Introduction to Knowledge Translation at CIHR Ian D Graham PhD by gjjur4356

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									        Health Research
         with an Impact

           Ian D Graham PhD
   Vice President, Knowledge Translation
            and Public Outreach
   Canadian Institutes of Health Research

New Brunswick Health Research Foundation
 Official Launch and 1st Annual Conference
              October 4th 2009
                                Health Research
                                  with an Impact

•   Doesn’t all health research have an impact?
•   Knowledge Translation as a mechanism for impact
•   Commonalities in our approaches to health research
•   KT infrastructure for achieving impact
                      Doesn’t all health research
                                have an impact?
• Consistent evidence of failure to translate research
  findings into clinical practice
   • 30-45% patients do not get treatments of proven
     effectiveness
   • 20–25% patients get care that is not needed or
     potentially harmful
    (McGlynn et al, 2003; Grol R, 2001; Schuster, McGlynn, Brook, 1998;)
• Cancer outcomes could be improved by 30% with
  optimum application of what is currently known
• 10% reduction in cancer mortality with widespread use
  of available therapies
   (CSCC 2001; Ford et al, 1990)
Knowledge Translation as a mechanism
              for impact
Knowledge Translation is part of our
            mandate
                 Context: CIHR Mandate
(4h) promoting the dissemination of knowledge and
     the application of health research to improve the
     health of Canadians
(4i) encouraging innovation, facilitating the
     commercialization of health research in Canada and
     promoting economic development through health
     research
(5f) communicate with the public, governments, the
     Canadian and international communities, voluntary
     organizations and the private sector on issues
     pertaining to health or health research
           Knowledge Translation is the bridge
               between discovery and impact


             (KT research and practice)



Research
outputs                                   Research impacts




     It’s is about making a difference
        What is Knowledge Translation?

KT is a dynamic and iterative process that includes
synthesis, dissemination, exchange and ethically
sound application of knowledge to improve the
health of Canadians, provide more effective health
services and products and strengthen the health
care system.
This process takes place within a complex system of
interactions between researchers and knowledge users which
may vary in intensity, complexity and level of engagement
depending on the nature of the research and the findings as
well as the needs of the particular knowledge user.
                  What is Knowledge Translation?
                               The contextualization and integration of research findings
                              of individual research studies within the larger body of
                              knowledge on the topic.
                               Synthesis is a family of methodologies for determining
    Knowledge synthesis       what is known in a given area or field and what the
                              knowledge gaps are.

                               Involves identifying the appropriate audience for the
       Dissemination          research findings, and tailoring the message and medium to
                              the audience.

                               Refers to the interaction between the knowledge user and
                              the researcher resulting in mutual learning, it encompasses
                              the concept of collaborative or participatory, action oriented
   Knowledge exchange         research where researchers and knowledge users work
                              together as partners to conduct research to solve knowledge
                              users’ problems (Integrated KT).

                               The iterative process by which knowledge is actually
                              considered, put into practice or used to improve health and
Ethically sound application   the health system.
       of knowledge            KT activities must be consistent with ethical principles and
                              norms, social values as well as legal and other regulatory
                              frameworks
             What is Knowledge Translation?
Knowledge translation is about:
• Making users aware of knowledge and facilitating their
  use of it to improve health and health care systems
• Closing the gap between what we know and what we do
  (reducing the know-do gap)
• Moving knowledge into action

Knowledge translation research (KT Science) is about:
• Studying the determinants of knowledge use and
  effective methods of promoting the uptake of knowledge
                  At CIHR we consider two
                    broad categories of KT
                   The researcher develops and implements
                   a plan for making knowledge users aware
End of grant KT    of the knowledge generated through a
                   research project




                   The researcher engages potential
                   knowledge users as partners in the
                   research process.
Integrated KT      This requires a collaborative or
                   participatory approach to research that is
                   action oriented and is solutions and
                   impact focused.
               What is end of grant KT?
A broad spectrum of activities including:
Diffusion
• Conference presentations
• Peer reviewed publications (Open access policy-
  Jan 1, 2008)
• Non-peer reviewed publications
• Website postings
                     What is end of grant KT?
Dissemination (activities that tailor the message and
  medium to a specific audience)
• End of grant report to funders
• Summary/briefings to stakeholders
• Educational sessions with patients, practitioners and/or
  policy makers
• Engaging knowledge users in developing & executing
  dissemination/implementation plan
• Tools creation
• Media engagement
• Use of knowledge brokers
                      What is end of grant KT?

