My first 100 days as a knowledge broker: Experiences on the CHErIsH project

CHErIsH researcher, Dr Susan Calnan, has recently written a blog post for the SPHeRE (Structured Population and Health-services Research Education) programme on her experiences of knowledge brokering for the CHErIsH project.

You can find the original blog here or read a copy of the article below.

Image: Pixabay

With the ever-increasing volume of research, finding ways to address the research-to-practice gap – the gap between knowledge creation and its use by healthcare practitioners and policymakers – is now more important than ever. This gap between knowledge creation and its use has important implications for our research: one frequently cited estimate is that it takes around 17 years to turn 14% of original research to the benefit of patient care.

Knowledge brokering is a burgeoning field that seeks to address the research-to-practice gap. A knowledge broker is essentially an intermediary person or organisation who/that develops relationships and connects producers and users of knowledge. It recognises the need for a more proactive and strategic approach to knowledge dissemination, rather than relying on the assumption that publication alone is the road to change. A knowledge broker can work in three interrelated ways, as Meyer (2010) outlines: as knowledge managers, linkage agents and capacity builders.

As part of CHErIsH – the Choosing Healthy Eating for Infant Health study – funding was provided to appoint and train a knowledge broker, under the HRB Knowledge Exchange and Dissemination Scheme (KEDS). This article outlines some of the key lessons learnt to date in this evolving role, as detailed under the following points:

Communicate the value of knowledge brokering: stakeholders need to understand first the value of and rationale for knowledge brokering; otherwise, they may view it as a superfluous activity. Be clear at the outset what knowledge brokering is and how it can add value for researchers, practitioners and policymakers. 

Talk to your knowledge stakeholders: begin by identifying the needs of both your knowledge users and makers. Try to identify what is the issue, where is the gap. This information can be gathered in a range of ways – from informal chats to more formal interviews or focus groups if you want to add to the evidence base in this area.

Identify barriers and facilitators to knowledge use: take note of the particular barriers and facilitators to knowledge use facing producers and users of research. These may differ according to the different disciplines: for example, in preliminary research carried out for CHErIsH, healthcare practitioners cited busy workload, time pressures and the broad scope of their work as barriers to knowledge use; researchers highlighted the growing volume of research, credibility of the source and time pressures as significant barriers.

Use an appropriate framework or template to guide your knowledge brokering plan: be strategic in your planning rather than adopting a scatter-gun approach. There is a growing body of literature on theories, models and frameworks that can be used in this field (e.g. see Strifler et al, 2018). The Knowledge-to-Action model (Graham et al, 2006) is a particularly popular model, and its outer ‘Action cycle’ can be used to guide the knowledge brokering process.

Tailor strategies towards your particular audience: consider the particular strategies that will work best with the particular target audience – there is no one-size-fits-all approach. For example, face-to-face exchange at a convenient time may work better for healthcare practitioners versus policy briefs or factsheets for policymakers.

Never underestimate the value of face-to-face exchange: personal contact and exchange is an important tool in the knowledge brokering toolbox. In feedback from the CHErIsH knowledge exchange meetings, for instance, the opportunity for face-to-face engagement and chance to give feedback/address problems were cited as the top two advantages by healthcare practitioners and researchers taking part in these meetings.

Monitor effectiveness: think about ways to gauge the effectiveness of your knowledge brokering plan; otherwise, how will you know if it is working. Examples could include the number of policy briefs distributed; number of hits on your website or followers on Twitter; documenting any change to policy or practice that has resulted from your efforts; or gathering feedback from stakeholders on how they found the process.

Consider the time factor: devise a timeline for your project. Different audiences and approaches may need to be targeted or applied at different timepoints – for example, contacting policymakers later on in the process when you have findings from a pilot or feasibility study. Also, remember that knowledge brokering takes time – for example, time to build relationships and trust with your knowledge stakeholders, time to synthesise and communicate findings from the research, and time to build capacity in knowledge brokering itself.

Knowledge translation for CHErIsH

CHErIsH is delighted to share with researchers and practitioners a copy of its Knowledge Translation strategy, available to view below. Knowledge translation is essentially about getting the right information to the right people at the right time and in the right format in order to influence decision making or practice (Knowledge Translation Australia). It has emerged in response to the research-to-practice gap – that is, the gap between knowledge creation and its use by healthcare practitioners and policymakers or stakeholders.

Activities in this area have been undertaken through funding provided to CHErIsH under the Health Research Board’s Knowledge Exchange and Dissemination Scheme (KEDS).

This strategy provides background information and outlines the key steps taken to devise a Knowledge Translation strategy for the project. CHErIsH has also sought to increase capacity in this area through training. This included one-week training undertaken last year by a member of the CHErIsH team at the Hospital for Sick Children’s (SickKids) Learning Institute in Toronto, Canada, a leading centre providing training and expertise in knowledge translation internationally.

A range of knowledge translation goals and measures are outlined in this strategy, including the following objectives: generating awareness about CHErIsH among researchers, healthcare practitioners and the general public; facilitating knowledge exchange between researchers and healthcare practitioners; increasing capacity in this field through training; and sharing knowledge in more easy-to-read and accessible formats.  

