Hello, this is Peter Levesque. Welcome to episode ten of the Knowledge Exchange Podcast. This podcast series is a product supported by the Canadian Council on Learning – Canada's leading organization committed to improving learning across Canada and in all walks of life. I want to thank the great staff at CCL for their efforts with this project to advance our understanding of effective knowledge exchange to improve the learning of Canadians. You can download this episode, as well as one of the ten future episodes in the series from my website at www.knowledgemobilization.net, from iTunes directly, just search for KM podcast. Alternatively go to knowledgeexchange.podomatic.com.
HIV/AIDS is an area of health recognized as a leader in moving research results into practice and policy. Increasingly, people like Dr. Robb Travers are helping to further transform organizations that have been funders of knowledge creation into active knowledge mobilizers. This interview provides great insight into the internal and external challenges of becoming an agency of knowledge mobilization; the rewards and challenges and the personal benefits for those involved. Robb is a man who inspires others to move forward; as we learn, we live, is the lesson I take from this conversation.
Peter: I'm here at 1300 Young Street in Toronto with Robb Travers. Rob why don't you introduce yourself – tell us a little bit about what you do? Robb: Okay. I'm Robb Travers, I work here at the Ontario HIV Treatment Network which is an organization that's funded by the Ontario Ministry of Health and Long Term Care to do a number of things that…we have a long mission statement but I'll break down what it is that we do and then talk a little bit about how I fit into that and how that's actually shifting and how that's timely for this interview actually. So essentially we're an organization that, over the last several years has transformed itself from being simply a funder of HIV research to being much more of a knowledge mobilizer – an organization that still principally funds research but also helps to build partnerships and create opportunities for exchange of knowledge between various stakeholders that work in the HIV field. In the HIV sector, community people are, I think at the very forefront of everything that we do. And by community people, I primarily mean people living with HIV and communities at risk and organizations that work for them and on their behalf. A lot of what we do and what I do in my job is forge and build partnerships between community people and researchers. My position title is Director of Community Based Research and I'm also a research scientist on staff so I spend about 50% of my time actually doing research that's community based – so where we see community people, academics and increasingly policy makers at the table in different studies focused on various marginalized communities that might be at risk of HIV. So I work with people as diverse as people living with HIV to…a couple of new studies that we're building right from the ground up that are focused on Muslim people in greater Toronto, LGBT newcomers. I work on research with transgender people, sex workers, a variety of very marginalized populations.
Peter: Okay.
Robb: And then the other 50% of my time is…so that's actually doing research…the other 50% of my time I help…I do….I build partnerships and in the last couple of years I've been involved in some very important endeavors related to knowledge dissemination like the development of the CBR newsletter that was focused on the HIV field – some Think Tanks that were focused on different kinds of populations. And then as an organization we're year two of a five year strategic plan – we're now shifting in the directions of really ramping up KTE initiatives and figuring out how do we re-jig programming to make sure that stakeholders of various sorts, get the information they need to make decisions better? Peter: So that's fundamentally what knowledge exchange is about and that's why I wanted to talk to you about this and one of the ways that CCL has been talking about knowledge exchange and knowledge mobilization is bringing people and evidence together to influence behavior. Robb: Yep Peter: How is that working out in the AIDS/HIV world? Robb: So when I think about this new framework that we're implementing in the organization – it's a knowledge-to-action framework. Peter: Okay Robb: And we're looking at building on working on the Canadian Health Services Research Foundation – we're looking at everything we do and we're looking that the acquire-assess-adapt and apply framework that they use. We did a study of aids service organizations in Ontario; looking at their capacities for knowledge uptake especially across those four domains and found that most of what they can do, is really at the acquire and assess level and most of probably funding, and what we've been doing has been at that acquire and assess level as well. So over the last couple of years we've been really critically thinking and especially over the last 6 months about how do we do things differently that bring people together in different kinds of scenarios where more the adapt and apply stuff can start to happen. So that means looking at things like our annual research conference for example, where we bring together 600 stakeholders mostly from Ontario but often from other parts of Canada, together to showcase research that we support and we fund and increasingly we're shifting the focus of that conference to offer not only your standard kinds of push or dissemination activities like oral abstract sessions but this year we're looking at doing things like research cafés for example where's there's ten or twelve different subject areas or topic areas that we're going to have key discussions that are being lead by experts in those different fields. So that might be something on gay men's interventions or microfinance for HIV positive people. We're looking more and more at the success of Think Tanks that we've pulled together over the last 2 years we've had I think 3 or 4 - one on needle exchange programs and one on mental health, one on housing. And at those Think Tanks, we invite literally a hand-picked audience of about 60 people from Policy, Service, Research and consumer stakeholder groups and bring them together – so let's take mental health for an example, there's a problem in the mental health and addictions sector in the HIV sector where if you're a person living with HIV who has an addiction, you're bounced back and forth between various sectors. They don't talk to each other right so decisions are being made about you here and being made about you here - you're making decisions about yourself as a consumer but where to go?... but nobody's actually talking to each other in those sectors. So the goal of that Think Tank was to pull together all of these stakeholders to get them talking about how do we provide better services – how do we build bridges between these 2 sectors – provide better services, effect policy change and actually get some research off the ground that can address some of the needs that people have whether it be health services research looking at how we can better organize services in some particular areas or barriers to services in another area or actually looking at testing out some interventions, you know that could work with various people.
