Effectiveness of Technology-Enabled Knowledge Translation Strategies in Improving the Use of Research in Public Health: Systematic Review

Brown, Alison; Barnes, Courtney; Byaruhanga, Judith; McLaughlin, Matthew; Hodder, Rebecca K; Booth, Debbie; Nathan, Nicole; Sutherland, Rachel; Wolfenden, Luke

doi:10.2196/17274

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Effectiveness of Technology-Enabled Knowledge Translation Strategies in Improving the Use of Research in Public Health: Systematic Review

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Author(s): Alison Brown , BNutrDiet ¹ ^, ² ^, ³ ^, ⁴ ^, , Courtney Barnes , BNutrDiet ¹ ^, ² ^, ³ ^, ⁴ , Judith Byaruhanga , MPH ¹ ^, ² ^, ³ ^, ⁴ , Matthew McLaughlin , BSc ¹ ^, ² ^, ³ ^, ⁴ , Rebecca K Hodder , PhD ¹ ^, ² ^, ³ ^, ⁴ , Debbie Booth , MAppSci ⁵ , Nicole Nathan , PhD ¹ ^, ² ^, ³ ^, ⁴ , Rachel Sutherland , PhD ¹ ^, ² ^, ³ ^, ⁴ , Luke Wolfenden , PhD ¹ ^, ² ^, ³ ^, ⁴

Editor(s): Gunther Eysenbach

Other contributor(s): Jiale Hu (Reviewer), Katja Reuter (Reviewer), Lauren Albrecht (Reviewer)

Publication date (Electronic): 31 July 2020

Journal: Journal of Medical Internet Research

Publisher: JMIR Publications

Keywords: knowledge translation, public health

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Abstract

Background

Knowledge translation (KT) aims to facilitate the use of research evidence in decision making. Changes in technology have provided considerable opportunities for KT strategies to improve access and use of evidence in decision making by public health policy makers and practitioners. Despite this opportunity, there have been no reviews that have assessed the effects of digital technology-enabled KT (TEKT) in the field of public health.

Objective

This study aims to examine the effectiveness of digital TEKT strategies in (1) improving the capacity for evidence-based decision making by public health policy makers and practitioners, (2) changing public health policy or practice, and (3) changes in individual or population health outcomes.

Methods

A search strategy was developed to identify randomized trials assessing the effectiveness of digital TEKT strategies in public health. Any primary research study with a randomized trial design was eligible. Searches for eligible studies were undertaken in multiple electronic bibliographic databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulative Index to Nursing and Allied Health Literature [CINAHL], and Scopus) and the reference lists of included studies. A hand search of 2 journals (Implementation Science and Journal of Medical Internet Research) and a gray literature search were also conducted. Pairs of independent review authors screened studies, assessed the risk of bias, and extracted data from relevant studies.

Results

Of the 6819 citations screened, 8 eligible randomized trials were included in the review. The studies examined the impact of digital TEKT strategies on health professionals, including nurses, child care health consultants, physiotherapists, primary health care workers, and public health practitioners. Overall, 5 of the interventions were web-training programs. The remaining 3 interventions included simulation games, access to digital resource materials and the use of tailored messaging, and a web-based registry. The findings suggest that digital TEKT interventions may be effective in improving the knowledge of public health professionals, relative to control, and may be as effective as a face-to-face KT approach. The effectiveness of digital TEKT strategies relative to a control or other digital KT interventions on measures of health professional self-efficacy to use evidence to enhance practice behavior or behavioral intention outcomes was mixed. The evidence regarding the effects on changes to health policy or practice following exposure to digital TEKT was mixed. No trials assessed the effects on individual or population-level health outcomes.

Conclusions

This review is the first to synthesize the effectiveness of digital TEKT interventions in a public health setting. Despite its potential, relatively few trials have been undertaken to investigate the impacts of digital TEKT interventions. The findings suggest that although a digital TEKT intervention may improve knowledge, the effects of such interventions on other outcomes are equivocal.

