How to cite this article: Olvera-Blanco MA, Moreno-Monsiváis MG, De la Garza-Salinas LH. Knowledge transfer for STI / HIV/AIDS prevention among adolescents. Rev Med Inst Mex Seguro Soc. 2015 Nov-Dec;53(6):742-8.
Received: April 22nd 2014
Accepted: July 13th 2015
María Antonieta Olvera-Blanco,a María Guadalupe Moreno-Monsiváis,b Laura Hermila de la Garza-Salinasc
aHospital Ángeles Valle Oriente
bFacultad de Enfermería, Universidad Autónoma de Nuevo León
cCoordinación Delegacional de Investigación en Salud, Instituto Mexicano del Seguro Social
Monterrey, Nuevo León, México
Communication with: María Antonieta Olvera-Blanco
Telephone: (81) 8368 7777, extensión 7703
Background: The transfer of knowledge is a crucial process for the functioning and continuation of training programs. The aim of this study was to determine how the transfer process works for the program JUVENIMSS and the factors that relate to the transfer of knowledge.
Methods: The study design was correlational, involving 122 health professionals. The Scale for the Measurement of Implementation Components was used. To analyze descriptive statistical data, overall index, instrument subscales, Kolmogorov-Smirnov goodness-of-fit test, and correlations were used.
Results: The average age of the professionals involved in the program was 37 years (standard deviation n = 10.5), with a predominance of females (84 %), and 48 % social workers. Knowledge transfer for the prevention of STI / HIV / AIDS among adolescents is correlated with administrative support, administrative personnel management, leadership, training, supervision / technical support and performance evaluation.
Conclusions: Knowledge transfer showed areas of opportunity that should be considered by decision-makers to promote the implementation and continuation of preventive programs to prevent risky sexual behavior among adolescents.
Keywords: Knowledge, Sexually transmitted diseases, HIV, Acquired immunodeficiency syndrome.
Knowledge transfer is a process difficult to understand, regarding the use of knowledge from scientific advances into practice. Canadian Institutes of Health Research (CIHR)1 say that there are various terminologies to describe knowledge transfer, such as: implementation, dissemination, distribution, use/utilization of research, and actionable knowledge. Regardless of the name attached to the transfer of knowledge, the process seeks to bring scientific evidence closer to the practical grounds which can be used to benefit those most vulnerable to health problems; it is necessary to leave the plane of what is known, to how to do it in professional practice in search of better health outcomes.
According to Fixsen et al.2 and CIHR,3 knowledge transfer takes place in several phases, such as exploration, installation, initial implementation, complete implementation, innovation, and sustainability. For their part Wandersman et al.4,5 through the Interactive System Model, reinterpret the aspects considered in the phases proposed by Fixsen et al.2 and state that knowledge transfer involves three systems, which were considered in this study as theoretical support for knowledge transfer: 1) synthesis and transfer system; 2) support system, and 3) delivery system.
The synthesis and the transfer system refer to the scientific evidence available to be used by health professionals. During this system the level of evidence available for transfer into practice is identified and determined in order to resolve the health needs of the population. In this system, organizational factors play a key role, and it is necessary to inspect or explore aspects of the organization that can positively or negatively influence the transfer of knowledge, such as human resources, administrative support, management by administrative staff, and leadership.4-8
The support system refers to the creation of capacity in health professionals for the implementation of the program.4-7 The support system is given by the general capacity and the specific capacity to transfer the program. General capacity indicates the aspects to improve infrastructure, skills, and motivation of human resources for program implementation; specific capacity is determined by training and technical support.4-7
The delivery system provides guidelines for implementing the program in a specific place, so that people can receive the benefit.4,5 The delivery system is given by the general capacity of the organization and the specific capacity for program transfer. The general capacity of the organization allows the continued operation of the program, which includes the sufficient number of trained personnel and connection with other organizations for its implementation. The specific capacity demands that the personnel involved have the knowledge and skills for implementation, also to assess performance for compliance established under the program.4,5 In order to identify the transfer process in a health program, reference was made to the JUVENIMSS program. This program was launched in 2007 at the national (Mexico) and state level (Nuevo Leon) by the Instituto Mexicano del Seguro Social (IMSS).9
The foundations of this program are based upon Normas Oficiales Mexicanas, clinical practice guidelines, research, and statistics at the national level. The program contains 16 educational sessions lasting an hour per session and includes information related to values, self-esteem, drug addiction, among others; however, for purposes of this study, only the transfer process for three sessions was analyzed, which correspond to STD/HIV/AIDS prevention, and sexual and reproductive health. The sessions are given to integrated groups of adolescents between 10-19 years. Health professionals function to orient adolescents in the prevention of some situations relevant to them such as the risk of sexually transmitted infections and unwanted pregnancies, as well as skills and knowledge about correct condom use.13
This precedent on the JUVENIMSS program shows the information that is given to this population group to reduce risky sexual behaviors in adolescents; however, the transfer of the program has not been analyzed, which is considered necessary to know how the transfer process works in practice and to identify factors that contribute to this process. The interactive system model,4,5 is considered appropriate to explain this process of knowledge transfer for the prevention of STI/HIV/AIDS among adolescents, since it has not been studied by research.
