Background
Methods
Realist evaluation phase I: Theory and proposition development
Literature scan
Stakeholder engagement
Theoretical frameworks
Abductive reasoning
Location | EFHIA Team Profile | Topic Area |
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PHUA | 3 front line staff; 1 to 12 years’ experience; previous experience with vulnerable populations; rare or occasional evidence experience | Oral Health - intended and unintended consequences of the promotional strategies |
PHUB | 4 front line staff; 11 to 35 years’ experience; previous experience with vulnerable populations; rare evidence experience | Sexual Health - to determine the impact of removing sexual health services from secondary schools |
PHUC | 5 managers; 15 to 34 years’ experience; 2 worked with vulnerable populations; 2 other health equity experience; rare or occasional use of evidence | Food Safety - the vendor application process |
PHUD | 2 policy staff/non-clinical; 4 to 25 years’ experience; worked with vulnerable populations; evidence experience high | Child Injury - health equity impact of injury prevention services provided to children in school settings and their parents in community settings |
Initial propositions
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Knowledge brokering at the local site will facilitate evidence familiarity and manageability, and increase user comfort and confidence in processing the evidence.
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Involvement of users in the knowledge production process aligns evidence with user needs and increases acceptance of the information.
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Adapting the knowledge to match user characteristics can encourage evidence use because there is increased understanding of the knowledge and consonance with the content.
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Correspondence between knowledge produced and the problem to be solved can facilitate evidence use because the users will perceive the knowledge as applicable.
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Knowledge brokering during the knowledge production process can help build relationships with users, establish trust and familiarity in the producer, and facilitate evidence use.
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Knowledge brokering at the local site can facilitate evidence use because users have timely access to knowledge, reducing the perception of barriers.
Realist evaluation phase II: Case study data collection
Recruitment and sample
Case Study Data Collection and Analysis
Activity | Baseline | Midpoint | End of Study |
---|---|---|---|
Document Review | ✓ | ✓ | |
KI Semi-structured Interviews | ✓ | ✓ | |
EFHIA Team Member Surveys | ✓ | ✓ | |
EFHIA Team Member Semi-structured Interviews | ✓ | ✓ | |
EFHIA Team Observation | ✓ |
Document review
Semi-structured interviews
EFHIA team member surveys
EFHIA team observation
Realist evaluation phase III: Identification of context-mechanism-outcome configurations and Demi-regularities
Member checking
Results
CMO evidence for propositions
Case Study Site | Contextual factors | Mechanisma | Outcomes related to use of evidence |
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PHU A | Organizational support for and interaction with knowledge broker | Increased practitioner confidence; trust in knowledge broker | More likely to use academic evidence source in the future (self-report) |
Real or perceived lack of time or skill to interpret evidence | Unable to “identify with” academic sources; (i.e., lack of consonance) | Limited use of academic evidence (i.e., references) in EFHIA | |
Familiarity with practical evidence (i.e., local surveillance, personal experience) | Safety and trust using own knowledge | Preferential use of practical evidence to complete EFHIA | |
PHU B | Set organizational direction for program action | Seeking alignment of evidence with desired action | Positive attitudinal change toward evidence (all sources) |
Real or perceived evidence characteristics of local data (reliable/relevant) | Evidence use experienced as positive “return on investment”; (i.e., good correspondence) | Use of practical evidence (i.e., local surveillance, personal experience) | |
Real or perceived evidence characteristics of academic data (difficult to access/not directly relevant) | Evidence use experienced as negative “return on investment”; (i.e., poor correspondence) | Limited use of academic evidence | |
PHU C | Unclear expectations or unclear EFHIA mandate | Hesitancy or acquiescence to existing knowledge | Limited evidence sought |
PHU D | Policy role in organization (non-clinical; non front-line service delivery oriented) | Strongly held individual and role-based evidence-use values | Increase use of academic evidence |
“In our case a big thing was having [name of knowledge broker] there …and we were more comfortable… in the fact that she could just help to shed a little bit of light, and then she was able to say, here’s a couple of places you might want to look for some information.” PHUA.
“We’ll definitely be bringing it to the team …in future planning that we need to [be] taking into account adding some research aspect or literatures into any of the upcoming campaigns or projects that our team does.” PHUA.
“… the sources that I found useful have been conference presentations and poster sessions you will never see [in] a journal, right? So, you know, it really does kind of suggest that if you kind of want to find out what’s working in, local implementation of interventions to address inequity, you’re probably going to really have to make some connections with people at that level” PHUC.
“…the biggest help was having [knowledge broker] as kind of our navigator, … it was a little bit like a light bulb went off, and I thought, okay, I get this now. And then it started to be really rewarding, because we were coming up with ideas that we hadn’t thought of before…” PHUA.
“I’ve relied on more of the committee, what has been brought to the table as compared to doing a ton of research on my own because I’ve got a number of other projects that are on my plate. So it’s sort of like I do read the stuff that comes in but I’m not going out and looking at it or evaluating it as I would assume that’s being done by those that are bringing it to the table.” PHUC.
Demi-regularities – Cross case conclusions
“…I feel like the literature review was probably the most challenging, partly because it’s very foreign to us. As we’ve mentioned before, we don’t typically do literature reviews in our program, we’re very clinical people and it’s kind of out there for us....” PHUA.
“I must’ve read that article three times and I still didn’t really know if it was relevant at the end of it so I just went with it wasn’t relevant, right because… I didn’t really know what it was saying.” PHUB.
“I think that the population data and our internal statistics are really helpful ‘cause they say, hey, this is what we’re doing and this is who we’re meeting [the needs of] and who we’re not meeting [the needs of].” PHUC.
“We did do a literature review as well but didn’t find a whole lot.” PHUA.“…my opinion at the beginning [of] it would be that oh my gosh, there’s not enough time for all of this work and all of this collection of data to just make one decision.” PHUB.
“…so it was kind of using our own sort of personal…clinical knowledge or clinical experiences that was the easiest to, kind of navigate through.” PHUA.