Roy Cameron

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. 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. 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). 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. 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?

A knowledge broker (KB) is a popular knowledge translation and exchange (KTE) strategy emerging in Canada to promote interaction between researchers and end users, as well as to develop capacity for evidence-informed decision making. A KB provides a link between research producers and end users by developing a mutual understanding of goals and cultures, collaborates with end users to identify issues and problems for which solutions are required, and facilitates the identification, access, assessment, interpretation, and translation of research evidence into local policy and practice. Knowledge-brokering can be carried out by individuals, groups and/or organizations, as well as entire countries. In each case, the KB is linked with a group of end users and focuses on promoting the integration of the best available evidence into policy and practice-related decisions. A KB intervention comprised one of three KTE interventions evaluated in a randomized controlled trial. KB activities were classified into the following categories: initial and ongoing needs assessments; scanning the horizon; knowledge management; KTE; network development, maintenance, and facilitation; facilitation of individual capacity development in evidence informed decision making; and g) facilitation of and support for organizational change. As the KB role developed during this study, central themes that emerged as particularly important included relationship development, ongoing support, customized approaches, and opportunities for individual and organizational capacity development. The novelty of the KB role in public health provides a unique opportunity to assess the need for and reaction to the role and its associated activities. Future research should include studies to evaluate the effectiveness of KBs in different settings and among different health care professionals, and to explore the optimal preparation and training of KBs, as well as the identification of the personality characteristics most closely associated with KB effectiveness. Studies should also seek to better understand which combination of KB activities are associated with optimal evidence-informed decision making outcomes, and whether the combination changes in different settings and among different health care decision makers.

The Canadian Cancer Society’s Centre for Behavioural Research and Program Evaluation (CBRPE) is a national asset for building pan-Canadian capacity to support intervention studies that guide population-level policies and programs. This paper briefly describes CBRPE’s experience in advancing this work in the field of prevention. The aim is to illuminate issues of central importance for advancing the goals of the Population Health Intervention Research Initiative for Canada. According to our experience, success in building the population intervention field will depend heavily on purposeful alignment across organizations to enable integration of research, evaluation, surveillance, policy and practice. CBRPE’s capacity development roles include a) a catalytic role in shaping this aligned inter-organizational milieu and b) investing our resources in building tangible assets (teams, indicators, data systems) that contribute relevant capacities within this emerging milieu. Challenges in building capacity in this field are described. Le Centre de recherche sur le comportement et d’évaluation des programmes (CRCÉP) de la Société canadienne du cancer est un atout national pour le développement des capacités pancanadiennes à l’appui d’études interventionnelles qui orienteront les politiques et les programmes axés sur les populations. Dans cet article, nous décrivons brièvement l’expérience du CRCÉP à cet égard dans le domaine de la prévention. Notre objectif est d’éclairer les enjeux déterminants pour faire progresser l’Initiative de recherche interventionnelle en santé des populations du Canada (IRISPC). D’après notre expérience, le renforcement des interventions axées sur la population dépendra beaucoup d’une concordance délibérée entre les organismes en cause pour permettre l’intégration de la recherche, de l’évaluation, de la surveillance, des politiques et des pratiques. En matière de renforcement des capacités, le CRCÉP joue un double rôle: a) il est un catalyseur qui favorise la concordance entre les organismes du milieu et b) il investit ses ressources dans la création d’actifs tangibles (équipes, indicateurs, systèmes de données) qui élargissent les capacités dans le milieu émergeant. Nous décrivons les difficultés associées au renforcement des capacités dans ce domaine.

The Canadian Cancer Society and the National Cancer Institute of Canada have charged their Centre for Behavioral Research and Program Evaluation with contributing to the development of the country’s systemic capacity to link research, policy, and practice related to population-level interventions. Local data collection and feedback systems are integral to this capacity. Canada’s School Health Action Planning and Evaluation System (SHAPES) allows data to be collected from all of a school’s students, and these data are used to produce computer-generated school “health profiles.” SHAPES is being used for intervention planning, evaluation, surveillance, and research across Canada. Strong demand and multipartner investment suggest that SHAPES is adding value in all of these domains. Such systems can contribute substantially to evidence-informed public health practice, public engagement, participatory action research, and relevant, timely population intervention research.

Le projet Canada en mouvement est né dans un contexte dynamique, en réponse au besoin manifeste d’accroître la capacité de soutien à la recherche sur les interventions axées sur la population. Notre article porte sur: a) le mouvement en faveur d’une approche structurée de la prévention des maladies chroniques au Canada, b) la science nouvelle des interventions axées sur la population, c) le développement d’infrastructures canadiennes à l’appui de cette science nouvelle et d) l’apport de Canada en mouvement à la création d’une plate-forme de recherche en santé et au lancement opportuniste d’une étude incluant une évaluation de l’impact sur la population d’une initiative de marketing privée. The Canada on the Move project developed within a dynamic context and in response to an expressed need for increased capacity to support research involving population-level interventions. This article describes a) the movement to create an organized approach to chronic disease prevention in Canada, b) the emerging science of population-level intervention, c) the development of Canadian infrastructure to support population intervention science, and d) the contribution of Canada on the Move in developing a health research platform and, opportunistically, instigating a study which included assessment of the population impact of a commercial marketing initiative.

Peterson et al. (1) found no evidence for the long-term effectiveness of a school-based social-influences approach to smoking prevention. Appropriately, this finding received considerable media attention. It will, and should, have an impact on decision makers responsible for directing smoking-prevention initiatives. As Clayton et al. (2) noted in an accompanying editorial, the results from the Hutchinson Smoking Prevention Project (HSPP) are compelling because of the quality of the design and implementation.

OBJECTIVES: This study determined the effect of provider (nurse or teacher) and training method (workshop or self-preparation) on outcomes of a social influences smoking prevention program. METHODS: One hundred elementary schools were stratified by school risk score (high risk = high smoking rate among senior students) and assigned randomly to conditions: (1) teacher/self-preparation, (2) teacher/workshop, (3) nurse/self-preparation, (4) nurse/workshop, and (5) control. Intervention occurred in grades 6 to 8. Smoking status at the end of grade 8 was the primary endpoint variable. RESULTS: Intervention reduced grade 8 smoking rates in high-risk schools (smoking rates of 26.9% in control vs 16.0% in intervention schools) but not in low-risk schools. There were no significant differences in outcome as a function of training method and no significant differences in outcome between teacher-provided and nurse-provided interventions in high- and medium-risk schools. Although nurses achieved better outcomes than did teachers in low-risk schools, neither provider type achieved outcomes superior to the control condition in those schools. CONCLUSIONS: Workshop training did not affect outcomes. Teachers and nurses were equally effective providers. Results suggest that programming should target high-risk schools.

A strong partnership between researchers and providers is crucial to advance the science of dissemination and to support dissemination of effective chronic disease prevention programs. We reflect on our experience in three recent studies, (a) COMMIT, (b) a National Survey of School Smoking Prevention Programs, and (c) an ongoing study of Training of Providers of Smoking Prevention Programs to identify specific ways in which research and provider communities might collaborate. We propose that a national working group of researchers and providers be established to support (a) dissemination of programs by creating and continuously updating an inventory of 'tested' methods and protocols for use in key community intervention channels (health care offices, worksites, etc.) and (b) dissemination research by establishing a shared set of research priorities and mechanisms to stimulate researcher-provider partnership during the research process.