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

• Knowledge sharing requires an understanding of the problems audiences face, the level of detail they need, and the style of thinking they use.

• The message must be one that is valuable to an audience based on their needs, delivered by a messenger they can trust, in language they are comfortable with.

Consider the audience

• Researchers, service providers, and policymakers may talk about their work in diverse ways. Researchers may communicate with one another in highly technical terms, whereas service providers may discuss similar issues in language based on their daily work, and policymakers in political jargon. If a community of people sharing knowledge spans several disciplines and contexts, a common language is needed.

Use Plain Language

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 1.1به 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

– 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)

professional behavior change strategies

• 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 guidelines should facilitate high-quality practice informed by evidence,

Clinical Practice Guideline

How are clinical practice guidelines developed?

essential elements

• 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)

• Guideline Implementability Assessment (GLIA) tool

• The ADAPTE tool that provides criteria to evaluate the clinical fidelity of recommendations and their link to evidence.

How do we determine the quality of clinical practice guidelines?

• local opinion leaders are “providers nominated by their colleagues as educationally influential”.

• 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

• 1) High level of knowledge• 2) Communication skills• 3) Taking into account stakeholders• 4) 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

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– 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• Personalized risk communication (Uptake for

screening test)• 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, Automated telephone monitoring and counseling, manual telephone follow-up, Reminders, special ‘reminder’ pill packaging, dose-dispensing units and medication charts, appointment and prescription refill reminders, direct observation of treatments, …)

strategies focusing on patients

Patient Decision Aids

A review of 2500 treatments found that only 17% had adequate scientific evidence to be classified as black or white; the majority were “grey” either because of insufficient evidence or because the balance between benefits and harms was close.– birth control, – options for menopause symptoms, – back pain, – osteoarthritis, – end-of-life care,– genetic testing, – breast and prostate cancer treatment,

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

presentation of outcome probabilities

clarify patients’ values for outcomes

Ottawa Hospital Research Institute (OHRI)

How do we determine the quality of patient decision aids?

• Patient decision aids• Personalized risk communication (Uptake for

screening test)• 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, Automated telephone monitoring and counseling, manual telephone follow-up, Reminders, special ‘reminder’ pill packaging, dose-dispensing units and medication charts, appointment and prescription refill reminders, direct observation of treatments, …)

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.

• 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

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)

صفحه: پيام اصلي 1(قلب گزارش)

چه كسي است این گزارش را می خواند؟الزم است چه مطلبي را در مورد اين پژوهش بداند؟چه چيز از يافته هاي اين مطالعه بر مي آيد؟

كنار گذاشتن كليه متوننكاتی كه مخاطب بايد از آن آگاه شود به صورت فهرست وارذكر خالصه نتايج ممنوع الزم نيست پيام شما حاوي توصيه هاي مشخص باشد، اگر نمي توان

نتيجه گيري قطعي نمود سوال مشخصي را كه بايد به آن پاسخ داد به صورت واضح مطرح نماييد و از نوشتن “پژوهش هاي بيشتري مورد

نياز است” بپرهيزيد.

صفحه: خالصه اجراييصفحه: خالصه اجرايي 3 3

نكات داراي اهميت بيشتر در ابتداي متن و نكات كماهميت تر در ادامه

نگارش با زبان شفاف و روشن ولي غيرعاميانه بهگونه اي كه فرد ناآشنا به پژوهش آن را كامال درك

نمايد اشاره به موضوع مورد بررسي و پاسخ هاي بدست

آمدهيافته هاي طرح به صورت فشرده سطر1-2روش اجرا و جزئيات تكنيكي در حد

صفحه: گزارشصفحه: گزارش 25 25: سوال پژوهش، پژوهش هاي قبلي و Contextزمينه و سابقه 1.

سهم اين پژوهش در پاسخ به سوال: مفهوم يافته ها براي مدير يا سياست Implicationsمفاهيم 2.

گذار، ذكر گستره تعميم نتايج، تفكيك پيام ها: طراحي مطالعه، روش ها، منبع داده ها، Approachرويكرد 3.

