EBDM among Canadian healthcares decision makers: Under a behavioural lens'

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EBDM among Canadian healthcares decision makers
Under a behavioural lens.

• Jalila Jbilou MD, MSc, PhD candidate
• Nabil Amara PhD, Associate Professor
• Réjean Landry PhD, Professor
• Chaire FCRSS/IRSC sur le transfert des
  connaissances et linnovation, Université Laval,
  Québec

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Acknowledgements
Authors are thankful for the financial support
provided to Jalila Jbilou bythe Public Health
Agency of Canada and the Institute of Public and
Population Health from the Canadian Institute of
Health Research to make it possible for her to
attend the 5th Nordic Health Promotion Research
Conference 2006, Esbjerg (DK)
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Presentation

• Introduction
• Methodology
• Findings
• Discussion and conclusion
• Implications

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Introduction

• In the field of health care, turbulences are
  explored from two angles
• structural reforms and changes
• crisis affecting public health, of which
  epidemics (SARS, Avian Influenza, obesity) is of
  particular concern.
• Recourse to scientific evidence remains the best
  option that would ensure the most effective
  decision

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Introduction

• Health care systems decisions have to take into
  consideration three values equity, efficiency,
  and autonomy (Contandriopoulos, 1994)
• In a complex environment (politics, economics,
  social, epidemics), uncertainties (intrinsic and
  extrinsic) and a wide pool of knowledge
• How to promote EBDM in health sector?

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Study hypothesis

• EBDM is a behaviour under will control
• Social norm, motivation, values and believes
  remain major determinants of EBDM
• Why and how verify such hypothesis?

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Relevance

• EBDM is a process made of five steps
  evidence acquisition, evidence
  comprehension, evidence citation, evidence
  adaptation and efforts conceded to promote
  evidence adoption
• 
  
  (Landry, Amara al. 2001)
• Decision makers are rational actors who utilize
  evidence depending on related benefits and risks
  that they are ready to take during
  decision-making process
• 
  (Walshe Rundall 2001)
• 
  

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Relevance

• A large literature on the procedural components
  of EBDM exists (e.g. information systems,
  capacity building, structural organization,
  organizational factors, utilization types.)
• (Landry, Amara al. 2001 Landry, Amara
  al. 2001 Amara, Ouimet al. 2003 Lindstrom
  2003 Niedzwiedzka 2003 Dobrow, Goel al. 2004
  Mitton Donaldson 2004)
• But few on its individual behavioral components
  
  
  (Carlsson 2002 Niedzwiedzka 2003)
• Need for a better comprehension and prediction of
  decision makers behavior toward evidence
  utilization during decision-making process in
  Canadian Governmental Health Organizations

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Study aims

• Determine explicative factors of EBDM behavior
  adoption among decision makers in Canadian
  Governmental Health Organizations
• Propose strategies to enhance EBDM among decision
  makers in Canadian Governmental Health
  Organizations

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Limits of the study

• TCI  tended to be particularly interested in
  understanding people's motivation to change
  behavior rather than ability to change 
• 
  
  (Jeffery 2004)
• In the present study, we aim at determining the
  explanatory factors of behaviours and it is
  important to mention that we are not interested
  in exploring the development of capacities
  supporting them

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MethodologyTriandis TIB (1979) and Banduras SE
(1986)

Socio-demographic characteristics Gender,
Education, Position in the organization
Social norms Normative believes, Existing social
roles believes, Perceived social pressures
Cognitive component of attitude Subjective
evaluation of advantages and\or inconveniences
and perceived consequences
Personal Norms  Personal obligation or
correspondence between values and behavior
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2
1
Affect
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Self-efficacy
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Facilitating conditions
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Motivation
Habits
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EBDM behavior to be adopted by decision makers
in Canadian Governmental Health organizations
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Methodology

• H.1. the perceived value of the research
  positively influences the EBDM adoption by
  Canadian Governmental health organizations
  decision makers (CGHODM) (cognitive component).
• H.2. the personal convictions of the individual
  positively influence the EBDM adoption by CGHODM
  (personal normative component)
• H.3. the beliefs in the existence of specific
  social roles and the felt pressures positively
  influence the adoption of the EBDM behaviour by
  CGHODM (social normative component)
• H.4. the valuing of the EBDM by CGHODM (emotional
  component)
• H.5. an organisational context favourable to
  research and to the use of the research results
  positively influence the adoption of the EBDM
  behaviour by CGHODM (conditions facilitation
  adoption)
• H.6. the recurrence of the behaviour positively
  influence the adoption of the EBDM behaviour by
  CGHODM (habit component)
• H.7. the intention positively influences the
  adoption of the EBDM behaviour by CGHODM
  (motivation component)
• H.8. the perceived self-efficacy positively
  influences the adoption of the EBDM behaviour by
  CGHODM
• H.9. the socio-demographic characteristics
  positively influences the adoption of the EBDM
  behaviour by CGHODM

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Methodology

• Quantitative methodology based on a
  questionnaire, elaborated for the purpose of an
  inquiry, administered in 2001 and having
  concerned research results utilization by
  decision makers (managers and professionals) in
  Canadian Governmental Health Organizations
• The behavior EBDM represents the dependent
  variable measured by an index composed of 5 items

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Results

• DETERMINANTS OF THE BEHAVIOR EBDM
• To study the impact of the explanatory variables
  on the adoption of the behavior EBDM by decision
  makers in Canadian Governmental Health
  Organizations (CGHO), we estimated by an MCO the
  following model
• EBDM ß0 ß1 PERTRE ß2 RECUL ß3 CONTU
  ß4 LnTSAC ß5 ACQUEF ß6 RECAPO ß7
  COLREC ß8 IMPRES ß9 GEND ß10 MOSDEG
  ß11 STATOR ß12 RADIC ß13 LnORSIZ ß14
  LnTSR e
• Where,
• ßi (i 0.14) are the coefficients to estimate.

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Conclusion

• Most of our hypothesis had been verified
• Particular results
• Radicalness of knowledge (Negative impact)
• Organization size (NS)
• We confirm that EBDM is a behavior that is
  determined by Self-efficacy and TIB components

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Practical implications

• At the individual level
• Education PhD/MSc
• Gender
• Research activity and culture
• Networking (diversified)

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Practical implications

• At the organizational level
• A global strategy for EBDM improvement among
  Decision Makers
• An integrative cultural (individual and peers
  valuation of research and EBDM, research culture)
  and structural (Work time management,
  collaborative research, resources for KT,
  impacts assessment) strategy

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Future researches

• What strategies had been judged to be effective
  and efficient in order to achieve a pragmatic
  change in favour of EBDM ?
• What are the effective and efficient
  organisational modalities to implement in order
  to provide a framework favouring EBDM in health
  care?
• What are the challenges that are to be confronted
  while striving to enhance the EBDM behaviour
  health care?

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Take home messages

• EBDM is an individual behavior that has to be
  supported by organizational structure and culture
  of KT/KU
• Determinants of EBDM are different depending on
  organizational level specific strategies and
  incentives has to be developed
• Three transversal determinants Time spent on
  evidence acquisition, Relevance of research for
  daily practice (adequacy and ready to use), and
  Researchs impacts (practice, services)

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Thank you for your attention

• For further information, would you please
  contact
• jalila.jbilou_at_fsa.ulaval.ca