Implementation research for digital technologies and tuberculosis

Implementation research for digital technologies and tuberculosis


Implementation research for digital technologies and tuberculosis

A toolkit for evaluating the implementation and scale-up of digital innovations across the tuberculosis continuum of care.

Module 6

Knowledge translation

Uptake of research findings that can be used to address an implementation challenge is a fundamental part of the IR process. The last module of this toolkit focuses on the translation of IR findings and knowledge into action and provides guidance on appropriate communication strategies that can be used to achieve this.

Uptake of IR findings

The end goal of IR is to have the lessons identified throughout the research integrated into the health system to ensure sustainable change. This relies on the acceptance of your findings by relevant health personnel and key decision-makers. The pertinent question then becomes: how can you promote the acceptance of your research findings by these key stakeholders?

Knowledge translation is the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health.1 In other words, knowledge translation is the process of interpreting and successfully communicating the findings to the individuals or groups who can effect change. Ensuring that these groups or individuals are identified early and engaged regularly throughout the IR process will help increase a sense of ownership over the research process and findings and increase the likelihood that the findings are taken up by the health system. These stakeholders should have been identified by your group in Module 1. If this has not already been completed, you may wish to revisit this module before continuing.

While most knowledge translation activities will obviously take place after you have completed your study, many potential funders will be interested in the broader impact of your research and its potential for contributing to, or catalysing change. You will also need to budget for any costs related to knowledge translation. Therefore, it is important to think through knowledge translation objectives and potential strategies during the development stage of the study.

Here’s an example of how IR findings have been used to support the wider use of a novel technology for TB

Using IR to compare human and algorithmic assessment of chest radiographs

Background: Chest radiography (CXR) is a recommended screening and triage tool for TB but its use is limited in many high TB burden settings due to a shortage of trained radiologists. Computer-aided detection (CAD) software employing artificial intelligence (AI) has become increasingly available over the last decade to automatically read and interpret digital CXRs . Deployment of this software could thus fulfil a critical gap in active TB case finding efforts. Implementation research was undertaken by the Stop TB Partnership’s TB REACH initiative to complement efficacy studies of CAD in support of active TB case finding activities in Nepal, Bangladesh, and Cameroon.

The IR study included multiple studies in various locations in the three countries. The studies used molecular WHO-recommended rapid diagnostic test results as the reference standard for CXR interpretations. First, a 2019 study compared the accuracy of three CAD algorithms against human readers to screen a dataset of CXRs collected in Nepal and Cameroon. Together, these studies provided evidence about how these tools can best be implemented to support TB programmes. These findings were disseminated with partners including the Global TB Department at WHO and as a result of the strength of these findings, and supported by findings of by similar studies undertaken elsewhere, the use of AI for TB screening and diagnosis has been included in WHO Guideline Development Group discussions

Developing a dissemination plan

A dissemination plan is a context-specific strategy to disseminate research findings to target audiences to achieve specific objectives. There will likely be multiple dissemination objectives that require different content, channels or tools and target different audiences. Strong dissemination plans include strategies that are tailored to address various objectives, rather than adopting a one size fits all approach. Strong dissemination plans also include mechanisms to evaluate relevant indicators and outcomes, so that the strategy and its products can be revised and improved.

Table 13 outlines the components and steps for developing a dissemination strategy. The specific messages and approaches, for example, that will be used in your strategy will not be determined until after the research has been completed. At this stage, you should ensure you are familiar with the process and use this information to begin thinking about what the longer-term strategic goals of the research are.

Dissemination strategies

There are various approaches to translating research findings into action and the choice of strategy should be informed by the overall knowledge translation objectives and target audience. The following are examples of dissemination strategies you may wish to use.

Policy briefs

Policy briefs are strategic documents aimed at policy or other decision-makers recommending a particular course of policy-related action in response to an identified issue. Policy briefs should be evidence-based (i.e. the policy recommendations should be supported by your research findings). Policy briefs are typically short in length (one page or less) and should be concise and attention grabbing. There are many great online resources available for those who are unfamiliar with this type of document, for example:

Peer-reviewed journal articles

Journals often have their own specific requirements for formatting, length or style that must be adhered to. If you are planning to develop an article, you should first identify an appropriate journal and read through their requirements and guidelines for submission before you start to write your paper (this information is often listed under a section entitled ‘Information for authors’).

As introduced in Module 4, there are various reporting guidelines depending on your study type that should be followed to improve the rigor and quality of your papers. These include CONSORT for pragmatic trials, STROBE for observational studies, and also StaRI specifically for implementation studies.

There is also the mHealth Evidence Reporting and Assessment (mERA) checklist that has been developed by WHO specifically to enhance the quality of reporting for mobile health interventions and associated research studies. While these guidelines focus specifically on mHealth, they could easily be adapted and used to develop papers reporting on the effectiveness of digital health interventions more broadly. The mERA checklist also includes methodological criteria common across all study types, as well as study-specific criteria for qualitative or quantitative studies.

Meeting or conference presentations

Conferences are an ideal way to disseminate information to other researchers and implementers, typically in the form of an oral or poster presentation. National conferences and meetings are a good opportunity to more directly target local decision-makers. With your team, brainstorm to identify or predict any strategic meeting opportunities where your key messages can be delivered. This may include forthcoming national planning processes or events, high-profile meeting or gatherings of key audience members, or strategic dates on which specific issues are likely to be highlighted and/or discussed.

There are several international conferences that are held on an annual, or bi-annual basis that you may wish to consider, such as The Union World Congress on Lung Health and the ICT4D Conference. Many conferences offer competitive scholarships to support the attendances of participants from low and middle-income countries; your chance of receiving a scholarship is higher for applicants who have had an abstract accepted for presentation at the conference. Conference websites should be checked for important information such as registration dates, scholarship information and deadlines and information for abstract submissions.

Reports, IEC materials, guidelines, etc.

There are many examples of other types of grey-literature products that can be developed to disseminate your research findings, such as research reports, infographics, media releases, social media campaigns, or more traditional information education and communication (IEC) materials. This list is not exhaustive; you should brainstorm possible strategies based on your target audience and objectives.

Ensure that any costs related to your dissemination plan are included in the IR budget.

There is commonly a lot of overlap among the scope of different journals (the categories provided in Table 13 should not been seen as mutually exclusive). Before deciding about where to submit your paper, you should visit journal websites and review the scope of the journal to determine its suitability for your paper. The examples of journals given here are all international; however, you may wish to check for relevant national or regional journals too.

Proposal checklist: Impact

Proposal checklist

Exercise: With your team, use this module’s information to develop a preliminary dissemination plan to include in your IR proposal. Remember that this plan can be amended and updated as you progress through your study.

Dissemination plan
  • Identifies the potential key messages to be disseminated upon completion of the project.
  • Statement on whether the knowledge transfer will be aimed at policy or programmatic change, or both.
  • Presents a proposed budget for the dissemination plan.
Target Audience
  • Identifies all known stakeholders and partners to be included in the knowledge transfer dissemination at the end of the project.
  • Determines the best way to communicate the project messages and key findings to the various target audiences (should be reflected in the dissemination strategy budget).
  • Identifies the main messages expected to be disseminated on the impact of the intervention, including lessons learned and potential good practice, including findings from the project evaluation. These messages should be updated and modified upon completion of the project and again when an evaluation is completed.
Channels and tools
  • Identifies, if known, channels and tools appropriate for the dissemination strategy according to the target audiences, stakeholders, and also aligned with the dissemination strategy proposed budget.

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