Overview
Health organizations in this study and the populations they serve vary considerably, and there is increasing recognition that differences in context make it difficult or impossible to replicate interventions exactly the same way across different conditions [
28]. It has been suggested that we should continue to expect standardization in the process, sequence and function of an intervention, but that we allow for adaptation to the dynamic and unique properties of each context [
15,
22,
29‐
33]. With this advice in mind, we have outlined a set of activities that we believe must be carried out in each setting to ensure valid, reliable and useful application of DPoRT. However, as we enter into this process and at the outset of each step, key stakeholders will be invited to engage in exchanges and assessments that will help tailor the form of these activities to suit their unique needs and realities.
To facilitate our intended IKT approach, we will use a KB team. In the literature, knowledge brokers have been described as trusted, knowledgeable, skilled and solution-oriented individuals or groups who act as ‘go-betweens’ to bring key stakeholders together in formal and informal venues for the purpose of acquiring, sharing and applying knowledge to improve decision making and/or the management/delivery of services [
34‐
39]. Knowledge brokering is becoming a popular strategy for linking the producers and users of knowledge to facilitate the reach and effective uptake of innovative research. There is an expanding literature describing the effectiveness of initiatives that have utilized knowledge brokering approaches (
e.g., public health [
40], mental health [
41], community-based non-profit organizations [
42], and clinical practice [
43,
44]). As supported by other experiences with knowledge brokering in public health [
33], we believe this is an appropriate approach to adopt as our primary KT strategy to support all project objectives. However, in contrast to strategies that use a single knowledge broker, we have established a KB team that spans the content expertise areas required to support the uptake and use of DPoRT. Specifically, the KB team consists of: a member of the DPoRT development research team, an epidemiologist trained in using DPoRT, and two research coordinators with expertise in KT and evaluation in health-related settings. The KB team will: provide support in building the partnerships (objective 1), lead, coordinate and monitor training and uptake activities, help to navigate and appraise DPoRT applications, identify barriers, and encourage collaborative, creative and context-specific problem-solving (objective 2). In addition, members of the KB team will facilitate and collect data for the evaluation (objective 3). DPoRT computations are relatively straightforward, but application of the tool may be challenging for the users, and one-off strategies such as a training workshop on how to run the software will not be sufficient to realize the potential value of the tool for informing decision making. The strategy must also consider that some of the users will not be applying DPoRT themselves but rather using the outputs of DPoRT. We believe that sustained partnerships between DPoRT users and the KB team will facilitate DPoRT application and ensure effective uptake and use.
We have designed a utilization-focused evaluation [
45,
46] leveraging the collaborative relationship with the DPoRT users. Our approach reinforces the IKT nature of this project such that the KB team facilitating the IKT approach will also be actively engaged in evaluation activities [
47], and the DPoRT users will be involved in focusing the evaluation [
46]. The evaluation will employ a multiple case study approach [
48] with the participating organizations as the units of analyses. The evaluation will occur throughout the action cycle and will be based on analysis of both quantitative and qualitative data collected from passive (observer notes) and active (surveys/interview) methods. This approach is particularly useful for this project because it can be applied when the activities involve complex social interactions, when control over variables is limited, and when the boundaries between the phenomenon under study (DPoRT use) and the application contexts (varied health-related organizations) are blurred [
48,
49]. Case study design also allows for an in-depth understanding of the action cycle in each setting, to explore organizational capacity, and to identify the barriers and facilitators to DPoRT use. Within-method triangulation [
50] will be used to gather in-depth information at multiple points in time and from multiple sources.
Sample
When DPoRT was developed, epidemiologists and decision makers (e.g., managers, directors, Medical Officers of Health, Chief Executive Officer or equivalent) working in health-related organizations were identified as the ideal users of the tool. It was expected that they would benefit most from identifying risks based on their unique community structures that could be used to directly inform jurisdictional programming decisions. As elaborated below, the participating organizations represent diverse contexts and will permit exploration of how the action cycle of the KtoA framework plays out under different conditions as well as allow us to test the robustness of our IKT approach.
