Research's practice and barriers of knowledge translation in Iran

Knowledge Translation is a process that includes synthesis, dissemination, exchange and application of knowledge to improve the health, services and products In this study we have attempted to examine the knowledge translation practice and its perceived barriers on the universalities and research institutes [research sector] in Iran. Both qualitative and quantitative approaches were used. In the quantitative section, a questionnaire had prepared for this study was completed by 88 authors country wide from randomly selected papers. In the qualitative section 13 in-depth interviews and 6 focus group discussions were held with managers and policy makers, clinical and health service providers, and researchers. Twenty four percent of the authors had no interaction whatsoever with the target audience. Lack of expectation toward creating change in the target audience, researchers' incentives, low level of trust among researchers and decision makers, absence of a predefined mechanism for delivery of research results and inappropriate research priorities were among the most important barriers identified in the qualitative section. Translation of research findings into some concrete outputs which can affect health of people is not in mandate of researchers and subsequently they are not prepared for this as well. Based on the barriers identified, it seems that the following interventions are necessary: cooperation among policy makers at macro and meso [organizational] level and the research sector; establishing networks for researchers and decision makers in choosing the research topic, priority setting, and building trust among researchers and policy makers

Disease surveillance and private sector in the metropolitans: a troublesome collaboration

An effective response to health problems is completely dependent upon the capacities of the health system in providing timely and valid information to take action. This study was designed to identify various reasons from various perspectives for underreporting disease by physicians in the private sector in big cities in developing countries setting. In this qualitative study, we used focus group discussions [16 manager], and in-depth semi-structured interviews [7 private physician, 2 experienced policy maker and a researcher]. We used the thematic approach for data analysis. Results were amplified by a comprehensive literature review. Themes were classified in 6 categories: Infrastructure and legal issues, the priority of disease reporting, workflow processes, motivation and attitude, human resources and knowledge and awareness. As the main reasons of under reporting, most physicians pointed out complicacy in reporting process and inadequate attention by the public sector. Managers emphasized instituting legal incentives and penalties. Experts focused on physicians' knowledge and expressed a need for continuing medical education programs. Independent interventions will have little chance of success and sustainability. Different intervention programs should consider legal issues, attitude and knowledge of physicians in the private sector, and building a simple reporting process for physicians. Intervention programs in which the reporting process offers incentives for all stakeholders can help improving and sustaining the disease reporting system

Only one third of Tehran's physicians are familiar with 'evidence-based clinical guidelines'

Clinical guidelines have increasingly been used as tools for applying new knowledge and research findings. Although, efforts have been made to produce clinical guidelines in Iran, it is not clear whether they have been used by physicians and what factors are associated with them? Four hundred and forty three practicing physicians in Tehran were selected from private clinics through weighted random sampling. The data collection tool was a questionnaire on familiarity and attitude toward clinical guidelines. The descriptive and analytical findings were analyzed with t-tests, Chi2, logistic and linear multivariate regression by SPSS, version 16. 31.8% of physicians were familiar with clinical guidelines. Based on the logistic regression model physicians' familiarity with clinical guidelines was positively and significantly associated with 'working experience in a health service delivery point' OR = 2.13 [95% CI, 1.17-3.90], 'familiarity with therapeutic protocols' OR = 2.09 [95% CI, 1.22-3.57] and 'holding a specialty degree' OR = 2.51 [95% CI, 1.24-5.07]. The mean overall attitude scores in the 'usefulness', 'reliability', and 'problems and barriers' domains were, respectively, 78.9 [SD = 16.5], 78.9 [SD = 19.7] and 50.4 [SD = 15.9] out of a total of 100 scores in each domain. No significant association was observed between attitude domains and other independent variables using multivariate linear regression. Little familiarity with clinical guidelines may represent weakness in of production and distribution of domestic evidence. Although, physicians considered guidelines as useful and reliable tools, but problems such as difficult access to guidelines and lack of facilities to apply them were stated as well

Methodologies and messages in Iranian articles on maternal care, diabetes mellitus, and tuberculosis, published in 2001-2006

An article with a clear message can transfer research knowledge better. However, this is the case when the message suits the type of study methodology [research design] and its results. The objective of this study was to assess the presence of message articles and the type of study methodologies. Articles published between 2001 and 2006, on maternal care, diabetes, and tuberculosis, which were based on studies performed on the Iranian population were investigated. A systematic search was performed in foreign databases 'Pubmed, Medline, and Embase', and national databases Iranmedex, SID [Scientific Information Database], and Iranpsych'. Seven hundred and ninety five articles were examined for the type of study methodology and presence of an actionable message [one that specifies what and how an action should be carried out]. Among the 795 articles accessed, cross sectional studies were the most frequent [50.9%] and systematic reviews were the least frequent [0.4%]. Cohort cases were observed in 6.9% of the cases. Actionable messages were observed in 22.1% of all the cases and 24.7% of the cross sectional studies. Cohort studies increased from 5% in 2001 to 6.9% in 2006, but the shortage of systematic reviews represented a major weakness in the country's knowledge production process. Studies with a higher level of evidence such as systematic reviews, and cohort and interventional studies should be among the priorities of knowledge production in the country

Health emergency mass notification: lessons learnt from the H1N1 pandemic in Tehran

Timely notification is of great importance in health emergencies. So identifying the most important sources of information used by people in emergencies seems necessary. The objective of this study was to assess peoples' level of awareness concerning the symptoms, routes of transmission, prevention, and treatment of H1N1 at the time of the pandemic and also to identify their most important source of information. Two telephone surveys were performed at the beginning of levels five and six of the pandemic at a four-month interval on two populations. Using a questionnaire, random phone numbers were called and 662 and 701 individuals from Tehran were surveyed at the two phases. Peoples' level of awareness concerning the disease, symptoms, its routes of transmission, prevention, and treatment of H1N1 had increased in the second phase of the study. At the same time, people were less afraid of the disease in the second phase. The most important sources of information used were TV, newspapers, and radio, respectively. Mass media including TV and newspapers were recognized as the most important sources of information used by the people in emergencies. It seems that designing educational programs and synchronizing the media's policies with health authorities can help fight future health emergencies and prevent delays in notifying people

[Do researchers have a correct impression of their knowledge translation?]

To assess researchers' impression of their own knowledge translation. The survey questionnaire was completed by 208 researchers in Tehran University of Medical sciences [TUMS]. They were asked about knowledge translation activities in one of the projects they had completed. They were also asked to score themselves on a scale of 0 to 10, where a higher score meant more activity. The correlation between theses two variables and its determinants were assessed by performing multiple linear regression analysis. Although the researchers had only gained an average of 19.5% of the maximum score of knowledge translation activities, they scored 58.6% of the total score in self-assessments [the difference was significant, P<0.001]. Pearson's correlation between the score of self-assessments [the difference was significant, P<0.001]. Pearson's correlation between the score of self-assessment and that obtained for the efforts made was 0.43, which indicates an average correlation between the rate of activity and self-assessment. Linear regression analysis showed that the difference between activities and self assessment scores increased with the increase in the number of years working as a professional [P=0.004]. Researchers overestimate their knowledge translation activities. Therefore education and familiarizing researchers with all the aspects of knowledge transfer and methods of assessing these activities can help in the application of research and also in utilization of its results