IAU research projects

Mobilising osteoarthritis guidelines

One of the first knowledge mobilisation research projects conducted by the IAU was a PhD by Dr Laura Swaithes, which explored the role of Knowledge Mobilisation between the MOSAICS research project and the implementation of its findings - JIGSAW / JIGSAW-E. The JIGSAW-e innovations have been recognised by national organisations, and, the Keele OA patient guidebook has been adopted by the UK and Dutch arthritis organisations. The Royal College of General Practitioners hosts the online-learning package developed for JIGSAW and NICE has endorsed the e-template for prompting and recording high-quality OA care.

A systematic review and thematic synthesis were conducted to explore the factors affecting the implementation of evidence-based guidelines for OA in primary care. Analysis of data from three focus groups (n=21), and qualitative interviews (n=13), were conducted with key stakeholders to understand KM in primary care. A triangulation protocol of the empirical findings was used to generate draft recommendation statements which were subsequently refined in a consensus exercise with stakeholders (n=27), at a national knowledge mobilisation event. This informed the development of a toolkit to optimise KM for OA in primary care.  

The study found that KM of research evidence for OA in primary care is complex and multifaceted and influenced by a range of patient and clinician motivators. Adopting a whole practice approach was beneficial in circumnavigating potential implementation challenges and co-producing implementation plans relevant to the local context. The nature and impact of facilitation in optimising KM was shown. Clinical-academic collaboration and engaging in 'knowledge networks' optimised the uptake of evidence for OA. The knowledge mobiliser role was central to driving knowledge into practice in a contextualised way and was adopted by people with different characteristics (in terms of status, power and role). The perceived importance of patient and public involvement (PPIE) in KM was highlighted, yet uncertainty exists regarding the impact and role of PPIE in KM.  

Triangulation of the three data sets produced a typology of six key empirical domains and a draft set of recommendation statements. The statements were refined following a consensus exercise with stakeholders (n=27) and the final toolkit developed.  

This empirical study of KM demonstrated the importance of the knowledge mobiliser, underpinned by a strong academic collaboration (and infrastructure for KM) to overcome contextual barriers to KM in primary care. Further work is needed to better understand the role of PPIE in KM and evaluate the utility and transferability of the implementation toolkit. 

Publications list

• Swaithes, L. Dziedzic, K. Finney, A. Cottrell, E. Jinks, C.Mallen, C. Curried, G. Paskins, Z. (2020) Understanding the uptake of a clinical innovation for osteoarthritis in real-world primary care: a qualitative study of knowledge mobilisation using the i-PARIHS framework. Implement Sci. 2020 Oct 28;15(1):95. doi: 10.1186/s13012-020-01055-2. PMID: 33115490 Free PMC article.
• Swaithes, L. Paskins, Z. Dziedzic, K. Finney, A. (2019). Factors influencing the implementation of evidence-based guidelines for osteoarthritis in primary care: A systematic review and thematic synthesis. Musculoskeletal care. 2020;1-10. DOI: 10.1002/msc1452

Communities of Practice

A Community of Practice (CoP) is 'a group of people, who share a concern, a set of problems, or a passion about a topic, and who deepen their knowledge and expertise in this area by interacting on an ongoing basis' (Wenger 2002). CoPs are an approach often adopted in the IAU as they offer a strategy for mobilising knowledge into practice by working within, and across, professional, public, organisational, and policy boundaries. In addition to delivering CoPs, we also conduct research to better understand the process and outcomes, particularly associated with KM and implementation.

Research has shown the variability in structure and function of CoPs, making it difficult to operationalise the approach. This study identifies recommendations for optimising the process of KM in CoPs. This study contributes to recognised gaps in the literature regarding public involvement in implementation including, ensuring that all stakeholders feel on an ‘equal footing’ at the beginning of a CoP (which may require preparation), and that lay members need ensuring why they are at table, what their role is and what knowledge they bring. CoPs are a strategy for reducing healthcare boundaries and silo working, and promoting partnership working and integrated services. 

Four themes were identified: Identifying and interpreting knowledge; practical implementation of a CoP; culture and relationship building; and responding to external context. Resource and infrastructure enabled the set-up, delivery and running of the CoP. Support for lay members is recommended to ensure effective participation and equity of power. CoP aims and purpose can develop iteratively, and this may enhance the ability to respond to contextual changes. Several recommendations for the practical application of CoPs are suggested to create the best environment for knowledge exchange and creation, support an equitable platform for participation, and help members to navigate and make sense of the CoP in a flexible way. This study identified how a CoP with diverse membership can promote partnership working at the intersection between knowledge and practice. Several important considerations for preparing for and operationalising the approach in implementation have been identified. Evaluation of the costs, effectiveness and impact of CoPs is needed to better understand the value added by the approach. More broadly, research is needed to explore the practical application of online CoPs and the role of international CoPs in optimising the uptake of innovations and best practice. 

