ARCHIVED - Integrated Strategy on Healthy Living and Chronic Diseases - Knowledge Development and Exchange Functional Component

 

Introduction and Context

1.0 Introduction

The Knowledge Development, Exchange and Dissemination Functional Component, herein referred to as Knowledge Development and Exchange (KD&E) as dissemination is subsumed within Knowledge Exchange. The KD&E Functional Component is one of six Functional Components in the Integrated Strategy on Healthy Living and Chronic Disease (ISLHCD). This formative evaluation focuses on the KD&E Functional Component’s activities. In particular, this report only includes KD&E initiatives delivered through the Centre for Chronic Disease Prevention and Control (CCDPC) and related work in the Public Health Agency of Canada’s (PHAC) Regional Offices.  The purpose of this report is to present the findings from the KD&E Formative Evaluation relating to issues of relevance, success/progress to date, and design and delivery of the various KD&E initiatives and program areas and the Functional Component as a whole.

1.1 Program Description

Overview of the Integrated Strategy on Healthy Living and Chronic Disease

The Public Health Agency of Canada (PHAC) overall approach to public health is founded on working closely with key stakeholders to promote and protect the health of Canadians through leadership, partnership, and innovation.  In the 2005 federal budget, $300 million over five years and $74.4 million per year in ongoing funding was provided to the PHAC for the ISHLCD. This funding provides for an integrated approach to addressing major chronic diseases through addressing risk factors, as well as through complementary disease-specific work.

This strategy consists of three pillars: 1) promoting health; 2) preventing chronic disease by minimizing risk, and 3) early detection and management of chronic disease, as well as disease-specific strategies on diabetes (non-Aboriginal elements), cancer, and cardiovascular disease (CVD).

Six Functional Components within the ISHLCD were identified to address the underlying factors influencing these three pillars:

  • Surveillance
  • Knowledge development, exchange and dissemination
  • Community-based programming and community capacity building
  • Public information
  • Leadership, coordination and strategic policy development
  • Monitoring and evaluation.

The ISHLCD consists of integrated as well as disease-specific strategies, and it is administered through a matrix structure composed of the following 14 program components and the above mention Functional Components.

ISHLCD Program Components:

  • Coordination;
  • Healthy Living Fund;
  • Intersectoral Healthy Living Network;
  • Healthy Living Social Marketing;
  • Healthy Living Knowledge Development and Exchange;
  • Joint Consortium for School Health;
  • Mental Health;
  • Observatory of Best Practices;
  • Demonstration Projects;
  • International Collaborations;
  • Enhanced Surveillance for Chronic Disease;
  • Renewed Canadian Diabetes Strategy (non-Aboriginal element);
  • Cancer; and
  • Cardiovascular Disease (CVD).

Overview of the KD&E Functional Component:

PHAC has has incorporated activities focused on advancing evidence-informed practice within the ISHLCD. Specifically, the Strategy calls for the development of a comprehensive system to:

  1. Better inform and support public health decision-makers working the areas of practice, policy and research; and
  2. Address gaps in resources currently available with respect to the development and dissemination of best practices for chronic disease interventions.

The overall objective of the Knowledge Development and Exchange Functional Component (KD&E) of the ISHLCD is to enhance evidence-informed policy and practice decision-making in chronic disease and health living. The KD&E Functional Component focuses on identifying, generating, collecting, evaluating and sharing the knowledge required to inform policy and program decision-making. The KD&E Functional Component’s various initiatives and program areas address the immediate outcome of engaging key stakeholders to improve inter-organizational, inter and intra-sectoral and multi-jurisdictional engagement. The intermediate outcomes of the KD&E Functional Component are aimed at: improving the climate for KD&E internally and externally; aligning internal resources and efforts to support KD&E; enhancing internal and external sharing and coordination; addressing knowledge and capacity gaps; and enhancing capacity for, access to and use of evidence in decision-making.

The KD&E is a function central to chronic disease prevention and healthy living and is a key federal public health role. This function includes a variety of activities and labels including creation of intelligence, knowledge management, and knowledge translation, building the evidence base and knowledge transfer and exchange.