Figure 1 shows the model of the knowledge transfer process for the prevention of STI/HIV/AIDS among adolescents based on the model of the interactive system, which provides a process to better understand how the synthesis and transfer, and support and delivery systems support efforts to bring research results into practice. The relationships are specified below: synthesis and transfer system of knowledge for the prevention of STI/HIV/AIDS among adolescents (KTSHA) and organizational factors directly affect health professionals’ support system for KTSHA, which directly affects the delivery system for KTSHA and influences the results of knowledge transfer for the prevention of STI/HIV/AIDS among adolescents.
Figure 1 nowledge transfer process model for STI/HIV/AIDS prevention in adolescents
This study had the following proposed objectives: 1) To determine how knowledge transfer operates for the prevention of STI/HIV/AIDS among adolescents who participated in the JUVENIMSS program, and 2) To determine the relationship between the systems of the transfer model and the results of knowledge transfer for the prevention of STI/HIV/AIDS among adolescents.
The study was quantitative with a correlational design, conducted during the period from June to October 2013. The population of interest was healthcare professionals of the IMSS health units participating in the JUVENIMSS program. It was a census sample equivalent to 122 health professionals who provide program sessions in 23 health units in Monterrey, Nuevo Leon, and its metropolitan area, whose sociodemographic characteristics are presented in Table I.
|Table I Sociodemographic characteristics of participants|
|Intern (dental surgeon and medicine)||6||5.0|
|Other (general nurse and Bachelor's degree)||6||5.0|
|Experience with adolescents|
|Enjoy working with adolescents|
|More than 2 years in JUVENIMSS program|
|I do not know||25||20.5|
|n = 122|
Data collection was performed through the Implementation Components Measurement Scale.10 It consists of 91 reagents, an example of which is "Did you receive training to participate in the JUVENIMSS program?" The response scale ranges from 1 = strongly disagree to 7 = strongly agree. It contains eight subscales such as human resources, administrative support, management by administrative personnel, leadership, training, supervision/technical support, performance evaluation, and knowledge transfer. The analysis of the internal consistency of the scale presented Cronbach's alpha coefficients between .79 and .91.11 For the present study, overall alpha focused on .90; alphas for each subscale of the instrument ranged between .64 and .95.
To conduct this study, approval was requested from the Research Ethics Committees of the Facultad de Enfermería of the Universidad Autónoma de Nuevo Leon, Mexico, as well as authorization from IMSS. Participants signed informed consent, and it was made sure that the physical space had privacy to fill out the previously mentioned documents.
For data analysis, SPSS version 17.0 was used to obtain descriptive statistics for the sociodemographic characteristics and variables of the study. Frequencies and percentages were used for categorical variables, and average, median, standard deviation, and confidence interval for continuous variables. Subsequently, global index and subscales of the instrument were made; each subscale has a minimum score of 0 and a maximum of 100; a higher score reflects greater adherence to the transfer process established as ideal. The distribution of variables was determined through the Kolmogorov-Smirnov goodness-of-fit test, and correlations were made between study variables (human resources, administrative support, management by administrative personnel, leadership, training, supervision/technical support, performance evaluation, and knowledge transfer for the prevention of STI/HIV/AIDS among adolescents). The study adhered to the provisions of the Reglamento de la Ley General de Salud en Materia de Investigación.12 At all times the dignity, anonymity, protection, and wellbeing of participants was respected.
The results of this study represent twenty health units that provide the JUVENIMSS program. Program facilitators were all health professionals (n = 122), 84% were female, 50% reported being married. The average age was 37 years (SD = 10.5). The average years of schooling achieved was 17 (SD = 2.2). 48% of participants were social workers, 13% doctors, among others. 57% of professionals reported experience in working with adolescents and 91% said they enjoy working with them, plus other percentages seen in Table I. The index subscales of the knowledge transfer process show higher scores in relation to human resources, training, and supervision/technical support. However, these scores are low when considering that the highest score corresponds to 100. The main areas of opportunity were found in administrative support (M = 46.99, SD = 30.80), performance evaluation (M = 49.30, SD = 30.31), and management by administrative staff (M = 49.30, SD = 31.68); this information is found in Table II.
|Table II Subscale and overall indices of knowledge transfer process|
|Management by administrative staff||49.30||58.33||31.68||43.31||55.29|
|Note: M = arithmetic average; MDN = median; SD = standard deviation; CI confidence interval|
Regarding human resources, it was found that only 9% of the workforce was hired solely to assist in the JUVENIMSS program; as for training, 67% said that it focused on the contents of the program, 62% had the opportunity to model and practice education sessions, 61% reported receiving training to participate in the program, and 21% reported receiving technical support once a week; of this percentage, 53% said that technical support was received in relation to program content. As for support and administrative staff, participants noted as a limiting factor insufficient resources for program development.
