Mobilising knowledge in complex health systems: a call to action

Holmes, Bev; Best, Allan; Davies, H. W. E.; Hunter, David E.; Kelly, Michael P.; Marshall, Martin; Rycroft-Malone, Joanne

doi:10.1332/174426416x14712553750311

Cited by 146 publications

(199 citation statements)

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“…Furthermore, end of life is heavily culture bound 19. We recognise that KTE is a non-linear process, made possible only when all relevant stakeholders work together to address their specific concerns, like those identified in this study and others, such as consistent leadership, local autonomy, passion and engagement at all levels 18. KTE is a necessary condition for the ultimate goal of knowledge mobilisation, and from this study, KTE is an essential foundation but insufficient to permit action; knowledge mobilisation in palliative care requires a whole system approach to introduce, manage and sustain change.…”

Section: Discussionmentioning

confidence: 88%

“…With or without access to professional networks, researchers and clinicians alike struggle with KTE as part of evidence use, due to the fundamental challenge of working with complexity18 due to ‘myriad elements of context’(p. 540) 18. In the palliative care setting, researchers described additional complexities due to multimorbid cases and negative perceptions.…”

Section: Discussionmentioning

confidence: 99%

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Barriers and facilitators to knowledge transfer and exchange in palliative care research

Kernohan

Brown

Payne

et al. 2018

BMJ EBM

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In order to ensure the effective transfer of research knowledge to those who can effect positive changes in practice, models of knowledge transfer and exchange (KTE) are required. Limited evidence exists as to how palliative care researchers use existing models to support their practice and to what extent they are perceived as effective. We set out to identify factors that influence KTE planning and implementation through semistructured interviews with experienced palliative care researchers in Ireland. Issues around KTE were drawn out through thematic analysis. Nine interviews were held with investigators on eight research projects. Ten themes were identified and categorised as either barriers or facilitators to KTE. Perceived barriers included inadequate time and funding, limited institutional capacity, competing priorities, weak communication channels and negative perceptions of palliative care. Perceived facilitators included dedicated time and resources, aligned priorities, strong professional networks, multipronged approach and KTE experience. In order to improve the quality, acceptability and reach of palliative research, it is vital that researchers improve their understanding of KTE within the context of palliative care, moving beyond academic dissemination to achieve research-informed practice by overcoming barriers to KTE through facilitated action. This study provides an overview of factors that influence KTE planning and implementation among palliative care researchers.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to knowledge transfer and exchange in palliative care research

Kernohan

Brown

Payne

et al. 2018

BMJ EBM

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“…Participatory research is commonly used in the fields of education and community development but with a few exceptions it has received a lukewarm reception in the health sector, where the more positivist concepts of objectivity and external validity trump more interpretivist approaches to the creation of new knowledge 37. Participatory models of evaluation should never replace established methodologies and there are a number of challenges that have been described elsewhere,6–8 including the risks of researchers being ‘captured’ by their practitioner colleagues, ethical issues and how best to develop a model supporting the professional development and advancement of researchers.…”

Section: Discussionmentioning

confidence: 99%

What can a participatory approach to evaluation contribute to the field of integrated care?

2016

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Better integration of care within the health sector and between health and social care is seen in many countries as an essential way of addressing the enduring problems of dwindling resources, changing demographics and unacceptable variation in quality of care. Current research evidence about the effectiveness of integration efforts supports neither the enthusiasm of those promoting and designing integrated care programmes nor the growing efforts of practitioners attempting to integrate care on the ground. In this paper we present a methodological approach, based on the principles of participatory research, that attempts to address this challenge. Participatory approaches are characterised by a desire to use social science methods to solve practical problems and a commitment on the part of researchers to substantive and sustained collaboration with relevant stakeholders. We describe how we applied an emerging practical model of participatory research, the researcher-in-residence model, to evaluate a large-scale integrated care programme in the UK. We propose that the approach added value to the programme in a number of ways: by engaging stakeholders in using established evidence and with the benefits of rigorously evaluating their work, by providing insights for local stakeholders that they were either not familiar with or had not fully considered in relation to the development and implementation of the programme and by challenging established mindsets and norms. While there is still much to learn about the benefits and challenges of applying participatory approaches in the health sector, we demonstrate how using such approaches have the potential to help practitioners integrate care more effectively in their daily practice and help progress the academic study of integrated care.

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“…The explicit use of creative methods in coproduction addresses many of the challenges of coproduction, namely imbalances or deficits of power, language, trust, and time. It fosters an inclusive nonhierarchical environment [28] that allows all participants to be recognized as experts and produces results in the form of visible and tangible outputs owned by those who created them [29]. …”

Section: Methodsmentioning

confidence: 99%

A Virtual Agent to Support Individuals Living With Physical and Mental Comorbidities: Co-Design and Acceptability Testing

Easton¹,

Potter²,

Bec³

et al. 2019

J Med Internet Res

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Background Individuals living with long-term physical health conditions frequently experience co-occurring mental health problems. This comorbidity has a significant impact on an individual’s levels of emotional distress, health outcomes, and associated health care utilization. As health care services struggle to meet demand and care increasingly moves to the community, digital tools are being promoted to support patients to self-manage their health. One such technology is the autonomous virtual agent (chatbot, conversational agent), which uses artificial intelligence (AI) to process the user’s written or spoken natural language and then to select or construct the corresponding appropriate responses. Objective This study aimed to co-design the content, functionality, and interface modalities of an autonomous virtual agent to support self-management for patients with an exemplar long-term condition (LTC; chronic pulmonary obstructive disease [COPD]) and then to assess the acceptability and system content. Methods We conducted 2 co-design workshops and a proof-of-concept implementation of an autonomous virtual agent with natural language processing capabilities. This implementation formed the basis for video-based scenario testing of acceptability with adults with a diagnosis of COPD and health professionals involved in their care. Results Adults (n=6) with a diagnosis of COPD and health professionals (n=5) specified 4 priority self-management scenarios for which they would like to receive support: at the time of diagnosis ( information provision ), during acute exacerbations ( crisis support ), during periods of low mood ( emotional support ), and for general self-management ( motivation ). From the scenario testing, 12 additional adults with COPD felt the system to be both acceptable and engaging, particularly with regard to internet-of-things capabilities. They felt the system would be particularly useful for individuals living alone. Conclusions Patients did not explicitly separate mental and physical health needs, although the content they developed for the virtual agent had a clear psychological approach. Supported self-management delivered via an autonomous virtual agent was acceptable to the participants. A co-design process has allowed the research team to identify key design principles, content, and functionality to underpin an autonomous agent for delivering self-management support to older adults living with COPD and potentially other LTCs.

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Mobilising knowledge in complex health systems: a call to action

Cited by 146 publications

References 0 publications

Barriers and facilitators to knowledge transfer and exchange in palliative care research

Barriers and facilitators to knowledge transfer and exchange in palliative care research

What can a participatory approach to evaluation contribute to the field of integrated care?

A Virtual Agent to Support Individuals Living With Physical and Mental Comorbidities: Co-Design and Acceptability Testing

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