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Most cited references 24

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Standardising outcomes for clinical trials and systematic reviews

Mike Clarke (2007)

Introduction Fifteen years ago, what was to become OMERACT met for the first time in The Netherlands to discuss ways in which the multitude of outcomes in assessments of the effects of treatments for rheumatoid arthritis might be standardised. In Trials, Tugwell et al have described the need for, and success of, this initiative [1] and Cooney and colleagues have set out their plans for a corresponding initiative for ulcerative colitis [2]. Why do we need such initiatives? What's the problem? And are these and other initiatives the solution? What's the problem? Every year, millions of journal articles are added to the tens of millions that already exist in the health literature, and tens of millions of web pages are added to the hundreds of millions currently available. Within these, there are many tens of thousands of research studies which might provide the evidence needed to make well-informed decisions about health care. The task of working through all this material is overwhelming enough, without then finding that the studies of relevance to the decision you wish to make all describe their findings in different ways, making it difficult if not impossible to draw out the relevant information. Of course, you might be able to find a systematic review, but even then there is no guarantee that the authors of that review will not have been faced with an insurmountable task of bringing together and making sense of a variety of studies that used a variety of outcomes and outcome measures. These difficulties are great enough but the problem gets even worse when one considers the potential for bias. If researchers have measured a particular outcome in a variety of ways, (for example using different pain instruments filled in by different people at different times) they might not report all of their findings from all of these measures. Studies have highlighted this problem in clinical trials, showing that this selectivity in reporting is usually driven by a desire to present the most positive or statistically significant results [3]. This will mean that, where the original researcher had a choice, the reader of the clinical trial report might be presented with an overly optimistic estimate of the effect of an intervention and therefore be led towards the wrong decision. In the 1990s, the potential scale of the problem of multiple outcome measures was highlighted in mental health by a comprehensive descriptive account of randomised trials in the treatment of people with schizophrenia. Thornley and Adams identified a total of 2000 such trials, which had assessed more than 600 different interventions. However, these trials had included an even greater number of rating scales for mental health than the number of interventions: 640 [4]. The potential for biased reported and the challenges of comparing the findings of different trials of different interventions using different ways of measuring illness make the identification of effective, ineffective and unproven treatments for this condition especially difficult [5]. This is true whether the readers of the report of a clinical trial are trying to use it to inform their decisions, or whether they are trying to combine similar trials within a systematic review. Thornley and Adams, who had done the descriptive study of the large number of rating scales in mental health trials, were faced with this very problem in a review of chlorpromazine. They concluded that review with the following implications for research, "if rating scales are to be employed, a concerted effort should be made to agree on which measures are the most useful. Studies within this review reported on so many scales that, even if results had not been poorly reported, they would have been difficult to synthesise in a clinically meaningful way." [6]. What's the solution? If we want to choose the shortest of three routes between two towns, how would we cope if told that one is 10 kilometres and another is 8 miles? Doing that conversion between miles and kilometres might not be too much of a problem, but what if the third route was said to be 32 furlongs? Now, imagine that the measurements had all been taken in different ways. One came from walking the route with a measuring wheel, one from an estimate based on the time taken to ride a horse between the two towns and one from using a ruler on a map. To make a well informed choice we would want the distances to be available to us in the same units, measured in the same ways. Making decisions about health care should be no different. We want to compare and contrast research findings on the basis of the same outcomes, measured in the same ways. Achieving this is not straightforward, but it is not impossible. Key steps are to decide on the core outcome measures and, in some cases, the core baseline variables, and for these to then be included in the conduct and reporting of research studies. One of the earliest examples is an initiative by the World Health Organisation in the late 1970s, relating to cancer trials. Meetings on the Standardization of Reporting Results of Cancer Treatment took place in Turin (1977) and in Brussels two years later. More than 30 representatives from cooperative groups doing randomised trials in cancer came together and their discussions led to a WHO Handbook of guidelines on the minimal requirements for data collection in cancer trials [7,8]. OMERACT has also grown by trying to reach a consensus among major stakeholders in the field of rheumatology [1] and the IMMPACT recommendations for chronic pain trials have arisen in a similar way [9]. Other approaches have included the use of literature surveys to identify the variety of outcome measures that have been used and reported, followed by group discussion. This is the case with low back pain [10], colon cancer [11] and an e-Delhi survey in maternity care [12]. Having developed these lists of outcomes measures, researchers need to use them and systematic reviewers need to build their reviews around them. These sets of standardised outcomes measures are not meant to stifle the development and use of other outcomes. Rather, they provide a core set of outcome measures, which researchers should use routinely. Researchers wishing to add other outcome measures in the context of their own trial would continue to do so but, when reporting their trial, selective reporting should be avoided through the presentation of the findings for both the core set and all additional outcome measures they collected. Furthermore, the use of the outcome measures in these core sets should not be restricted to research studies. They are also relevant within routine practice. If they are collected within such practice, they would help the provider and the receiver of health care to assess their progress and facilitate their understanding of the relevance to them of the findings of research. Journals such as Trials can help by highlighting initiatives such as those discussed in rheumatology [1] and ulcerative colitis [2]. They should encourage researchers to report their findings for the outcome measures in the core sets, and provide them with the space to do so. This will allow readers and systematic reviewers to make best use of the reported trials. Conclusion When there are differences among the results of similar clinical trials, the fundamental issues of interest to people making decisions about health care are likely to concern the interventions that were tested, the types of patient in the study, or both; not the different outcome measure used. The latter is important but if one remembers that the studies were probably not done to assess differences between the various ways of measuring outcomes, but, rather, differences between the interventions, the benefits of consistency become obvious. Achieving consistency is not something that can be left to serendipity. It will require consensus, guidelines and adherence. The papers in Trials and others mentioned in this commentary show how this might happen. Competing interests I am the author of one of the papers on a core set of outcomes for healthcare research, which is cited in this paper.

