Jaleh Gholami Eshlaghi MD. MPH. PhD Candidate in Epidemiology

Jaleh Gholami EshlaghiMD. MPH. PhD Candidate in Epidemiology

آشنایی با اصول کلی که در هنگام انتقال دانش باید در نظر گرفت•آشنایی با برخی از روش های انتقال دانش برای گروه های متفاوت •

مخاطبینآشنایی با روش های موثر انتقال دانش•توجه به اثربخشی روش های انتقال هنگام تدوین استراتژی انتقال•

اهداف آموزشی این بخش

Message (WHAT?)

Target Audience ( To WHOM?)

Messenger (BY WHOM?)

Evaluation (with what EFFECT should it be transferred?)

Knowledge transfer process and support system (HOW?)

Review

Level of Evidence

Barriers

Consider the audience:

– the problems audiences face, – the message that is valuable to him/her– the level of detail they need, – the style of thinking they use– the messenger they can trust– the language they are comfortable with

What should be considered?

مرور نظام مند و متاآناليز كارازمايي هاي باليني شاهد دار تصادفي •شده نشان مي دهد كه ميزان خطر نسبي شكستگي ران براي

-0.89% 95 (با حدود اطمينان 1.1 به تنهايي Dمصرف ويتامين) مي باشد در حالي خطر نسبي شكستگي ران در صورت 1.36

(با حدود اطمينان 0.82 و مكمل كلسيم برابر با Dمصرف ويتامين ) مي باشد.0.94, %0.71 95

در صورت مصرف مكمل كلسيم باعث كاهش خطر Dويتامين • به تنهايي Dشكستگي ران مي شود در صورتي كه مصرف ويتامين

اين تاثير را ندارد.

Example

Evidence based medicine should be complemented by evidence based

implementation.

Richard Grol

• Health care Professionals• Patients• Policy makers and managers

strategies focusing:

– Printed Educational material (Clinical Practice Guideline, audio-visual materials, and electronic publications)

– Educational Meeting• Didactic meeting (Lectures, Conferences)• Interactive Educational Meeting (workshop)

– Educational Outreach (Prescribing behavior)– Local opinion leaders (Educationally influential

providers)– Audit and feedback (Any summary of Clinical

performance)– Reminders (Patient or encounter specific

information)

strategies focusing on professionals

• Evidence-based clinical practice guidelines are knowledge tools defined as systematically developed statements that help clinicians and patients make decisions about appropriate health care for specific clinical circumstances.

Clinical Practice Guideline

How are clinical practice guidelines developed?

• Establish multidisciplinary guideline team• Identify clinical question that explicitly defines the patients,

intervention/exposure, comparisons (if relevant), outcomes of interest and setting

• Conduct a systematic review of evidence• Appraise and interpret evidence and come to consensus on its

meaning• Draft guideline recommendations that align with evidentiary

base• Complete an external review of draft report among intended

users and key stakeholders• Revise the guidelines in response to external review• Read the final guideline report for distribution and dissemination• Prepare implementation strategy

Appraisal of Guidelines Research and Evaluation (AGREE)

• Opinion leadership is the degree to which an individual is able to influence other individuals’ attitudes or overt behavior informally in a desired way with relative frequency.

Local opinion leaders

This informal leadership is not a function of the individual’s formal position or status in the system, it is earned and maintained by the individual’s – Technical competence, – social accessibility, and – conformity to the systems norms.

opinion leaders have more:– external communication, – higher social status, – innovative

Local opinion leaders

• High level of knowledge• Communication skills• Taking into account stakeholders• Professional ethics

Local opinion leaders characteristics in Iran

G085

G095

G086

G087

G033

G032

G128

G078G116

G090

G027 G147

G150

G049

G069

G140

G051

G050 G099

G047

G048

G053

G007

G141

G013

G009

G001G005

G123

G100

G098

G111

G112

G113

G065 G062 G017

G064G071

G011 G015

G004

G114

G139

G089

G115

G074

Gynaecologists’ social network

18/47

– Printed Educational material (Clinical Practice Guideline, audio-visual materials, and electronic publications)