Ontario
The two participating public health units in Ontario have different internal capacities and serve different types of communities. Peel Public Health (PPH) is a local public health department serving over 1.3 million residents in three primarily urban municipalities. PPH is part of the Health Services Department within the regional government whereby Peel Regional Council serves as its Board of Health. PPH’s 700-member staff provide services specified in the Ontario Public Health Standards and the Health Protection and Promotion Act [
51]. Peel is a rapidly growing and highly diverse community with a large immigrant population (49%). Within PPH there will be one main group of DPoRT users: the epidemiology team, which provides synthesized health status data to public health teams to support informed decisions about programming. We conducted pilot work in Peel prior to developing this protocol, which informed our IKT approach as well as training materials.
Simcoe Muskoka District Health Unit (SMDHU) is a local public health unit situated at the north end of the Greater Golden Horseshoe and in the heart of Ontario’s ‘Cottage County’. The health unit’s jurisdiction covers over 8,000 km2 and includes 2 upper tier governments, 2 cities and 24 smaller municipalities. In 2006, the total population for Simcoe and Muskoka was 479,767; projections suggest this number will be 40% higher and will include many seniors by 2025. The SMDHU Board of Health is an autonomous governing structure made up of appointees from the County of Simcoe, District of Muskoka, City of Barrie, City of Orillia and Provincial designates. The health unit has 400 staff members. Within SMDHU there will be two main beneficiaries of DPoRT: the Planning and Evaluation team within Corporate Services and the Chronic Disease Prevention Healthy Lifestyle (CDP-HL) team within Healthy Living Services. The Medical Officer of Health, one epidemiologist, and one manager from the CDP-HL team will be the primary participants.
Manitoba
DPoRT was validated in Manitoba because of the different population structure from Ontario, thus demonstrating the robustness of the tool [
10]. More importantly, diabetes is a significant health problem in Manitoba, and diabetes prevention and planning is a priority for decision makers. We will engage with several decision makers in Manitoba representing a range of populations, as well as a diverse set of DPoRT users responsible for diabetes prevention and planning. Manitoba Health is a department within the Government of Manitoba which operates under the provisions of the legislation and the responsibilities of the Minister of Health. The legislation, as well as emerging health and healthcare issues, guides the planning and delivery of healthcare services for Manitobans. Manitoba Health is currently undertaking a Chronic Disease Prevention Initiative (CDPI), which will benefit from DPoRT application to inform the most relevant strategies for diabetes prevention. Regional Health Authorities (RHAs) via ‘The Need To Know’ (NTK) Team: We will apply DPoRT to the local regions in Manitoba via the NTK Team, which is a well-established conduit for KtoA in the province [
18,
52,
53]. The three objectives of the NTK Team are to create new knowledge of high relevance to policy and planning imperatives in the regions, to engage in capacity building activities among the partners, and to ensure that the research is disseminated and applied at the regional level. The NTK Team involves scientists from the Manitoba Centre for Health Policy (MCHP), high-level planners from each of Manitoba’s five RHAs and Manitoba Health. The team meets three times a year, for two-day meetings. Team members take on the critical role of knowledge uptake when they facilitate roundtable discussions in the annual MCHP/RHA Workshop Days, where RHA board members, chief executive officers, vice presidents, program managers, Medical Officers of Health, and others examine current MCHP research report findings. These workshops are designed specifically so that RHAs can learn about better ways to use population-based data to guide priorities for regional strategic plans and operations. Disseminating DPoRT to the RHAs via the NTK team is a resourceful way of leveraging an existing and effective KT conduit. Through the NTK team, interested RHAs will be connected to the KB team and invited to participate in the KtoA process. In order to build capacity for DPoRT use, Manitoba Health will work in collaboration with the interested RHAs.