The Contextual Approach in Health Research: Two Empirical Studies

Researchers are being encouraged to consider contextual influences on health-related outcomes. To support this perspective, two context-sensitive studies were conducted. The first study explored the utilization of a research report by Ontario public health units, and examined whether utilization differed by involvement in the research process. Research utilization was conceptualized as a three stage process (reading, information processing and application). Using a case study design, results from three involved public health units and three uninvolved units demonstrated that inclusion in the research process led to a greater understanding of the analysis and increased the value associated with the report. Involvement did not, however, lead to greater research utilization. An associated contextual analysis provided a rich backdrop, highlighting the general challenges of implementing research-based guidelines given front-line workers\u27 current realities. The second study examined the influence of contextual level (e.g., health region level) socioeconomic status on a woman\u27s lifetime mammography screening uptake. A secondary data analysis was conducted using Ontario data from the 1996 National Population Health Survey. Logistic hierarchical multilevel modelling was used to examine the regional variation in mammography uptake, and to examine the role of contextual and individual level variables on regional variation. The estimated average proportion of Ontario women, aged 50-69, who reported ever having had a mammogram was 0.86. Results demonstrated modest variations among health regions in ever having had a mammogram. These variations could not be explained by the variables considered in this study. Individual level variables demonstrated an association with mammography uptake, as did regional level education and regional median family income. Furthermore, each of these latter two contextual variables demonstrated interaction effects with the individual level variable, social involvement. Thus, contextual variables played a significant role in mammography uptake. Contextual circumstances ought to be considered during the development of breast health promotion programs and policies

Individual and Regional Determinants of Mammography Uptake

Background: Analysis of mammography utilization has traditionally been performed from an individual-level perspective. The purpose of this study was to explore the combined influence of individual- and regional-level determinants of mammography utilization. Methods: Logistic hierarchical multilevel modelling was used to investigate the influences of region of residence and individual characteristics on mammography utilization. Socioeconomic status information about health planning regions was derived from the 1996 Canadian Census. Individual-level information was extracted from the 1996 National Population Health Survey. Results: After controlling for individual-level education, regions with fewer high school graduates had lower levels of mammography utilization. A cross-level interaction between regional-level education and individual-level social involvement was found. Other individual-level variables associated with screening confirmed previous literature findings. Conclusion: Our findings suggest that higher levels of participation in social activities modify the detrimental influence on mammography utilization of living in a less educated region. This challenges the current focus of mammography screening research on individual-level determinants of uptake. Multilevel, synergistic strategies to possibly achieve higher levels of screening should be considered by health promotion program planners

Community-based knowledge translation: unexplored opportunities

<p>Abstract</p> <p>Background</p> <p>Knowledge translation is an interactive process of knowledge exchange between health researchers and knowledge users. Given that the health system is broad in scope, it is important to reflect on how definitions and applications of knowledge translation might differ by setting and focus. Community-based organizations and their practitioners share common characteristics related to their setting, the evidence used in this setting, and anticipated outcomes that are not, in our experience, satisfactorily reflected in current knowledge translation approaches, frameworks, or tools.</p> <p>Discussion</p> <p>Community-based organizations face a distinctive set of challenges and concerns related to engaging in the knowledge translation process, suggesting a unique perspective on knowledge translation in these settings. Specifically, community-based organizations tend to value the process of working in collaboration with multi-sector stakeholders in order to achieve an outcome. A feature of such community-based collaborations is the way in which 'evidence' is conceptualized or defined by these partners, which may in turn influence the degree to which generalizable research evidence in particular is relevant and useful when balanced against more contextually-informed knowledge, such as tacit knowledge. Related to the issues of evidence and context is the desire for local information. For knowledge translation researchers, developing processes to assist community-based organizations to adapt research findings to local circumstances may be the most helpful way to advance decision making in this area. A final characteristic shared by community-based organizations is involvement in advocacy activities, a function that has been virtually ignored in traditional knowledge translation approaches.</p> <p>Summary</p> <p>This commentary is intended to stimulate further discussion in the area of community-based knowledge translation. Knowledge translation, and exchange, between communities, community-based organizations, decision makers, and researchers is likely to be beneficial when ensuring that 'evidence' meets the needs of all end users and that decisions are based on both relevant research and community requirements. Further exploratory work is needed to identify alternative methods for evaluating these strategies when applied within community-based settings.</p

