Integrated knowledge translation to strengthen public policy research: a case study from experimental research on income assistance receipt among people who use drugs

Joanna Mendell, Lindsey Richardson, Joanna Mendell, Lindsey Richardson

Abstract

Background: Solutions to complex public health issues should be informed by scientific evidence, yet there are important differences between policy and research processes that make this relationship challenging. Integrated knowledge translation (IKT) is a strategy of sustained stakeholder engagement that intends to address barriers to evidence use. We highlight an example of an IKT project alongside a randomized controlled trial of a public policy intervention that tested different disbursement patterns of income assistance among people who use drugs in Vancouver, British Columbia.

Methods: A case study design was used where an IKT strategy led by a knowledge broker embedded within the research team acts as the case. This case study evaluates the process and effectiveness of the integrated knowledge translation project by measuring intermediate outcomes within a Theory of Change created to map pathways to impact. Content analysis was performed using an evaluation template through document review, post-event evaluations, and detailed tracking of media, knowledge translation activities and requests for information.

Results: A host of knowledge translation products synthesized existing research about the harms of synchronized income assistance disbursement and supported stakeholder engagement, facilitating conversation, relationship building and trust with stakeholders. Engagement improved knowledge of the contextual feasibility for system change, and contributed experiential knowledge to study findings. A combination of access to information and stakeholder and media engagement led to increased acknowledgement of the issue by policy makers directly involved in the income assistance system.

Conclusions: This project shows how a multipronged approach to IKT addressed barriers to evidence-informed public policy and successfully contributed to increased public discourse around income assistance policy reform. Additionally, sustained engagement with diverse stakeholders led to improved contextual knowledge and understanding of potential community level impacts that, along with scientific results, improved the evidence available to inform system change. This case study provides insight into the role IKT can play alongside research aimed at public policy improvements.

Trial registration: This IKT project was embedded within the study titled: The impact of Alternative Social Assistance Disbursement on Drug-Related Harm (TASA), known as Cheque Day Study, registered on ClinicalTrials.gov ( NCT02457949 ) May 29, 2015.

Keywords: Evidence-informed policy; Integrated knowledge translation; Stakeholder engagement.

Conflict of interest statement

The authors declare that they have no competing interests in this section, financial or otherwise.

Figures

Fig. 1
Fig. 1
Cheque Day Study theory of change
Fig. 2
Fig. 2
Cheque Day Study integrated knowledge translation model

