Knowledge TranslationKnowledge Translationand Equityand Equity

forfor

Information in Health Sciences Information in Health Sciences

relevant to this session on :relevant to this session on :

Research, Communication and Decision MakingResearch, Communication and Decision Making

A Unique Mandate:The Canadian Govt has revitalised its Health Researchmandate through the establishment of 13 virtual health institutes.

The parliamentary act states :The objective of the CIHR is to excel, according to internationally accepted standards of scientific excellence,

in the creation of new knowledge and its

translation into:•improved health ….•more effective services and products..•a strengthened health care system..

[CIHR Act; April 2000]

Canadian Institutes of Health Research [CIHR]

New role in Communication and Decision Making

Canadian Global Health Research Initiative 20012001 CIHR – IDRC – CIDA - Health CanadaCIHR – IDRC – CIDA - Health Canada

International Development Research Centre (IDRC) Experience fostering research in developing countries; Program in Equity and Knowledge Transfer

Health Canada (HC) Considerable networks, knowledge base and recognized leadership;

Canadian International Development Agency (CIDA) Considerable development experience and its emphasis on evidence based health development;

Canadian Institutes of Health Research (CIHR) Strong tradition of excellence in research through the peer-review process; new commitment to research transfer & knowledge exchange.

Canadian Global Health Research Coalition:Coalition:

Vision:Vision:

Equity-oriented focusEquity-oriented focus

Knowledge Generation and Knowledge Generation and Knowledge Knowledge Translation Translation

Balanced approachBalanced approach

Putting Southern countries first Putting Southern countries first

Inclusive pInclusive partnerships artnerships

MentoringMentoring

Link to international development agendaLink to international development agenda

Draft Framework:Draft Framework:Knowledge TranslationKnowledge Translation ‘ Cube’ ‘ Cube’

Policy Makers

Consumers

Researchers

Stage

of K

T Res

earc

h Cyc

le

1 2 3 4Research Pillars

Sources of Knowledge

Us

es

of

He

alth

Kn

ow

led

ge

Media

KT1

KT2

KT3

KT4

KT5

KT6

Health Providers

Draft Framework:Draft Framework:Knowledge TranslationKnowledge Translation ‘ Cube’ ‘ Cube’

Policy Makers

Consumers

Researchers

Stage

of K

T Res

earc

h Cyc

le

1 2 3 4Research Pillars

Sources of Knowledge

Us

es

of

He

alth

Kn

ow

led

ge

Media

KT1

KT2

KT3

KT4

KT5

KT6

Health Providers

Define Define the health the health problemproblem

Define Define the health the health problemproblem

1.Generate 1.Generate new informationnew information

2.Summarize 2.Summarize existing evidenceexisting evidence

3. Combine evidence on 3. Combine evidence on benefits, harm, costs benefits, harm, costs

& preferences& preferences

4. 4. Create evidence-based Create evidence-based messages messages

and performance criteriaand performance criteria

5. Develop measures 5. Develop measures of utilization of utilization & outcomes& outcomes

6. Measure variations 6. Measure variations in utilization in utilization & outcomes& outcomes

Evidence generationEvidence implementation

Knowledge Translation Research Cycle

Draft Framework:Draft Framework:Knowledge TranslationKnowledge Translation ‘ Cube’ ‘ Cube’

Policy Makers

Consumers

Researchers

Stage

of K

T Res

earc

h Cyc

le

1 2 3 4

Research Pillars -Sources of Knowledge

Use

s o

f He

alth

Kn

ow

led

ge

Media

KT1

KT2

KT3

KT4

KT5

KT6

Health Providers

Basic PopulationClinical

Draft Framework:Draft Framework:Knowledge TranslationKnowledge Translation ‘ Cube’ ‘ Cube’

Policy Makers

Consumers

Researchers

Stage

of K

T Res

earc

h Cyc

le

1 2 3 4Research Pillars

Sources of Knowledge

Us

es

of

He

alth

Kn

ow

led

ge

Media

KT1

KT2

KT3

KT4

KT5

KT6

Health Providers

Policy Makers

Consumers

Researchers

Stage

of R

esea

rch

Cycle

1 2 3 4Research Pillars

Sources of Knowledge

Us

es

of

He

alth

Kn

ow

led

ge

Media

KT1

KT2

KT3

KT4

KT5

KT6

Health Providers

Knowledge Knowledge TranslationTranslation Cube Cube

Knowledge Translation relevant to Knowledge Translation relevant to Policy MakersPolicy Makers

They need the Evidence on which interventions They need the Evidence on which interventions in health actually do more good than harm!in health actually do more good than harm!

