Impact of Gender on Knowledge Translation Interventions
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The aim of this team grant is to create new knowledge about the integration of gender considerations into knowledge translation interventions involving human participants. CIHR defines knowledge translation (KT) as "a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system." Given that social norms affect behaviour, gender-specific differences may explain variation in outcomes or impacts of KT interventions.
The specific objectives of this funding opportunity are to:
- Generate evidence about whether applying sex- and gender-based analysis to knowledge translation interventions involving human participants improves effectiveness, thereby contributing to improved health outcomes;
- Contribute to a broader knowledge base on how to effectively and appropriately integrate gender into KT interventions;
- Facilitate the consideration and development of gender-transformative approaches in KT interventions.
Awardees and their project abstracts
Does One Size Fit All? The Implications of Gender for OR Team Performance, Teamwork Interventions, and Equitable Patient Outcomes.
Nominated Principal Investigator: Sylvain Boet
Effective teamwork in the operating room (OR) is essential to surgical patient safety and improved health outcomes. Interventions to promote evidence-based practice have been shown to effectively improve teamwork in the OR to some degree. Yet, investigations of OR teamwork have overlooked the role of gender in OR teamwork, despite evidence from other areas of healthcare demonstrating its relevance to team interactions, practice patterns, care delivery, and patient outcomes. Without this knowledge, interventions to optimize teamwork have remained “gender neutral” (i.e. have not considered how gender may influence teamwork skills as well as barriers and facilitators for attaining these skills). The study of gender and teamwork in the OR has largely been limited by the practical challenges associated with obtaining high-quality OR data. Our group belongs to the international Surgical Safety Network, which uses OR Black Box technology to improve practice in the OR and obtain the best possible outcomes for all patients. Like black boxes used in aviation, the OR Black Box is an innovative tool that records detailed information from the surgical environment (e.g. audio, video, patient vitals). We plan to use the OR Black Box as part of a mixed methods study to: (1) describe variation in teamwork by gender and its impact on patient outcomes, and (2) determine the impact of gender on teamwork skills, barriers, and facilitators to enhance the effectiveness of teamwork interventions in the OR. This novel contribution will increase our understanding about how gender influences OR teamwork and its barriers and facilitators, and the findings will inform future interventions to improve teamwork through incorporating a gender perspective. Our study is a critical first step to the responsible implementation of teamwork interventions that consider gender and will enable comparisons of effectiveness between these interventions and those that do not take a gender perspective.
A gender transformative approach to improve outcomes and equity among persons with Traumatic Brain Injury
Nominated Principal Investigator: Angela Colantonio
Traumatic brain injury (TBI) is a leading cause of death and disability in Canada and globally. The Canadian Longitudinal Study on Aging indicates that one out of four Canadians report a history of TBI. The Public Health Agency of Canada reported that TBI is among the most costly neurological conditions, set to cost 8 billion by 2031. Concussions, the most common form of TBI, are now a federal priority. Traumatic brain injury is considered a risk factor for Alzheimer’s disease and has been associated with increased rates of depression, anxiety, substance abuse, and sleep disorders which further compromise long-term health and social isolation, unemployment, homelessness and criminalization. Interventions addressing these challenges exist but consumers report a lack of tailored approaches. In particular, sex and gender related differences in acute injury, rehabilitation and community re-integration impact health, access to supports and preferences for care. Research has focused on men creating a significant knowledge gap about TBI in women, leading to misdiagnosis and inadequate treatment and support. Addressing this gap, this project will generate evidence about whether applying sex and gender based analysis to knowledge translation interventions involving persons with TBI improves effectiveness. The project examines the impact of a sex and gender approach on existing evidence, knowledge translation efforts and interventions. A pilot project utilizing our knowledge-to-action framework will identify facilitators addressing gender roles, gender identity, gender relations and institutionalized gender. An implementation intervention will be tailored to address sex, gender and other identity or diversity related characteristics identified in the barriers assessment.
