The process of knowledge translation begs us not only to ask the important questions, but also the questions that really matter. In health practice, knowledge translation first appeared as ‘bench to bedside’ or ‘campus to clinic’ (Greenhalgh & Wieringa, 2011), it was also found that “managers and policy makers fail to draw consistently on robust evidence when designing services or allocating resources” (Greenhalgh & Wieringa, 502). The decision and motivations to turn evidence into evidence based policy is contextually based, the facts are always value laden and their application is also affected by the situation. Greenhalgh & Wieringa (2011) highlight a notion that is well documented process, despite good evidence, policy makers are not always inclined to carry out the recommendations. As Lewis (2007) states evidence base medicine and evidence based decision-making have yet to be revolutionary, he acknowledges that evidence should be more influential but this has yet to be a reality.
You would be hard to pressed to find an individual that does not have an opinion on food, we need it, we love it, and it is connected to our most basic human experience. In the words of Wendell Berry, “to be interested in food but not in food production is clearly absurd.” Food is connected to our well-being on so many levels. The state of food production is being challenged by the integration of genetically modified or genetically modified organisms (GMO), the implications of GMO products is not well understood.
Last week the Canadian Seed Trade Association (CSTA) failed to support a resolution about the regulation of GMO alfalfa at its semi-annual meeting. The CSTA is responsible for “representing 128 corporate members engaged in all aspects of seed research, production and marketing, both domestically and internationally” (Canadian Seed Trade Association, 2013). The resolution, brought to the floor wanted to support regulation of growing GMO alfalfa in dedicated areas of the province of Manitoba, whilst other areas could stay GMO free. GMO soy and corn has contaminated the Canadian markets, right of entry to European and Japanese markets have already become inaccessible for fear that we cannot guarantee the purity of that seed (CBC, 2013). Lack of access might not be the only concern, “a growing body of research connects these foods with health concerns and environmental damage” (David Suzuki Foundation, 2013). The fact is that we don’t know the impacts of GMO products, and more importantly the spread of these GMO plants is out of control in most developed countries (Sustainable Pulse, 2013).
Evidence is showing that we cannot control the growing and harvesting of GMO crops, secondly we are not sure of the long-term effects that GMOs will have on our health or the health of our planet. As Jane Barrett, negotiator for SATAWU, recently said “A farmer’s job is to take care of the soil, the plants will do the rest”. We are responsible for the actions that we take; stewardship of the planet is a serious responsibility.
The disconnect in this example is between the lack of action towards regulating something that is possibly harmful to human health, as exemplified by Michie et al. (2005), “[t]he implementation of evidence based practice (EBP) depends on human behaviour” (32). This behaviour is influenced by so many triggers, such as social or economic, and what needs to be highlighted is that regardless of evidence the actions that we take are based in complex systems influenced by so many differing stimuli.
In the field of knowledge translation where we are able to name many practical examples where good evidence is not being applied, in my opinion we need to start asking the more contextual questions, all the theory, frameworks or models are not going to solve our problems. If dissemination is the problem, let us be creative and proactive in developing knowledge translation that is effective in the context that we are trying to consider. When the important questions are asked, it is imperative that we all act with the intention of sharing that knowledge, and that we act in conjunction with the evidence not in despite of it.
Barrett, J. (November 2, 2013). SATAWU Presentation, ITF Youth Climate Change Africa regional meeting, Johanesburg, South Africa.
Canadian Seed Trade Association. (2013). Home. Retrieved from: cdnseed.org
CBC. (2013). Farmers protest introduction of GM alfalfa. Retrieved from: http://www.cbc.ca/news/business/farmers-protest-introduction-of-gm-alfalfa-1.1363280
David Suzuki Foundation. (2013). Understanding GMO. Retrieved from: http://www.davidsuzuki.org/what-you-can-do/queen-of-green/faqs/food/understanding-gmo/
Greenhalgh, T., & Wieringa, S. (2011). Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review. Journal of Social Medicine, 104, 501-509. Doi: 10.1258/jrsm.2011.110285
Lewis, S. (2007). Toward a general theory of indifference to research-based evidence. Journal of Health Services Research and Policy, 2 (1), 1-7.
