Knowledge Mobilization Network Research Articles

Engaging young people within a collaborative knowledge mobilization network: Development and evaluation.

BackgroundIt is critical that mental health systems place a focus on prevention and early intervention focused on young people while integrating youth voice to guide priority directions.ObjectiveThis study was designed to better understand how youth advisories can be utilized to influence strategic directions within integrated knowledge mobilization networks operating within the youth mental health system.DesignTo support this objective, we reviewed the detailed stages of development in establishing a youth advisory within a national network designed to support the integration of youth services. We also engaged the advisory in a participatory evaluation process that examined the extent to which the network had created processes to include youth voice in decision‐making.ResultsResults from the surveys identified moderate to high levels of individual engagement as well as strong development of processes and procedures that support the inclusion of youth voice across the network.DiscussionMajor successes and challenges are presented and discussed with respect to the development of the advisory. The findings are useful for youth advocates and adult allies working to support youth engagement (YE) in knowledge mobilization to enhance the mental health services system. This study also contributes to research and evaluation efforts examining YE and represents an exemplar methodology for evaluating YE efforts at the system level.Patient or Public ContributionYoung people as mental health service users and youth mental health advocates were involved in the design, data collection, analysis and interpretation of the data as well as the preparation of this manuscript.

P.062 Interpersonal cognitive differentiation and interpersonal cognitive richness as mediators of self-reflectivity and neurocognition on negative symptoms in psychosis

After 17 years, the Pediatric Emergency Care Applied Research Network has demonstrated its significant contribution to the care of acutely ill and injured children through the successful completion of more than 35 research studies. Despite the importance of research findings and the numerous publications in medical journals, the information is not easily accessible by parents, families, or nonresearch medical providers. Another group of investigators has developed knowledge translation and dissemination using social media through the Translating Emergency Knowledge for Kids knowledge mobilization network. This model is an example for other networks and outlines the challenges of dissemination of findings. The network’s research is widely published and has been incorporated into national guidelines, but the Pediatric Emergency Care Applied Research Network’s next challenge is translation of network findings into practice so every child who seeks emergency care in the United States in large or small emergency departments can be treated with evidence-based medicine.

Implementation of pain best practices as part of the spinal cord injury knowledge mobilization network

Context/objective: The spinal cord injury (SCI) knowledge mobilization network (KMN) is a community of practice formed in 2011 as part of a national best practice implementation (BPI) effort to improve SCI care. This study objective was to determine whether completion and documentation of pain practices could be improved in a neurorehabilitation setting using the KMN implementation approach.Design: Single site, pre–post intervention study.Setting: Neurorehabilitation hospital.Participants: Twenty sequential consenting inpatients with SCI, with retrospective comparative analysis of 50 sequential SCI admissions pre-KMN.Interventions: A local Site Implementation Team (SIT) was formed to develop an implementation plan, including acceptable timeframes for completion and documentation of four specific pain best practices: (1) pain assessment on admission, (2) development of an Inter-Professional Pain Treatment Plan (IPTP), (3) pain monitoring throughout admission, and (4) a pain discharge plan.Outcomes: Provider adherences to pain best practices were the primary outcomes. The secondary outcome was patient satisfaction.Results: Provider adherence for most outcomes exceeded 70% completion within acceptable timeframes, with improvements found for all outcomes as compared to the retrospective cohort. Notably, pain education as part of the IPTP improved from 12% completion to 74%, documenting pain onset from 4.5% to 80% and pain discharge plan from 40% to 74%. Overall, participants were satisfied with their pain management.Conclusions: Pain best practices were more consistently documented after the KMN implementation. Pain practices in all four areas have now been expanded to all inpatient diagnoses using the same forms and framework created in the implementation process.

