Abstract
BackgroundKnowledge brokering is a knowledge translation approach that has been gaining popularity in Canada although the effectiveness is unknown. This study evaluated the effectiveness of generalised, exclusively email-based prompts versus a personalised remote knowledge broker for delivering evidence-based mood management interventions within an existing smoking cessation programme in primary care settings.MethodsThe study design is a cluster randomised controlled trial of 123 Ontario Family Health Teams participating in the Smoking Treatment for Ontario Patients programme. They were randomly allocated 1:1 for healthcare providers to receive either: a remote knowledge broker offering tailored support via phone and email (group A), or a generalised monthly email focused on tobacco and depression treatment (group B), to encourage the implementation of an evidence-based mood management intervention to smokers presenting depressive symptoms. The primary outcome was participants’ acceptance of a self-help mood management resource. The secondary outcome was smoking abstinence at 6-month follow-up, measured by self-report of smoking abstinence for at least 7 previous days. The tertiary outcome was the costs of delivering each intervention arm, which, together with the effectiveness outcomes, were used to undertake a cost minimisation analysis.ResultsBetween February 2018 and January 2019, 7175 smokers were screened for depression and 2765 (39%) reported current/past depression. Among those who reported current/past depression, 29% (437/1486) and 27% (345/1277) of patients accepted the mood management resource in group A and group B, respectively. The adjusted generalised estimating equations showed that there was no significant difference between the two treatment groups in patients’ odds of accepting the mood management resource or in the patients’ odds of smoking abstinence at follow-up. The cost minimisation analysis showed that the email strategy was the least costly option.ConclusionsMost participants did not accept the resource regardless of remote knowledge broker strategy. In contexts with an existing KT infrastructure, decision-makers should consider an email strategy when making changes to a programme given its lower cost compared with other strategies. More research is required to improve remote knowledge broker strategies.Trial registrationClinicalTrials.gov, NCT03130998. Registered April 18, 2017, (Archived on WebCite at www.webcitation.org/6ylyS6RTe)
Highlights
Knowledge brokering is a knowledge translation approach that has been gaining popularity in Canada the effectiveness is unknown
Given the costs and resources associated with traditional, in-person, models of knowledge brokering [20, 21], some programme implementers have shifted to remote KB services, including virtual communities of practice (CoP), emails and phone calls [20, 22, 23]
Pre-intervention-readiness survey The readiness survey was shared with all Family Health Team (FHT) who were actively participating in the Smoking Treatment for Ontario Patients (STOP) programme and had a lead implementer in place at the time the survey was sent out (n = 125)
Summary
Knowledge brokering is a knowledge translation approach that has been gaining popularity in Canada the effectiveness is unknown. This study evaluated the effectiveness of generalised, exclusively email-based prompts versus a personalised remote knowledge broker for delivering evidence-based mood management interventions within an existing smoking cessation programme in primary care settings. While funding agencies and policy- and decision-makers have promoted the application of EBP within primary care settings to enhance the quality of healthcare programmes and improve patient care, implementing new research into clinical practice, and sustaining these evidence-based interventions long term, is often challenging [3,4,5]. Various knowledge translation (KT) strategies have been used to help build capacity and encourage the implementation of EBP within healthcare settings, including training [6, 7], technologyenabled supports [8,9,10], financial incentives [5, 11], policy initiatives [5] and knowledge brokering [5, 12]. The effectiveness of KBs operating from remote contexts has not been rigorously evaluated in primary care
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