Application* (moving research into practice in cases where
  the strength of evidence is sufficient)
• Understanding the context/environment where research is
  to be applied
• Identifying barriers to the uptake of the research findings
• Adapting knowledge, tailoring messages and interventions
  to promote uptake
• Evaluating the implementation process and outcomes
• Working within a conceptual framework

     *NB knowledge application is often a fundamental
            component of integrated KT as well
                       What is integrated KT?

• a way of doing research
• collaborative, participatory, action-oriented, community
  based research, co-production of knowledge, mode 2
  research
• involves engaging and integrating knowledge users
  into the research process
• Knowledge users can be:
   – Policy- and decision-makers from the community to
     the federal level, researchers, the public, industry,
     clinicians, the media
   – Investigators from different disciplines, teams,
     countries
                      What is integrated KT?

Knowledge users and researchers (knowledge creators)
  work together to:
    shape the research questions
    interpret the study findings and craft messaging
     around them
    move the research results into practice

   In our view – this is the minimum requirement for
     conducting integrated KT
                   What is integrated KT?
In addition, knowledge users and researchers (knowledge
   creators) can work together to:

    shape the research questions
    decide on the methodology
    help with data collection and tools development
    interpret the study findings and craft messaging
     around them
    move the research results into practice
    widespread dissemination and application
         Review implications of integrated KT

By requiring both researchers and knowledge users to be
  part of the research team, integrated KT requires merit
  review:
• Both knowledge users and researchers on the review
  panel
• Each proposal scored on impact/relevance as well as
  scientific merit
• Panellists often need orientation materials explaining
  the process as well as worksheets to apply the criteria
• Both “types” of panel members have a voice
                  Health research with an impact
                          means avoiding waste:

• Avoiding waste????
• Chalmers and Glaziou1: “Within specific health
  problems there is little research on the extent to
  which questions addressed by researchers match
  questions of relevance to patients and clinicians.
• e.g. the research priorities of patients with
  osteoarthritis of the knee favoured more rigorous
  evaluation of physiotherapy and surgery – 9%
  wanted more research on drugs, yet 80% of RCTs of
  patients with this condition were on drugs
         Iain Chalmers, Glaziou,P. Avoidable waste in the production
     and reporting of research evidence. The Lancet 2009 374 86-89.
                          Having an impact means
                          closing the gap between
                               evidence and action
          Some general KT principles:
1. Researchers need to do the right research

    need for synthesis to determine what we
     already know (or should know if we were to
     summarize the existing knowledge)
    Paul Ewald*: “We have in hand most of the
     information we need to facilitate a new
     golden age of medicine. And what we don’t
     have in hand we can get fairly readily by
     wise investment in targeted research and
     intervention.”

      *From John Brockman. “What is Your Dangerous Idea”
             Some general KT principles for
                        achieving impact:
1. Researchers need to do the right research
    need for synthesis to determine what we
     already know (or should know if we were to
     summarize the existing knowledge)
    need to determine where there is a strong
     evidence base and move that evidence into
     action
    today's health problems are complex and
     interdisciplinary and require mixed methods to
     solve
    primary research needs to be targeted to fill the
     known gaps in our knowledge base
    primary research needs to be solutions-based
                Some general KT principles for
                          achieving impact :


2.    The right people need to be involved from the
      beginning

      need applied, collaborative, interdisciplinary
       research (in other words: integrated KT)
      users of the research need to be helping to set
       the research agenda and define the research
       questions to ensure relevance and greater
       likelihood of uptake of the results when they
       become available
              Some general KT principles for
                        achieving impact :