Example: Web-Based Example: Web-Based Cochrane LibraryCochrane Library

www.Cochrane.orgwww.Cochrane.org

VHL Version for Latin America and VHL Version for Latin America and Caribbean- Stay tuned for Dr Abel Packer! Caribbean- Stay tuned for Dr Abel Packer!

Cochrane Collaboration Cochrane Collaboration ObjectivesObjectives

To help people make well informed decisions by To help people make well informed decisions by preparing, maintaining and promoting access to preparing, maintaining and promoting access to systematic reviews of studies on the effects of systematic reviews of studies on the effects of health and health carehealth and health care practices and policies. practices and policies.

Www.Cochrane.orgWww.Cochrane.org

Campbell Collaboration Campbell Collaboration ObjectivesObjectives

To help people make well informed decisions by To help people make well informed decisions by preparing, maintaining and promoting access to preparing, maintaining and promoting access to systematic reviews of studies on the effects of systematic reviews of studies on the effects of -----------, -----, and -----------------, -----, and ------ interventions upon interventions upon health.health.

Campbell Collaboration Campbell Collaboration ObjectivesObjectives

To help people make well informed decisions by To help people make well informed decisions by preparing, maintaining and promoting access to preparing, maintaining and promoting access to systematic reviews of studies on the effects of systematic reviews of studies on the effects of educational, legal and socialeducational, legal and social interventions interventions upon upon health.health.

www.campbellcollaboration.orgwww.campbellcollaboration.org

The Cochrane CollaborationKnowledge Translation (KT)

KT:KT:DisseminationDisseminationPrimaryPrimary

studiesstudies

KT:KT:EvidencEvidenceesynthessynthesisis

KT:KT:

policymakerspolicymakers

practitionerspractitioners

consumersconsumers

KT:InformedKT:Informed decisionsdecisions

Cochrane reviews being undertaken relevant to the ten Cochrane reviews being undertaken relevant to the ten projected leading causes of Disability-Adjusted Life Years projected leading causes of Disability-Adjusted Life Years in 2020, DEVELOPED REGIONSin 2020, DEVELOPED REGIONS

Ischaemic heart disease Ischaemic heart disease YesYesCerebrovascular diseaseCerebrovascular disease YesYesUnipolar major depressionUnipolar major depression Yes Yes Trachea, bronchus and lung cancersTrachea, bronchus and lung cancers Yes YesRoad traffic accidentsRoad traffic accidents YesYesAlcohol useAlcohol use YesYesOsteoarthritisOsteoarthritis YesYesDementiaDementia YesYesChronic obstructive lung diseaseChronic obstructive lung disease YesYes

Self-inflicted injuriesSelf-inflicted injuries YesYes

Knowledge Translation for Policy Makers

Cochrane reviews being undertaken relevant to the ten Cochrane reviews being undertaken relevant to the ten projected leading causes of Disability-Adjusted Life projected leading causes of Disability-Adjusted Life Years in 2020, IN DEVELOPING REGIONSYears in 2020, IN DEVELOPING REGIONS

Unipolar major depressionUnipolar major depression Yes Yes

Road traffic accidentsRoad traffic accidents YesYes

Ischaemic heart diseaseIschaemic heart disease Yes Yes

Chronic obstructive lung diseaseChronic obstructive lung disease Yes Yes

Cerebrovascular diseaseCerebrovascular disease YesYes

TuberculosisTuberculosis YesYes

Lower respiratory tract infectionsLower respiratory tract infections YesYes

War injuriesWar injuries YesYes

Diarrhoeal diseasesDiarrhoeal diseases YesYes

HIV HIV YesYes

Knowledge Translation for Policy Makers

Title of this talk emphasised EquityTitle of this talk emphasised Equity

Knowledge TranslationKnowledge Translationand and EquityEquity

forfor

Information in Health Sciences Information in Health Sciences

relevant to this session on :relevant to this session on :

