Knowledge translation for realist reviews: a participatory approach for a review on scaling up complex interventions.

BACKGROUND: Knowledge syntheses that use a realist methodology are gaining popularity. Yet, there are few reports in the literature that describe how results are summarised, shared and used. This paper aims to inform knowledge translation (KT) for realist reviews by describing the process of developing a KT strategy for a review on pathways for scaling up complex public health interventions. METHODS: The participatory approach used for the realist review was also used to develop the KT strategy. The approach included three main steps, namely (1) an international meeting focused on interpreting preliminary findings from the realist review and seeking input on KT activities; (2) a targeted literature review on KT for realist reviews; and (3) consultations with primary knowledge users of the review. RESULTS: The international meeting identified a general preference among knowledge users for findings from the review that are action oriented. A need was also identified for understanding how to tailor findings for specific knowledge user groups in relation to their needs. The literature review identified four papers that included brief descriptions of planned or actual KT activities for specific research studies; however, information was minimal on what KT activities or products work for whom, under what conditions and why. The consultations revealed that KT for realist reviews should consider the following: (1) activities closely aligned with the preferences of specific knowledge user groups; (2) key findings that are sensitive to factors within the knowledge user's context; and (3) actionable statements that can advance KT goals, activities or products. The KT strategy derived from the three activities includes a planning framework and tailored KT activities that address preferences of knowledge users for findings that are action oriented and context relevant. CONCLUSIONS: This paper provides an example of a KT strategy for realist reviews that blends theoretical and practical insights. Evaluation of the strategy's implementation will provide useful insights on its effectiveness and potential for broader application.

Scaling up complex interventions: insights from a realist synthesis.

Preventing chronic diseases, such as cancer, cardiovascular disease and diabetes, requires complex interventions, involving multi-component and multi-level efforts that are tailored to the contexts in which they are delivered. Despite an increasing number of complex interventions in public health, many fail to be 'scaled up'. This study aimed to increase understanding of how and under what conditions complex public health interventions may be scaled up to benefit more people and populations.A realist synthesis was conducted and discussed at an in-person workshop involving practitioners responsible for scaling up activities. Realist approaches view causality through the linkages between changes in contexts (C) that activate mechanisms (M), leading to specific outcomes (O) (CMO configurations). To focus this review, three cases of complex interventions that had been successfully scaled up were included: Vibrant Communities, Youth Build USA and Pathways to Education. A search strategy of published and grey literature related to each case was developed, involving searches of relevant databases and nominations from experts. Data extracted from included documents were classified according to CMO configurations within strategic themes. Findings were compared and contrasted with guidance from diffusion theory, and interpreted with knowledge users to identify practical implications and potential directions for future research.Four core mechanisms were identified, namely awareness, commitment, confidence and trust. These mechanisms were activated within two broad scaling up strategies, those of renewing and regenerating, and documenting success. Within each strategy, specific actions to change contexts included building partnerships, conducting evaluations, engaging political support and adapting funding models. These modified contexts triggered the identified mechanisms, leading to a range of scaling up outcomes, such as commitment of new communities, changes in relevant legislation, or agreements with new funding partners.This synthesis applies and advances theory, realist methods and the practice of scaling up complex interventions. Practitioners may benefit from a number of coordinated efforts, including conducting or commissioning evaluations at strategic moments, mobilising local and political support through relevant partnerships, and promoting ongoing knowledge exchange in peer learning networks. Action research studies guided by these findings, and studies on knowledge translation for realist syntheses are promising future directions.

Evaluating a Tool to Support the Integration of Gender in Programs to Promote Men's Health.

Men's disproportionate rate of suicide and substance use has been linked to problematic conformity to traditional masculine ideals. Mental health promotion interventions directed toward men should address the gender-specific needs of men; yet, no tools exist to provide such guidance. To address this need, the Check-Mate tool was developed as part of a global evaluation of the Movember Foundation's Social Innovators Challenge (SIC). The tool provides an initial set of evidence-based guidelines for incorporating gender-related influences in men's mental health promotion programs. This article describes the development of Check-Mate and an evaluation of its usability and usefulness. Using a qualitative descriptive approach, semistructured interviews were conducted with the leads for eight of the SIC projects; they used the tool for these. Data were analyzed using conventional content analysis. Overall, project leads found the tool user-friendly. Identified strengths of Check-Mate included its practicality, adaptability, usefulness for priming thinking on gender sensitization, and value in guiding program planning and implementation. With respect to limitations, project leads explained that the complexity of men's mental health promotion programming may limit applicability of some or all approaches included in Check-Mate. They also expressed concern about how using Check-Mate might reinforce hegemonic masculine ideals. It was suggested that examples illustrating the use of Check-Mate would be a helpful accompaniment to the tool. Findings indicate that Check-Mate is a useful guide in men's mental health promotion programming. In addition to future testing of the tool in different settings, links between the tool's approaches and program outcomes should be explored.

