Trustworthy clinical practice guidelines assist health care professionals in selecting the management options that optimize patient health outcomes. The development of trustworthy guidelines requires the consideration of many aspects and the involvement of multiple contributors, often working in groups. The guideline panel plays the key role in the development process as it is responsible for prioritizing topics that should be covered as part of the guideline effort, formulating questions, reviewing the evidence, developing and agreeing on the recommendations, and endorsing the final guideline document. Ensuring transparency throughout the process by appropriately organizing and documenting panel activities is an essential standard that is used to assess the credibility of a developed guideline and its resulting recommendations. The adoption of conceptual frameworks that systematically guides panel members in their decision-making process (e.g. the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks) can aid in the formulation of methodologically sound recommendations. In this dissertation, I used the example of a guideline on diagnosis and treatment of autism spectrum disorders to describe how rigorous research methods can support guideline panels in the development process from early stages to the formulation of recommendations. In another prominent guideline development effort with the American Society of Hematology, I have identified two steps in the process where panel members may benefit from further support and addressed these gaps by conceptualizing and developing novel approaches. The first approach comprises modelling baseline risk estimates for patient-important outcomes when only surrogate data is available. The second approach proposes a method to estimate decision thresholds for judgments on health benefits and harms using the GRADE EtD framework. While these approaches are tailored to address specific guideline panel needs, guideline methodologists could use the underlying concepts to find solutions to aid guideline panels in other steps of the development process. / Thesis / Doctor of Philosophy (PhD) / Clinical practice guidelines assist health care professionals in selecting management options that can best improve the health outcomes of their patients. The development of trustworthy guidelines is a complex process that requires the contribution of several entities. The guideline panel, which typically comprises different experts (clinicians, patient representatives, experts in research methodologies) plays the key role in this process as it is responsible for selecting the most important questions to address in the guideline, reviewing the evidence supporting an option, agreeing on the recommendations, and endorsing the final guideline document. To ensure that the process of developing guidelines is transparent and that the recommendations are credible, it is important that panel activities are well documented and follow rigorous methods. Structured frameworks, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) approach, have been developed to systematically guide the panel members and to minimize the error that could be introduced while making decisions. In this thesis, I describe the development of an approach and its application for comprehensive guideline development by the Italian National Health Institute, to describe rigorous guideline development and propose two novel approaches to further assist panel members in enhancing their guideline development. The first of these two enhancements to guideline development describes how to derive a modelled estimate of the risk of having certain health conditions when this data is not directly available in the medical literature. The second of the two enhancements is a method to support guideline panels in judging how substantial the desirable and undesirable effects of health interventions are. Both approaches were tailored to fit specific needs but can be adapted to inform the improvement of other steps in the guideline development process.

This thesis explores the transformations of evidence in health research synthesis studies – studies that bring together evidence from a number of research reports on the same/ similar topic. It argues that health research synthesis is a broad and intriguing field in a state of pre-formation, in spite of the fact that it may appear well established if equated with its exemplar method – the systematic review inclusive of meta-analysis. Transformations of evidence are processes by which pieces of evidence are modified from what they are in the primary study report into what is needed in the synthesis study while, supposedly, having their integrity fully preserved. Such processes have received no focused attention in the literature. Yet they are key to the validity and reliability of synthesis studies. This work begins to describe them and explore their frequency, scope and drivers. A ‘meta-scientific’ perspective is taken, where ‘meta-scientific’ is understood to include primarily ideas from the philosophy of science and methodological texts in health research, and, to a lesser extent, social studies of science and psychology of science thinking. A range of meta-scientific ideas on evidence and factors that shape it guide the analysis of processes of “data extraction” and “coding” during which much evidence is transformed. The core of the analysis involves the application of an extensive Analysis Framework to 17 highly heterogeneous research papers on cancer. Five non-standard ‘injunctions’ complement the Analysis Framework – for comprehensiveness, extensive multiple coding, extreme transparency, combination of critical appraisal and critique, and for first coding as close as possible to the original and then extending towards larger transformations. Findings suggest even lower credibility of the current overall model of health research synthesis than initially expected. Implications are discussed and a radical vision for the future proposed.