Over the past year, CHErIsH has been applying the measures outlined in this strategy and looks forward to learning more about the area of knowledge translation, strengthening efforts to reduce the research-to-practice gap.  

World Obesity Day and spotlight on childhood obesity

Today is World Obesity Day (11th October) – an annual campaign seeking to stimulate and support practical actions that will help people achieve and maintain a healthy weight and reverse the global obesity crisis. The campaign was first launched in 2015 by the World Obesity Federation, the federation representing organisations dedicated to solving the issue of obesity.

The CHErIsH study is an example of a multi-component intervention that seeks to support and promote healthy infant feeding practices among parents and primary caregivers. Research on the feasibility of CHErIsH is continuing at the Mallow Primary Healthcare Centre in Co. Cork and the findings from this research should be available early next year. A key focus of and the primary impetus for CHErIsH is to help reduce the risk of childhood overweight and obesity.

The issue of childhood obesity has received particular attention in recent days and weeks with the publication of two key reports to coincide with World Obesity Day. The first is the Atlas of Childhood Obesity, published by the World Obesity Federation earlier this month. The global atlas presents data for 191 countries (including Ireland) based on their current and predicted levels of obesity in children, the risk factors and the presence of government policies to tackle obesity. The report highlights the need for greater progress and government action in this area, indicating that no country has a better than 50 percent chance of meeting their target for tackling childhood obesity.

The second publication is an independent report by former UK Chief Medical Officer, Professor Sally Davies – entitled Time to Solve Childhood Obesity. Published this week, the hard-hitting report once again highlights the lack of government action in tackling the issue of childhood obesity. The report outlines key principles that should underpin further action in this area, with a particular focus on primary prevention – including shaping environments to ensure that children eat healthier and are more active. A BMJ opinion piece published on the same day offers further commentary on this report, conceding that a radical increase in both the breadth and intensity of actions to tackle childhood obesity is required if we are to halve its prevalence by 2030.

These reports underline the seriousness of the childhood obesity issue, which is estimated to increase by 100 million worldwide by 2030 among school-age children and adolescents, unless substantial interventions are implemented to prevent and treat childhood obesity.  

CHErIsH is a novel intervention that seeks to promote healthy infant feeding, viewing early feeding as a critical window in which parents or caregivers can reduce the risk of childhood obesity and overweight. The CHErIsH team is committed to helping to stem the rise of childhood overweight and obesity, as part of the global and multi-faceted efforts to address this critical issue. On World Obesity Day, CHErIsH would like to thank all its stakeholders, including its primary care partner, for their commitment and efforts in helping to design and implement this multi-component intervention, and the team looks forward to sharing the findings of its latest research.

Note: The World Obesity Federation has announced that, from next year, World Obesity Day will move to 4th March. It states that the new World Obesity Day 2020 will focus on changing the narratives around obesity globally in coordination with national and regional efforts.

CHErIsH feasibility study protocol now published

The CHErIsH team is happy to announce that the protocol for its feasibility study has now been published on BMJ Open and is available to view online.

The protocol provides a description of the non-randomised feasibility study for this infant feeding intervention and the accompanying implementation strategy. This feasibility study is currently underway at the Mallow Primary Healthcare Centre.

Well done to the CHErIsH team on this latest publication. The protocol is available to view at: https://bmjopen.bmj.com/content/bmjopen/9/8/e029607.full.pdf

European Obesity Day takes place this week

This week marks European Obesity Day (18th May), an annual awareness day which seeks to highlight Europe’s growing obesity problem and the need for better prevention and treatment in this area.

The campaign, which is an initiative of the European Association for the Study of Obesity (EASO), was first held in 2010 and continues to generate awareness and support across 32 European countries. To mark the campaign, a wide range of events are being held throughout Europe this week, including free health check-ups and healthy eating advice, walks and runs to encourage exercise, open days at hospitals and treatment centres, and training and information for healthcare providers.

Maintaining the focus on the need to address obesity is crucial given the extent and impact of this global problem. The World Health Organization (WHO) cites obesity as one of the greatest public health challenges of the 21st century, with its prevalence almost tripling since the mid-1970s. Regarding childhood overweight/obesity, an estimated 41 million children under the age of 5 years were living with overweight/obesity in 2016. In Ireland, as many as one in four Irish children is now considered to be affected by overweight/obesity, and evidence suggests that these children are more likely to remain overweight/obese into adulthood.

The CHErIsH project is committed to addressing childhood overweight/obesity through its ongoing research and interventions in the area of early infant feeding. Early infant feeding practices are known to play a role in the risk of overweight/obesity in later childhood and adult life.

A feasibility study examining the implementation of a multi-component intervention seeking to improve early infant (aged 0–2 years) feeding practices is currently underway, and the CHErIsH team looks forward to updating stakeholders on the outcomes of this important research.

To coincide with European Obesity Day, the Association for the Study of Obesity in Ireland (ASOI) is also hosting its annual conference and AGM this week (17th-18th May). The conference will feature leading national and international experts in the field. Oral presentations will include a discussion by Dr Sharleen O’Reilly on barriers and enablers to successful extended breastfeeding in women with high BMIs, and a presentation by Marita Hennessy on obesity prevention during the first 1,000 days.