Michie, S., et al. (2005). Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality Safety Health Care, 4, 23-33. doi: 10.1136/qshc.2004.011155
Sustainable Pulse. (2013). Spread of GM Crops Out of Control in Many Countries – New Report Retrieved from: http://sustainablepulse.com/2013/11/12/spread-of-gm-crops-out-of-control-in-many-countries-breaking-news/#.UorXP8Skqn8
The Delphi Method is a survey technique that began during the 1940s as a method to obtain expert forecasts about the future of military technology. The Delphi method utilizes multiple rounds of surveys in order to obtain consensus from a group of individuals deemed experts in a particular field. Common group communication failures can be avoided using this method, such as power dynamics or pressure to conform (Jewell 2011) and it promotes in-depth conversation among your chosen experts. While discussing the technique in our class session, some raised the question, who is considered an “expert”? Is it limited to those with high levels of education or more explicit knowledge? One of the advantages of the Delphi method is that it allows the researcher to define the “experts” and thus permits a consideration of what is most suitable in the context of your research question. Experts in the case of the Delphi method are individuals with extensive knowledge on a topic, and therefore individuals with extensive tacit knowledge could be selected as experts, depending on your question.
In order to practice the technique, I facilitated the formulation of a Delphi method survey of recent MPH graduates (within the past 5 years) in a recent class. Using class input we formulated the following 1st round survey questions:
1. What do you see as the 3 most important emerging trends in public health?
2. What areas of public health do you see as having the greatest job growth potential in the near future?
3. What do you believe to have been the single most important factor in attaining your current position (e.g. personal or professional connections, in-depth knowledge of a field, advanced ability in a skill, etc)?
4. Having now entered the workforce, what skill or area do you regret not having enhanced further during your graduate degree?
Completion of the 1st round allowed for a reflection on the use of the Delphi method more broadly. One interesting issue that emerged in our survey was the reluctance of our chosen “experts” to speculate about the future. In our case, as was raised in class, perhaps a more appropriate group of experts would have been higher level professionals in the field or those more associated with career counseling and forecasting. I imagine such a group would be more comfortable providing their opinion on the future, compared to our respondents who felt this was perhaps beyond their scope of knowledge of the field of public health.
Another important point to consider is whether your question would be better answered using a standard survey. When using the Delphi method, it’s important to remember you are seeking the informed opinion of your respondents. In the case of our survey, a question such as #4 would perhaps be better suited for a standard survey utilizing sampling methods that allowed for generalization to the target population. As was demonstrated in a class example (Milat 2012), this might also take the form of reaching consensus about a shared definition (in the case of our example, “scaling-up”).
Finally, the smaller scale and more selective nature of the Delphi method provide an excellent space for open dialogue around your subject of choice. An interesting issue that emerged from the first round and was not addressed in the survey instrument was our definition of “graduate”. As it turns out, 5 out of 13 participants had not completed their final project although they are working full time and finished their coursework. The multi-phase nature of this method allows for a continued conversation around this topic, something that otherwise might have to be postponed until another phase of research if using a standard survey.
Jewell, A. (2011). The Delphi Technique. Available at: http://delphitechnique.blogspot.ca/2011/02/what-is-delphi-technique_13.html
Milat, A.J. et al. (2012). The concept of scalability: increasing the scale and potential adoption of health promotion interventions into policy and practice. Health Promotion International, 28(3).
Knowledge translation literature includes evidence about supports to assist physicians in clinical decision making to improve quality and improve evidence-based care (Kawamoto et al, 2006; Grol and Grimshaw, 2003). These are called clinical decision support systems. In developed countries, patients have been found to receive only half of recommended care, the other half being either wrong, out of date, or erroneous (Grol and Grimshaw, 2003). A review of trials to identify aspects of clinical decision support making showed that decision support systems improved clinical practice in 68% of trials, and four aspects were found to be most useful. These include decision supports as part of clinician workflow, provision of recommendations instead of assessments, provision of decision support at the time and place of decision-making, and computer based decision support systems (Grol and Grimshaw, 2003).