– Educational Meeting• Didactic meeting (Lectures, Conferences)• Interactive Educational Meeting (workshop)

– Educational Outreach (Prescribing behavior)– Local opinion leaders (Educationally influential

providers)– Audit and feedback (Any summary of Clinical

performance)– Reminders (Patient or encounter specific

information)

Effectiveness of professional behavior change strategies

• Patient decision aids• Interactive Health Communication Applications

(Information packages for patients that combine health information with at least one of social support, decision support, or behavior change support)

• Interventions to enhance medication adherence (Instruction, telephone monitoring and counseling, Reminders, special ‘reminder’ pill packaging, …)

strategies focusing on patients

What are patient decision aids?

Patient decision aids translate evidence into patient-friendly tools to inform patients about their options, help them clarify the value they place on benefits versus harms, and guide them in the process of decision making.

Formats for decision aids are:• paper-based booklets, • video/DVDs,• decision boards, • and internet-based materials

Ottawa Hospital Research Institute (OHRI)

presentation of outcome probabilities

Ottawa PDA format

clarify patients’ values for outcomes

How do we determine the quality of

patient decision aids?

IPDAS Criteria

• Patient decision aids• Interactive Health Communication Applications

(Information packages for patients that combine health information with at least one of social support, decision support, or behavior change support)

• Interventions to enhance medication adherence (Instruction, telephone monitoring and counseling, Reminders, special ‘reminder’ pill packaging, …)

Effectiveness of knowledge translation strategies focusing on patients

Do patient decision aids work?

PDAs improve:

• patients’ participation in decision making,• knowledge of options, • agreement between patients’ values and the

subsequent treatment or screening decisions.• realistic expectations of the chances of benefits,

harms, and side effects• More use of conservative options, • without apparent adverse effects on health outcomes

or anxiety.

Reader Friendly Writing (1:3:25)

Policy brief

strategies focusing on professionals

1:3:251: Main message1: Main message

3: 3: Executive Summary25: The Report

““Reader Friendly Writing” Writing for Reader Friendly Writing” Writing for health policy makers, planners and health policy makers, planners and

managersmanagers

((Canadian Health Service Research Canadian Health Service Research Foundation)Foundation)

• This part is one page of main message bullets. • They are the heart of your report, the lessons decision

makers can take from your research. • Set aside your text and focus on expressing clear

conclusions based on what you've learned. • Consider your audience - who are they, and what do

they most need to know about what you've learned? • tell decision makers what implications your work has

for theirs.• if you're really not ready to draw more conclusions,

don't just fall back on "more research is needed." Use your main messages to define the questions that still need to be asked.

Main Messages

• The three in 1:3:25 is the executive summary. • An executive summary is not an academic abstract;

it's much more like a newspaper story, where the most interesting stuff goes at the top, followed by the background and context and less important information further down.

• This is not the place for more than a line or two about your approach, methods and other technical details.

Executive Summary

• Context• Implications• Approach• Results• Additional Resources• Further Research• References and Bibliography• appendix

The Report

Policy briefs are a relatively new approach to packaging research

evidence for policymakers.

Policy Brief

• Title• Key messages

– What is the problem?– What do we know (and not know) about viable

options to address the problem?– What implementation considerations need to be

borne in mind?• Report

– Introduction that describes the issue and the context in which it will be addressed

– Definition of the problem– Options for addressing the problem, with each one

assessed in a table (an example is shown below)

Possible outline of a policy brief

• In contrast to the substantial evidence base on the effectiveness of knowledge translation strategies targeting health care professionals and patients, we are not aware of any experimental studies evaluating the effects of knowledge translation research that focused on policy makers or senior health service managers.

Effectiveness of knowledge translation strategies focusing on policy makers and

senior health service managers

Mass media Continuous medical education Structural modification and support Financial incentives Changing rules and regulations …

Other strategies

Thank you