from the leading medical journals.
    2. PubMed by clicking first on the “Topic-specific queries” link on the homepage and then search in “Health services research queries”.

 

During the last session of the day, participants from the same Units/Centres formed working groups to answer the questions provided below together.  This should happen in the context of the individual reflections during the course of the day.

  1. What is the problem addressed by your research?
  2. How did the problem come to attention and has this process influenced the prospect of it being addressed? (I.e. is this issue already on the agenda?  If so, why?  E.g. media coverage of a bad incident.)
  3. What indicators can be used, or collected, to establish the magnitude of the problem and to measure progress in addressing it?
  4. What comparisons can be made to establish the magnitude of the problem and to measure progress in addressing it? And what did the reviews tell you?
  5. How can a problem be framed (or described) in a way that will motivate different groups? And what did reviews tell you?

Tomorrow morning we will start with each Unit/Centre providing feedback to the rest of the participants.

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Who am I and what is this workshop about?

In Uncategorized on April 26, 2012 by Centre for Evidence-based Health Care

My name is Anel Schoonees and I am a researcher at the Centre for Evidence-based Health Care, Stellenbosch University, South Africa www.sun.ac.za/cebhc.  My background is in nutrition and clinical epidemiology.

Knowledge translation is the process in which the gap between research and healthcare decision-making is being closed. Makerere University and McMaster University, in partnership with the Centre for Best Practices in Health, Yaoundé Central Hospital, is organizing a 5-day, non-residential training workshop on knowledge translation from 30th April to 4th May 2012 in Yaoundé, Cameroon at the Yaoundé Central Hospital.

The objectives of the workshop are to:

  • learn how to find and use research evidence in the policy-making process;
  • discuss common barriers in using research evidence in the policy-making process and approaches to overcoming these barriers;
  • understand how to train and impart skills learned in the workshop to build capacity among your local knowledge translation platform team members.

In this workshop researchers and healthcare professionals will be building skills in how to assist evidence-informed policy-making. Every evening for the duration of this workshop I will be blogging about the event – reflecting on what I’ve learnt and in doing so sharing my learning experience with you.  You’re welcome to join me in finding out what knowledge translation is all about.