To determine the relationships between variables of the knowledge transfer process, Spearman correlation was done, which reported significant associations between the study variables (Table III). The correlations between knowledge transfer for the prevention of STI/HIV/AIDS among adolescents with administrative support, management by administrative personnel, leadership, training, supervision/technical support, and performance evaluation, were found statistically significant (p < .01). However, human resources were not associated with knowledge transfer.
|Table III Matrix of correlations of knowledge transfer process|
|1. administrative support||1|
|2. management by administrative personnel||0.60 *||1|
|3. leadership||0.56 *||0.72 *||1|
|4. training||.18||0.21 *||0.22 *||1|
|5. supervision/technical support||0.39 *||0.46 *||0.50 *||0.63 *||1|
|6. performance evaluation||0.49 *||0.42 *||0.55 *||0.38 *||0.69 *||1|
|7. knowledge transfer||0.60 *||0.65 *||0.75 *||0.24 *||0.53 *||0.56 *||1|
|* p <.05 * p <.01|
Study results helped identify that there are areas of opportunity for successful knowledge transfer for the prevention of STI/HIV/AIDS among adolescents in the JUVENIMSS program. In the process of knowledge transfer, having sufficient and exclusive staff with training previously received for program development proves to be a priority to facilitate the initiation, development, and maintenance of a program.2-5,11,14 However, this study obtained a very small sample of staff who were hired to work exclusively in the JUVENIMSS program. Given this limitation, the rest of the staff working in the unit participated so that the sessions would be provided in educational institutions. Health professionals involved in the program are primarily female (85%), similar to that reported by other reserchers15 who say that women are more participatory in prevention programs.
The participants in this study reported that administrative support, performance evaluation, and management by administrative staff are aspects of low compliance for knowledge transfer. The results showed that there were not sufficient resources to implement the program, which is an area of opportunity for successful knowledge transfer. Also, it is a relevant fact that administrative staff has not cooperated with educational institutions to offer the program with managers, nor have they secured enough resources (human, material, and infrastructure) to initiate and maintain the JUVENIMSS program, affecting program implementation.16,17
According to Ogden et al.,11 these deficiencies can impact both the program and the technical support provided to health professionals. This study found a low percentage of technical support, similar to that reported by Duffy et al.,18 however, findings reported by other authors19-21 were different, with higher percentages in technical support for the proper functioning of the program. This result is related to the insufficient human resources allocated to the program.
The training of personnel involved in the program is another important aspect in knowledge transfer; however, health professionals who participated in this study did not receive sufficient training. Staff should be trained to acquire knowledge and develop skills and abilities to carry out the program, which is consistent with that reported by various authors.4-5,11,14,21-25 Knowledge transfer was found significantly associated with administrative support, management by administrative personnel, leadership, training, supervision/technical support, and performance evaluation, which is consistent with that reported by Ogden et al.11 and Wandersman et al.4,5 However, the human resources variable did not correlate with knowledge transfer, probably because of the small number of professionals hired exclusively to participate in the program.
The results of this study are considered relevant for decision-makers in the JUVENIMSS program and generally for managers in the health area. There is a need to develop an evidence-based clinical practice, for the benefit of the population through better health outcomes; however, greater management of resources by administrative staff is required to allow the evidence to be transferred into practice through programs that can be effectively maintained and sustained for the population.
The results of this study showed knowledge transfer of the JUVENIMSS program for the prevention of STD/HIV/AIDS and its main areas of opportunity, such as providing sufficient staff exclusively involved in the program, having human resources to support training, re-training, supervision, and technical support for staff involved in the program. The literature indicates that an effective knowledge transfer process requires three systems; in this study, these three systems relate as stipulated by the model of the interactive system. The study findings are considered relevant to decision-makers at IMSS. It is necessary to design strategies that facilitate the transfer of knowledge into practice in order to ensure that adolescents participating in the JUVENIMSS program develop preventive measures for STD/HIV/AIDS and behaviors protective of sexual risk.
We thank Dr. Dean Fixsen for authorizing the Implementation Components Measurement Scale and IMSS health personnel for their willingness to carry out this investigation.
Conflict of interest statement: The authors have completed and submitted the form translated into Spanish for the declaration of potential conflicts of interest of the International Committee of Medical Journal Editors, and none were reported in relation to this article.