Publications list

• Swaithes, L. Paskins, Z. Quicke, J. Stevenson, K. Fell, K. Dziedzic, K. (2022). Optimising the process of knowledge mobilisation in Communities of Practice: recommendations from a multi-method qualitative study (in press).
• Kay Stevenson, Helen Duffy, Simon Somerville, Vince Cooper, Rhian Hughes, Krysia Dziedzic, 66. Can Communities of Practice Assist the Implementation of Research Across the Academic Health Sciences Network?, Rheumatology, Volume 53, Issue suppl_1, April 2014, Page i80, https://doi.org/10.1093/rheumatology/keu099.00

Ongoing research

PP4M: Improving review appointments for people with long term health conditions) General practices in England undertake regular reviews with patients for individual long-term health conditions. For people with multiple long-term health conditions, this approach of reviewing one health condition at a time can lead to fragmented care. A promising approach aimed at improving personalised care and increasing efficiency is to use a ‘smart’ template enabling an integrated multimorbidity review which covers all of a patient’s most important health problems at one time. In collaboration with Ardens, we have helped to develop a suitable template which ensures that QOF requirements are met, but focuses on the problems that matter most to patients. The template supports self-management and shared decision-making, leading to agreeing an individualised care and support plan for each patient with multimorbidity. This project involves studying the implementation of this template and how it can be further improved. The template will be made widely available to general practices and supported with training and other tools to aid implementation. Intervention implementation and effectiveness will be evaluated using mixed methods including a questionnaire to clinical staff, a before-and-after patient survey, and extraction and analysis of routinely collected data. In a few practices we will also undertake interviews with staff, interviews with patients, and video-recorded observations of consultations. This project will provide evidence to inform broad-scale implementation of a ‘whole-person’ review for patients with multimorbidity in line with the NHS Comprehensive Model for Personalised Care.

PPIE research

PIPER - Pathways to Implementation for Public Engagement in Research (PIPER) 

Developing a role for patients and the public in the implementation of health and social care research evidence into practice.

This study will address an unmet need, to understand the potential role of patients, service users and the public in the implementation of evidence into practice in health and social care. Our conversations and collaborations with PPI contributors nationally and internationally have shown they are keen to understand how they can be involved in the implementation of evidence into practice. 

Implementing research evidence into health and social care practice can help ensure health and social care is high quality, cost-effective, acceptable and appropriate for patients and service users. Implementation activities are usually led by health and care professionals or researchers with variable success.  Patients, carers, service users and the public are key partners and can play different roles in the implementation of evidence into practice. They can work with health and care professionals in implementation partnerships, or lead implementation activities, supported by health and care professionals. Yet their role is often neglected. While awareness of the possibilities for public involvement in implementation is increasing, we have a limited understanding of the potential roles and contributions patients, carers, service users and the public could make to implementation practice.  

This study will address the key gap in our knowledge and practice, by answering the overall question, 'how best can we involve patients, carers, service users and the public in the implementation of health and social care research evidence into practice?'

Reviewing public involvement sections of reports from NIHR organisations to identify best practice

The National Institute for Health and Care Research(NIHR) is a United Kingdom government agency which funds research into health and social care. With a budget of over £1.2 billion in 2019–20, its mission is to "improve the health and wealth of the nation through research". A range of different organisations support the design and delivery of NIHR-funded research. Examples of such organisations include the NIHR Research Design Service (RDS), NIHR Applied Research Collaborations (ARCs) and NIHR Biomedical Research Centres (BRCs).  

Each organisation is required to describe how they involved and engaged patients and the public in their activities in relation to their patient and public involvement and engagement (PPIE) strategies and the UK Standards for Public Involvement. The six standards are:  

1. Inclusive opportunities: Offer public involvement opportunities that are accessible and that reach people and groups according to research needs. 
2. Working together: Work together in a way that values all contributions, and that builds and sustains mutually respectful and productive relationships. 
3. Support and learning: Offer and promote support and learning opportunities that build confidence and skills for public involvement in research. 
4. Governance: Involve the public in research management, regulation, leadership and decision-making. 
5. Communications: Use plain language for well-timed and relevant communications, as part of involvement plans and activities. 
6. Impact: Seek improvement by identifying and sharing the difference that public involvement makes to research 

The annual reports contain rich data on PPIE practice and challenges. The NIHR has invited Keele University to conduct a review of the public involvement sections of annual reports.  

We will aim to identify the different patterns of PPIE practice, and within it, highlight features of what good looks like in experimental medicine and applied health research contexts.