Development of an implementation-focused network to improve healthcare delivery as informed by the experiences of the SCI knowledge mobilization network

Context: Implementing research findings into clinical practice is challenging. This manuscript outlines the experiences and key learnings from a network that operated as a community of practice across seven Canadian Spinal Cord Injury (SCI) rehabilitation centers. These learnings are being used to inform a new implementation-focused network involving SCI rehabilitation programs based in Ontario, Canada.Methods: The SCI KMN adapted and applied implementation science principles based on the National Implementation Research Network’s (NIRN) Active Implementation Frameworks in the implementation of best practices in pressure injury and pain prevention and management.Results: The SCI KMN was successful in implementing best practices in both pressure ulcer and pain prevention and management across the various participating sites. Other key objectives met were building capacity in implementation methods in site personnel so that project scaling could occur with these skills and expertise applied to numerous other initiatives. Additionally, various papers, abstracts and conference presentation as well as an implementation guide were disseminated to inform the field of implementation science.Conclusion: The key lessons learned from this experience are being used to develop a new implementation-focused network. Features felt to be especially important for the SCI KMN includes a highly representative governance structure, the use of indicators within an overall evaluation framework and the systematic application of implementation processes with shared learnings supporting each site.

What makes for effective, sustainable youth engagement in knowledge mobilization? A perspective for health services.

BackgroundYoung people who seek mental health treatment often also seek the services of non‐profit organizations to support their well‐being. Wisdom2Action (W2A) is a Canadian knowledge mobilization network that focuses on improving the mental health and well‐being of children and youth in challenging contexts by increasing the use of evaluation, evidence and engagement in the youth‐serving sector. Since 2013, W2A has engaged youth advisors (YAs) to provide input to W2A's Board, lead their own projects and co‐design W2A activities.ObjectiveIn fall 2017, the YAs, as well as adult Board members and W2A staff, collaborated in a participatory evaluation to better understand the experiences and impacts of youth engagement. This article describes insights derived through this process.Design and participantsBoard, YAs and staff members participated in a reflective approach to informing, analysing and sharing the findings from this process. Individual interviews and review of documents, as well as iterative cycles of group analysis and synthesis, were conducted.ResultsBoth YAC members and W2A benefit from YAs’ leadership and engagement. The YAs position themselves as members of the youth‐serving sector, not merely recipients of its services; as such, their professional development aligns with the mandates of W2A and merits further investment, despite challenges in impact measurement.ConclusionThis article identifies challenges and facilitators of implementing an effective and sustainable youth advisory council model of engagement in the context of a pan‐Canadian network. The mutual gains and areas of growth for youth, adults and the organization described can inform health services, as well as funders and advocates for youth well‐being.

The Spinal Cord Injury Pressure Ulcer Scale (SCIPUS): an assessment of validity using Rasch analysis.

Secondary analysis of retrospective data. The aim of this study was to further validate the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) using Rasch analysis. Two rehabilitation centers in Canada. Data were collected as part of the Spinal Cord Injury Knowledge Mobilization Network (SCI KMN) initiative. The SCIPUS was completed within 72 h of inpatient admission. Persons admitted for initial rehabilitation in two inpatient spinal cord rehabilitation programs were included in the project. Data from 886 participants were analyzed, approximately 60% of whom were males. Rasch analyses demonstrated that the SCIPUS, in its current format did not meet criteria required for true measurement. A transformed version of the SCIPUS obtained by deletion of misfitting items and modification of the response scales improved fit to the model and showed preliminary evidence of unidimensionality. The person separation index, however indicated that the scale requires further adjustments of its scoring options. In its original form, the SCIPUS does not meet the requirements of the Rasch model and its total score should be used cautiously. However, following some adjustments to the items such as addressing DIF between sites to insure a standardized assessment across sites and adding response options to some of the items, interval-scale measurement should be possible.

Implementation of Pressure Injury Prevention Best Practices Across 6 Canadian Rehabilitation Sites: Results From the Spinal Cord Injury Knowledge Mobilization Network