In short, the basic problem to be addressed by the KD&E Functional Component and its constituent parts is a “disconnect” between evidence, policy and practice for chronic disease. The concepts and activities relating to KD&E are quite complex and evidence of what works is in its infancy contributing to lack of clarity in KD&E activity decision-making and roles. In order to contribute to conceptual clarity, the KD&E Functional Component is grounded on a knowledge cycle that includes identifying knowledge and exchange needs to creating, collecting, translating and disseminating knowledge and supporting uptake; informed use of evidence; and evaluation at individual and organizational levels (Annex 1).

Consistent with the overall ISHLCD, the following principles guide the work of the KD&E Functional Component and informed the development of the KD&E Functional Component’s outcomes:

  • The Agency provides a federal focal point for activities and enables relevant organizations to align their efforts for impact;
  • A learning approach is taken to allow for continuous improvement;
  • The Agency provides unique value to move from fragmentation of efforts within and across agencies to alignment and synergy;
  • Plans and activities are developed based on best available evidence;
  • Activities are adaptive and responsive to changes in the environment, goals, or new knowledge;
  • Engagement with partners, especially other national and provincial organizations, is a critical success factor;
  • Capacity building is a key focus to enable organizations and individual decision makers at multiple levels and in multiple sectors to generate and embrace a culture of evidence-informed decision-making.

The KD&E Functional Component of the ISHLCD is advanced through four action areas: System Support; Knowledge Development; Knowledge Exchange and Capacity Building; and Learning from Practice as outlined in the Component Logic Model (Figure 1).

System support entails undertaking activities both internally and with external stakeholder organizations to support joint priority setting, planning, communication, coordination and infrastructure development, as well as contribute to public health system capacity building and climate for KD&E (i.e., commitment, understanding and resources to support KD&E).

Knowledge development includes both the creation and synthesis of knowledge in consultation with and based on the needs of knowledge users (key target audiences and partners). This can be achieved through literature reviews, risk assessment analyses, systematic reviews, economic analyses and intervention research.

Knowledge exchange and capacity building activities focus on both assessing needs and planning and implementing actions to support the development of tools, resources, skills, exchange mechanisms, knowledge translation, and application and adoption of evidence in practice.

Learning from practice entails activities to document, share and use lessons learned from policy and practice settings. This includes facilitating the sharing of evaluation findings between practitioners and policymakers, collection and dissemination of practice reflections and practice-based evidence from the field, as well as mechanisms to facilitate alignment between intervention, evaluation and research programs, and funding activities.

Figure 1. KD&E Functional Component Logic Model

ISHLCD - Knowledge Development, Exchange and Dissemination (KDE) Functional Component Logic Model
Figure 1. KD&E Functional Component Logic Model - Text equivalent

This figure depicts a logic model for the Knowledge Development and Exchange Functional Component initiatives including key action areas, activities, target groups, outputs, immediate, intermediate and final outcomes as well as the relationships between each of these elements.

KD&E Functional Component Initiatives and Program Areas

This evaluation report focuses on five KD&E Functional Component Initiatives and Program areas, which are outlined below. These initiatives and activities are primarily delivered through the Evidence and Risk Assessment Division of the Centre for Chronic Disease Prevention and Control in the Public Health Agency and related KD&E work in the PHAC Regional offices. This evaluation does not include Region-specific KD&E activities (i.e., the Alberta Regional Office’s work on KD&E Needs Assessment with Alberta community organizations).

1. Canadian Best Practices Initiative

The Canadian Best Practices Initiative (CBPI) contributes to enhancing the quality of policy and program decision-making by enabling access to the best available evidence on chronic disease prevention and health promotion practices. The CBPI targets decision makers in practice, policy and research. The CBPI consists of three components: 1. an on-line Portal to assist health promotion users in finding and applying evidence in their practice; 2. development of knowledge exchange and capacity building activities to increase use of Portal content and contribution to the Portal of new content from the field; and, 3. monitoring the uptake and use of these practices in the Canadian context so as to track impact and learn more about how these practices evolve.