Research, Communication and Decision Research, Communication and Decision MakingMaking

New Cochrane-Campbell Project-New Cochrane-Campbell Project-Apply the ‘Equity Lens’ to all Cochrane Apply the ‘Equity Lens’ to all Cochrane and Campbell Reviewsand Campbell Reviews

Document whether theDocument whether the

..Cochrane Cochrane [Health] Interventions[Health] Interventions

..CampbellCampbell [Educational,Legal,Social] Interventions [Educational,Legal,Social] Interventions

do they work in the do they work in the disadvantaged?disadvantaged?

Equity: Do therapies that work in the Equity: Do therapies that work in the Rich also work in the Poor Aspects?Rich also work in the Poor Aspects?

In many situations probably not!In many situations probably not! Poor accessPoor access

Poor healthcarePoor healthcare Poor CompliancePoor Compliance

Recognised Need for a VHL Database for the Recognised Need for a VHL Database for the ‘Poor’‘Poor’

Strategies for tackling health Strategies for tackling health inequalitiesinequalitiesWe need international exchange of experiencesWe need international exchange of experiences

with developing and implementing interventionswith developing and implementing interventions

and policies to reduce socioeconomic inequalitiesand policies to reduce socioeconomic inequalities

in health in order to increase learning speed inin health in order to increase learning speed in

this fieldthis field

J P MackenbachJ P Mackenbach BMJ BMJ 2002;325:1029–322002;325:1029–32

U of O IPH is Co-Convening with U of Aberdeen in UK ,a joint Methods Gp in Equity Interventions within Campbell and Cochrane Collaborations

New Cochrane/Campbell Group:New Cochrane/Campbell Group:Systematic reviews of Interventions to Systematic reviews of Interventions to reduce socioeconomic inequalities in healthreduce socioeconomic inequalities in health

Australia, Canada, Norway, South Africa, UK, USA Australia, Canada, Norway, South Africa, UK, USA

Please join us!Please join us!

New Cochrane/Campbell Equity GroupNew Cochrane/Campbell Equity Group

Objectives:Objectives: To apply the ‘Equity Lens’ to all To apply the ‘Equity Lens’ to all

Cochrane/Campbell Reviews to identify Cochrane/Campbell Reviews to identify interventions that improve health status in interventions that improve health status in the disadvantaged and reduce health the disadvantaged and reduce health inequitiesinequities Series of systematic reviews on effective Series of systematic reviews on effective

interventionsinterventions Link this into Virtual Health LibrariesLink this into Virtual Health Libraries

What does applying the Equity Lens to What does applying the Equity Lens to Cochrane /Campbell Reviews mean?Cochrane /Campbell Reviews mean?

Disadvantaged is not just Socio-economic Disadvantaged is not just Socio-economic Status! Status!

What other groupings of disadvantaged What other groupings of disadvantaged should one consider?should one consider?

Equity Gradients -Equity Gradients -Not just Socio-economic Status!Not just Socio-economic Status!

‘PROGRESS’ [Evans and Brown].

Place of Residence Race/ethnicity Occupation Gender Religion Education SES Social networks/resources

Current Project with Library Scientists:Current Project with Library Scientists:

How do we search the literature including How do we search the literature including Cochrane and Campbell databases for the Cochrane and Campbell databases for the different groups of Disadvantaged?different groups of Disadvantaged?

