ARCHIVED - Integrated Strategy on Healthy Living and Chronic Diseases - Knowledge Development and Exchange Functional Component

 

Executive Summary

The Knowledge Development, Exchange and Dissemination (KDED) Functional Component is herein referred to as Knowledge Development and Exchange (KD&E) as dissemination is subsumed within Knowledge Exchange. The KD&E is one of six Functional Components, namely Surveillance; Community-based programming and community capacity building; Public Information; Leadership, coordination and strategic policy development; and Monitoring and evaluation, of the Public Health Agency of Canada’s Integrated Strategy on Healthy Living and Chronic Disease (ISHLCD).  The conceptual framework for the Strategy rests on three pillars: promoting health; preventing chronic disease by minimizing risk; and early detection and management of chronic disease.

The overall objective of the KD&E Functional Component is to enhance evidence-informed policy and practice decision-making in chronic disease and healthy living.  The activities of the KD&E Functional Component focus on identifying, generating, collecting, evaluating, sharing and supporting use of the knowledge required to inform policy and program decision-making.

This evaluation conforms to Treasury Board’s reporting requirements as set out in the Fully Elaborated Results-based Management and Accountability Framework of the ISHLCD. The objective of this formative evaluation is to provide PHAC decision-makers with information on the KD&E Functional Component’s relevance, success/progress to date, and design and delivery issues of the various KD&E Functional Component initiatives and program areas.

The majority of KD&E Functional Component initiatives are undertaken by the Evidence and Risk Assessment Division of the Centre for Chronic Disease Prevention and Control.  Additional KD&E work has also been delivered by the Centre for Health Promotion (which is reported separately in the Healthy Living program component evaluation), and the PHAC Regional Offices.

This formative evaluation focuses on the KD&E Functional Component’s initiatives delivered through CCDPC and the related support work in PHAC Regional Offices. This evaluation does not include Region-specific KD&E activities (i.e., the Alberta Regional Office’s work on KD&E needs assessment with its community organizations).

Methods

The evaluation draws on several lines of evidence: relevant background literature; analysis of KD&E project reports and documents prepared by PHAC or PHAC-sponsored KD&E activities; interviews with PHAC program staff (including managers) actively involved with KD&E initiatives; and interviews with a group of external stakeholders involved in PHAC’s KD&E initiatives. This Formative evaluation covered KD&E activities from the Fall of 2005 to the Fall of 2008.

This evaluation used a mixed methods design including both qualitative and quantitative data sources. It addresses both questions of convergence of findings as well as completeness and explanatory value of the analysis from internal interviews (n= 11 interviews), external stakeholder interviews (n= 9), the Canadian Best Practices Portal evaluation, and project file reviews (n= 61 documents).

Findings

Relevance

Published literature and several influential national reports have identified key gaps between evidence, policy and practice in the area of healthy living and chronic disease prevention, underscoring the continued relevance of the KD&E Functional Component’s activities in Canada. Both internal and external interview respondents consistently highlighted the continued need for the KD&E Functional Component overall and its specific initiatives.  However, there is a need for better coordination of its activities and increased integration of the work undertaken by the different Functional Components in the ISHLCD.  This is not a suggestion that there is overlap and duplication within and across Functional Components.  The KD&E Functional Component has a similar focus as the work of some external organizations working in this area (e.g., National Collaborating Centre on Methods and Tools); however, this was not a concern for the internal and external key informants given the large need for KD&E support in healthy living and chronic disease. There is no actual duplication of work undertaken by provinces/territories or other external organizations.

Success / progress

KD&E System Support and Coordination (i.e., priority setting, infrastructure development)

About half of the PHAC key informants reported that their activities addressed system support. The Internal KD&E Network and External KD&E Advisory Committee are closely linked and both contributing to joint planning, priority setting and activity coordination for overall KD&E System Support. In addition, one third of the PHAC key informants noted some joint implementation of KD&E activities intended to increase system support with other external organizations.

Development of new knowledge products with stakeholders

PHAC key informants reported that the majority of their KD&E activities addressed knowledge development through the production of reports and syntheses often in consultation with external stakeholders and target audiences.

Knowledge Exchange and Capacity Building with stakeholders

PHAC key informants reported that consultation with target audiences and key partners to support capacity building and/or knowledge exchange activities has not been the primary focus of activities to date. However, several staff spoke of the need to focus more efforts on knowledge exchange and capacity building activities and described current plans for new activities in this area.

Learning from Practice with stakeholders

A few of the external key informants suggested that PHAC (and other public health organizations) do not give sufficient attention to documenting or sharing the learning available from practitioners to inform decision-making.  PHAC, and other federal government departments, should enhance its collaborations with non-governmental organizations serving public health and health care professionals.  An area that would benefit from federal government assistance is systems or infrastructure to support information flow on effective interventions and evaluations between professionals, organizations and jurisdictions.

Key reach target groups identified

While overall most KD&E activities have identified target groups, specific reach targets for reach levels have often not been set. The current outreach efforts to stakeholders are also seen as inadequate.  Several external key informants also underlined that PHAC lacks ongoing mechanisms to receive advice that could improve its policy and program development and their implementation to support KD&E.