2. KD&E Demonstration Projects

The Demonstration Projects are intended to leverage P/T efforts that align with federal priorities, by finding out what works and sharing new knowledge nationally to support consistently high quality, evidence-based programs across Canada. They aim to contribute to improved, evidence-based programming and disease prevention innovations and successes across the country. P/T projects may include activities which identify promising innovations, gather and synthesize evidence, develop integrated strategies for chronic disease, better link existing public health functions to support effective KD&E, and undertake KD&E. There are three funded P/T Demonstration projects: Manitoba (MB) Chronic Disease Prevention Initiative (CDPI) contribution agreement ongoing to 2010, and Northwest Territories (NWT) and Nunavut (NU), which were both funded with one year grants.

3. Canadian Task Force on Preventive Health CareFootnote 1

The Canadian Task Force on Preventive Health Care is being established through PHAC to lead the development and dissemination of evidence-based clinical practice guidelines and recommendations, for health care practitioners, to support preventive primary care. The Task Force Scientific Panel of independent experts will identify topic areas of priority for primary and preventive care, review the best available evidence and lead the development of practice guidelines and related recommendations. The Task Force operations will be supported by a team of professionals in PHAC as well as a university-based Evidence Review and Synthesis Centre (to be co-funded by CIHR) responsible for developing systematic evidence reviews to inform guideline and recommendation development.

4. Disease-specific activities:

A number of disease-specific activities that focused on new knowledge development and synthesis including:

  • Diabetes, CVD, and Cancer-related statistical assessment of relationships between various determinants and risk factors (e.g., eating habits, activity levels, socio-economics status) for disease (e.g., hypertension, colorectal cancer, less common cancers) for various settings and populations (e.g., rural, migrant populations) using P/T survey, administrative data and systematic reviews.
  • Effectiveness studies of diabetes and CVD screening interventions using a common screening questionnaire (e.g., CAN-Risk tool in primary care settings). This has been implemented in screening pilot projects in participating P/Ts (Nova Scotia, Prince Edward Island, New Brunswick, Manitoba and Saskatchewan).
  • Economic and health outcome analysis of burden of chronic disease (diabetes, CVD) using micro-economic simulation models to facilitate studying intervention effectiveness, evaluation techniques and cost-effectiveness analysis of CVD and diabetes program outcome estimations. There are also processes in place for developing micro-simulation models for population-level diabetes.
5. Overall KD&E Planning/Coordination activities:

In addition to the above mentioned initiatives and program areas, there are overall KD&E planning and coordination activities. One set of activities which began in 2007 relates to communication mechanisms and joint planning and collaborative activities of the Internal KD&E Network (which includes manager or staff representatives of all KD&E Functional Component Initiatives, disease strategies and surveillance, as well as KD&E relevant representatives from Strategic Initiatives and Innovations Directorate and Office of Public Health Practice), which serves to internally support, build capacity and coordinate efforts within the KD&E Functional Component overall. A related set of secretariat and leadership activities are undertaken to support the KD&E External Advisory Committee which was formed in 2008. This group is made up of representatives from several national and provincial NGOs with a mandate relevant to KD&E in healthy living and chronic disease (e.g., Canadian Public Health Association, Chronic Disease Prevention Alliance of Canada), P/T governments (representatives from Public Health Network Expert Groups), academics with KD&E expertise and several members from the KD&E Internal Network. The KD&E External Advisory Committee serves to provide strategic advice to PHAC on evidence-informed approaches for KD&E and advice on advancing KD&E Functional Component initiatives including the joint work of the Internal KD&E. It also acts as a consultation and knowledge exchange mechanism with key stakeholder organizations active in external KD&E work.

On the advice and guidance of the KD&E External Advisory Committee and the Internal KD&E Network, Evidence and Risk Assessment Division staff also lead and support a number of integrative KD&E activities addressing multiple chronic diseases, which began in 2008, including a Food Security Knowledge Initiative, an annual Knowledge Exchange Forum, external needs assessments on pan-Canadian evaluation and practice-based learning supports and building towards KD&E system approaches, and internal needs assessment and planning to strengthen PHAC’s internal KD&E capacity.