One of the hallmarks of modern western medicine is ‘informed decision making’ or ‘informed choice’. This refers to discussing the benefits and problems of various types of care decisions and pathways of care with patients. Physicians are often time-pressed or not well enough informed about options for care, so do not provide the options in a way that is easily understood by their patients.
Goldberg (2009) in ‘Informed Decision Making in Maternity Care’ outlines the optimum in maternity care; every pregnant woman has the right to base her decisions on accurate, up to date, understandable information. This statement is backed up by all provincial, national and international organizations involved in maternity care such as College of Midwives of British Columbia, Society of Obstetricians and Gynecologists of Canada and International Confederation of Midwives. Goldberg (2009) explains that decision making can be complex and multi-layered.
I went to a perinatal conference last weekend where a talk by prenatal educator Penny Simkin spoke about “Decision Fatigue’ from the client’s point of view. The third of three studies about women’s voices on childbirth (Declerq et al 2013, study in progress, reference of prior study below), found that although pregnant women wanted knowledge, most of them were poorly informed. It also revealed that most women trusted their caregivers and usually followed their recommendations although they are presented with inaccurate incomplete information by caregivers. To remedy this, mothers are urged to consult books and websites. Penny Simkin discussed the myriad of choices offered to mothers expecting babies, concluding that there were too many options and too many choices. In Simkin’s book (2012) ‘Pregnancy, Childbirth and the Newborn’, the worksheet for preparing your birth plan shows 47 categories of birth events and 179 birth options. We were told that a ‘google’ search for induction of labour led to 8,880,000 results! What are options to this dilemma of too much information?
Midwifery care is one option. Midwives in Canada are paid to spend time (up to one hour per visit) to discuss choices and facilitate informed choice decisions. But with over 90% of women in Canada unable to access midwives for their care, childbirth classes that include evidence based discussions of informed consent patient decision making aids may be useful to fill in this gap. The Cochrane updated review of patient decision aids (Stacy et al, 2011) found that when patients use decision aids they improve their knowledge of the options, have more accurate expectations of possible benefits and harms, use their own values to make choices, and participate more in decision making regarding their care. The Ottawa Hospital Research Institute (2013) has a series of decision aids. The challenge lies in the difficulties in maintaining up-to-date evidence in the tools. These are general patient aids and few are for pregnant women. Canadian childbirth or midwifery organizations would make an important contribution if research members could develop decision aids and maintain them based on current evidence.
DeClerq E, Sakala C, Curry M, Appelbaum S, Resher P. Listening to mothers: pregnancy and birth 2 (2005). Journal of Perinatal Education.
Goldberg, H (2009). Informed decision making in maternity care. Journal of Perinatal Education. 18(1). 32-40.
Grol, R & Grimshaw, J. (2003). From best evidence to best practice: effective implementation of change in patients’ care. The Lancet. 362. 1225-1229.
Kawamoto K, Houlihan C, Balas E, Lobach D. (2005). Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. British Medical Journal. 330. 765-772.
Simkin P, Whalley J, Keppler A. (2012). Pregnancy, Childbirth and the Newborn: the complete guide. Simon & Schuster, New York, NY.
Stacy D, Bennet C, Barry M et al, (2011). Decision aids for people facing health treatment or screening decisions. The Cochrane Collaboration. John Wiley and Sons.
Ottawa Hospital Research Institute. Patient Decision Aids (2013). http://decisionaid.ohri.ca/
image from google images: doctor with pregnant woman in office.
As a highly under-skilled and over-critical future public health practitioner, I feel it necessary to confess my severe deficit of knowledge regarding the policy process. Our exploration earlier in the semester of the clash in agendas, priorities and timeframes between policy makers and researchers shed light onto the fact that I am not entirely alone in my academia-induced ignorance of how policy is really happening (Choi et al 2005, Brownson el al 2005). An article a classmate passed along to me clarified for me that I was not alone in my ignorance, and gives me the confidence to share it with you bloggers and classmates.