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Systematic review of knowledge translation strategies in the allied health professions

Shannon D. Scott, Lauren Albrecht, Kathy O’Leary … (2012)

Background Knowledge translation (KT) aims to close the research-practice gap in order to realize and maximize the benefits of research within the practice setting. Previous studies have investigated KT strategies in nursing and medicine; however, the present study is the first systematic review of the effectiveness of a variety of KT interventions in five allied health disciplines: dietetics, occupational therapy, pharmacy, physiotherapy, and speech-language pathology. Methods A health research librarian developed and implemented search strategies in eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, CENTRAL) using language (English) and date restrictions (1985 to March 2010). Other relevant sources were manually searched. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. Within each profession, evidence tables were created, grouping and analyzing data by research design, KT strategy, targeted behaviour, and primary outcome. The published descriptions of the KT interventions were compared to the Workgroup for Intervention Development and Evaluation Research (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions. Results A total of 2,638 articles were located and the titles and abstracts were screened. Of those, 1,172 full-text articles were reviewed and subsequently 32 studies were included in the systematic review. A variety of single (n = 15) and multiple (n = 17) KT interventions were identified, with educational meetings being the predominant KT strategy (n = 11). The majority of primary outcomes were identified as professional/process outcomes (n = 25); however, patient outcomes (n = 4), economic outcomes (n = 2), and multiple primary outcomes (n = 1) were also represented. Generally, the studies were of low methodological quality. Outcome reporting bias was common and precluded clear determination of intervention effectiveness. In the majority of studies, the interventions demonstrated mixed effects on primary outcomes, and only four studies demonstrated statistically significant, positive effects on primary outcomes. None of the studies satisfied the four WIDER Recommendations. Conclusions Across five allied health professions, equivocal results, low methodological quality, and outcome reporting bias limited our ability to recommend one KT strategy over another. Further research employing the WIDER Recommendations is needed to inform the development and implementation of effective KT interventions in allied health.

