Dissecting technology-enabled knowledge translation: essential challenges, unprecedented opportunities.
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Delivery of Health Care↗
Biomedical subjects
Allan Best
Publications and source records attributed to Allan Best.
A national survey on the patterns of treatment of inflammatory bowel disease in Canada.
BACKGROUND: There is a general lack of information on the care of inflammatory bowel disease (IBD) in a broad, geographically diverse, non-clinic population. The purposes of this study were (1) to compare a sample drawn from the membership of a national Crohn's and Colitis Foundation to published clinic-based and population-based IBD samples, (2) to describe current patterns of health care use, and (3) to determine if unexpected variations exist in how and by whom IBD is treated. METHODS: Mailed survey of 4453 members of the Crohn's and Colitis Foundation of Canada. The questionnaire, in members stated language of preference, included items on demographic and disease characteristics, general health behaviors and current and past IBD treatment. Each member received an initial and one reminder mailing. RESULTS: Questionnaires were returned by 1787, 913, and 128 people with Crohn's disease, ulcerative colitis and indeterminate colitis, respectively. At least one operation had been performed on 1159 Crohn's disease patients, with risk increasing with duration of disease. Regional variation in surgical rates in ulcerative colitis patients was identified. 6-mercaptopurine/azathioprine was used by 24% of patients with Crohn's disease and 12% of patients with ulcerative colitis (95% CI for the difference: 8.9%-15%). In patients with Crohn's disease, use was not associated with gender, income or region of residence but was associated with age and markers of disease activity. Infliximab was used by 112 respondents (4%), the majority of whom had Crohn's disease. Variations in infliximab use based on region of residence and income were not seen. Sixty-eight percent of respondents indicated that they depended most on a gastroenterologist for their IBD care. There was significant regional variation in this. However, satisfaction with primary physician did not depend on physician type (for example, gastroenterologist versus general practitioner). CONCLUSION: This study achieved the goal of obtaining a large, geographically diverse sample that is more representative of the general IBD population than a clinic sample would have been. We could find no evidence of significant regional variation in medical treatments due to gender, region of residence or income level. Differences were noted between different age groups, which deserves further attention.
Adolescent↗
Technology-enabled knowledge translation: building a framework for collaboration.
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Canada↗
Complementary and alternative medicine use by Canadian patients with inflammatory bowel disease: results from a national survey.
OBJECTIVE: Previous studies of complementary and alternative medicine (CAM) use by patients with inflammatory bowel disease (IBD) have relied on samples from specialty clinics. The aim of this study was to determine the prevalence of use and perceived outcomes of CAM in a large, diverse IBD population. METHODS: A postal survey of the members of the Crohn's and Colitis Foundation of Canada gathered data on demographic, disease, and conventional IBD treatment characteristics, and on the use and perceived effects of CAM. Respondents were characterized as not using CAM, as past or present users of CAM for their IBD, or as present users of CAM for other reasons. Comparisons between groups were made with the chi(2) test. RESULTS: The final sample included 2847 IBD patients. Current or past use of CAM for IBD was reported by 1332 patients, of whom 666 continued their use of CAM. Use was lowest in the eastern provinces and highest in the west. Only 15% had used CAM before their IBD diagnosis. Herbal therapies were the most commonly used (41% of CAM users). Improvements in sense of well-being, IBD symptoms, and sense of control over the disease were the most commonly reported benefits. Only 16% of prior CAM users reported any adverse effect of CAM use. A complementary practitioner was consulted by 34%. During the previous year, 46% had spend more than $250 on CAM. CONCLUSIONS: Use of CAM by IBD patients is very common. Most of these patients attribute significant benefits to their CAM use. Few report significant adverse events.
Adolescent↗
Youth Tobacco Cessation Collaborative and National Blueprint for Action.
OBJECTIVES: To describe the formation of the Youth Tobacco Cessation Collaborative (YTCC), a voluntary collaborative of leading funders of youth tobacco cessation research and services. METHODS: The long-term goal and specific short-term (2-year) goals, strategies, and accomplishments are briefly described with reference to its guiding action plan: National Blueprint for Action: Youth and Young Adult Tobacco-Use Cessation. RESULTS: Aiming to accelerate the pace of discovery and application, YTCC efforts have created a strategic vision for making progress toward filling key knowledge and intervention gaps. CONCLUSIONS: Lessons learned about effective partnership are reviewed, and future directions are described.
Adolescent↗
The evolution of cancer control research: an international perspective from Canada and the United States.
Four phases in the evolution of cancer control frameworks are reviewed, highlighting how national Canadian and United States planning and implementation activities have built on each other's work to define and guide cancer control research. Hallmarks have come to be: (a) coordination of the cycle that applies research to practice and policy decisions; (b) synthesis of knowledge at each phase of cancer control framework; (c) a focus on populations and public health with feedback loops between fundamental and applied research; and (d) interdisciplinary integration of the biological, behavioral, social, and other population sciences. Current research priorities and initiatives based on the research framework now common to both Canada and the United States are described. We conclude by calling for an international forum for the systematic advancement of cancer control research, and closer ties between the cancer control communities in North America.