3. Knowledge-users need to make the research right
   for their own context

    research is not used like a can opener
    knowledge-users need to adapt, contextualize
     and take ownership of knowledge for local use
    as research producers, this means you need to
     help them sufficiently understand your work so
     that they are able to put it to use
                          Achieving impact:
                   closing the gap between
                       evidence and action
How to close the gap between evidence and action:
  shift attention from individual adopters to the
    organizational and environmental context for
    change
  set targets for change
  monitor uptake of the research and evaluate the
    health and system outcomes/impact
  keep it simple
  focus on a few important targets, practical
    indicators
How do we measure impact at CIHR?
                                 Types of impact

Impact writ large: Impact framework – adapted from/by
  the CAHS
Impact at the level of an individual study - included in
  merit review of integrated knowledge translation
  grants
                            Impact writ large:
                  the CIHR Impact Framework
• Advancing Knowledge
   – discoveries/breakthroughs, contributions to the scientific
     literature.
• Building Capacity
   – development and enhancement of research skills in
     individuals and teams.
• Informing Decision-Making (knowledge use)
   – impacts of research in the areas of science, public, clinical
     and managerial decision-making, practice and policy.
• Health & Health System Impacts
   – advances in prevention, diagnosis, treatment and
     palliation as well as advances in the way the system
     functions.
• Economic Impacts
   – commercialization of discoveries; direct cost savings; and
     human capital gains.
                  Impact at the level of an
           individual study: Merit Review
Research question: To what extent does the research
  question respond to an important need identified by
  the knowledge-user(s) on the research team

Research approach: To what extent are the knowledge-
  user team members meaningfully engaged where
  appropriate (e.g. in defining the research questions,
  informing the research plan, interpreting the findings,
  informing the end-of-grant KT plan)?
                   Impact at the level of an
            individual study: Merit Review
Feasibility: To what extent are the knowledge-users on
  the team committed to applying the findings when
  they become available and is their application
  achievable in the particular practice, program and/or
  policy context?
• To what extent does the researcher-knowledge-user
  team have the necessary expertise and track record
  to deliver on the project’s objective(s), including the
  objectives of the end-of-grant KT plan?
                  Impact at the level of an
           individual study: Merit Review
Outcomes: To what extent will the project have a
  substantive and sustainable impact on health
  outcomes, practice, programs and/or policy in the
  study context?
• To what extent will the project’s findings be
  transferable to other practice, programs and/or policy
  contexts?
• To what extent is the evaluation plan appropriate to
  assess the project’s impact?
Commonalities in our approaches to
        health research
             Commonalities in our approaches
                           to health research

Translation to the Broad Community
• We believe in effective mechanisms for linkage between researchers
   and users of health research to enhance the relevance and value of
   publicly funded research
Capacity Building
• We will strive to build a strong and stable infrastructure to strengthen
   health research capacity in New Brunswick
Leveraging
• We are committed to using provincial health research funds to provide
   a platform that ensures the successful acquisition of additional research
   funds from public and private sector, both national and international
Culture of Innovation
• We believe in fostering a culture of innovation by engaging health
   researchers in the excitement of discovery, and by supporting the
   creation, growth, and maturation of new discoveries and technologies
   with market potential at all stages of the innovation pipeline
                 CIHR’s Health Research Roadmap


Four main Strategic Directions:
1. Invest in world class excellence
2. Address health and health system research
    priorities (considered within the light of the S&T and STIC
    sub-priorities)
3. Accelerate the capture of health and economic
    benefits of health research
4. Achieve organizational excellence, foster ethics
    and demonstrate impact
               CIHR’s Health Research Roadmap


Strategic Direction 3: Accelerate the capture of health
   and economic benefits of health research
• Reaping socio-economic benefits from research
   through KT and partnerships
• Enhancing the application of research and its
   evaluation
                Accelerate the capture of health
        and economic benefits of health research
Reaping socio-economic benefits from research through
   KT and partnerships

1.   Facilitate and strengthen partnerships between
     researchers and knowledge users and between
     CIHR and a variety of organizations to achieve
     impact

2.   Support evidence-informed policy making to
     improve health and the health system at both the
     provincial and federal levels.