In “Evidence and Healthy Public Policy: Insights from Health and Political Sciences”, Fafard (2008) analyzes precisely this gap in understanding between health scientists and policy makers. Fafard compares the linear view of policy making often addressed in health literature (Figure 1) to the commonly used stages cycle of the policy realm (Figure 2). It’s interesting and useful to view these visual representations of this process from the respective discipline’s, as they seem to draw out a summary of the mental models that underscore the gap in understanding between these two fields. These two simple representations provide a powerful tool for interrupting the health scientist’s false perception of the policy process by complicating their notion of a linear evidence-to-policy progression.
There are some key differences in policy practice to point out. One major issue surrounding evidence in the agenda setting phase, is how exactly the issue is being framed. As Fafard notes for example, “When an issue is framed as a technical problem, experts can and do often dominate the process of decision-making” (p. 10). A point that brings to my mind the current discourse on Health in all Policies, and the never-ending plea of the health sector for us to be a priority in the face of intersectoral priority setting. The field of resource management comes to mind as a highly interdisciplinary field where it is undoubtedly difficult to prioritize health in the discussion. So how exactly do you frame resource management in a way that encourages the integration of health evidence into decision-making processes? Recent efforts such as Ecohealth make an attempt at this reframing so as to include health experts in the decision-making.
Another important error in the health scientist’s mental model is the apparent halt at policy formulation. To the “policy maker” (“policy makers” and “decision makers”, he points out, are not very well defined in health sciences literature and in fact are can change throughout the policy process) this might however be merely a milestone in a continued process toward successful implementation and evaluation of the policy. This ties into the health scientist’s mental model inserting one decision at the end of the knowledge transfer process, whereas the stages cycle entails various decisions amongst different groups with varied levels of power throughout.
All in all it would seem that the realities of the policy cycle in fact favor the integration of evidence more than a linear model would lead the unversed health scientist to believe. Evidence can take on different forms at different stages of the process, whether it be framing an issue to put it on the agenda or evaluating the impact of a particular policy after its implementation, so there’s hope for us yet.
Brownson R.C. et al (2006). Researchers and Policy Makers: Travelers in Parallel Universes. American Journal of Preventive Medicine, 30(2), 164-172.
Choi B. et al. Can scientists and policy makers work together? Journal of Epidemiology and Community Health, 59, 632-637.
Fafard, P. (2008). Evidence and Healthy Public Policy: Insights from Health and Political Sciences.
For knowledge translation professionals, knowledge may be the business, but not all the wares are alike. We must make a distinction between explicit and tacit knowledge (TK). The former refers to formal knowledge such as data published in peer-reviewed studies and evidence-based practice guidelines. The latter is informal: unwritten practices or ‘tricks of the trade’ generally acquired through lived experience. It also encompasses less conscious knowledge such as intuition or ‘going with one’s gut’ (Welsh & Lyons, 2001). Yale anthropologist James Scott (1998) makes a strong case for the importance of TK, arguing that it central to the functioning of modern day corporations and states. In its absence, productivity falls and these entities cease to function efficiently. This is well illustrated by work-to-rule strikes: in performing only those responsibilities formally detailed in their job descriptions, employees can reduce an organization’s productivity, which is dependent on informal practices (Scott, 1998, p. 310).
Unsurprisingly, TK also plays a central role in clinical and public health practice. Yoshioka-Maeda et al. (2006) found that public health nurses working in Japan relied on tacit knowledge to plan and coordinate services for clients with complex needs. In doing so, the nurses departed from traditional planning processes that begin with a community assessment, instead allowing problems to emerge from their everyday interactions with clients. Likewise, Kothari et al. (2012) point to an important role for TK in creating or adapting an intervention so that it attends to the local context. Tacit knowledge provides not only contextual information but is vital to accomplishing everyday activities when time and resources are at a premium. Practitioners will rely on past experience to make decisions about personnel (“Is this person reliable?”) and methods (Kothari et al., 2012). Gabbay and le May reported that practitioners in the UK infrequently used evidence-based practice guidelines in their daily interactions with patients, relying instead on ‘mindlines’: “collectively reinforced, internalised tacit guidelines” developed through experience (2004, pp. 1014-1015). However, these engrained habits may also be a barrier to change; it may be hard to convince practitioners to modify engrained habits (Kothari et al., 2012, p. 30).