جزئيات نمونه گيري، تكنيك هاي آناليز و ...: نگارش نتايج به صورت خالصه و پررنگ نمودن Resultsنتايج 4.

پيام ها، استفاده از جداول و نمودارها: ساير منابع كه براي Additional Resourcesمنابع اضافي 5.

سياست گذار مي تواند مفيد باشد: فهرست نمودن شكاف Further Researchپژوهش هاي بيشتر 6.

هاي موجود، طرح پرسش هاي مشخص: مشخص References and Bibliographyمراجع و كتابشناسي 7.

است نمودن مواردي كه مفيدترپيوست: يافته هايي كه مستقيما به نتيجه گيري ارتباط ندارند، 8.

مواد و روش هاي تكنيكي، مراجعي کامل

Effect sizes of multifaceted interventions by number of

interventions

رسانه های گروهیرسانه های گروهیاعالم از مردم % 50در یک پژوهش در شهر تهران نزديک به •

وپزشکي خود اطالعات بهداشتي کردند ازطريق صدا و سيما درصد پاسخگويان 16راکسب مي کنند. در حالی که

درصد از»افراد عادي« 9درصد از»کتاب ها« 11از»پزشکان«، درصد از»مطبوعات« اطالعات بهداشتي 6(آشنايان واقوام) و

وپزشکي خود راکسب مي کنند.

اعالم داشتند که اخبار سالمت کسب % مردم 58در مطالعه ای •آنها نسبت رفتار و نگرش شده از طریق رسانه، موجب تغییر

به مسائل سالمت شده است. برخی بیماران تحت تاثیر اخباری که پخش می شود حتی نحوه درمان خود را تغییر می دهند.

منبع اطالعات پزشكان و مردم در زمينه منبع اطالعات پزشكان و مردم در زمينه ماه پس از ماه پس از 22بيماري آنفلوانزاي خوكي بيماري آنفلوانزاي خوكي

آغاز پاندمی بيماريآغاز پاندمی بيماري

مردم اطالعات خود را % 80/1پزشكان و 75/6%

در زمينه بيماري آنفلوانزاي خوكي از تلويزيون

و يا روزنامه ها و مجالت عمومي بدست آورده

بودند.

ارزش هاي خبري از نگاه ارزش هاي خبري از نگاه خبرنگارانخبرنگاران

تازگی خبر1.

موضوع روز2.

موضوعات در مورد مسائل مهم3.

فراگير بودن (جمعيتي مخاطب بزرگتر باشد)4.

عدد بزرگ5.

شهرت بیان کننده خبر6.

مجاورت (كشورهاي همسايه)7.

استثنا بودن خبر8.

اخبار در زمینه يك برخورد يا چالش9.

در مطالعه ای که در مرکز تحقیقات •

بهره برداری از دانش سالمت در سال

صورت گرفت مشاهده شد که 1387

اخبار سالمت درج شده در % 18حدود

شواهد روزنامه های عمومی از نظر

فاقد صالحیت انتشار می باشند.علمی

اخبار درمان ارزيابيهایمعيار

مربوط به درمان در امریکا: ارزيابي اخبارهایمعياربحث در مورد هزینه ها1.سنجش فواید2.سنجش زیان ها3.اشاره به دیگر گزینه های موجود4.جستجوي منابع و توجه به تعارض منافع در منبع خبر 5.اجتناب از استفاده تجاری از بیماریها 6. کیفیت شواهد7.جدید بودن موضوع مورد بررسی 8.بررسي در دسترس بودن روش9.

بررسی های فراتر10.

Gary Schwitzer. How Do US Journalists Cover Treatments, Tests, Products, and Procedures? An Evaluation of 500 Stories. PLoS Medicine. May

2008, 5(5).

Key Messages

• Knowledge sharing requires an understanding of the problems audiences face, the level of detail they need, and the style of thinking they use.

• Evidence based medicine should be complemented by evidence based implementation.

• Interactive or mixed/interactive educational meetings were generally

• effective resulting in moderate. In contrast, didactic meetings were largely ineffective.

• There is not any evidence of the effects of knowledge translation strategies that focused on policy makers or senior health service managers.