The primary aim of this study was to identify information needs and preferences for research information, perceived barriers to using research evidence, and perceptions of use of research evidence among three organizations involved in delivering, improving access to, or making recommendations for, services for families with children with disabilities. The findings of this inquiry may be applicable to other community-based health care settings. Similar findings have been reported among public health decision-makers in Canada and the US. These studies have reported that public health professionals at all decision-making levels want quick and easy access to synthesized, high-quality evidence that clearly articulates implications for policy and practice [5, 27, 40]. Given these findings it is likely that health care decision-makers engaged in the provision of health care services to individuals, families, groups, and populations in a variety of community-based settings, experience similar information needs and preferences to the ones reported in this paper. The findings reported in this paper will be particularly useful for health services researchers, especially those in the field of childhood disabilities and research-producing organizations that create research information applicable for use by community-based organizations.
One opportunity available in this study was the possibility to seek the perspectives of people working in three types of organizations whose roles and responsibilities, functions, and relationships with CanChild differed considerably. This afforded the chance to explore both common features across settings and variations by type of organization. It is not surprising that people working in the DHCs, which are research-focused organizations, often expressed different perspectives from practice-based respondents in the CTCs and CCACs concerning their use of research evidence, barriers to use, and organizational culture,. While it is somewhat intuitive that research-generating organizations would report greater use of research evidence in decision-making, it remains unclear if this is the result of research producers being more comfortable with the use of research evidence in general, or if the types of decisions they were engaged in lent themselves more easily to the incorporation of research evidence than those faced by the two more practice-based settings (CTCs and CCACs). Research has shown that the most commonly reported facilitators to the use of research evidence in policy-making are timeliness and relevance of the research, and research that includes a summary with clear recommendations [41, 42].
Given that one of the roles of the DHCs was to influence provincial health policies by making recommendations for programs and services, and that DHC's self-reported use of research evidence was fairly high, one could conclude that the research evidence available for the treatment of childhood disabilities was relevant and adequate for the decision-making activities faced by DHCs. While it is not surprising that the DHCs reported higher use of research evidence in their decision-making, fewer barriers to its use, and an organizational culture more conducive to research use, this finding does imply that research-producers like the DHCs can also be important target audiences for research evidence. It would be prudent, therefore, for organizations like CanChild to develop collaborative relationships with organizations like the DHCs, so as to become more familiar with their information needs and preferences, and then develop and implement KT activities to address these needs.
Between the latter two groups of respondents (CTCs and CCACs), there were also some observed differences that likely reflect, among other factors, the more fully established partnership between the CTCs and CanChild. The relationship between the CCACs and CanChild, while established, was still very new. Given their role of coordinating a broad array of services within a complex mandate, the CCACs were not at that time perceived as a key target audience for CanChild's research dissemination program. It might be that greater interaction between researchers at CanChild and the CTCs explains why the CTCs generally reported greater ease of use of recently received research information, higher scores on the extent to which research information was actively sought before making decisions, and fewer perceived barriers to using research evidence in practice than the CCACs. These results are also supported by Innvaer and colleagues who found that personal contact between research producers and users was an important facilitator of research use .
However, these findings might also reflect that the available research evidence was more relevant and targeted at the type of decisions being made by those in the CTCs than those in the CCACs. For example, some of the Keeping Current pieces disseminated by CanChild focused on the effectiveness of clinical interventions for children with disabilities, as well as the merits of implementing family-centered care. These topics would be applicable not only to decisions clinicians faced in daily practice, but also to managers and directors who might be in the process of improving and revising programs, and to CEOs engaged in broad policy level decisions about service provision generally or in how services could be organized. It is likely that the research evidence disseminated by CanChild at that time was more closely aligned with the types of decisions encountered by the CTCs and therefore encouraged respondents to look for this evidence prior to making practice decisions. Similar findings have been reported by Dobbins and colleagues, who reported that public health decision-makers were significantly more likely to incorporate research evidence into program planning decisions when the evidence was very relevant to the decisions in which they were engaged [39, 39]. Others have articulated that an important component of facilitating the use of research evidence is providing evidence to decision-makers that clearly answers their questions .
It could be argued, however, that the evidence disseminated by CanChild was more relevant for the CTCs because of the longstanding collaborative relationship that existed between them. By working collaboratively over a number of years, the CTCs were equal partners in identifying research questions that needed to be addressed, and CanChild developed a program of research focused on meeting those needs. More collaborative relationships between research users and producers have been advocated by many as a means of improving research transfer and uptake [3, 24, 43–46].
