Intergovernmental committee on Drugs working party on Fetal Alcohol Spectrum Disorders
Fetal Alcohol Spectrum Disorders in Australia: An Update
8.6 Dissemination and Knowledge Transfer
To achieve the above wide ranging changes to individual workers and organisational and systems responses is a large and complex task. The introduction of any new area or innovation is challenging, as noted earlier. Underscoring this challenge is evidence that indicates that transfer of knowledge and best practice into organisations is often slow, costly and prone to failure, with approximately 70 percent of all change programs failing after initiation (By 2005).
To identify the evidence of the most effective means by which to facilitate the uptake of new innovations, the National Centre for Education and Training on Addiction (NCETA) has undertaken a systematic review of the research on different strategies used to improved practice (Bywood et al. 2008)*. We examined research evidence on the effectiveness of the 16 different strategies shown in Table 8.1.
Table 8.1 Types of strategy used to improve practice (Bywood et al. 2008)Professional interventions
1. Educational materials
2. Local consensus processes
3. Educational meetings
4. Educational outreach (academic detailing)
5. Local opinion leaders
6. Patient-mediated interventions
7. Prompts and reminders
8. Audit and feedback
9. Financial incentives
10. Electronic educational sources
11. Record and office systems
12. Multi-disciplinary collaborative approaches
13. Alternative care approaches
14. Continuous quality improvement
15. Mass media
16. Multi-faceted interventions
The strongest strategies for effectiveness in achieving professional practice change was for:
- 1. Interactive educational meetings
- 2. Educational outreach visits
- 3. Prompts and reminders
- 4. Audit and feedback.
These strategies have applicability in the upskilling of workers and associated systems change in relation to FASD. Strategies 1. (interactive educational meetings) and 2. (educational outreach visits) involve interaction between the worker and a change agent and also on-site sessions. Strategies 3. (provision of prompts and reminders) and 4. (auditing and feedback) address organisational issues and require changes to the operating systems to ensure that workers are able to implement the new knowledge they have acquired or the new practice regime. For example that might involve in this context a reminder to assess all new pregnant mothers for risky drinking.
In much the same way that there is a range of factors that predispose, precipitate and perpetuate risky behaviours among individuals, similar factors operate in regard to professional practice. Change is complex and requires a multi-level approach that incorporates not just training for individual workers but also a raft of broader systems change components to address the full range of barriers and stigma associated with FASD.
NCETA has recently examined the theories which underpin professional behaviour and organisational change (Bywood et al. 2008). While no theory fully or adequately accounts for the change process, the Theory of Planned Behaviour (TPB) contains elements that may be of value in the present context (Ajzen 1985). TPB defines the behaviour of interest in terms of the target, action, context and time. For example, if the behaviour of interest is to persuade practitioners to advise women to stop drinking alcohol during pregnancy, then applying the TPB would involve :
- Target - general practitioners / obstetricians
- Action - advise pregnant female patients to stop drinking
- Context - during a routine visit
- Time - in practice hours.
- Alcohol is the most popular and widely used psychoactive substance in Australia and plays a significant role in a wide range of social activities. One of the largest social changes that has occurred in recent years relates to the increased similarity in patterns of alcohol use by men and women.
- Changes in drinking behaviours have occurred in the broader context of a large number of changes in the social and cultural norms for young people, particularly among young women.
- To be effective, interventions and prevention strategies for FASD need to consider the well established nature of drinking patterns, and the social and symbolic significance of alcohol in young women’s lives.
- Evidence suggests that uptake of new knowledge and best practice into organisations is often slow, costly and prone to failure. The most effective strategies to achieve change in professional practice are: interactive educational sessions; educational outreach visits by FASD experts; prompts and reminders; and auditing of organisational systems to ensure clinicians are able to implement new knowledge and provision of feedback to clinicians and services.
- Training of health professionals is essential to achieve better prevention and intervention responses to FASD; however, a raft of organisational changes are also required if strategies are to be successful. These changes face a range of barriers, which may be found across a variety of areas, including resource availability, policy approaches, and the political, practice, social and educational environments in which change must take place.
- Finally, crucial impediments to change relate to stigma and to negative and punitive attitudes surrounding problematic alcohol use and FASD. These should also be addressed.