References

    1. Kothari A, Wathen CN. A critical second look at integrated knowledge translation. Health Policy. 2013;109(2):187–191. doi: 10.1016/j.healthpol.2012.11.004.
    1. Landry R, Lamari M, Amara N. The extent and determinants of the utilization of university research in government agencies. Public Adm Rev. 2003;63(2):192–205. doi: 10.1111/1540-6210.00279.
    1. Wathen CN, MacMillan HL. The role of integrated knowledge translation in intervention research. Prev Sci. 2018;19(3):319–327. doi: 10.1007/s11121-015-0564-9.
    1. Gagliardi AR, Berta W, Kothari A, Boyko J, Urquhart R. Integrated knowledge translation (IKT) in health care: a scoping review. Implement Sci. 2015;11(1) [cited 2018 Nov 5]; Available from: .
    1. Canadian Institutes of Health Research . Guide to knowledge translation planning at CIHR: integrated and end-of-grant approaches. Ottawa: Canadian Institutes of Health Research; 2012.
    1. Graham ID. Lost in Knowledge Translation: Time For A Map? J Contin Educ Health Prof. 2006;26(1):13. doi: 10.1002/chp.47.
    1. McIsaac J-LD, Penney TL, Storey KE, Sigfridson L, Cunningham J, Kuhle S, et al. Integrated knowledge translation in population health intervention research: a case study of implementation and outcomes from a school-based project. Health Res Policy Syst 2018;16(1). [cited 2018 Nov 5]; 10.1186/s12961-018-0351-8.
    1. Straus SE, Tetroe J, Graham ID. Knowledge Translation in Health Care: Moving from Evidence to Practice. 2nd ed. Chichester: Wiley; 2013.
    1. Dobbins M, Robeson P, Ciliska D, Hanna S, Cameron R, O’Mara L, et al. A description of a knowledge broker role implemented as part of a randomized controlled trial evaluating three knowledge translation strategies. Implement Sci. 2009;4(1):23. doi: 10.1186/1748-5908-4-23.
    1. Canadian Institutes of Health Research . About us - CIHR. 2005.
    1. Ginsburg LR, Lewis S, Zackheim L, Casebeer A. Revisiting interaction in knowledge translation. Implement Sci. 2007;2(1):34. doi: 10.1186/1748-5908-2-34.
    1. Kothari A, MacLean L, Edwards N, Hobbs A. Indicators at the interface: managing policymaker-researcher collaboration. Knowl Manag Res Pract. 2011;9(3):203–214. doi: 10.1057/kmrp.2011.16.
    1. Kothari A, McCutcheon C, Graham ID. Defining integrated knowledge translation and moving forward: a response to recent commentaries. Int J Health Policy Manag. 2017;6(5):299–300. doi: 10.15171/ijhpm.2017.15.
    1. Jull J, Giles A, Graham ID. Community-based participatory research and integrated knowledge translation: advancing the co-creation of knowledge. Implement Sci. 2017;12 [cited 2018 Oct 10] Available from: .
    1. Nguyen T, Graham ID, Mrklas KJ, Bowen S, Cargo M, Estabrooks CA, et al. How does integrated knowledge translation (IKT) compare to other collaborative research approaches to generating and translating knowledge? Learning from experts in the field. Health Res Policy Syst. 2020;18(1) [cited 2020 Oct 25]. 10.1186/s12961-020-0539-6.
    1. Kothari A, Sibbald SL, Wathen CN. Evaluation of partnerships in a transnational family violence prevention network using an integrated knowledge translation and exchange model: a mixed methods study. Health Res Policy Syst. 2014;12(1):25. doi: 10.1186/1478-4505-12-25.
    1. Davies H, Nutley S, Walter I. Why “knowledge transfer” is misconceived for applied social research. J Health Serv Res Policy. 2008;13(3):188–190. doi: 10.1258/jhsrp.2008.008055.
    1. Graham ID, Tetroe J, Pearson A. Turning Knowledge into Action: Practical Guidance on How to Do Integrated Knowledge Translation Research. 2014.
    1. Choi BCK. Can scientists and policy makers work together? J Epidemiol Community Health. 2005;59(8):632–637. doi: 10.1136/jech.2004.031765.
    1. Richardson L, Laing A, Milloy M-J, Maynard R, Nosyk B, Marshall B, et al. Protocol of the impact of alternative social assistance disbursement on drug-related harm (TASA) study: a randomized controlled trial to evaluate changes to payment timing and frequency among people who use illicit drugs. BMC Public Health. 2016;16(1):668. doi: 10.1186/s12889-016-3304-6.
    1. Nelson K. Mechanisms of poverty alleviation: anti-poverty effects of non-means-tested and means-tested benefits in five welfare states. J Eur Soc Policy. 2004;14(4):371–390. doi: 10.1177/0958928704046879.
    1. Rosen MI. The check effect reconsidered. Addiction. 2011;106(6):1071–1077. doi: 10.1111/j.1360-0443.2011.03409.x.
    1. Anis AH, Sun H, Guh DP, Schechter MT, O’Shaughnessy MV. Leaving hospital against medical advice among HIV-positive patients. CMAJ. 2002;167(6):633–637.
    1. Brunette DD, Kominsky J, Ruiz E. Correlation of emergency health care use, 911 volume, and jail activity with welfare check distribution. Ann Emerg Med. 1991;20(7):739–742. doi: 10.1016/S0196-0644(05)80834-0.
    1. Catalano R, McConnell W, Forster P, McFarland B, Shumway M, Thornton D. Does the disbursement of income increase psychiatric emergencies involving drugs and alcohol? Health Serv Res. 2000;35(4):813–823.