Knowledge transfer is a complex phenomenon that includes more than simply getting the right information into the hands of the right people at the right time. It is equally important that health care decision-making be influenced by a combination of clinical judgment, patient preferences, resources, and research evidence [47–49]. However, these findings are noteworthy because they demonstrate the importance of research-producing organizations knowing not only who their target audience(s) are and what their needs are concerning research evidence, but also what questions require answers, and what kind of answers are optimal for different types of decisions. In order to know the needs of their target audiences, researchers and research-producing organizations will have to invest significant effort to identify their target audiences, develop a collaborative relationship, engage meaningfully with them to develop research questions and designs, and work with them to interpret, translate, and apply the results of research evidence into policy and practice. These same messages have been corroborated by others who have advocated for enhanced collaborative relationships between research-producing organizations and intended research users [3, 45, 50–52].
The results reported in this study illustrate considerable consistency across organization type and position in relation to the preferred methods for receiving research information. There were no significant differences observed by level of decision-maker, and only one difference observed by organization type, with DHCs preferring listservs considerably more than either CTCs or CCACs as a method for receiving research information. The top four methods preferred for receiving research information were websites, health-related research journals, electronic mail, and conferences/workshops. Some of these findings (electronic mail and websites) have been supported by others [5, 11], while other research has shown limited preference for conferences/workshops. Generally, studies in this field have indicated that conferences are not an effective way of promoting knowledge transfer and uptake among health service decision-makers, policy-makers and practitioners [20, 53, 54]. It may be that conferences and workshops needed to be assessed separately in this study, and that participants preferred workshops that were interactive and developed with the needs of users in mind, as opposed to the traditional conference format.
Formats of research information preferred by participants in this study were first, executive summaries, followed by abstracts. The least preferred was full text original articles/reports. These findings continue to highlight that it is important to frame research evidence in ways that are sensitive not only to the needs of various audiences, but also the available resources and skills of those audiences. Similar findings have been reported elsewhere [55–58]. Ely and colleagues suggest that evidence can be provided to primary care physicians at the point of care, but it is most useful when it has been digested into quickly accessible summaries. They further suggest that researchers need to frame their answers to research questions better, and that this would be accomplished by researchers becoming more familiar with the questions that occur in practice/policy-making. In order to become more familiar with the research questions, researchers would have to engage in more meaningful dialogue with target users, which would be facilitated through the development of collaborative relationships [9, 44, 51].
Cogdill explored the information needs and information-seeking behaviours of nurse practitioners, and found that education or outreach programs can be used to promote the use of information resources to retrieve evidence from clinical research to support various practice decisions . However, these programs must be developed in a way that builds on what is known about the clinician's information needs, as well as how they resolve these needs. For example, a number of studies report that health professionals generally turn to other health professionals first to obtain information to resolve an information need, as opposed to written research reports [55, 57, 59].
In the study by Thompson and colleagues, it was found that nurses accessed 'evidence-based' information sources in the context of continuing professional development and formal education or training. Other influences included being involved in the production of local protocols and guidelines, interpreting research such as clinical trials, or using research evidence to help resolve conflict between colleagues . The nurses in Thompson's study also articulated what made an information source in this case usually clinical nurse specialists useful: directly answered the question posed; seen to be authoritative and trustworthy, provided or could potentially provide a balance of 'background' (factual) knowledge as well as foreground (management) knowledge; provided supportive and unchallenging information; and had no or minimal associated need for critical appraisal.
Another implication of this observation is the need for researchers and research-producing organizations to 'translate' findings into plain language, devoid of the jargon with which researchers traditionally communicate within the field. Similar findings were reported by Dobbins and colleagues in a study of public health decision-makers . In this national study, public health decision-makers indicated that what they needed most from public health researchers were two-page executive summaries that clearly communicated the issue from a local context, highlighted available evidence, and identified specific practice and policy implications for each evidence point.
An important barrier to implementing the suggestions made in this paper exists for academic researchers. The production of synthesized, relevant, and applied research information that requires the sustainability of collaborative relationships between the researcher and target audiences in order to product these documents, has been less valued for promotion and tenure than peer-reviewed materials. One can only hope that as the imperative of knowledge transfer and exchange becomes more widely valued so too will these translation activities within academic centres. Work is currently ongoing to develop criteria upon which such activities can be included and evaluated for the purposes of tenure and promotion.
The findings of this study provide certain optimism for CanChild in relation to its knowledge transfer and exchange strategy. Generally CanChild is on its way to achieving its goal of promoting evidence-informed decision-making among the CTCs in Ontario. These results also provide direction and guidance to CanChild concerning additional strategies that must be considered and implemented, as well as the identification and development of new collaborative relationships that must be fostered in order to fully realize their mandate.