No curso da investigação criminal, a execução de alguns meios de obtenção de prova pode implicar restrições aos direitos fundamentais do investigado ou de terceiros. As medidas restritivas de direitos fundamentais estão sujeitas a controle de constitucionalidade através da regra da proporcionalidade. Os meios de obtenção de prova são atividades de pesquisa e registro de fontes de provas e elementos de informação úteis para a persecução penal. Durante a regular execução de um meio de obtenção de prova, podem surgir resultados probatórios relativos a indivíduos e/ou crimes excluídos da situação histórica de vida da investigação que legitimou o ato. As fontes de provas e os elementos de informação obtidos durante a execução de um meio de obtenção de prova e que possuem conexão com a situação histórica de vida da investigação são conhecimentos da investigação, enquanto os que não possuem esse vínculo são conhecimentos fortuitos. De acordo com a regra da proporcionalidade, as medidas restritivas de direitos fundamentais devem estar previstas em lei e sua execução exige prévia autorização judicial. A admissibilidade dos conhecimentos fortuitos para fins probatórios depende do cumprimento desses requisitos, sob pena de haver violação ilegítima de direitos fundamentais, tornando a prova ilícita. / In the course of a criminal investigation, the research of evidence may cause restriction to the investigated persons fundamental rights or to a third persons rights. Any fundamental right restriction shall be preceded by constitutionality control, which must be done in the light of the proportionality rule. The evidence discovery is an activity of research and recording of evidentiary source and other useful data for the criminal investigation and prosecution. During the ordinary execution of a research of evidence, it could emerge evidentiary result related to individuals and/or crimes that are not related to the historical situation of life that caused the issuing of judicial authorization for such a research. The evidentiary sources and other information obtained during the execution of a research of evidence that are connected to the historical situation of life that caused the issuing of its judicial authorization are called knowledge of the investigation. The ones which are not connected to it are called fortuitous knowledge. According to the proportionality rule, any investigative measure which causes a fundamental right restriction must be enshrined in a statutory provision and its execution requires prior judicial authorization. The evidentiary admissibility of fortuitous knowledge depends on the accomplishment of such requirements. Otherwise, there would be unlawful violation of fundamental rights, which would cause the evidence to be illegal.

No curso da investigação criminal, a execução de alguns meios de obtenção de prova pode implicar restrições aos direitos fundamentais do investigado ou de terceiros. As medidas restritivas de direitos fundamentais estão sujeitas a controle de constitucionalidade através da regra da proporcionalidade. Os meios de obtenção de prova são atividades de pesquisa e registro de fontes de provas e elementos de informação úteis para a persecução penal. Durante a regular execução de um meio de obtenção de prova, podem surgir resultados probatórios relativos a indivíduos e/ou crimes excluídos da situação histórica de vida da investigação que legitimou o ato. As fontes de provas e os elementos de informação obtidos durante a execução de um meio de obtenção de prova e que possuem conexão com a situação histórica de vida da investigação são conhecimentos da investigação, enquanto os que não possuem esse vínculo são conhecimentos fortuitos. De acordo com a regra da proporcionalidade, as medidas restritivas de direitos fundamentais devem estar previstas em lei e sua execução exige prévia autorização judicial. A admissibilidade dos conhecimentos fortuitos para fins probatórios depende do cumprimento desses requisitos, sob pena de haver violação ilegítima de direitos fundamentais, tornando a prova ilícita. / In the course of a criminal investigation, the research of evidence may cause restriction to the investigated persons fundamental rights or to a third persons rights. Any fundamental right restriction shall be preceded by constitutionality control, which must be done in the light of the proportionality rule. The evidence discovery is an activity of research and recording of evidentiary source and other useful data for the criminal investigation and prosecution. During the ordinary execution of a research of evidence, it could emerge evidentiary result related to individuals and/or crimes that are not related to the historical situation of life that caused the issuing of judicial authorization for such a research. The evidentiary sources and other information obtained during the execution of a research of evidence that are connected to the historical situation of life that caused the issuing of its judicial authorization are called knowledge of the investigation. The ones which are not connected to it are called fortuitous knowledge. According to the proportionality rule, any investigative measure which causes a fundamental right restriction must be enshrined in a statutory provision and its execution requires prior judicial authorization. The evidentiary admissibility of fortuitous knowledge depends on the accomplishment of such requirements. Otherwise, there would be unlawful violation of fundamental rights, which would cause the evidence to be illegal.