Integrating and measuring the effect of sex, gender and gender transformative approaches to substance use treatment, prevention and harm reduction in Canada
Nominated principal Investigator: Lorraine Greaves
In the midst of a serious opioid crisis, emerging cannabis legalization, ongoing binge drinking patterns, and the introduction of e-cigarettes, there is an immediate need to understand sex and gender related implications of these trends, and how to respond to them in practice. This Team will develop and test the impact of incorporating sex, gender and gender transformative variables and principles into existing substance use treatment, harm reduction, and health promotion/prevention materials and programs in three settings in Canada. The substance use system is underdeveloped with respect to the inclusion of sex and gender in its approaches, materials and messaging, and the application of gender transformative principles is scarce. All genders are affected by gendered norms, stereotypes, relations and power distributions but we do not currently have an evidence-based gendered response to opioid overuse, cannabis, e-cigarettes or binge drinking. We will work in three settings to co-develop a set of interventions that incorporate sex, gender and gender transformative principles into programs, messages, staff education and materials. The implementation of these approaches and their effectiveness in shifting knowledge, attitudes and practice will be measured. These efforts will rely on ongoing systematic reviews, knowledge translation approaches in training, education, program design and prevention messaging, in conjunction with practice wisdom from three organizations. Gendered approaches to knowledge translation that address equity are a key challenge for treatment, harm reduction and prevention programs. This Team will translate and tailor evidence in: education of staff and clients; client-practitioner interactions; program design; and enhanced messaging. This is essential to adequately address root causes and health inequities associated with substance use in Canada.
Modeling an approach to gender-conscious participatory action-oriented research and knowledge transfer favouring equality, equity and occupational/environmental health
Nominated Principal Investigator: Marie Laberge
Participatory approaches which integrate knowledge users from the beginning and throughout research (integrated knowledge transfer, or iKT) have been shown to garner better results in terms of uptake of knowledge and health outcomes. When this participatory approach also includes specific attention to sex and gender (s/g) it can further improve relevance and results, but runs certain risks, such as stereotyping. This proposal pulls together a well seasoned team, with experience in participatory research on sex and gender going back to the 70s, and emerging scholars of environmental and occupational health. Studies and iKT projects conducted by team members include subjects such as seasonal workers’ health, work-family interface, occupational health & safety training, and influences of sex and gender on environmental effects in the immune system. The goal of the project is to closely examine past and current research with an aim to producing reproducible strategies for best practices in the integration of sex and gender in iKT. We will undertake an analysis and evaluation, in collaboration with our partners, of the mechanisms underlying successful partnerships, obstacles to the uptake of research results for gender and health, and training approaches. The results will improve researchers’ ability to successfully include sex and gender considerations in their KT projects, with demonstrable improvements on personal and public health ensuing.
mATrICES-F : Sex- and gender-oriented knowledge translation in Francophone contexts
Nominated Principal Investigator: France Légaré
Sex- and gender-oriented knowledge translation (KT) could potentially reduce the waste of research efforts and health services. The adaptation of research questions, processes and health services to target populations inevitably requires that their specific characteristics and contexts are taken into account. Our interdisciplinary, cross-sectoral and pan-Canadian team proposes the co-construction – in collaboration with all stakeholders – of sex- and gender-oriented KT strategies for francophone populations, and the assessment of their efficacy in order to optimize research knowledge uptake by users of health and social services. Our mixed-methods participatory research will be performed in three key stages: 1) Co-construction of a training course and a person-centred KT intervention for health professionals which incorporates sex- and gender-based analysis; 2) Evaluation of the training and KT intervention in a pilot project implementing a multiple-case study on three sites: the first will be in Quebec, the second in New Brunswick and the third in Ontario. The gender-oriented KT intervention will be compared to a gender-neutral intervention; 3) Recommendations, stabilization of partnerships developed in this research and dissemination of results. This project will create the first interdisciplinary, cross-sectoral and pan-Canadian team focused on the development of efficient sex- and gender-oriented KT strategies for francophone contexts in order to optimize uptake of research knowledge by users of health and social services in these contexts and reduce the waste of research efforts and health services.
Transforming the practice of KT: Embedding gender
Nominated Principal Investigator: Sharon Straus
Knowledge translation (KT) is about how we use research in healthcare. Its goal is to improve the care that patients receive through use of the best available research evidence. Unfortunately, researchers and those who do KT have not done a good job of thinking about sex, gender, and identity. Many KT methods involve using frameworks. A framework is a set of items or factors that may influence why people do things or why things happen. For example, a framework may have a list of factors (e.g., knowledge, skills, emotion, etc.) that may make an individual for or against using research evidence to improve the health care system. So far, no KT frameworks include factors related to gender and identity. It is possible that gender may influence an individual to be for or against using evidence to improve the health care system. In this study we will develop and evaluate existing KT frameworks, which will be improved by adding in elements of individual identity. We will conduct a study that includes 3 parts. In part 1, we will ask people who do KT to pick which steps in the KT process would benefit from including identity-related factors and do interviews with people who develop interventions to find out about their personal barriers to considering identity in their KT work. We will then use this information to pick KT frameworks and update them to include identity-related factors. We will also create a training course for people who develop interventions to learn how to use these updated frameworks. In part 2, we will evaluate the training course, comparing it to an existing training course that has no content on identity. In part 3, we will pilot the updated frameworks in 6 KT projects to see how they have used the updated frameworks.
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