Program Reach / Intended Beneficiaries:

The key intended beneficiaries of the KD&E Functional Component activities are policy, practice and research decision makers in the following types of organizations:

  • PHAC
  • P/T governments
  • Local/regional/provincial and national public health organizations and primary care settings
  • Non-governmental (NGOs) active in the health domain
  • University-based researchers, health institutions (researchers, educators, students)
  • Health Canada, Canadian Institute for Health Information (CIHI), Canadian Institute of Health Research (CIHR) and other Government of Canada Health Portfolio Stakeholders.
  • Other federal government departments

Program Delivery & Coordination

Most of the KD&E Functional Component funded activities are located in the Evidence and Risk Assessment Division of the Centre for Chronic Disease Prevention and Control (CCDPC), within the Health Promotion and Chronic Disease Prevention Branch of the Public Health Agency of Canada. The KD&E Functional Component also includes the work of the KD&E Specialists working in PHAC’s Regional Offices, which includes a combination of region-specific, pan-regional and CCDPC KD&E activities. As noted previously, the region-specific KD&E activities are not within the scope of this report. While the KD&E Functional Component also includes KD&E-Component funded activities in PHAC’s Centre for Health Promotion (CHP), these activities are not reported in this evaluation report as they are integrated into the formative evaluation of the Healthy Living Program Component.

Tables 1 and 2 present an overall picture of the planned and actual resources expenditures and staff positions to date associated with the KD&E Functional Component, respectively, within the Evidence and Risk Assessment Division (ERAD). ERAD is the primary place of delivery for the KD&E Functional Component initiatives and program areas. The planned KD&E Functional Component Resources (financial and human) figures are drawn from the Treasury Board Submission program resource tables. The actual financial resource expenditures are from ERAD’s Systems Application Program (SAP) financial database. To date, the large majority of KD&E financial and staff resources support disease-specific risk assessment knowledge development activities. The full time equivalent staff (FTE) numbers presented in the table include term and casual staff and therefore do not reflect the number of full time indeterminate staff positions. For financial resources, 2005/06 is not included in either planned or the actual tables as funding did not flow until late in the fiscal year and thus no substantial activity took place.

Table 1. KD&E Functional Component Resources from ERAD (Planned)
  2006/2007 2007/2008 2008/2009 Totals
Operating & Maintenance $2,179,038 $3,442,470 $4,291,655 $9,913,163
Grants & Contributions $5,832,550 $7,400,000 $9,050,750 $22,283,300
Total $8,011,588 $10,842,470 $13,342,405 $32,196,463
KDE FTEs 26.20 28 35 N/A

Table 2. KD&E Functional Component Resources from ERAD (Actual)
  2006/2007 2007/2008 2008/2009 Totals
Operating & Maintenance $1,259,562 $1,910,051 $3,655,628Table 4 - Footnote * $6,825,241
Grants & Contributions $2,105,623 $1,254,200 $1,334,182 $4,694,005
Total $3,365,185 $3,164,251 $4,989,810 $11,519,246
KDE FTEs 21.63 23.45 27.35 N/A
*Actual expenditures for 2008/09 are as of March 31, 2009. Final expenditure information is not available until June 2009.

There is a significant difference between the planned and actual resource expenditures for the KD&E Functional Component. While differences between planned and actual expenditures are to be expected, certain unanticipated events reduced the scope of work and distributions of funds for this Component. Much of the difference between planned and actual expenditures can be explained by a number of factors. Due to the creation of the Canadian Partnership against Cancer and its mandate for knowledge exchange, funds originally earmarked for cancer KD&E activities were reallocated primarily to surveillance and community-based programming (approximately $5.98M). In addition, due to the partial implementation of the Demonstration Program related to grant review and approval processes Demonstration Project G&C funding was not expended (approximately $7M). As well, due to the establishment and funding of the Canadian Heart Health Strategy and Action Plan development through an external steering committee, CVD KD&E resources were also reallocated to this CVD policy development work (approximately $750K). Other resource reallocations and under-expenditures amounted to approximately $1.5M over 2007-2009 related to under-staffing in ERAD.Footnote 2 Finally, during this time period there were Branch budget reductions of 25% (2006/07), a 3% claw-back including Agency and Branch-level levies (2007/08), and an 8% government-wide cost-cutting exercise (2007/08).