Canada↗
Ethical dimensions in the borderland between conventional and complementary/alternative medicine.
Consumer enthusiasm for complementary and alternative medicine presents complex challenges for conventional Western biomedically dominated health care systems and for those who practice within them. In particular, this trend forces new ethical dilemmas related to how we create consensus about the nature of ethical clinical practice and what constitutes evidence sufficient for public health policy. In this paper, we examine the historical context into which complementary and alternative medicine has been introduced, and consider the ethical and scientific challenges with which it confronts mainstream health systems.
Complementary Therapies↗
An integrative framework for community partnering to translate theory into effective health promotion strategy.
INTRODUCTION: Although there is general agreement about the complex interplay among individual-, family-, organizational-, and community-level factors as they influence health outcomes, there is still a gap between health promotion research and practice. The authors suggest that a disjuncture exists between the multiple theories and models of health promotion and the practitioner's need for a more unified set of guidelines for comprehensive planning of programs. Therefore, we put forward in this paper an idea toward closing the gap between research and practice, a case for developing an overarching framework--with several health promotion models that could integrate existing theories--and applying it to comprehensive health promotion strategy. AN INTEGRATIVE FRAMEWORK: We outline a theoretical foundation for future health promotion research and practice that integrates four models: the social ecology; the Life Course Health Development; the Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation-Policy, Regulatory and Organizational Constructs in Educational and Environmental Development; and the community partnering models. The first three models are well developed and complementary. There is little consensus on the latter model, community partnering. However, we suggest that such a model is a vital part of an overall framework, and we present an approach to reconciling theoretical tensions among researchers and practitioners involved in community health promotion. INTEGRATING THE MODELS: THE NEED FOR SYSTEMS THEORY AND THINKING: Systems theory has been relatively ignored both by the health promotion field and, more generally, by the health services. We make a case for greater use of systems theory in the development of an overall framework, both to improve integration and to incorporate key concepts from the diverse systems literatures of other disciplines. VISION FOR HEALTHY COMMUNITIES: (1) Researchers and practitioners understand the complex interplay among individual-, family-, organizational-, and community-level factors as they influence population health; (2) health promotion researchers and practitioners collaborate effectively with others in the community to create integrated strategies that work as a system to address a wide array of health-related factors; (3) The Healthy People Objectives for the Nation includes balanced indicators to reflect health promotion realities and research-measures effects on all levels; (4) the gap between community health promotion "best practices" guidelines and the way things work in the everyday world of health promotion practice has been substantially closed. CONCLUSIONS AND RECOMMENDATIONS: We suggest critical next steps toward closing the gap between health promotion research and practice: investing in networks that promote, support, and sustain ongoing dialogue and sharing of experience; finding common ground in an approach to community partnering; and gaining consensus on the proposed integrating framework.
Canada↗
Health promotion dissemination and systems thinking: towards an integrative model.
OBJECTIVE: To help close the gap between health promotion research and practice by using systems thinking. METHODS: We reviewed 3 national US tobacco control initiatives and a project (ISIS) that had introduced systems thinking to tobacco control, speculating on ways in which systems thinking may add value to health promotion dissemination and implementation in general. RESULTS: The diversity of disciplines involved in tobacco control have created disconnection in the field; systems thinking is necessary to increase the impact of strategies. CONCLUSION: Systems thinking has potential to improve synthesis, translation, and dissemination of research findings in other health promotion initiatives.
Adolescent↗
Complementary therapy use in HIV/AIDS.
OBJECTIVE: To examine the social psychological aspects of complementary therapy use in HIV/AIDS health care and to identify what happens in a person's illness management process when incorporated into their care for HIV-related symptoms. METHODS: Grounded theory research method guided sampling, data collection and analysis with 21 males at various AIDS service organizations. FINDINGS: A grounded theory model Finding a Way to Live was developed. Participants experienced a six-stage process whereby the HIV served as a precondition for a profound self-transformation; a commitment to and rediscovery of the meaning of life. Complementary therapies, referred to as 'tools' by the participants, were cited as an integral part of how people living with HIV found wellness within their illness. The type of therapy, meanings attached to them, intention for and frequency of use corresponded to where individuals were in the six-stage process. As participants began to experience personal growth, the nature of the therapies shifted from those being highly tangible and focusing on the physical self to those facilitating inner awareness, such as meditation. CONCLUSIONS: The process of integration was a complex, ongoing process wherein complementary therapies were an integral part of facilitating learning, self-discovery and ultimately, healing.
Adult↗