Knowledge Translation

Moving from Best Evidence

to Best Practice

Ann McKibbon MLS PhD

Health Information Research Unit
McMaster University
Professor emeritum
KT is
 Taking what we know and applying it…

 Behaviour change based on knowledge

 Getting research findings into practice
Disclaimers
 I view KT as large
 Background is health sciences—all of what I
have to say applies to all disciplines
 Retired for 4 years
 Learning is based on fun and interaction
 Goals today
 History of KT
 Want you to experience breadth of KT
 Types/forms/intensity of KT
 Searching for KT in research literature
 Example of 2 models of KT
 KT examples
 Tool (Sick Kids toolkit)
 Stretch yourself and have some fun
Forms of KT
 KT has 2 forms:
 Research into KT to make it better
 Practical form to take what we know/discover
and insure that we help make it happen

 Today: Practical
 Researcher Obligations

 Base your research on

Important questions
What we already know
Existing gaps

 Do high quality, feasible-to-apply research

 Report findings in a timely and accurate manner
 Work to make sure your findings are applied
(translated)
Why is KT important?
~55% of patients get less than adequate care
 30% to 40% not get what they should get
 20% to 25% get what…
 should not have
 they do not need
 McGlynn E. NEJM 2003.
 If optimal cancer care for adults…
 30% improvement in cancer outcomes
 10% reduction in cancer mortality
 Exercise likely better than meds in many situations
Australia 2009-2010
History
Plotinus (Roman 205-207 AD)
“Knowledge, if it does
not determine action
is dead to us”

http://www.philosophyarchive.co
m/index.php?title=Plotinus
Arabic world--Avicenna
 “…the practice of
medicine is not the work
which the physician
carries out but it is the
branch of medical
knowledge, which when
acquired, enables one to
form an opinion upon
which to base the proper
plan of treatment”
 980 to 1037
James Lind Vitamin C 1747

Published 1753 applied 1795 (50% mortality)

 Louis Pasteur

“To him who devotes his life

to science, nothing can
give more happiness than
increasing the number of
discoveries, but his cup of
joy is full when the results
of his studies immediately
find practical applications.”
Quoted by René J. Dubos in Louis Pasteur, Free Lance of Science
http://www.whonamedit.com/doctor.cfm/2994.html
Definition
Canadian Institute for Health Research

“the exchange, synthesis, and ethically-sound

application of knowledge – with a complex
system of interactions among researchers
and users – to accelerate the capture of the
benefits of research for [the people we serve]
through improved health, more effective
services and products, and a strengthened
health care system.”
Definition
find your own working definition

Harnessing our evidence

Knowledge to action
Behavioural change (based on knowledge)

KT is not a “one size fits all” kind of thing

Failures of KT
Still need some more KT
Successes of KT
Failures of KT
Failures of KT
 Childhood immunizations and autism
 Immunization in some populations
 Obesity
 Physical activity
 Opioid crisis
 Smoking outside North America
 Climate change
Still needs some more KT
Still needs some more KT
 Smoking in North America
 Antibiotics for viral infections
 Flu vaccinations for health professionals
 Hand washing
 Fast food restaurants’ menu choices
Successes of KT
Successes of KT
 Seatbelts
 Motorcycle helmets in Canada
 Infant and toddler car seats
 Breast feeding in North America
 Sprinkles (iron)
 Anything Apple
 Pharmaceutical industry
 Advertising industry
 Question
What proportion of research dollars are spent on
knowledge generation vs translation?

 100:1 generation vs translation

 10:1 generation vs translation
 1:1 generation vs translation
 1:10 generation vs translation
 1:100 generation vs translation
 Answer
What proportion of research dollars are spent on
knowledge generation vs translation?
 100:1 generation vs translation
 10:1 generation vs translation
 1:1 generation vs translation
 1:10 generation vs translation
 1:100 generation vs translation
Searching challenges
 Multiple names
 Not everyone who does KT
labels it as such

 Do a lot of seeking
 Seek out help from librarian
KT Terms
 Applied health research
 Capacity building
 Complex interventions
 Complexity science
 Complexity studies
 Co-optation
 Diffusion of innovations
 Diffusion(s)
 Dissemination
 Evidence based practice
 Getting knowledge into practice
 Implementation
 Implementation research
 Implementation science
http://whatiskt.wikispaces.com/
 Information dissemination and
utilization
 Innovation adaptation
 Innovation adoption
 Innovation diffusion
 Knowledge communication
 Knowledge cycle
 Knowledge dissemination
 Knowledge exchange
 Knowledge management
 Knowledge mobilization
(mobilisation)
 Knowledge transfer
 Knowledge translation
 Knowledge transformation
 Knowledge uptake
KT Terms
 Knowledge utiliz(s)ation
 Linkage and exchange
 Organizational change
 Outcomes effectiveness
research
 Policy research
 Popularization (popularisation)
of research
 Research into action
 Research into practice
 Research mediation
 Research transfer
 Research transformation
 Research translation
 Research utiliz(s)ation
 Sociology of knowledge
 Technology transfer
 Third mission
 Translation(al) research
 Translation(al) science
 Transmission
 Utilization (utilisation)
 Knowledge to action
 Knowledge development and
application
 Knowledge diffusion
 Applied dissemination
 Effective dissemination
 Research implementation
 Quality improvement/assurance
Disciplinarity of KT
 Pharmaceutical industry
 Public health
 Nursing
 Psychology
 Medicine
 Engineering (technology transfer)
 Management studies (change management)
 Advertising and marketing
 Cognitive science
 Education
 Parenting
KT has 3 audiences

 Individuals
 Decision makers
 Policy people
End of grant KT
Integrated KT
 Do you do your KT work within the study
frame or after the end of your project?

