Knowledge Brokers – getting knowledge from researchers to practitioners

Marjolijn Ketelaar

Kenniscentrum Revalidatiegeneeskunde Utrecht

Clinical practice

Research

Bridging the gap. HOW?

Knowledge Brokers: Knowledge Brokers:

What are they and how can they help move What are they and how can they help move research into clinical practice?research into clinical practice?

CP 2009 Conference Saturday February 21, 2009

Dianne RussellPeter RosenbaumJan Willem Gorter

CanChild Centre for Childhood Disability ResearchMcMaster University, Hamilton, ON. Canada

Johanna DarrahUniversity of Alberta, Edmonton, Alberta, Canada

Lori RoxboroughSunnyhill Health Centre for Children, Vancouver, BC Canada

Dianne CameronCentre for Ability, Vancouver, BC Canada

Marjolijn KetelaarRC De HoogstraatNetChildPERRIN

Objectives of the workshop

• To share our experiences with knowledge translation and Knowledge Brokering

What do we mean by knowledge translation anyway?

• Research transfer

• Knowledge transfer

• Knowledge exchange

• Knowledge mobilization

• Utilization and diffusion

• Knowledge transfer and exchange

CIHR definition of Knowledge Translation

A dynamic, iterative process that includes synthesis, dissemination, exchange, and ethically-sound application of knowledge to improve the health of people, provide more effective health services and

products and strengthen the health care system.

Do you think there is a gap between knowing and doing?

Evidence that research is not being translated into clinical practice

• 20-25% of patients get care that is not needed or potentially harmful

• 30-40% of patients do not get treatments of proven effectiveness

Schuster, McGlynn, Brook (1998); Grol (2001)

Time for you to get to work….

Talk to the person on either side of you

(3 minutes) and answer this question

• I’d use evidence from research in my practice but…..

Barriers

• Huge amount of information

• Lack of time

• We’re not doing he wrong things

• Trust all information that is coming up?

• Changing yourself is not enough

• Changing attitude

Talk to the person on either side of you

(3 minutes) and answer this question

• What are some possible supports to implementing evidence into practice?

Supports

• Way results are presented– Back to earth– Presentations

• Money– E.g., Buy instruments

• Good, easy to use instruments• Contact to people with experience• Leadership – decide what to do• Group process

Traditional methods of KT have focused on publication of journal articles and conference presentations

Suggested reading

child* OR pediatric:

3426 hits

rehabilitation OR therapy OR intervention:

5113 hits

538!!

Pubmed.com

Papers published in last 30 days

18 papers each day!

A journey with PERRIN

PERRIN? What’s that?

KinderrevalidatieFonds AdriaanStichting

Stichting Bio Kinderrevalidatie

A national research program

PERRINPEdiatric Rehabilitation Research In the Netherlands

• Parents• Children, adolescents, young adults• Health and care professionals

Themes:• development• prognosis• processes of care

Questions.....

Why PERRIN?

• Develop instruments

• Insight in development and determinants

Goals of PERRIN

Cerebral Palsy

Activities andparticipation

Instruments

CP 0-5 CP 9-16CP 5-9 ProCPCP 16-24

PEDI GMFM GMFCS MPOC VABS etc

Development and prognosis

TP

Started in 2001

Knowledge Transfer

• Papers in scientifc journals

• Papers in professional journals

• Factsheets• www.perrin.nl

0

5

10

15

20

25

30

35

40

45

%

GMFM-66 GMFCS

gehoord vanervaringHeard about

Experience with

One step further-

Workshops

Interactive workshops were more successful than more “traditional” other strategies, such as

– peer-reviewed publications

– presentations

– posting information on web sites

Phys & Occ Ther in Pediatrics 2008; 28: 191-206

BUT

USE GMFM-66

What do we know about effective KT

strategies?

• Passive dissemination strategies are useful to increase awareness and knowledge but do not lead to substantial changes in practice

Knowledge transfer

• It involves– Getting the right information– To the right people– In the right form– At the right time– For the right impact

(Julie Gilbert, KT manager, The Change Foundation)

What works to promote evidence-based practice?....data from 93 studies

1. Ongoing dissemination of information

2. Interaction between research and users3. Social influence (power of influential people to persuade)

4. Facilitation (provision of technical, financial, organizational and emotional support)

5. Reinforcement (reminders, rewards for collaborative behaviour)

Walter, Nutley & Davis. Evidence & Policy 2005; 1: 335-631

What do we know about effective KT

strategies?

• Emerging evidence that Knowledge Brokers who are located at each site and understand the local context (supports & barriers) are helpful in moving evidence into practice

Knowledge Brokering

“bringing people together to help build relationships, uncover needs, and share ideas and evidence that will let them do their jobs better”

Canadian Health Services Research Foundation (CHSRF)

“Local champions”

“Opinion leaders”

“Change agents”

Talk to the person on either side of you

(3 minutes) and answer this question

• What skills would be important for a Knowledge Broker to have?

• Researcher competent• Meet colleagues – time & money• Excited by the subject• Communicative• Enthusiasm• Leader that is supportive• Flexible – new ideas – tru out new things• Open minded – live with your own past• Respect clinicians and researchers – get respect• Hold on – be strong!• Convincing person – formal and informal leadership!

KB-projectsCanada

Netherlands

Clinical practiceResearch

Knowledge Brokers

Knowledge Brokers PERRIN

Network of “influential” therapists

Pilot with:- 4 rehabilitation centers- 6 instruments (a.o. GMFCS and GMFM)

Purpose:

From “knowing” to “doing”

KB-projectsCanada

Netherlands

Clinical practiceResearch

ResearchersBroker to the Brokers

KnowledgeBrokers

Professionals working inclinical practice

Knowledge Brokers“Brokers to the Brokers”

and Researchers

Lessons Learned

Lessons Learned

• KB as facilitator (rather than expert) should be:– Reflective and flexible– Able to respond in a timely manner– Able to explain KB-role to others

• Should have:– Designated time – Resources to support the KB role (responsibility of

researchers?)

Lessons Learned

Crucial aspects:– “Broker to the Broker” (linking researchers with KBs)

– Convincing stakeholders • Responsibility to children and families – evidence based

practice

– What knowledge should be brokered and who decides, based on what? (Challenge: Finding enough strong evidence)

• Great experiences:– Use of instruments increased!– Professionals felt more confident in

choosing instruments– KBs enthusiasm – job satisfaction– Network of KBs – creativity, enthusiasm,

learn from each other– Spill over to others not “formally” involved

Lessons Learned

Russell et al, in preparationRivard et al, in preparation

www.canchild.ca – Knowledge brokering

One of the creative ideas

A flyer with measures

Take home message

• Create ways for researchers and research users to get together

• Create a climate in service delivery organizations conducive to research uptake

• Multi-faceted strategies to promote use are more likely to be successful than single interventions.

Questions?