Search terms for EquitySearch terms for Equity TermMeSHKeywordsEquityequit$ or inequit$ Inequalityequalit$ or inequalit$TermMeSHKeywordsEquityequit$ or inequit$ Inequalityequalit$ or inequalit$

P - Place of residenceP - Place of residence (urban vs. rural)Urban population/ or rural population/ (urban vs. rural)Urban population/ or rural population/ or Rural or urban or inner city or residenceor Rural or urban or inner city or residence

R – Race/ethnicityR – Race/ethnicity Exp Ethnic Groups or eh.fs. (ethnology sub- Exp Ethnic Groups or eh.fs. (ethnology sub-heading)Ethnic$ or ethnol$ or Aborigines or Arabs or Asian Americans or heading)Ethnic$ or ethnol$ or Aborigines or Arabs or Asian Americans or Blacks or Eskimos or Gypsies or Hispanic Americans or Indians, or Jews or Blacks or Eskimos or Gypsies or Hispanic Americans or Indians, or Jews or Whites or racism or segregationWhites or racism or segregation

O – OccupationO – Occupation Occupations/ (this is a term under socioeconomic factors) or Occupations/ (this is a term under socioeconomic factors) or employmentVocation$ or occupation$ or job or profession or career or employmentVocation$ or occupation$ or job or profession or career or employmentemployment

G – GenderG – Gender Male/ of female/ or prejudice (for bias)Male or female or gender or Male/ of female/ or prejudice (for bias)Male or female or gender or sexism or discrimination sexism or discrimination

R – ReligionR – Religion Exp ReligionReligion or religious or prayer or meditate$ (add Exp ReligionReligion or religious or prayer or meditate$ (add specific religions?)specific religions?)

E – EducationE – Education (educational level)Exp educationEducation or school$ or (educational level)Exp educationEducation or school$ or college or university$ or degree (may bring too many off-focus articles) or college or university$ or degree (may bring too many off-focus articles) or certificate or certified or professionalcertificate or certified or professional

S – Socioeconomic statusS – Socioeconomic status Exp Socioeconomic factors/Socioeconomic or Exp Socioeconomic factors/Socioeconomic or poverty or standard$ of living or high-income population or low-income poverty or standard$ of living or high-income population or low-income populationpopulation

S – Social capital/resourcesS – Social capital/resources *Culture/Social values, custom$, belief$ *Culture/Social values, custom$, belief$

Project: 10% sample to establish a baseline

CIHR KT CubeCIHR KT Cube

Policy Makers

Consumers

Researchers

Stage

of R

esea

rch

Cycle

1 2 3 4Research Pillars

Sources of Knowledge

Us

es

of

He

alth

Kn

ow

led

ge

Media

KT1

KT2

KT3

KT4

KT5

KT6

Health Providers

The Cochrane CollaborationKnowledge Translation (KT)

KT:KT:DisseminationDisseminationPrimaryPrimary

studiesstudies

KT:KT:EvidencEvidenceesynthessynthesisis

KT:KT:

policymakerspolicymakers

practitionerpractitionerss

consumersconsumers

KT:InformedKT:Informed decisionsdecisions

Knowledge Translation relevant to Knowledge Translation relevant to Clinicians and Health PractitionersClinicians and Health Practitioners They need the Evidence on which interventions They need the Evidence on which interventions

in health actually do more good than harm!in health actually do more good than harm!

Example: Web-Based Example: Web-Based Cochrane LibraryCochrane Library www.Cochrane.orgwww.Cochrane.org

VHL Version for Latin America and VHL Version for Latin America and Caribbean- Stay tuned for Dr Abel Packer! Caribbean- Stay tuned for Dr Abel Packer!

Mexican Cochrane Centre/Information Mexican Cochrane Centre/Information Center for Decisions in Health (CENIDS) Center for Decisions in Health (CENIDS) of the National Institute for Public Health of the National Institute for Public Health (INSP). Dr Gladys Faba et al(INSP). Dr Gladys Faba et al

Project on evidence-based, user-friendly bulletins for primary Project on evidence-based, user-friendly bulletins for primary care physicians, nurses and health care administrators. care physicians, nurses and health care administrators.

The content is based on up-to-date Cochrane reviews of the The content is based on up-to-date Cochrane reviews of the evidence and includes information on etiology, management, evidence and includes information on etiology, management, prevention and diagnosis. prevention and diagnosis.

The Ministry of Health is actively engaged in the project by The Ministry of Health is actively engaged in the project by suggesting priority health areas and supporting suggesting priority health areas and supporting implementation. implementation.

