Knowledge Translation research

The World Health Organization’s (WHO) 11 day in-service Integrated Management of Neonatal and Childhood Illnesses (IMNCI) trainings started back in 1999, while the Essential Newborn (ENC) trainings were initiated about 10 years. Both were taken up by the Pakistan MNCH programme, with international donor and technical agencies funding them that included the United States Aid for International Development (USAID), UNICEF, Save the Children Federation and others. With varying numbers of trainings across all Pakistani provinces, considerable resources have been, and continue to be spent in these trainings.
This review of the effectiveness and implementation of in-service IMNCI and ENC trainings attempts at filling the gap in literature and establish whether trainings are making the impact envisioned when these were planned.

The Study is concurrent nested mixed method design. The quantitative component is cross-sectional, quasi-experimental, with comparison of trained and not trained groups of health care workers (HCW), with knowledge tests and observation of their skills. Case observations involved infants and children. Skills for ENC skills  were observed on a mannequin (neonatal simulator) by administering case scenarios. For knowledge assessment of both trainings, HCWs were administered a knowledge test with multiple choice questions.

For qualitative inquiry, in-depth interviews were conducted with key informants (KIs), facility managers, management personnel, facilitators and trained HCWs on relevance of training content and process, selection criteria, sites, implementation, and monitoring and supervision.

For the quantitative assessment, the study universe comprised of HCWs trained in IMNCI or ENC since May 2009 till January 2012. Sample sizes were estimated based on the normal approximation to the binomial distribution. For the IMNCI review, a sample of 66 trained HCWs, 22 from each cadre (MOs, LHV/Nurses and MT/HT/Dispenser) were purposively selected from the lists provided by the DOH/MNCH Programmes, from 3 levels of facilities (DHQH/THQH, RHC and BHU). An equal number of not trained workers from matching cadres comprised the comparison group. It was planned to observe all 132 workers for 2 cases of children aged 2 months to 5 years, and 1 infant aged less than 2 months. Each case was re-checked against the IMNCI “Gold Standard” by an independent evaluator, who also conducted the care-taker exit interviews to check for counselling practices.

For ENC, a total of 44 workers from each trained cadre (22 WMOs, and 22 LHV/Nurses) were selected from 2 levels of facilities (DHQH/THQH, RHC), with an equally matched number and cadre from the not trained group. All workers (88) were observed for skills on a mannequin.
Facility assessments for readiness of implementation of both IMNCI and ENC guidelines were also conducted at all facilities where trained workers were posted.

The WHO recommended priority and supplementary indicators applicable to the adapted IMNCI course in Pakistan were calculated to allow for international comparisons to be made.

This is the first study of its kind from the country, where IMNCI and ENC trainings have been promoted and conducted. Relevant conclusions and recommendations were made in consultation with the Technical Advisory Committee on the various aspects of improving the effectiveness of these trainings.

Recent research calls for greater consideration of design, by considering it further from the perspective of technology innovation management. In the attempt to cover this gap, the paper intends to explore how design can be used to support translational processes that connect and align different stakeholders in academic entrepreneurship.

Objectives: There have been 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. We 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.

Study Design: An exploratory study employed quantitative and qualitative methods of online surveys and in-depth interviews to collect data from all meeting participants.

Methods: All participants in the Bangladesh and South Africa meetings were invited to complete an online survey during the meetings and over the following six weeks. Of 411 participants in the 2012 Bangladesh meeting, 148 participants from 22 countries completed the survey. Eleven of these respondents (from eight countries) were interviewed. Of the 436 participants in the 2013 South Africa meeting, 126 respondents from 33 countries completed an online survey; none of these respondents were interviewed.

Results: The analysis revealed that most respondents used new knowledge to advocate for policy change (2012: 65.5%; 2013: 67.5%) or improve service quality (2012: 60.1%; 2013: 70.6%). 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%).

Discussion: Findings on knowledge use and sharing suggest that most respondents saw themselves as knowledge brokers or intermediaries in a position to influence the translation of knowledge into action in health policy and practices in their countries. Results suggest that supporting knowledge brokers working in a local and regional context to spur change, as described in the paper, has the potential to improve health outcomes. Further research is needed to isolate specific interventions and their knowledge translation outcomes.