A cluster randomised controlled trial to assess the effectiveness of knowledge translation strategies for obesity prevention

Elizabeth Waters, Boyd Swinburn, Sing Kai Lo, Rebecca Armstrong*, Maureen Dobbins, Laurie Anderson

*Cochrane Health Promotion & Public Health Field, VicHealth School of Health and Social Development, Deakin University

Acknowledgements

• Professor Boyd Swinburn• Professor Rob Carter• Professor Sing Kai Lo• Assoc Professor Maureen Dobbins• Dr Laurie Anderson• Dr Mark Petticrew• QLD Health• Victorian DHS• Victorian Health Promotion Foundation (VicHealth)• PHAC

Knowledge translation

• Where knowledge goes through iterative process of exchange, synthesis and application

• Much rhetorical discussion, some action, but limited empirical research

• Passive dissemination unlikely to be effective• Interactive models are promising

– Researchers, policy makers and practitioners work together to frame research

• Facilitative, social influence models are promising in improving the uptake of secondary research (Nutley et al 2006)

Knowledge translation in Australia

• Interest increasing – very limited empirical research• E.g. NHMRC adjudication

– Investigators plans for publication and research transfer• Commitment to evidence but to varying degrees• Lots of debate about terminology – transfer, translation,

exchange• Focus on clearinghouses, practice guides, dissemination

activities

• Do these change practice? Are they cost-effective? What other methods of KT could we consider?...need for rigorous research

Local government in Victoria, Australia

• 79 local governments• Planning and building, roads and parking, health

services, people services, waste management, animal management, recreation and culture, local laws

• All legislated to develop Municipal Public Health Plans– Identify, assess and address public health dangers

• Work with a range of primary and community health agencies

Pilot study

• Conducted to assess acceptability of KT trial• Random sample of 10% of local governments• 100% responded positively to the study• Increased pressure to use evidence to inform

decision-making• 75% suggested their council would be very

willing to participate; 25% were supportive but could not commit until full proposal presented

Proposed study: 2007-2008

• Funded by National Health and Medical Research Council 2007-2009

• Team comprising Deakin University (AUS), CDC (USA), McMaster University (CAN), Medical Research Council for Social and Public Health Research (UK)

• Evaluating learnings from comparable studies including Dobbins et al www.health-evidence.ca

Aim

• Conduct a cluster randomised controlled trial of the effectiveness of knowledge translation strategies in increasing the adoption and implementation of effective policies, programs and interventions by local governments, with a focus on multi-factoral and multi-sectoral initiatives for childhood obesity prevention (focussing on healthy eating and physical activity).

Theoretical frameworks

• Diffusion of innovations• Organisational theory• Learning theory• Political science/decision-making

Study components

• Review of existing studies/options• Audit of public health plans• Intervention

2 study arms1. Usual practice2. Facilitated, social model of knowledge

translation and exchangea) Knowledge brokerb) Workforce developmentc) Forums

Evaluation

• Process evaluation– Questionnaires, journals

• Economic evaluation– Financial and time resources via questionnaires

• Modified realistic evaluation– Impact and outcome evaluation– Change in use, change in knowledge, change in

confidence– Document review and questionnaires

MPH audit

• Most local governments have some focus on obesity prevention (healthy eating and/or physical activity).

• Physical activity is the most popular obesity prevention action, with a strong focus on walking and cycling.

• Within healthy eating, much of the action relates to food security (e.g. local access to foods within communities particularly for children and young people).

MPH audit

• Preliminary analysis would suggest that many local governments use evidence in some form to justify their priorities.

• Very few appear to do so systematically or rigorously.• We have been unable to identify any local

governments who have used evidence explicitly in their plans to support their strategy selection. However, many acknowledge the role of community consultation in this process.

Challenges

• Multi-sector approach by LGs• Diversity of expertise around evidence• Transient workforce• ‘Noisy environment’ – many OP interventions• Level of priority to topic may differ across LGs• Limited evidence in some areas• Politics of decision-making

Contribution to evidence for PH and KST&E

• Rigorous evaluation of a model that aims to support multi-sectoral evidence-informed public health practice

• Exploration of use of evidence within local government setting

• Development of recommendations for practice oriented research

Further information

Rebecca Armstrong

Cochrane HPPH Field

rarmstrong@vichealth.vic.gov.au

www.vichealth.vic.gov.au/cochrane