If TK plays such an important role, how can we manage it to our benefit? Gabbay and le May’s (2004) observed that tacit knowledge exchange took place primarily through interpersonal interactions; the same story emerged from Kothari et al.’s (2012) interviews with practitioners in Ontario. We can encourage such exchanges through promoting and assisting in the development of communities of practice. For a model we might look to Ontario’s Seniors Health Research Transfer Network; there, dedicated knowledge brokers have worked to establish new connections with- and facilitate meetings between practitioners working in the field of seniors’ health (Conklin et al., 2013). We might also take a cue from work done outside of public health. NASA (2013) compiled and published a collection of interviews with individuals who had worked on the space shuttle program. Such an initiative allows individuals to benefit from TK when face-to-face contact is not possible. While these are promising practices, some TK may not be well suited to transfer, as it is often context-specific. Furthermore, there may be certain affective dimensions of TK that we cannot package; lived experience may be essential to knowing or understanding certain phenomena (e.g. managing traumatic experiences).
The lesson for researchers and practitioners is that we must reorient the way in which we evaluate evidence. As the aforementioned studies demonstrate, qualitative inquiry is much better placed to capture the nuances of TK in a given context. In research and practice many accept a specific hierarchy of evidence that privileges formal or explicit knowledge. This hierarchy places randomized, ostensibly generalizable studies (e.g. systematic reviews and meta-analyses) over case studies and those employing non-random samples. If TK plays an essential role in oiling the gears of program planning and implementation, then perhaps the hierarchy of evidence needs reconsidering. While individual case studies are at the bottom of the evidence hierarchy, such a study might provide the crucial “how” or “why” that Riley et al. (2008) find lacking in many program evaluations.
Conklin, J., Lusk, E., Harris, M., & Stolee, P. (2013). Knowledge brokers in a knowledge network: the case of Seniors Health Research Transfer Network knowledge brokers. Implementation Science, 8(1), 7.
Gabbay, J., & May, A. L. (2004). Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care. BMJ, 329(7473), 1013.
Kothari, A., Rudman, D., Dobbins, M., Rouse, M., Sibbald, S., & Edwards, N. (2012). The use of tacit and explicit knowledge in public health: a qualitative study. Implementation Science, 7(1), 20.
National Aeronautics and Space Administration. (2013). NASA JSC Space Shuttle Program Tacit Knowledge Capture Project. Retrieved from http://www.jsc.nasa.gov/history/oral_histories/ssp.htm.
Riley, B. L., MacDonald, J., Mansi, O., Kothari, A., Kurtz, D., von Tettenborn, L. I., & Edwards, N. C. (2008). Is reporting on interventions a weak link in understanding how and why they work? A preliminary exploration using community heart health exemplars. Implementation Science, 3(1), 27.
Scott, J. C. (1998). Seeing like a state: How certain schemes to improve the human condition have failed. Yale University Press.
Welsh, I., & Lyons, C. M. (2001). Evidence‐based care and the case for intuition and tacit knowledge in clinical assessment and decision making in mental health nursing practice: An empirical contribution to the debate. Journal of Psychiatric and Mental Health Nursing, 8(4), 299-305.
Yoshioka-Maeda, K., Murashima, S., & Asahara, K. (2006). Tacit knowledge of public health nurses in identifying community health problems and need for new services: a case study. International journal of nursing studies, 43(7), 819-826.
Collective impact is an approach to large-scale social problems that has been gaining recognition in the past few years. The strategy is based on large-scale collaboration across a group of partners that agree to scrap their individual agendas for a unified solution. The approach includes the integration of shared measurement into the process to assure that how impact will be demonstrated is unified across partners (Heierbacher, 2013).