ObjectiveTo use the theoretical frameworks of implementation science to implement pressure injury (PI) prevention best practices in spinal cord injury (SCI) rehabilitation. DesignQuality improvement. SettingSix Canadian SCI rehabilitation centers. ParticipantsInpatients (N=2371) admitted from 2011 to 2015. InterventionsThe SCI Knowledge Mobilization Network (SCI KMN) selected and implemented 2 PI prevention best practices at 6 Canadian SCI rehabilitation centers: (1) completing a comprehensive PI risk assessment comprised of a structured risk assessment instrument followed by an individualized, interprofessional risk factor determination and prevention plan; and (2) providing structured and individualized PI prevention patient education. Active Implementation Frameworks provided a systematic approach to best practice implementation. Main Outcome MeasuresImplementation indicators (completion rates) and patient outcomes (PI incidence, patient education survey). ResultsAfter implementation, risk assessment completion rates improved from 46% to 94% (P<.05). Between initial (2012-2013) and full (2014-2015) implementation stages, completion rates improved for both interprofessional risk factor determination (67% to 96%) and prevention plans (67% to 94%). Documentation of patient education also increased to 86% (vs. 71% preimplementation). At rehabilitation admission 22% of patients had PIs, with 14% of individuals developing new PIs during rehabilitation. The overall PI prevalence was 30%. Considering only PIs of stage 2 or greater, prevalence was 21% and incidence 7%. There were no statistically significant differences in PI incidence between pre- and postimplementation. Patient education surveys indicated that PI education improved patients’ knowledge of prevention strategies. ConclusionsActive Implementation Frameworks supported successful implementation of PI prevention best practices across the 6 participating SCI KMN sites. Achieving a reduction in PI incidence will require additional measures, and there is an ongoing need to strengthen the evidence base underpinning PI prevention guidelines.

An inclusive, online Delphi process for setting targets for best practice implementation for spinal cord injury.

The Spinal Cord Injury Knowledge Mobilization Network is a pan-Canadian community of practice composed of seven rehabilitation hospitals. The goal of this network is to utilize implementation science processes to facilitate the adoption of best practice in spinal cord injury (SCI) rehabilitation. In addition to selecting specific practices for implementation, a key aspect of effective implementation is the engagement of stakeholders in decision-making processes. To achieve this, the network utilized a Delphi process to reach consensus on two pressure ulcer prevention and management practices to be implemented in SCI inpatient rehabilitation. A diverse, multidisciplinary panel of clinicians, researchers, sponsoring agency representatives, and persons with SCI participated in this process. An online Delphi process was conducted in order to prioritize pressure ulcer prevention and management best practice recommendations and performance indicators for implementation. The process was conducted in six stages: (1) steering committee selection; (2) identification and selection of evidence; (3) participant selection and recruitment; (4) survey development; (5) identification of voting criteria; and (6) five rounds of voting. The Delphi process resulted in the selection of two best practices: (1) comprehensive risk assessment and (2) education for pressure ulcer prevention and management in persons with SCI. In this Delphi process, a large expert panel achieved consensus on best practice recommendations and associated performance indicators for implementation. This process was undertaken as a first step towards optimization of service delivery and outcomes for persons with SCI across Canada.

The Pediatric Emergency Care Applied Research Network and Knowledge Translation

After 17 years, the Pediatric Emergency Care Applied Research Network has demonstrated its significant contribution to the care of acutely ill and injured children through the successful completion of more than 35 research studies. Despite the importance of research findings and the numerous publications in medical journals, the information is not easily accessible by parents, families, or nonresearch medical providers. Another group of investigators has developed knowledge translation and dissemination using social media through the Translating Emergency Knowledge for Kids knowledge mobilization network. This model is an example for other networks and outlines the challenges of dissemination of findings. The network’s research is widely published and has been incorporated into national guidelines, but the Pediatric Emergency Care Applied Research Network’s next challenge is translation of network findings into practice so every child who seeks emergency care in the United States in large or small emergency departments can be treated with evidence-based medicine.

P024: Sharing evidence, experiences and expertise: the value of networking to standardize emergency care for kids in Canada