Tobacco Control Interest Groups and Their Influence on Parliamentary Committees in Canada

Objectives: The aim of this study was to determine how tobacco control interest groups influence tobacco policy decision-making through submissions and presentations to parliamentary committees. Methods: A qualitative content analysis was used to examine the presentations and submissions on tobacco-related legislation made to parliamentary committees between 1996 and 2004. The sample was identified from the public list of tobacco-related bills tabled in both the House of Commons and the Senate; the Government of Canada website and LEGISinfo were used to determine which committee reviewed the relevant bill. Committee clerks were asked to send submissions and presentations related to specific bills identified through LEGISinfo. Submissions and presentations were scanned and entered into QSR N6 software for coding. The coding instrument was adapted from previous studies employing qualitative content analysis. Montini and Bero\u27s recommendations were used to evaluate the submissions and presentations. Results: Tobacco control interest groups did present scientific evidence to support tobacco control. However, they underused credible witnesses to present information at meetings. The topics presented by tobacco control interests groups were usually relevant to the bill being discussed. Discussion: Tobacco control interest groups employed some of the strategies suggested by Montini and Bero in their attempt to influence parliamentary committees through submissions and presentations. They did include scientific evidence in their submissions; however, they could improve their strategies in the area of using credible witnesses, such as scientists and medical experts. Incorporating Montini and Bero\u27s recommendations into lobbying efforts may increase success in influencing committees

Research and Knowledge in Ontario Tobacco Control Networks

Objectives: This study sought to better understand the role of research knowledge in Ontario tobacco control networks by asking: 1) How is research managed; 2) How is research evaluated; and 3) How is research utilized? Methods: This is a secondary analysis of a qualitative study based on individual semi-structured interviews with 29 participants between January and May 2006. These participants were purposefully sampled from across four Ministries in the provincial government (n=7), non-government (n=15), and public health organizations (n=7). Interviews were transcribed verbatim and coded and analyzed using QSR N7 qualitative software. This study received ethics approval from The University of Western Ontario Health Research Ethics Board. Results: There exists a dissonance between the preference for peer-reviewed, unbiased, non-partisan knowledge to support claims and the need for fast, “real-time” information on which to base tobacco-related policy decisions. Second, there is a great deal of tacit knowledge held by experts within the Ontario tobacco control community. The networks among government, non-government, and public health organizations are the structures through which tacit knowledge is exchanged. These networks are dynamic, fluid and shifting. Conclusion: There exists a gap in the production and utilization of research knowledge for tobacco control policy. Tacit knowledge held by experts in Ontario tobacco control networks is an integral means of managing and evaluating research knowledge. Finally, this study builds on Weiss’s concept of tactical model of evidence use by highlighting the utilization of research to enhance one’s credibility

Comparing Views about Evidence in Ontario Public Health Units: A Qualitative Descriptive Study