Proponents of this approach argue that the recent boom in philanthrocapitalism pushes back on such a strategy, by scaling-up select organizations as the key to creating needed changes. Although some problems using such an isolated impact approach, i.e. funding solutions through single organizations, such a collective impact approach is better suited for adaptive problems with complex solutions involving different sectors. The approach incorporates a backbone organization as a central manager of the collaborative effort, though this organization may be represented by a variety of sectors (NGO, government, funder-based, etc) (Kania and Kramer, 2011).
The table below outlines the five conditions of collective impact (Kania and Kramer, 2011):
This approach seems well suited to a field of interest of mine, water resource management. One of the tricky aspects of such an approach in a complex field such as water resource management is arriving at the common understanding of the problem, as different sectors may have more in-depth knowledge of particular aspects with technical language of their field. Approaches such as diagraming can be used to simplify more scientific concepts for diverse stakeholder groups and a focus needs to be made on simplifying concepts and priorities that are perhaps not understood outside of a particular discipline, for example engineering. Additionally, though the approach has been documented in many developed countries, there seems to be an absence of success stories from the developing world. One issue in the context of a developing country, for example Nicaragua, is the lack of baseline data from which to make measurements. In such a context, monitoring and surveillance efforts would require complete transformations not only to take shape across sectors but also to become a unified process. In some ways, the absence of proper surveillance leaves room for constructing surveillance efforts more collaboratively from the ground up versus other contexts that would require adaptation of present strategies.
This approach provides straightforward guidance to collaborative intersectoral approaches and could easily be integrated with other tools to enhance dialogue and participation around a unified vision with the right mix of stakeholders.
Heierbacher, S. (2013). Collective Impact: A Game Changing Model for the Social Sector. National Coalition for Dialogue and Deliberation. Available at: http://ncdd.org/12858
Kania, J. and Kramer, M. (2011). Collective Impact: Large-scale social change requires broad cross-sector coordination, yet the social sector remains focused on the isolated intervention of individual organizations. Stanford Social Innovation Review. Available at: http://www.ssireview.org/articles/entry/collective_impact.
Late last week Rona Ambrose, Canada’s Health Minister, announced a new regulation that would deny clinical treatment of diacetylmorphine for heroin addicts (Vancouver Metro, October 4-6, 2013; Vancouver Sun, October 5, 2013). The news comes in stark contradiction that this treatment is more effective for certain types of addicts than the currently widely accepted methadone treatment, “[p]rescribed, supervised use of diacetylmorphine appears to be a safe and effective adjunctive treatment for this severely affected population of patients who would otherwise remain outside the health care system” (Oviedo-Joekes, et al., 786). According the North American Opiate Medication Initiative (NAOMI), a randomized control trial that evaluates the feasibility and effectiveness of heroin-assisted treatment in Canada (Oviedo-Joekes, et al., 2008), not only were patients on this treatment less likely to relapse but their lifetime cost of health care and criminal justice system were also reduced. We also have several former addicts who are speaking out to tell their personal stories of success. When medically supervised this treatment works, and in turn may lead to lower overall costs to Canadian society through lowered health and justice costs. When the government is looking to cut costs why are they discounting good science that is showing cost-saving opportunities?
Is this an example of failed knowledge translation, “[t]his means that patients are denied treatment of proven benefit because the time it takes for research to become incorporated into practice is unacceptably long” (Graham et al., 13). Graham et al. (2006) critiques the time required to show positive research results and transfer that into positive outcomes for patients. In the diacetylmorphine example, the translation is interrupted by not only the acceptability to practice but the interference of the Harper administration in a treatment for which they are disregarding because of a public relations boost and marginalization of a population who probably will not be targeted in his upcoming re-election bid. However to those Canadians who are paying attention – don’t we need to provide the best quality care whilst reducing the financial burden on our public systems.
