National Drug Strategy
National Drug Strategy

Intergovernmental committee on Drugs working party on Fetal Alcohol Spectrum Disorders

Monograph

Fetal Alcohol Spectrum Disorders in Australia: An Update

June 2012

8.6 Dissemination and Knowledge Transfer

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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

Organisational interventions
11. Record and office systems
12. Multi-disciplinary collaborative approaches
13. Alternative care approaches
14. Continuous quality improvement

Other interventions
15. Mass media
16. Multi-faceted interventions

The strongest strategies for effectiveness in achieving professional practice change was for: For accessibility requirements this table is displayed in HTML. For the table version, please view the PDF.

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 : As appreciation and understanding of FASD and its causes and consequences is still a relatively recent phenomenon, a comprehensive set of strategies will be required to bring about change in health and human services workers and the service delivery systems in which they function. Such a comprehensive strategy should include, but extends well beyond, provision of training. Encouragingly, there is increased interest is issues pertaining to child protection and parenting in general in the community and by relevant service sectors. Dealing more effectively with FASD is therefore likely to be more positively received than was previously the case. Nonetheless, to successfully tackle this issue there are crucial impediments related to stigma and negative and punitive attitudes must also be addressed.

Key points

* Copies of the three documents in this series are downloadable from the NCETA website.
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