Evaluation to date has very positive, focusing on health Evaluation to date has very positive, focusing on health practitioner satisfaction and self-reported use of the bulletins.practitioner satisfaction and self-reported use of the bulletins.

Equity: Because these bulletins are directed towards primary Equity: Because these bulletins are directed towards primary care needs and distributed to rural practitioners serving the care needs and distributed to rural practitioners serving the poorest communities and with little access to continuing poorest communities and with little access to continuing medical education, it will be great interest to assess whether medical education, it will be great interest to assess whether these bulletins will help reduce socioeconomic inequities in these bulletins will help reduce socioeconomic inequities in health. health.

CIHR KT CubeCIHR KT Cube

Policy Makers

Consumers

Researchers

Stage

of R

esea

rch

Cycle

1 2 3 4Research Pillars

Sources of Knowledge

Us

es

of

He

alth

Kn

ow

led

ge

Media

KT1

KT2

KT3

KT4

KT5

KT6

Health Providers

Health ConsumersHealth Consumers

They also need the Evidence on which They also need the Evidence on which interventions in health actually do more good interventions in health actually do more good than harm!than harm!

Example: Web-Based Example: Web-Based Cochrane LibraryCochrane Library www.Cochrane.orgwww.Cochrane.org

VHL Version for Latin America and VHL Version for Latin America and Caribbean- Stay tuned for Dr Abel Packer! Caribbean- Stay tuned for Dr Abel Packer!

Cochrane Reviews for Consumers on the Internet

www. cochraneconsumer.com

www. cochrane.org

Knowledge Translation Consumer Knowledge Translation Consumer Projects using Cochrane for research, Projects using Cochrane for research, communication and decision-making. communication and decision-making.

The ‘expert consumer.’The ‘expert consumer.’ KT Project CIHR 2003KT Project CIHR 2003

Cochrane/Campbell Evidence for the 4 Cochrane/Campbell Evidence for the 4 characteristics of an ‘effective consumer’.characteristics of an ‘effective consumer’. Ability to understand health condition and Ability to understand health condition and

their benefits and harms.their benefits and harms. Ability to clarify personal values for options, Ability to clarify personal values for options,

benefits and harms.benefits and harms. Ability to negotiate chosen role in care.Ability to negotiate chosen role in care. Ability to negotiate and achieved preferred Ability to negotiate and achieved preferred

health optionshealth options

Please join us if you are interested !

Shared Decision Making and the Shared Decision Making and the Health Coach ConceptHealth Coach Concept

Goal: Goal: Improve evidence-based decision making Improve evidence-based decision making

capacity of women and girls (gatekeepers capacity of women and girls (gatekeepers to the health of families)to the health of families)

StrategiesStrategies Decision support toolsDecision support tools Health coaches Health coaches

Health Coaching in ChileHealth Coaching in Chile

Project PartnersProject Partners

University of OttawaUniversity of Ottawa

Pontificia Universidad Católica de ChilePontificia Universidad Católica de Chile

Comuna of La PintanaComuna of La Pintana

A CIDA funded projectA CIDA funded project

Finally..Finally.. Next Steps Next Steps

Equity and Knowledge Translation are priority areas in Canada.

Plans for follow-up grants for global networks and centres linked to international development agendainked to international development agenda

Need Inclusive Knowledge Translation PNeed Inclusive Knowledge Translation Partnershipsartnerships Health Science Libraries and Virtual Health Libraries Health Science Libraries and Virtual Health Libraries

will be essential to the success of this!will be essential to the success of this!

Research Transfer/ Research Transfer/ Knowledge ExchangeKnowledge Exchange

Partnerships are the key:Partnerships are the key:Researchers -- research “Researchers -- research “producersproducers””

• in universities, institutes, government departmentsin universities, institutes, government departmentsResearch Research users” – users” – the “four P’s”:the “four P’s”:

• Program administratorsProgram administrators• Policy makersPolicy makers• Practitioners – clinical/public healthPractitioners – clinical/public health• Public – including NGOs/”civil society” Public – including NGOs/”civil society”

organizationsorganizations

Unlimited potential and synergy in Unlimited potential and synergy in pursuing opportunities!pursuing opportunities!