Caplan (1979) discusses the two-communities theory which explores the gap between academia and the political realm. The “the spectre of knowledge misuse by political power tends to widen the gap” (459) between communities. Many times this divide leaves researchers wondering how or when their finding will ever be applied in the real world. Looking specifically at the example above, despite the research, despite the pleas of practitioners, the government unilaterally will act within the power of the crown. Is this really an example of lack of information, or the lack of knowledge translation to Rona Ambrose? Perhaps this gap that exists between our two communities needs to be explored. There needs to be more than a transfer of information, perhaps a personal relationship with the people that this government is apparently leading is required.
Caplan, N. (1979). The two-communities theory and knowledge utilization. American Behavioral Scientist, 22 (3), 459-470.
Graham, I., Logan, J., Harrison, M., Straus, S.,Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in knowledge translation: Time for a map? The Journal of Continuing Education in the Health Professions, 26 (1), 13-24. DOI: 10.1002/chp.47
Jackson, E.(October 3, 2013). Health Minister Rona Ambrose’s heroin ban ‘ignores science’. Metro Vancouver. Retrieved from: http://metronews.ca/news/vancouver/814664/health-minister-rona-ambroses-heroin-ban-ignores-science/
Oviedo-Joekes, E., Brisette, S., Marsh, D., Lauzon, P., Guh, D., Anis, A., & Schechter, M. (2009). Diacetylmorphinr versus methadone for the treatment of opioid addiction. The New England Journal of Medicine, 361 (8), 777-786.
Oviedo-Joekes, E., Nosyk, B., Brissette, S., Chettiar, J., Schneeberger, P., Marsh, D., Krausz, M., Anis, A. & Schecter, M. (2008. The North American Opiate Medication Initiative (NAOMI): Profile of participants in North America’s first trial of heroin-assisted treatment. Journal of Urban Health, 85 (6), 812-825.
Robinson, M., & O’Neil, P. (October 5, 2013). B.C. Clashes with Ottawa over heroin research. The Vancouver Sun. Retrieved from: http://www.vancouversun.com/clashes+with+Ottawa+over+heroin+research/9001727/story.html
Much of the discussion in this weeks readings resonated with the frustrations that arose for me during my summer practicum observing and documenting progress toward the achievement of the Millennium Development Goals (MDGs) in Northern Nicaragua. Working under an initiative that integrated every buzzword of the hour was a fascinating experience and I came to realize just how far buzzwords really make it beyond air-conditioned offices in capital cities. Intersectoral participatory work is complex and if trust can be cultivated while carefully treading around a “Christian, Socialist, and Solidarity!” government, it’s cherished.
During my short time there I found that proposals for intervention were drowning in evidence with each of the latest and greatest international declarations from social determinants of health, to health in all policies, to the most cost effective water purification strategies. With the crunch of funding deadlines and lack of time and financial resources to properly execute intersectoral work that truly valued local actor’s voices however, much of this evidence could not be put to good use. The call to action for “approaches that employ the principles of community-based participatory research and team science that take stakeholder and local perspectives and treat all collaborators as valued “experts” on their domains of interest” (Glasgow et al, p. 649) was acknowledged, but failed in practice.
My primary focus for this work was MDG 7, Target 10: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. In order to build off of these shortcomings I witnessed during my time in the field I’d like to explore this issue further in the context of the course. If domestic water quality management is the most cost effective water treatment strategy, how can that awareness be put into action in the community? How can trust built between intersectoral actors be fostered and taken advantage of to create sustainable change? Effective solutions for collaboratively translating the growing body evidence surrounding water security worldwide into sustainable changes are needed. Moving past buzzwords and into evaluating implementation strategies, I think a focus not only on effective interventions but on building effective long-term relationships across sectors in the effort to promote evidence-based practice will be a key to the on-going improvements of health outcomes.
Glasgow RE, Green LW, Taylor MV, Strange KC. (2012). Evidence integration triangle for aligning science with policy and practice. American Journal of Preventive Medicine, 42(6), 646-654.
Fall 2013 about a dozen of us (united under the rubric of SFU’s HSCI 891 graduate seminar) are embarking on explorations related to KT, aka dissemination and implementation. Join in! Enjoy! Save the world!