 Benefits and more work for Integrated KT—

more bonus points for CIHR and other
funding too
3 Approaches/Intensities of KT
1. Diffusion
1. Let it happen

2. Dissemination
1. Help it happen

3. Application
1. Make it happen
1. Diffusion—let KT happen
 Everett Rogers—Diffusion Model
 Malcolm Gladwell—Tipping Point

 Sociological approach to changing behaviours

 Populations in social networks
 Think cell phones, tablets, Netflixs
Rogers Diffusion of Innovation Model
http://www.utwente.nl/cw/theorieenoverzicht/Theory%20clusters/Communication%20and
%20Information%20Technology/Diffusion_of_Innovations_Theory.doc

/
http://investeddevelopment.com/about/
Diffusion in health care, etc
 Netflix

 Hormone replacement after Women’s Health

Initiative publication (fastest I have ever seen)

 Cholesterol lowering agents (slower)

2. Help it happen (passive)
 Conference attendance, posters,
presentations
 Publish papers in usual journals
 Do rounds at your institution
 Newsletters for professional associations
 Press releases
 Continuing education/other educational
events
3. Make it happen—most effective
Example: Bone fractures
http://www.webmd.com/osteoporosis/ss/slideshow-osteoporosis-overview
Improved Osteoporosis Care in
Ontario Long Term Care Facilities
Kennedy CC, Ioannidis G, Giangregorio LM, Adachi JD,
Thabane L, Morin SN, Crilly RG, Marr S, Josse RG, Lohfeld L,
Pickard LE, King S, van der Horst ML, Campbell G, Stroud J,
Dolovich L, Sawka AM, Jain R, Nash L, Papaioannou A.
Successful knowledge translation
intervention in long-term care: final
results from the vitamin D and
osteoporosis study (ViDOS) pilot cluster
randomized controlled trial. Trials. 2015 May
12;16:214. 20 authors from many domains
Improved Osteoporosis Care in
Ontario Long Term Care Facilities
McMaster
Medicine, CE&B, Family Medicine
St Peters Hospital, Hamilton Health Sciences
University of Waterloo
Western University
University of Toronto
St. Mikes, Medicine
McGill
Medical Pharmacies Group
Osteoporosis Canada
Improved Osteoporosis Care in
Ontario Long Term Care Facilities
Osteoporosis expert
Geriatrician
Pharmacist
Researchers
qualitative and quantitative
Statistician
Kinesiologist
Long term care health professionals and staff
Patient advocate group member
Industry representative
Steps to get Intervention Right
 Systematic reviews (theirs and others)
 Summaries of the evidence
 Collected and reviewed existing local data
 Compared evidence with performance data
 Involved almost everyone in planning
including LTC people
 Pilot tested
 Multiple interventions
Steps of the Intervention
 Professional Advisory Committee each LTC facility
 3 educational sessions, 1 every 6 months
 Learning modules, key messages, evidence, group discussions
 Expert opinion leader/study coordinator at each site
 DVD 10 minutes on prevention
 Audit and Feedback—each LTC site and all individuals
 Reminders, point of care tools on prescribing
 Treatment alerts, checklists, X-ray stamp with “please rule out…
 Action planning at each site
 Internal champion at each site
 Osteoporosis LTC website for champions, etc
 Toolkit of tools including all training materials* (all groups)
Results

CONCLUSIONS: “Our KT intervention

significantly improved the prescribing of
vitamin D and calcium and is a model that
could potentially be applied to other areas
requiring quality improvement.”

…no differences in fracture rates

Capability = physical and psychological
Opportunity = social and physical
Motivation = automatic and reflective
C = capability M = motivation O = opportunity
Mapping of interventions to
BCW
https://static-content.springer.com/esm/art%3A10.1186%2F1748-5908-
6-42/MediaObjects/13012_2011_352_MOESM8_ESM.PDF
Attributes of a good KT person
 Team player with many connections across
and within disciplines
 Comfortable with complex problems
 Creative, capable of out-of-the-box thinking
 Patient
 Somewhat lacking in ego
 Don’t forget to use the Sick Kids template for
planning….
Disinformation/Fake News
 35 deaths in Europe in 2015-16 from measles
 Ebola spread based on information that people
feared the motives of quarantines
 Deaths in Nigeria from eating salt and bitter
melons to prevent Ebola
 Rumours of bad vaccines led to fewer
immunizations to prevent Zika spread
 Diphtheria deaths in Malyasia
 Conspiracy fears keep polio alive in Pakistan
Questions