A mixed methods evaluation of capturing and sharing practitioner experience for improving local tobacco control strategies.

OBJECTIVE: Practitioner experience is one type of evidence that is used in public health planning and action. Yet, methods for capturing and sharing experience are under-developed. We evaluated the reach, uptake and use of an example of capturing and sharing practitioner experience from tobacco control known as documentation of practice (DoP) reports. METHODS: The participatory, mixed methods approach included the following: a document review to capture data related to the extent and how DoP reports reached the target population; an online survey to assess awareness, use and perceptions about DoP reports; and semi-structured interviews to identify and explore examples of instrumental, conceptual and symbolic use of DoP reports. The samples for the survey and interviews included tobacco control practitioners from public health units in Ontario, Canada. RESULTS: Seventy-three individuals participated in the survey and 10 were interviewed. Awareness of at least one DoP report was high. The most common way of learning about DoP reports was email. DoP reports focused on policy issues had highest use; these reports were used in conceptual (helped raise awareness), instrumental (directly informed local policy development) and symbolic (confirmed a choice already made) ways. DoP reports may be improved with key messages, shorter development timelines, more relevant topic selection and dissemination to audiences beyond public health. CONCLUSION: DoP reports are useful to public health practitioners working in tobacco control within Ontario; refinements to development and dissemination processes will enhance use. Future studies and adaptations of DoP reports could help improve use of practitioner experience as one source of evidence informing public health practice.

Exploring the unanticipated effects of multi-sectoral partnerships in chronic disease prevention.

Multi-sectoral partnerships are important parts of many public health efforts to address chronic diseases, such as cancer, diabetes, and cardiovascular disease. Despite the potential value of multi-sectoral approaches, uncertainty exists regarding their effects on individuals, organizations, communities and populations. This article reports on a study that examined the unanticipated effects (both positive and negative) of the Public Health Agency of Canada's (the Agency) Multi-sectoral Partnerships initiative, which supports more than 30 multi-sectoral partnership projects across Canada. Thirteen semi-structured interviews were conducted with staff from organizations participating in 3 diverse partnership projects as part of the Agency's multi-sectoral partnerships initiative. Multiple unanticipated effects were identified and organized into 4 themes: (1) insights about the flexibility and responsiveness of government; (2) access to new and valuable resources (people, skills, expertise); (3) opportunity to build new capacities; and (4) understanding realistic timelines for partnership activities and outcomes. While these effects were unanticipated for study participants, they resonate with insights from the literature on multi-sectoral partnerships. These results raise a number of questions for consideration as partnership initiatives continue to evolve, including the types of training that partners might need; the individual and organizational capacities required for partnership approaches; and the evaluation techniques that might be most useful to capture the non-linear effects of partnership approaches.

Interorganizational relationships in the Heart and Stroke Foundation's Spark Together for Healthy Kids™: insights from using network analysis.

The Heart and Stroke Foundation's Spark Together for Healthy Kids™ (Spark) is a multiyear initiative in Ontario, Canada, that takes a population approach to obesity prevention. It focuses on creating healthy environments by improving access to healthy foods and physical activity, with an emphasis on strengthening the advocacy capacity of organizations and citizens. Consistent with the complexity of the intervention, the evaluation of Spark applied systems concepts and methods to test the utility of network analysis as a method for evaluation, and to inform collaborations of organizations involved in programs and advocacy. Relationships among organizations from different sectors and jurisdictional levels with a focus on school community environments were of particular interest. Interorganizational network analysis was used to understand these relationships, including the role of the Heart and Stroke Foundation. Findings revealed a niche brokering role for the Heart and Stroke Foundation and other provincial and national organizations, and the importance of these brokers for engaging local and regional organizations. Findings also reinforced the importance of a mixed methods approach to network analysis, and the potential value of the analysis for scientific and practical purposes.