1. A social network analysis to study the implementation of a knowledge translation intervention in a Canadian public health department Reza Yousefi Nooraie, Maureen Dobbins 1

2. The complexity of evidence-informed decision-making in public health the quality of evidence community views social and political pressures organizational constraints 2

3. The importance of social context the effect of KT interventions could not be determined without considering the impact of context (LaRocca 2012) Social networks as opportunities and constraints – access to resources – collaboration and partnership – social influence – social norms 3

4. Local opinion leaders (OLs) someone who is able to informally affect others’ attitudes and behaviours in a desired way is earned as a result of competence, accessibility, trustworthiness, and conformity to social norms. A sociometric (network) approach to identifying opinion leaders 4

5. Study context An organization-wide KT intervention in three public health departments in Ontario varied in size, complexity, and their commitment and types of policies for implementing EIDM. 5

6. Tailored KT intervention knowledge broker (KB) mentoring of small groups through the EIDM process workshops one-on-one consultation and support 9-10 months 6

7. Social network survey (baseline/follow-up) -Identify up to 5 staff in health department: Information seeking: to whom you regularly turn to get help incorporating research evidence to inform practice Expertise recognition: who are experienced and knowledgeable in finding research evidence and translating it into practice Friendship: whom you consider as your personal friends 7

8. highly engaged: Intensively involved in KT intervention – based on KB journal, attendance lists of workshops, and online survey Opinion leaders (OLs): the highest quartile of centrality in information-seeking and expertise recognition networks Highly engaged OLs 8

9. Mixed-effects model DV: Change in evidence-based practice implementation scores (Mazurek Melnyk 2008) over time IV: – highly engaged in KT – seeking information from a highly engaged peer – seeking information from a highly engaged OL 9

10. Change in EBP implementation behavior scores 10 Highly engaged seeking information from a highly engaged seeking information from a highly engaged OL Change in behavior over time nnn-0.8(0.5) nyn-0.1(1.3) nyy2.3(1.1)* ynn1.0(2.0) yyn-1.0(2.8) yyy4.1(1.4)** Not engaged in KT intervention, influenced by highly engaged OLs small cohesive group of highly engaged OLs

11. Department A EIDM a strategic priority and committed resources Managers and project specialists were requested to engage 18 Rapid Reviews KB facilitated Critical Appraisal Clubs Regular meetings 11

12. Department A (n=268) 12 47 highly engaged (18%) 17 highly engaged OLs (36%) managers and project specialists also central in friendship network

13. Improvement in EBP implementation scores 13

14. Interpretation The highly engaged opinion leaders improved the behavior of their peers Opinion leaders who were highly engaged in KT, improved their behavior if they shaped a dense social network among themselves 14

15. Recommendations engagement of opinion leaders role definition Continuous nature of the intervention formation of communities of practice 15