A cluster randomised controlled trial to assess the effectiveness of knowledge translation strategies for obesity prevention

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A cluster randomised controlled trial to assess
the effectiveness of knowledge translation
strategies for obesity prevention

• Elizabeth Waters, Boyd Swinburn, Sing Kai Lo,
  Rebecca Armstrong, Maureen Dobbins, Laurie
  Anderson
• Cochrane Health Promotion Public Health Field,
  VicHealth
• School of Health and Social Development, Deakin
  University

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Acknowledgements

• Professor Boyd Swinburn
• Professor Rob Carter
• Professor Sing Kai Lo
• Assoc Professor Maureen Dobbins
• Dr Laurie Anderson
• Dr Mark Petticrew
• QLD Health
• Victorian DHS
• Victorian Health Promotion Foundation (VicHealth)
• PHAC

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Knowledge translation

• Where knowledge goes through iterative process of
  exchange, synthesis and application
• Much rhetorical discussion, some action, but
  limited empirical research
• Passive dissemination unlikely to be effective
• Interactive models are promising
• Researchers, policy makers and practitioners work
  together to frame research
• Facilitative, social influence models are
  promising in improving the uptake of secondary
  research (Nutley et al 2006)

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Knowledge translation in Australia

• Interest increasing very limited empirical
  research
• E.g. NHMRC adjudication
• Investigators plans for publication and research
  transfer
• Commitment to evidence but to varying degrees
• Lots of debate about terminology transfer,
  translation, exchange
• Focus on clearinghouses, practice guides,
  dissemination activities
• Do these change practice? Are they
  cost-effective? What other methods of KT could we
  consider?...need for rigorous research

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Local government in Victoria, Australia

• 79 local governments
• Planning and building, roads and parking, health
  services, people services, waste management,
  animal management, recreation and culture, local
  laws
• All legislated to develop Municipal Public Health
  Plans
• Identify, assess and address public health
  dangers
• Work with a range of primary and community health
  agencies

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Pilot study

• Conducted to assess acceptability of KT trial
• Random sample of 10 of local governments
• 100 responded positively to the study
• Increased pressure to use evidence to inform
  decision-making
• 75 suggested their council would be very willing
  to participate 25 were supportive but could not
  commit until full proposal presented

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Proposed study 2007-2008

• Funded by National Health and Medical Research
  Council 2007-2009
• Team comprising Deakin University (AUS), CDC
  (USA), McMaster University (CAN), Medical
  Research Council for Social and Public Health
  Research (UK)
• Evaluating learnings from comparable studies
  including Dobbins et al www.health-evidence.ca

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Aim

• Conduct a cluster randomised controlled trial of
  the effectiveness of knowledge translation
  strategies in increasing the adoption and
  implementation of effective policies, programs
  and interventions by local governments, with a
  focus on multi-factoral and multi-sectoral
  initiatives for childhood obesity prevention
  (focussing on healthy eating and physical
  activity).

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Theoretical frameworks

• Diffusion of innovations
• Organisational theory
• Learning theory
• Political science/decision-making

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Study components

• Review of existing studies/options
• Audit of public health plans
• Intervention
• 2 study arms
• Usual practice
• Facilitated, social model of knowledge
  translation and exchange
• Knowledge broker
• Workforce development
• Forums

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Evaluation

• Process evaluation
• Questionnaires, journals
• Economic evaluation
• Financial and time resources via questionnaires
• Modified realistic evaluation
• Impact and outcome evaluation
• Change in use, change in knowledge, change in
  confidence
• Document review and questionnaires

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MPH audit

• Most local governments have some focus on obesity
  prevention (healthy eating and/or physical
  activity).
• Physical activity is the most popular obesity
  prevention action, with a strong focus on walking
  and cycling.
• Within healthy eating, much of the action relates
  to food security (e.g. local access to foods
  within communities particularly for children and
  young people).

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MPH audit

• Preliminary analysis would suggest that many
  local governments use evidence in some form to
  justify their priorities.
• Very few appear to do so systematically or
  rigorously.
• We have been unable to identify any local
  governments who have used evidence explicitly in
  their plans to support their strategy selection.
  However, many acknowledge the role of community
  consultation in this process.

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Challenges

• Multi-sector approach by LGs
• Diversity of expertise around evidence
• Transient workforce
• Noisy environment many OP interventions
• Level of priority to topic may differ across LGs
• Limited evidence in some areas
• Politics of decision-making

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Contribution to evidence for PH and KSTE

• Rigorous evaluation of a model that aims to
  support multi-sectoral evidence-informed public
  health practice
• Exploration of use of evidence within local
  government setting
• Development of recommendations for practice
  oriented research

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Further information

• Rebecca Armstrong
• Cochrane HPPH Field
• rarmstrong_at_vichealth.vic.gov.au
• www.vichealth.vic.gov.au/cochrane