Progress in immediate and intermediate outcomes

Increased engagement (networking and collaboration) among relevant organizations was seen by a majority of the PHAC key informants to be an early outcome of the KD&E Functional Component.  For most, this included improved inter-organizational engagement through networking and collaboration.

For about half of the PHAC key informants interviewed, improvements were observed in multi-jurisdictional engagement through the activities of the various KD&E initiatives. In this area, the examples came most frequently from the P/T demonstration projects and surveillance activity. About one third of the PHAC key informants reported evidence of improved inter-sectoral engagement through various KD&E initiatives.

Overall, the progress toward the intended intermediate outcomes, in the view of the PHAC key informants, is not consistent across KD&E initiatives. Different initiatives show progress on different outcomes and to different degrees depending on the nature and focus of the initiative. There is agreement that the following outcomes have shown the most progress to date:

  1. Improved awareness and climate, (i.e., commitment, understanding and resourcing to support KD&E activities),  for KD&E
  2. Increased sharing of information and knowledge with and between external organizations active in KD&E
  3. Identification of assets and gaps in knowledge and capacity

There is agreement that the following outcomes are where less progress has been made to date: enhanced external KD&E planning, coordination and implementation; and increased use and adoption of evidence and tools from evidence inventories.

Design and Delivery

A continuing role for PHAC in supporting KD&E initiatives was strongly endorsed by all of those interviewed internally and externally.  However, there are some perceived gaps and challenges to the success of the KD&E Functional Component.  These include: lack of funding for knowledge exchange activities and integrative/coordinated KD&E work (across multiple diseases and risk factors); consultation with others working on the same issues across Canada could be strengthened, along with the consultative and coordinating mechanisms within PHAC; more emphasis on research on the effectiveness of specific types of interventions; and increased clarity of direction and respective roles for KD&E and in relation to other components of the ISHLCD.

Key Lessons Learned

The experience to date is that the KD&E within the ISHLCD requires: increased clarity mission and leadership; enhanced staff expertise and dedicated positions; and realigned budgetary resources for KD&E related to intervention evidence (e.g., Best Practices, Task Force, and KD&E integrated work). There was consensus that it is insufficient to focus on producing knowledge without a requirement to move beyond research and analysis of existing data to a serious focus on how to share and exchange learning with target audiences and support uptake of new knowledge. A move to collaborative activities was seen as integral to success in this area.

Suggestions to improve the KD&E Functional Component

The external stakeholders saw two issues as fundamental to KD&E efforts to foster improvement in healthy living and reduced chronic disease. There needs to be sufficient investment in integrative KD&E work to support intervention evidence generation and use applied with high intensity to result in chronic disease and healthy living policy and practice change. Currently, resources are spread over a number of small knowledge development activities. There needs to be a shift away from a primary emphasis on disease-specific strategies and a return to a better balance in overall chronic disease prevention approaches, based on the view that the roots of many chronic diseases and related prevention efforts are often the same.

The PHAC key informants suggested that the KD&E Functional Component and the ISHLCD overall would benefit from stronger internal priority setting, communication and coordination.

Gaps and Challenges

Gaps were perceived both by internal and external key informants. For instance, inadequate consultation mechanisms, (e.g., meetings, regular updates), inside and outside of PHAC were highlighted. Inadequate research and knowledge synthesis on the effectiveness of interventions was underlined as a major gap in the PHAC KD&E activities. A third of the internal key informants stated the need for more intervention research.

The PHAC key informants recognized a number of challenges to the KD&E Functional Component activities. These challenges related to staff capacity (knowledge, practice and skills), resources for KE activities, intervention evidence, internal priority setting and coordination, and lack of understanding of KD&E. Communication, both internally and externally was discussed as a major challenge, as well as clarity of senior management directions for KD&E internally.

Recommendations

The following recommendations have been made to strengthen the KD&E Functional Component design and effectiveness.

  1. Strengthen the integration of the ISHLCD and resource KD&E integrative and horizontal chronic disease activities appropriately. There is a need for stronger coordination, clarity in roles and better integration across components within ISHLCD.
  2. Clarify KD&E scope of mandate and roles and responsibilities in relation to other Functional Components and KD&E work overall in CCDPC. This also should include expanded emphasis on conducting, supporting and synthesizing intervention research and greater focus on knowledge exchange activities.
  3. Clarify and describe the program theory (and related outputs/expected outcomes) for the various KD&E initiatives and program areas including greater emphasis on knowledge exchange, capacity building for uptake and learning from practice.
  4. Institute a performance measurement framework and ongoing monitoring strategy for KD&E that supports and is consistent with evaluation for the ISHLCD overall.
  5. Begin to plan for an outcome evaluation to determine achievements and synthesize learnings. In-depth evaluation for particular initiatives, and an outcome evaluation of the KD&E Functional Component should be planned well and data collection begin early.
  6. Institute better communication mechanisms both internally between different divisions and Centres/Regional Offices and the KD&E initiatives and externally with key stakeholders.

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