Elsevier

Social Science & Medicine

Volume 75, Issue 11, December 2012, Pages 1938-1945
Social Science & Medicine

Review
Deliberative dialogues as a mechanism for knowledge translation and exchange in health systems decision-making

https://doi.org/10.1016/j.socscimed.2012.06.016Get rights and content

Abstract

Models that describe the key features and intended effects of specific knowledge translation and exchange (KTE) interventions are much less prominent than models that provide a more general understanding of KTE. Our aim was to develop a model in order to describe the key features and intended effects of deliberative dialogues used as a KTE strategy and to understand how deliberative dialogues can support evidence-informed policymaking. By using critical interpretive synthesis, we identified 17 papers representing four fields of enquiry and integrated our findings into a model. The key features described in the model are: 1) an appropriate (i.e., conducive to the particular dialogue) meeting environment; 2) an appropriate mix of participants; and, 3) an appropriate use of research evidence. These features combine to create three types of intended effects: 1) short-term individual-level; 3) medium-term community/organizational-level; and, 3) long-term system-level. The concept of capacity building helps to explain the relationship between features and effects. The model is a useful contribution to the KTE field because it is a practical tool that could be used to guide the development and evaluation of deliberative dialogues in order to understand more about achieving particular outcomes in relation to specific issues or contexts.

Section snippets

Background

An important goal of system-level knowledge translation and exchange (KTE) is using evidence in decision-making about problems or issues affecting the health system (Canadian Health Services Research Foundation (CHSRF), 2006). KTE is broadly defined as “a dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health status, provide more effective health services and products, and strengthen the healthcare

Methods

We used CIS (Dixon-Woods et al., 2006) in order to focus on the conceptual translation of quantitative and qualitative studies, as well as non-empirical papers. The question that guided our review was: What are the key features of deliberative dialogues, their intended effects and the relationships between features and effects, particularly as they help to explain their potential as a KTE strategy?

We used three strategies to identify papers. We: 1) searched the following databases from 1980 to

Results

We identified 4487 non-duplicate articles from our database search. We retrieved 71 of these for full text review (kappa = 0.75, 95% CI 0.43–1.0), as well as 8 additional papers from references and key informants. Of these 79 full-text papers, we included 17 that met our inclusion criteria (kappa = 0.39, 95% CI -0.37–1.16) and we excluded 62 for the following reasons: 60 did not meet the inclusion criteria; and, 2 papers were not available. (We considered kappa to be fair given that the codes

Model: key features and intended effects of deliberative dialogues as a KTE strategy

We devised a model based on the findings that emerged from the synthesis process. The model combines: 1) constructs related to key features; 2) constructs related to intended effects; and, 3) the synthetic construct of ‘capacity building’. Our analysis did not reveal any data about relationships between key features and intended effects. However, the concept of ‘capacity building’ seemed to underpin what we found. Thus, we considered capacity building to be a synthetic construct that helps to

Appropriate meeting environment

The literature reflected the importance of ensuring that the meeting environment is conducive to deliberation about a policy issue. Although we identified several design features important to creating a meeting that enables free-ranging discussion, many of the features identified are consistent with any meeting that aims to create an environment in which meaningful participant communication (i.e., exchanging thoughts, ideas or information) is optimized (Gregory, Hartz-Karp, & Watson, 2008; Hunt

Intended effects

Understanding what the intended effects of deliberative dialogues are is a necessary precondition of determining their effectiveness. Based on the literature we reviewed the intended effects of deliberative dialogues may occur at the individual, community/organizational or system levels, and these can be considered in the short, medium or long-term.

Synthesizing construct: capacity building

We identified ‘capacity building’ as a synthesizing construct that helps to explain the relationships between key features and intended effects of deliberative dialogues when used as a KTE strategy. Capacity building involves strengthening knowledge, abilities, skills and actions in order that an individual, organization, community or system can meet its goals.

The papers from the field of environmental policy most notably discussed capacity building. For example, Beierle (2002) points out that

Discussion

We created a model that demonstrates how deliberative dialogues can initiate a KTE process that contributes to evidence-informed health system decision-making. In addition to creating a model, several key findings emerged from our review of the literature. First, the majority of the literature we reviewed was theoretical or focussed on evaluating the procedural aspects of deliberative dialogues, which, until recently, has also been a major focus in the deliberation methods literature more

Strengths and limitations

Our study has two main strengths. First, while tools and models exist to support the development and evaluation of KTE interventions targeted at changing the behaviour of healthcare professionals (Davis et al., 2003; DiCenso et al., 2002; Dobbins, Ciliska, Estabrooks, & Hayward, 2005), we generated a model that can be used to support evidence-informed health policy decision-making. Second, despite the challenges we encountered while synthesizing empirical and non-empirical forms of evidence

Acknowledgements

The authors wish to thank Dr. Mary Dixon-Woods and Dr. Kate Flemming for input and advice using the critical interpretive synthesis method. The authors would also like to acknowledge the financial support of the Community Alliances for Health Research and Knowledge Translation on Pain.

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