1.2 Evaluation Context

While knowledge to action is a central focus of the PHAC Strategic Plan, across the PHAC as a whole there is currently no overarching Knowledge Translation or Knowledge Strategy for PHAC and no clear leadership or coordination of such efforts. In addition, it should be noted that the concepts and theories behind effective knowledge production, exchange and adoption are complex and the science of measurement and understanding effective strategies and activities for KD&E is very much under development. As such, during the time covered by this formative evaluation, the PHAC KD&E Functional Component and its activities were at various stages of development and continuing to evolve. This context has provided challenges for both design and delivery aspects of the KD&E Functional Component overall and has also posed challenges for evaluation.

The KD&E Functional Component formative evaluation is designed to provide PHAC decision-makers with information on relevance; success/progress; design and delivery; and progress towards early outcomes. In addition, this formative evaluation is designed to assist the KD&E Functional Component in meeting its reporting requirements under the fully-elaborated Results-based Management and Accountability Framework (RMAF) for the ISHLCD. This formative evaluation focuses on the KD&E Functional Component’s initiatives delivered through CCDPC and the related work in PHAC Regional Offices. The scope of this evaluation does not include region-specific KD&E activities, i.e., the Alberta Regional Office’s work on KD&E needs assessment with community organizations.

The KD&E Monitoring and Evaluation Plan (Annex 3) provides a description of formative evaluation questions, indicators and relevant data sources for this evaluation. It is clear that this Plan focuses on identifying, collecting, analyzing and sharing the knowledge required to inform PHAC’s ISHLCD and KD&E policy and program decision-making.  The primary question for this formative evaluation is the extent to which the KD&E Functional Component is implementing its planned activities, achieving its intended outputs and making progress towards planned outcomes as outlined in the component logic model. Table 3 presents the KD&E formative evaluation questions addressed in this report.

Table 3: KD&E Functional Component Evaluation Issues and Questions
Issues/Questions
A) Relevance – does the component continue to be consistent with departmental and government-wide priorities and does it realistically address a real need?
A.1 Is there a continued need for the KD&E Functional Component?
A.2 Is there overlap and duplication within the KD&E Functional Component or across other ISHLCD Functional Components?
A.3 Are there any elements of the KD&E Functional Component that should be transferred in whole or in part to the Provinces/Territories or other external organizations?
B) Success/progress – Is the component effective, within budget and without unwanted outcomes?
B.1 What have been the key activities and outputs achieved?
B.1.1 To what extent have priorities been jointly set and activities been planned and implemented with internal and external stakeholder to increase system support and coordinate KD&E activities overall?
B.1.2 To what extent have new knowledge products been developed in consultation with intended users and partners?
B.1.3 To what extent have knowledge exchange and capacity building activities been planned; and implemented in consultation with key partners and target audiences?
B.2 To what extent have key reach target groups been met with; and key target groups
B.3 To what extent has progress been to date made on direct immediate or intermediate outcomes?
B.4 What have been the unintended positive or negative impacts, if any, of the KD&E Functional Component to date?
C) Design and Delivery – are the most appropriate and effective means being used to achieve objectives, relative to alternative design and delivery approaches?
C.1 Are roles and responsibilities in supporting KD&E Functional Component clearly defined and understood?
C.2 Are there any key gaps in the KD&E Functional Component?
C.3 What have been the key lessons learned to date in the KD&E component and specific KD&E initiatives?
C.4 Is the current monitoring system for the KD&E Functional Component effective?
C.5 As the KD&E Functional Component continues, how could its design, delivery, and impact be improved?
 

The scope of this formative evaluation includes KD&E activities from the Fall of 2005 to the Fall of 2008. During this time frame, the various KD&E initiatives and program areas were at different stages of development and implementation. For example, this report covers the partial operation of the KD&E Demonstration Program on P/T funded projects. As well, it only includes the developmental phase of the Canadian Task Force on Preventive Health Care (development of renewed Task Force model, funding strategy, structure development, etc.) as the Task Force Scientific panel and its main activities were not yet operational during the time frame of this evaluation report.


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