Introduction: TREKK is a national knowledge mobilization network of clinicians, researchers and parents aimed at improving emergency care for children by increasing collaborations between general and pediatric emergency departments (ED). This study aimed to determine patterns of knowledge sharing within the network and identify connections, barriers and opportunities to obtaining pediatric information and training. Methods: Social network analysis (SNA) uses network theory to understand patterns of interaction. Two SNAs were conducted in 2014 and 2015 using an online network survey distributed to 37 general EDs. Data was analyzed using UCI Net and Netdraw to identify connections, knowledge sharing and knowledge brokers within the network. Building on these results, we then conducted 22 semi-structured follow-up interviews (2016) with healthcare professionals (HCPs) at General EDs across Canada, purposefully sampled to include individuals from connected and disconnected sites, as identified in the SNA. Interviews were analyzed by 2 reviewers using content and thematic analysis. Results: SNA data was analyzed for 135 participants across the network. Results from 2014 showed that the network was divided along provincial lines, with most individuals connecting with colleagues within their own institution. Results from 2015 showed more inter-site interconnectivity and a reduction in isolated sites over time from 17 to 3. Interview participants included physicians (59%) and nurses (41%) from 18 general EDs in urban (68%) and rural/remote (32%) Canada. HCPs sought information both formally and informally, by using guidelines, talking to colleagues, and attending pediatric related training sessions. Network structure and processes were felt to increase connections, support practice change, and promote standards of care. Participants identified personal, organizational and system-level barriers to information and skill acquisition, including resources and personal costs, geography, dissemination, and time. Providing easy access to information at the point of care was promoted through enhancing content visibility and by embedding resources into local systems. There remains a need to share successful methods of local dissemination and implementation across the network, and to leverage local professional champions such as clinical nurse liaisons. Conclusion: This study highlights the power of a network to increase connections between HCPs working in general and pediatric EDs. Findings reinforce the critical role of ongoing network evaluation to improve the design and delivery of knowledge mobilization initiatives.

Computation and analysis of temporal betweenness in a knowledge mobilization network

BackgroundHighly dynamic social networks, where connectivity continuously changes in time, are becoming more and more pervasive. Knowledge mobilization, which refers to the use of knowledge toward the achievement of goals, is one of the many examples of dynamic social networks. Despite the wide use and extensive study of dynamic networks, their temporal component is often neglected in social network analysis, and statistical measures are usually performed on static network representations. As a result, measures of importance (like betweenness centrality) typically do not reveal the temporal role of the entities involved. Our goal is to contribute to fill this limitation by proposing a form of temporal betweenness measure (foremost betweenness).MethodsOur method is analytical as well as experimental: we design an algorithm to compute foremost betweenness, and we apply it to a case study to analyze a knowledge mobilization network.ResultsWe propose a form of temporal betweenness measure (foremost betweenness) to analyze a knowledge mobilization network and we introduce, for the first time, an algorithm to compute exact foremost betweenness. We then show that this measure, which explicitly takes time into account, allows us to detect centrality roles that were completely hidden in the classical statistical analysis. In particular, we uncover nodes whose static centrality was negligible, but whose temporal role might instead be important to accelerate mobilization flow in the network. We also observe the reverse behavior by detecting nodes with high static centrality, whose role as temporal bridges is instead very low.ConclusionIn this paper, we focus on a form of temporal betweenness designed to detect accelerators in dynamic networks. By revealing potentially important temporal roles, this study is a first step toward a better understanding of the impact of time in social networks and opens the road to further investigation.

The application of implementation science for pressure ulcer prevention best practices in an inpatient spinal cord injury rehabilitation program

ObjectivesTo implement pressure ulcer (PU) prevention best practices in spinal cord injury (SCI) rehabilitation using implementation science frameworks.DesignQuality improvement.SettingSCI Rehabilitation Center.ParticipantsInpatients admitted January 2012 to July 2013.InterventionsImplementation of two PU best practices were targeted: (1) completing a comprehensive PU risk assessment and individualized interprofessional PU prevention plan (PUPP); and (2) providing patient education for PU prevention; as part of the pan-Canadian SCI Knowledge Mobilization Network. At our center, the SCI Pressure Ulcer Scale replaced the Braden risk assessment scale and an interprofessional PUPP form was implemented. Comprehensive educational programing existed, so efforts focused on improving documentation. Implementation science frameworks provided structure for a systematic approach to best practice implementation (BPI): (1) site implementation team, (2) implementation drivers, (3) stages of implementation, and (4) improvement cycles. Strategies were developed to address key implementation drivers (staff competency, organizational supports, and leadership) through the four stages of implementation: exploration, installation, initial implementation, and full implementation. Improvement cycles were used to address BPI challenges.Outcome MeasuresImplementation processes (e.g. staff training) and BPI outcomes (completion rates).ResultsFollowing BPI, risk assessment completion rates improved from 29 to 82%. The PUPP completion rate was 89%. PU education was documented for 45% of patients (vs. 21% pre-implementation).ConclusionImplementation science provided a framework and effective tools for successful pressure ulcer BPI in SCI rehabilitation. Ongoing improvement cycles will target timeliness of tool completion and documentation of patient education.