Jhpiego (Norton, Reynolds); Save the Children (Howell)
"An interactive meeting format alone does not ensure knowledge translation afterwards..."
In light of increasing calls for more research on interventions to successfully translate evidence-based knowledge into improved health policy and practices, this paper reports on an exploratory study of knowledge translation interventions conducted with participants of global health meetings held in Bangladesh in 2012 and in South Africa in 2013. The authors measured stakeholders' uptake of evidence-based knowledge in terms of their translation of this knowledge into actions around public health policy and practice. The research sought to determine whether participants shared and used knowledge from the meetings to improve health policy and practices in their settings and the factors influencing sharing and use.
This paper focuses on knowledge translation efforts of global health programmes such as the United States Agency for International Development (USAID)'s Maternal and Child Health Integrated Program (MCHIP), led by Jhpiego, Save the Children's Saving Newborn Lives (SNL) Program, and programmes supported by the United Nations Children's Fund (UNICEF) and other major donors. These programmes aim to scale up evidence-based, high-impact maternal, newborn, and child health interventions in low-resource countries to reduce mortality and improve service quality. To this end, MCHIP, SNL, and other similar initiatives have integrated knowledge translation into implementation of programmes so as to serve as knowledge brokers between global leaders, such as the World Health Organization (WHO), and country stakeholders. They have also cultivated individual knowledge brokers in the countries where they have worked to foster change. One knowledge brokering approach utilised by these maternal and newborn health programmes was to periodically hold technical meetings with stakeholders in Africa, Asia, and worldwide. The format of the meetings, as shown in Figure 2 in the paper, included knowledge creation and knowledge action activities that coincided with Graham et al.'s Knowledge-to-Action (KTA) Framework, which is shown above and described in detail.
This research focuses on two technical meetings: one held in Dhaka, Bangladesh, in May 2012 with 411 participants from 30 countries, and one held in Johannesburg, South Africa, in April 2013 with 436 participants from 50 countries. The actions of the Pakistan team before, during, and after the 2012 Bangladesh conference offer an example of how the process worked. In 2012, the team from Pakistan was composed of members working for United Nations (UN) agencies, government, non-governmental organisations (NGOs), and academic institutions in the areas of programme development and management, health service delivery, advocacy, and teaching and training. In preparing their country situational poster, the Pakistan team identified priority interventions for their country related to preventing postpartum haemorrhage and pre-eclampsia/eclampsia. After the conference, the team worked with provincial departments of health, professional bodies, academic institutions, civil society organisations, and development partners to advance the introduction and scale-up of evidence-based interventions to prevent postpartum haemorrhage. These interventions, called out in the Lahore Declaration of 30 May 2012, included adding misoprostol to the essential drug list.
All participants in the Bangladesh and South Africa meetings were invited to complete an online survey during the meetings and over the following 6 weeks. The analysis revealed that most respondents used new knowledge to advocate for policy change (2012: 65.5%; 2013: 67.5%), such as adapting meeting knowledge for use in a local context and sharing with those in a position to change policies, or to improve service quality (2012: 60.1%; 2013: 70.6%). Respondents who gave examples of use of new knowledge to design programmes reported that they shared the information with groups involved in programme or project design in order to gain acceptance of an intervention that was discussed at the meetings. Several examples of use mentioned conducting training of healthcare providers on the newborn resuscitation technique covered in the skills sessions of the meetings. Other examples respondents gave included using information for health care-related procurement and guidelines. The type of knowledge that respondents most commonly shared was clinical or scientific information (2012: 79.1%; 2013: 66.7%) and country-specific information (2012: 73.0%; 2013: 71.4%). Most 2012 respondents shared knowledge because they thought it would be useful to a co-worker or colleague (79.7%).
Open-ended responses and interviews conducted as part of the research highlighted aspects of the meetings that literature shows are facilitators for KTA. For example, the importance of human interaction came across in comments both about restribution of knowledge to colleagues and about country teams working together prior to, during, and after the meetings. Another KTA facilitator - interactive learning activities for decision-makers - was referenced multiple times by participants who trained others after the meeting on the Helping Babies Breathe technique they learned during the skills sessions. The meetings' approach of engaging participants from multiple health care roles and at multiple stages before, during, and after technical meetings is described here as a promising practice. Furthermore, evidence suggests that knowledge brokers can be most effective when facilitating uptake of knowledge in the form of key messages with an audience predisposed to act on evidence. The meetings' design reflected this promising practice by focusing on a few technical problems with associated technical briefs and other knowledge products that participants could take back to their countries for use. Thus, the combination of focused key messages with knowledge products that can be adapted for local use by knowledge brokers is a promising practice for translating knowledge into action.
The authors conclude that "[e]ngagement of country teams and meeting planners in a process involving actions before, during, and after meetings as described in this paper are needed to facilitate KTA in a local context to improve health policy and practice. Supporting knowledge brokers at technical meetings in ways that incorporate knowledge creation and action processes (as described by Graham et al.) before, during, and after the meeting is a promising practice for knowledge translation to improve health policy and practice."
Public Health (2016), http://dx.doi.org/10.1016/j.puhe.2016.04.012 - sourced from Maternal and Child Survival Program (MCSP) website, June 6 2016.