Although I am struggling with the broadness of this model, I found it helpful to identify multi-level contributors/factors to any KT plan.
I liked the framework because it is broad enough to encompass any research/individual/society related elements. My only concern is that how a researcher would assess role-players performance in any four phases of KT function. For instance, Broth et al. state that pre-adoption phase “focuses on intervention, consumer, provider, and organizational characteristics that could influence the ultimate adoption of EBIs” (p. 323). They also assert that “wide-ranging factors” should been systematically investigated for the fulfillment of each phase goals. My question here is how?
What I liked the most about this model was dedicating a specific phase for “sustainability” that examines “how EBIs are maintained or institutionalized over the long term, or expanded within and across specific settings or services delivery systems” (p. 324). This is the most complicated process and if attains, that would be an incredible success.
I also find Table 1 of this article very useful, particularly in terms of “examples of key research questions”. Depending on at what stage a researcher is more interested, she can use the example questions as a very good start.
Based on this framework, I would like to develop a model for KT in the field of pain management. According to Statistic Canada in 2012, 14.1% of BC population aged 12 and over reported having pain or discomfort that prevents activities, plus 11.5 % of British Colombians complained of moderate or severe pain or discomfort. Therefore, from every 4 BC residents, one experienced pain in 2012. This number is gradually increasing from 2003 every year.
According to Pain in Canada Fact Sheet, Chronic pain costs more than cancer, heart disease and HIV combined. “Estimates place direct health care costs for Canada to be more than $6 billion per year and productivity costs related to job loss and sick days at $37 billion per year” (Phillips and Schopflocher 2008; Schopflocher, Jovey et al. 2010).
Therefore, I would like to work on KT strategies for managing pain.
Using Table 2 of Spoth’s article, I would set my “high priority research questions”:
- Pre-adoption: how do various preferences about evidence-based interventions attributes influence ultimate patients’ choices and demand who are struggling with pain?
- Adoption: how are various types of evidence used by patients in their adoption decision making?
- Implementation: which systems factors are most important in quality implementation of specific evidence-based interventions for patients in pain?
- Sustainability: what funding models and financing systems are most conductive to sustainability? (I would probably change my approach here, and try to answer the sustainability question for patients in pain by employing motivational theories and frameworks)
I would work on those questions for the rest of the semester.
Do you remember the old fable entitled, ” The Grasshopper and the Ant”? It is a classic, and if you are not familiar a quick search on Google or Youtube may be worth a smile or two. To summarize, the grasshopper basks in the glory of the summer sun while the ant stores food for the winter. Once winter arrives, the grasshopper is horribly unprepared; his refusal to plan for the future catches up to him. The ant on the other hand, works hard in the summer in order to be prepared for winter. The ant invests in the long-term, while the grasshopper is far more short-sighted.
A recent report put out by the Office of the Auditor General outlined health spending in BC. The report suggests that although prevention has been a prevalent topic in previous Throne Speeches, population health and wellness accounts for less than 5% of total health care spending. This report, and the resultant response from the Health Minister, was picked up by both the CBC and the Huffington Post. As quoted in these articles, the Health Minister suggests that we need to look not only at the dollar amounts, but also on the health outcomes of British Columbians. Point taken. However, some critics, perhaps rightfully so, put an emphasis on the numbers.
If, for example, we look at the 536 million dollars that the health authorities spent on the sector of population health and wellness, and compare it to the reported 514 million dollars spent on the new roof for BC place stadium (the Globe and Mail reports that the office of the Auditor General is looking in to the cost and value of the new roof in question), some people might wonder where our priorities lie?
I think that we need to follow the ant’s lead, and prepare for winter. I think we should promote wellness, and prevent illness, wherever and whenever possible. To foster such an approach, I think we need at least three components: (1) An engaged and responsible public (2) A reduction in the fragmentation of government and (3) A commitment to evidence based prevention.
As a university student, I am often disappointed when I am presented with the voter turnout among fellow classmates. Some seem to be disillusioned and fed up with the political process, and I can understand that I suppose. However, I would encourage anyone who is feeling discouraged to avoid withdrawing themselves from the equation. Such feelings are a great time to engage one’s self, to inform one’s self, and to vote on every election day. Dissatisfied people are often looking for a change, and often have new ideas.
Speaking of new ideas, I think we are in need of one. Here’s a question, “How do we reduce the fragmentation found within governments?”. Any takers? I wish I had the answer. I think it is harder for any government to invest in prevention programs when the ‘return on the investment’ might be materialized in a sector of government that did not spend the initial dollars. I think we need to find a way to create a more collaborative governance system. I think we need an open dialogue among all parties involved.
That leaves us with the all important question of cost. Can we afford prevention? We already spend so much on healthcare, can we really afford another expense? I think we need to be very cognizant with how we spend public funds, and we need to spend responsibly. One way to help keep us honest might be to adopt and evidence based approach. Before we open the collective purse, let’s ask “How confident are we that this program will produce the desired outcomes?”. If we add some research evidence to the equation, I think we have a better chance of achieving our goals. I am not arguing that research evidence should be the only evidence required, far from it, but, I am arguing that we should certainly consider and value it.
So, as we hope for sun this upcoming summer, let’s prepare for winter…and take a lesson from the ant.