3.   Facilitate innovation and commercialization

4.   Implement citizen engagement and public outreach
     initiatives
                   Accelerate the capture of health
           and economic benefits of health research


Enhancing the application of research and its evaluation

5.   Advance the application of research and its
     evaluation

6.   Build capacity of both researchers and knowledge
     users to engage in KT

7.   Increase the number of researchers to advance the
     science of KT
KT infrastructure for achieving impact
                           KT Funding Opportunities
Synthesis           • CIHR funds the Canadian Cochrane Network and Centre
                    • Knowledge Synthesis FO
                    • Operating grants competition - reviewed by KTR panel
Integrated KT       • Knowledge Synthesis FO
                    • Knowledge to Action FO
                    • Partnerships for Health System Improvement FO
                    • Meeting, Planning and Dissemination grant – KT Events
                      to develop collaborative relationships and grant proposals

End of Grant KT     • Meeting, Planning and Dissemination grant – KT
                      Supplement to disseminate results
                    • Allowable expense as part of a grant application
Commercialization   • Proof of Principle FO
                    • CIHR/SME FO
                    • Science to Business FO
Science of KT       • Operating grants competition - KTR Panel
Training            • Doctoral, Fellowship, New Investigators Awards
                    • Health Research Communications Award, Journalism
                      Award
                                  KT Funding Opportunities:
                                many serve multiple functions
                                                               Science of KT
   KT Awards (New Investigator, Fellowships, Doctoral)
Strategic Training Initiative in Health Research (STIHR)
                                         Operating grants        Synthesis
                                      Canadian Cochrane
                                         Evidence on Tap
                                    Knowledge Synthesis             Integrated KT
    Partnerships in Health System Improvement (PHSI)
                                       KT Awards (Prizes)
                                      Knowledge to Action
                                   KT Supplement Grants
                   Meeting, Planning and Dissemination           End of Grant KT
                                  Proof of Principle (POP)
                                               SME/CIHR
                                      Science to Business    Commercialization
Knowledge Synthesis Grant
Supports teams of researchers and decision-makers
to produce knowledge syntheses ($100 000 per year)
and scoping reviews ($50 000 per year), that respond
to the information needs of knowledge-users in all
areas of health. Partners can, but are not required to
make in-kind or cash contributions.

Partnerships for Health Systems Improvement
Supports teams of researchers and decision-makers
interested in conducting applied health research useful
to health system managers and or policy-makers.
CIHR pays up to $400 000 over 3 years, with an
additional 20 to 30% required from partners.
Knowledge to Action Grant
Supports teams engaged in knowledge translation
(KT) at the community, regional, provincial or federal
level by funding KT and implementation activities of
researchers and decision-makers/knowledge-users.
 CIHR pays up to $100 000 per year for one or two
years. Partners can, but are not required to make in-
kind or cash contributions.
                Meetings, Planning and Dissemination
                                             Grants
•   provide support for meetings, planning and/or
    dissemination activities consistent with the mandate of
    CIHR and relevant to CIHR Institutes, Initiatives, or
    Branches.

• Competition Dates
   – 3 competitions/year.
   – Applications due: Oct 1, Feb 1, June 1
   – Decision/funding dates: Jan 1, May 1, Sept 1

• Term and amounts
   – 1 year, non-renewable grants
   – Maximum grant value is $15,000
            Meetings Planning and Dissemination
                                         Grant:
                                KT Supplement

                             amount


• Up to $40 000 for KT activities at the end of a CIHR
  grant when it is appropriate to disseminate the results
  of the research beyond the traditional scientific
  community and using methods supplementary to and
  in addition to publication in peer-reviewed journals.


• Offered three times a year: October 1, February 1
  and June 1
        More KT Funding Opportunities


• Training and Personnel Awards
• Knowledge Translation priority awards:
   – New Investigator Award
   – Fellowship Award
   – Doctoral Research Award
• Health Research Communications Award
                         My question is:
                        Are we making an
                             impact?




Bottom line: we all want to make an impact
For more information, visit our web page:
http://www.cihr-irsc.gc.ca/e/29418.html
http://www.cihr-irsc.gc.ca/f/29418.html




    ian.graham@cihr-irsc.gc.ca

              Thank you

								
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