    1. Catalano R, McConnell W. Psychiatric emergencies: the check effect revisited. J Health Soc Behav. 1999;40(1):79–86. doi: 10.2307/2676380.
    1. Chan ACH, Palepu A, Guh DP, Sun H, Schechter MT, O’Shaughnessy MV, et al. HIV-positive injection drug users who leave the hospital against medical advice: the mitigating role of methadone and social support. J Acquir Immune Defic Syndr. 2004;35(1):56–59. doi: 10.1097/00126334-200401010-00008.
    1. Dobkin C, Puller SL. The effects of government transfers on monthly cycles in drug abuse, hospitalization and mortality. J Public Econ. 2007;91(11–12):2137–2157. doi: 10.1016/j.jpubeco.2007.04.007.
    1. Halpern SD, Mechem CC. Declining rate of substance abuse throughout the month. Am J Med. 2001;110(5):347–351. doi: 10.1016/S0002-9343(00)00749-X.
    1. Maynard C, Cox GB. Datapoints: association between week of the month and hospitalization for substance abuse. Psychiatr Serv. 2000;51(1):31. doi: 10.1176/ps.51.1.31.
    1. Otterstatter MC, Amlani A, Guan TH, Richardson L, Buxton JA. Illicit drug overdose deaths resulting from income assistance payments: analysis of the ‘check effect’ using daily mortality data. Int J Drug Policy. 2016;33:83–87. doi: 10.1016/j.drugpo.2016.05.010.
    1. Phillips DP, Christenfeld N, Ryan NM. An increase in the number of deaths in the United States in the first week of the month — an association with substance abuse and other causes of death. N Engl J Med. 1999;341(2):93–98. doi: 10.1056/NEJM199907083410206.
    1. Riddell C, Riddell R. Welfare checks, drug consumption, and health: evidence from vancouver injection drug users. J Hum Res. 2006;XLI(1):138–161. doi: 10.3368/jhr.XLI.1.138.
    1. Shaner A, Eckman TA, Roberts LJ, Wilkins JN, Tucker DE, Tsuang JW, et al. Disability income, cocaine use, and repeated hospitalization among schizophrenic cocaine abusers — a government-sponsored revolving door? N Engl J Med. 1995;333(12):777–783. doi: 10.1056/NEJM199509213331207.
    1. Svikis DS, Pickens RW, Schweitzer W, Johnson E, Haug N. Weekly patterns of drug treatment attendance. Am J Public Health. 1999;89(5):752–755. doi: 10.2105/AJPH.89.5.752.
    1. Verheul G, Singer SM, Christenson JM. Mortality and morbidity associated with the distribution of monthly welfare payments. Acad Emerg Med. 1997;4(2):118–123. doi: 10.1111/j.1553-2712.1997.tb03717.x.
    1. Anderson A. The Aspen Insititute on Community Change. 2005. The community Builder’s approach to theory of change: a practical guide to theory development.
    1. Fazey I, Bunse L, Msika J, Pinke M, Preedy K, Evely AC, et al. Evaluating knowledge exchange in interdisciplinary and multi-stakeholder research. Glob Environ Chang. 2014;25:204–220. doi: 10.1016/j.gloenvcha.2013.12.012.
    1. Downie A. Impact Pathways for the IDS Knowledge Services. 2008. From Access to Action; p. 24.
    1. Sudsawad P. Knowledge translation: introduction to models, strategies, and measures. Austin: Southwest Educational Development Laboratory, National Center for the Dissemination of Disability Research; 2007.
    1. MacGregor JC, Wathen N, Kothari A, Hundal PK, Naimi A. Strategies to promote uptake and use of intimate partner violence and child maltreatment knowledge: an integrative review. BMC Public Health. 2014;14(1) [cited 2018 Nov 14]. 10.1186/1471-2458-14-862.
    1. Patton MQ. Evaluation for the way we work. Nonprof Quart. 2006;13(1):28–33.
    1. Vancouver News at 6 . CBC News. 2018.
    1. B.C. Liberals calling on province to stagger welfare cheques to avoid ‘Welfare Wednesday’ | 2019 [cited 2019 Aug 28]. Available from: . Accessed 28 Aug 2019.
    1. Richardson L, Laing A, Choi J, Nosova E. Reconfiguring social-structural pressures towards violence and drug-related harm: Experimental evidence of the unintended consequences of income assistance policy change. Vancouver: Oral Presentation, Violence and Society presented at: Canadian Sociological Association Annual Meeting; 2019.
    1. Richardson L, Laing A, Choi J, Nosova E. Social policy and the opioid crisis: How changing the income assistance system could reduce inequality in drug use outcomes. Vancouver: Oral Presentation Research Methods presented at: Canadian Sociological Association Annual Meeting; 2019.
    1. Bill M 208–2019: Welfare Payment System Reflection Act. [cited 2019 Aug 28]. Available from: . Accessed 28 Aug 2019.
    1. Yung K. Supporting the Call for Changing the Cheque Day Paradigm. 2019.
    1. Innvar S, Vist G, Trommald M, Oxman A. Health policy-makers’ perceptions of their use of evidence: A systematic review. J Health Serv Res Policy. 2002;7:239. doi: 10.1258/135581902320432778.
    1. Reed MS, Bryce R, Machen R. Pathways to policy impact: a new approach for planning and evidencing research impact. Ecid Policy. 2018;14(3):431–458. doi: 10.1332/174426418X15326967547242.

Source: PubMed

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