Background: Ways of perceiving evidence by public health managers, practitioners and policy makers is one of the key determinants of evidence uptake. Recent public policy in Ontario requires programs to be based on evidence. Therefore, understanding views about evidence in both practice and policy contexts is important to bridge the research-policy-practice gap in public health. Objective and Methods: This qualitative descriptive study examined understandings about evidence in Ontario public health units by comparing perspectives from managers and frontline staff across six geographically-diverse units. A secondary qualitative content analysis was used to re-analyze transcripts of focus groups from the Renewal of Public Health Systems (RePHS) research project. Results: Similarities and differences were revealed with respect to how public health managers and frontline staff view evidence. Although both managers and frontline staff understand that multiple forms of evidence exist and that these forms must be integrated when making decisions regarding program development and implementation, frontline staff highlighted the role of practice-based evidence. Both groups named tools and processes that were available to assist their decision-making. Frontline staff indicated capacity building as important for supporting evidence use. Both groups noted that leadership could present a challenge to evidence-based programs if not supportive of the evidence-based solution for public health problems. However, the understanding of leadership differed between frontline staff and managers. Conclusion: Findings from this study provide insight into how use of evidence can be promoted and how to better support policy implementation efforts within practice contexts

Extending Collaborations for Knowledge Translation: Lessons from the Community-based Participatory Research Literature

The purpose of this paper is to expand the current focus on researcher-decision-maker knowledge translation (KT) partnerships to include community partners. Lessons were drawn from the community-based participatory research literature. An inductive thematic analysis was conducted, using forty-two eligible articles, and resulted in the identification of four themes (principles, structure, process and relationships) and associated factors that could contribute to KT collaborations among the three groups of actors. These findings are presented in a KT Triad framework. Thus, the framework provides specific lessons to facilitate researcher-decision-makercommunity collaborations based on an established body of literature. Including community partners in the KT process is important for integrating community context and needs into research-to-policy deliberations

Increasing Capacity for Knowledge Translation: Understanding How Some Researchers Engage Policy-makers

The potential for research to influence policy, and for researchers to influence policy actors, is significant. The purpose of this qualitative study was to explore the experiences of health services researchers engaging in (or not able to engage in) policy-relevant research. Semi-structured telephone interviews were completed with 23 experienced researchers.The results paint a complex and dynamic picture of the policy environment and the relationship between government officials and academic researchers. Elements of this complexity included diverse understandings of the nature of policy and how research relates to policy; dealing with multiple stakeholders in the policy-making process; and identifying strategies to manage the different cultures of government and academia

Promising points for intervention in re-imagining partnered research in health services comment on “Experience of health leadership in partnering with university-based researchers in Canada – A call to ‘re-imagine’ research”

In this commentary, we respond to Bowen and colleagues’ empirical study of research partnerships between Canadian health organizations and university-based investigators. We draw on our experiences of university and health-services partnerships to elaborate on some of the misalignments between researchers and health services leaders identified by Bowen et al. We take up Bowen and colleagues’ call to re-imagine research by proposing three promising points of intervention in research partnerships. These are: (1) orient towards research relationships rather than project-based partnerships; (2) recognize shared and diverging expectations and objectives; and (3) foster a more nuanced understanding of mutual gains

Effectively engaging stakeholders and the public in developing violence prevention messages

Background: Preventing family violence requires that stakeholders and the broader public be involved in developing evidence-based violence prevention strategies. However, gaps exist in between what we know (knowledge), what we do (action), and the structures supporting practice (policy). Discussion: We discuss the broad challenge of mobilizing knowledge-for-action in family violence, with a primary focus on the issue of how stakeholders and the public can be effectively engaged when developing and communicating evidence-based violence prevention messages. We suggest that a comprehensive approach to stakeholder and public engagement in developing violence prevention messages includes: 1) clear and consistent messaging; 2) identifying and using, as appropriate, lessons from campaigns that show evidence of reducing specific types of violence; and 3) evidence-informed approaches for communicating to specific groups. Components of a comprehensive approach must take into account the available research evidence, implementation feasibility, and the context-specific nature of family violence. Summary: While strategies exist for engaging stakeholders and the public in messaging about family violence prevention, knowledge mobilization must be informed by evidence, dialogue with stakeholders, and proactive media strategies. This paper will be of interest to public health practitioners or others involved in planning and implementing violence prevention programs because it highlights what is known about the issue, potential solutions, and implementation considerations