So everything we're doing, we're kind of standing back, I would say with this KTE critical eye and saying “So what, what's changing? Is anything changing? Is anybody actually using what we produce or help to produce to actually make decisions for people?” The other thing that we're that I think that's kind of…it's quite innovative I think, yet in some ways it's very simplistic and reasonable is a funder we're starting to say to the people that we support, “what practical application does your work have for people on the front lines?” So you know the whole standard way of doing a research poster or an oral abstract, background, methods, results, findings…we've shifted that now to what was the problem? What did we do? What did we find and what are the implications for policy and practice?
So we have this kind of new thinking about how to do all of these things that fits into this knowledge-to-action framework and I think it's new for us - it's interesting to watch the shift as an organization in terms of cultural shift so we have some new staff that have joined – a couple are KT coordinators – one's a Director of KT, one's a manager there. All have come on in the last let's say…well summer's still coming on…last 2 to 4 weeks. So there's this kind of cultural shift happening where we're now starting to say “well you know community based research won't be this giant focus anymore, it will be one tool of KTE”. It won't be an entire focus of the organization anymore - it's developing into this big focus ….this shift. Peter: So what supporting that? One of the things that I've heard in the conversations with other people is that when you have this shift, for the shift to be successful you need sets of incentives to affect behavior and then you need an infrastructure to kind of support it. What does that look like in this context?
Robb: People need information to make decisions right?
Peter: Right.
Robb: Whatever stakeholder role they're playing, whether it's a policy maker, service provider, a person living with HIV and we know that evidence isn't always what's used to make the those decisions. So…I'm struck by people who've told me they work at the AIDS Committee of Toronto – I'll use that AIDS Service Organization as an example - a phenomenal organization that does incredible work – they have the largest publicly funded AIDS library in North America – 2 full time staff librarians – a dream come true for somebody who's working in HIV research right? People in the organization though – and this may have changed but this was about a year and half ago that I had this conversation – actually don't use the stacks – they don't use their journal stacks in the organization. So they're doing counseling and prevention work based on some other kind of knowledge base which is probably a valid knowledge base – it could be based on lived experience or what they're seeing on the front lines but they're not using evidence, you know that kind of hard core evidence that we think about in the research to inform the program. Peter: Well expand about that because that's actually one of my questions is when you hear the word “evidence”, when you use evidence, what do you mean? Robb: Well, there's what it means and what I'd like it to mean – there's a difference. What it means globally, when I think of it – we had this discussion yesterday, one of my colleagues and I where he wrote in a funding application that we're going to use…scientific…the advantage of this grant is it's going to have scientific data plus personal experiences and I said, “What's the scientific data?” and he said, “Well the quantitative survey data” and I said, “What's the personal experiences?” And he said “well the qualitative data” and I said “Isn't the qualitative data the scientific evidence as well?” So we ended up having this big philosophical discussion about what is knowledge and it was based largely on this kind of difference between what our own personal opinions might be as researchers versus what policy makers might seek out in determining the credibility of different forms of knowledge. So I look at is as, in the field that I work in, the kind of the wisdom that's brought from the front lines, the wisdom that's brought from lived experience comes together with the tools we bring as researchers and if we can find methods to actually illuminate that and bring it together to something that's meaningful and coherent and has some kind of change purpose to it, to me that's evidence – that's sound evidence. Peter: Okay.
Let me make a jump between evidence and knowledge exchange, and knowledge-to-action to the concept of lifelong learning. Learning about how to cope with HIV is critical to extend your life and so the concept of lifelong learning in this context is really interesting.
Robb: yep Peter: The Canadian Council on Learning has been trying to create a context and a culture of lifelong learning. In this environment, what does that mean?
Robb: In HIV?
Peter: Yep.
Robb: For somebody living with HIV if I were to speak on their behalf… Well HIV is very interesting and pre-Vancouver 1996 the International AIDS Conference – as some people call it the Proteus moment, where all of a sudden there was hope on the horizon. It was the first time at an international conference when we were talking about you know what, we may actually be, not close to a cure, but we may be close to a pathway that could see AIDS going from this acute illness to something that was more a kin to a chronic manageable illness.
And so people living with HIV had to live with almost this reconstruct of put their lives or put them back together and go from thinking, I'm an individual dying, to I'm an individual who will likely live 20 or 30 more years depending on my social circumstances. So we also know pretty well from research that if somebody living with HIV is chronically unemployed or living in poverty or is a new immigrant or is from and endemic country or experiences other kinds of social exclusion or racism, their lifespan is going to be affected and their quality of life during that lifespan is going to be adversely affected as well. In terms of lifelong learning I think there was this drastic shift from how do I die with dignity and with this illness to how do I live with something that's chronic and that's going to be quite challenging over time and how do I become a consumer of knowledge. So one of the things that strikes me about people with HIV when I think about lifelong learning and knowledge, is just how wise they are and how much knowledge they take in and how connected they are to these networks of knowledge.
Often it could just simply be a group of peers that see the same infectious disease specialist or see the AIDS doc but they talk to each other. They talk to each other about the efficacy of new treatments and how long they'll last and this kind of testing and that kind of testing. I'm amazed actually - I think it must be at times a nightmare being a physician in those scenarios where you have to respond to what actually is a fairly sophisticated group of consumers when it comes to learning and demanding and wanting knowledge – there's a hunger for it. Peter: The learning process that they engage in as individuals and then collectively as this community of people that are dealing with some of the same issues is really is…quite powerful because as they learn they live.
Robb: Yes. What it's also done though - just building on what you're saying – is it shifted the way we provide services and think about service. So we don't think about service anymore in this field as a psycho-social counseling for people – that happens of course it does – it's not the primary game anymore and before it was – it was kind of counseling people toward death and doing prevention oriented work for people that were still HIV negative. Now service has become about giving people knowledge.
Peter: Okay Robb: Getting them knowledge to make decisions about their health.