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A randomized controlled trial evaluating the impact of knowledge translation and exchange strategies

Maureen Dobbins, Steven E Hanna, Donna Ciliska … (2009)

Context Significant resources and time are invested in the production of research knowledge. The primary objective of this randomized controlled trial was to evaluate the effectiveness of three knowledge translation and exchange strategies in the incorporation of research evidence into public health policies and programs. Methods This trial was conducted with a national sample of public health departments in Canada from 2004 to 2006. The three interventions, implemented over one year in 2005, included access to an online registry of research evidence; tailored messaging; and a knowledge broker. The primary outcome assessed the extent to which research evidence was used in a recent program decision, and the secondary outcome measured the change in the sum of evidence-informed healthy body weight promotion policies or programs being delivered at health departments. Mixed-effects models were used to test the hypotheses. Findings One hundred and eight of 141 (77%) health departments participated in this study. No significant effect of the intervention was observed for primary outcome (p < 0.45). However, for public health policies and programs (HPPs), a significant effect of the intervention was observed only for tailored, targeted messages (p < 0.01). The treatment effect was moderated by organizational research culture (e.g., value placed on research evidence in decision making). Conclusion The results of this study suggest that under certain conditions tailored, targeted messages are more effective than knowledge brokering and access to an online registry of research evidence. Greater emphasis on the identification of organizational factors is needed in order to implement strategies that best meet the needs of individual organizations. Trial Registration The trial registration number and title are as follows: ISRCTN35240937 -- Is a knowledge broker more effective than other strategies in promoting evidence-based physical activity and healthy body weight programming?

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Author and article information

Contributors

Alison Brown:

ORCID: https://orcid.org/0000-0002-4233-7467

Hunter New England Population HealthBooth BuildingLongworth AvenueWallsend, 2287Australia61 249246685alison.brown7@health.nsw.gov.au

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J. Med. Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: July 2020

Publication date (Electronic): 31 July 2020

Volume: 22

Issue: 7

Electronic Location Identifier: e17274

Affiliations

[1 ] School of Medicine and Public Health University of Newcastle Callaghan Australia

[2 ] Hunter New England Population Health Wallsend Australia

[3 ] Hunter Medical Research Institute New Lambton Heights Australia

[4 ] Priority Research Centre for Health Behaviour University of Newcastle Callaghan Australia

[5 ] University Library Academic Division University of Newcastle Callaghan Australia

Author notes

Corresponding Author: Alison Brown alison.brown7@ 123456health.nsw.gov.au

Author information

Alison Brown https://orcid.org/0000-0002-4233-7467

Courtney Barnes https://orcid.org/0000-0003-4870-910X

Judith Byaruhanga https://orcid.org/0000-0003-0382-1552

Matthew McLaughlin https://orcid.org/0000-0003-2870-8556

Rebecca K Hodder https://orcid.org/0000-0003-3730-0907

Debbie Booth https://orcid.org/0000-0002-2466-3541

Nicole Nathan https://orcid.org/0000-0002-7726-1714

Rachel Sutherland https://orcid.org/0000-0003-0470-7663

Luke Wolfenden https://orcid.org/0000-0002-6178-3868

Article

Publisher ID: v22i7e17274

DOI: 10.2196/17274

PMC ID: 7428911

PubMed ID: 32735231

SO-VID: c7294889-b01c-4761-b244-8dc5f151ba79

Copyright © ©Alison Brown, Courtney Barnes, Judith Byaruhanga, Matthew McLaughlin, Rebecca K Hodder, Debbie Booth, Nicole Nathan, Rachel Sutherland, Luke Wolfenden. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 31.07.2020.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 2 December 2019

Date revision requested : 10 January 2020

Date revision received : 12 March 2020

Date accepted : 23 March 2020

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