La demande de formation en transfert de connaissances (TC) est si importante que les organisations qui offrent de telles formations ont du mal à y répondre entièrement en présentiel. C’est pourquoi une formation en ligne de type Massive Open Online Course (MOOC) a été développée. Elle a pour objectif l’utilisation et l’appropriation du processus de TC par les milieux de pratique, les décideurs et le grand public. L’objectif de ce mémoire était d’évaluer un MOOC d’introduction au TC en recueillant les opinions, les réactions, l’appropriation et les changements de pratique des utilisateurs. L’étude a utilisé un devis qualitatif. Un questionnaire administré dès le début du cours via la plateforme a permis de constituer le profil des participants par le biais de leurs données descriptives, des raisons de leur inscription et de leurs intentions vis-à-vis du cours. Ensuite, des entrevues semi-dirigées individuelles ont été conduites (n = 16) avec des apprenants professionnels ayant complété le cours et étant issus de cinq pays francophones d’Afrique de l’Ouest (Canada, France, Burkina Faso, Mali, Sénégal). Les contenus du MOOC d’introduction au TC ont généralement été appréciés et réutilisés par les répondants. L’analyse des entrevues révèlent un motif principal menant à la complétion du cours : la possibilité immédiate pour les professionnels de valoriser leurs apprentissages dans leurs milieux de pratique. L’étude met en évidence le potentiel des MOOC pour l’acquisition de connaissances et de compétences de professionnels en matière de TC. Cependant, la majorité des personnes soulèvent le manque d’interaction entre apprenants et expriment leur besoin d’accompagnement avec un formateur afin d’approfondir les sujets abordés pendant le cours. Les résultats révèlent également des enjeux de connexion et d’accessibilité du cours liés au réseau Internet et à la stabilité d’accès à l’électricité dans les pays d’Afrique de l’Ouest. Finalement, plusieurs recommandations et pistes d’explorations ont été formulées afin d’optimiser les futures conceptions de MOOC sur le TC. / The demand for knowledge transfer (KT) training has become so prominent in recent years that it made it nearly impossible to do it entirely in person for organizations offering such training. For this reason, a Massive Open Online Course (MOOC) has been developed with the clear objective of providing efficient knowledge transfer, needed for policymakers, practice settings, and the public sphere. The goal of this dissertation was to evaluate a MOOC about KT introduction, by collecting its users' opinions, reactions, appropriation, and changes in practice. A Qualitative study has been conducted, following a thorough questionnaire administered at the beginning of the course in favor of creating profiles of the participants using their descriptive data, their reasons for enrollment, and true intentions toward the course. Individual semi-structured interviews were conducted with 16 users that have completed the course. The interviewees were from five different French-speaking countries (French Canada, France, Burkina Faso, Mali, Senegal). The content of the MOOC has been generally appreciated and reused by its users. The initial results reveal that the main reason for completing the course was the immediate usability of the knowledge acquired from the course in their real work environment. The study highlights the great potential of MOOCs in the field of KT for the efficient acquisition of knowledge and skills. However, most people raise the lack of interaction between learners and express their need for coaching with an instructor to deepen the topics covered during the course. The preliminary results also reveal issues of poor internet connection and lack of accessibility to the course because of the shortfall of electricity in West African countries. To address these issues, several recommendations and avenues of exploration were formulated to optimize and improve the structure of MOOCs for knowledge transfer.

L’utilisation des connaissances issues de la recherche (CIR) est primordiale pour informer les politiques, les interventions et les pratiques en santé, spécialement dans les pays à faible revenu où les indicateurs de santé des populations sont toujours inquiétants. Toutefois, encore peu d’études ont été réalisées pour mieux comprendre comment favoriser le transfert et l’utilisation de ces connaissances, spécialement en Afrique de l’Ouest. La présente thèse vise donc à faire avancer les connaissances en évaluant différentes stratégies de transfert de connaissances (TC) en santé publique mises en œuvre au Burkina Faso dans le cadre du programme de recherche Équité-Santé (2012-2017). Ces stratégies de TC visaient à créer des opportunités d’échanges entre les chercheurs et les utilisateurs potentiels des CIR et ainsi, réduire l’écart entre les connaissances issues de la recherche en santé et leur utilisation. Trois stratégies de TC distinctes ont été étudiées soit 1) un atelier de dissémination de la recherche, 2) un atelier incluant un processus délibératif et 3) une stratégie de courtage de connaissances. Elles ont impliqué une diversité d’acteurs tels que des chercheurs, des décideurs, des professionnels de santé et des représentants d’organisations non-gouvernementales et de la société civile. Une évaluation de la mise en œuvre et des effets a été réalisée pour les deux ateliers et une évaluation des processus de mise en œuvre a été conduite pour la stratégie de courtage de connaissances, étant donné l’arrêt de l’initiative plus tôt que prévu. Les activités d’évaluation ont mobilisé des approches méthodologiques complémentaires et divers outils pour collecter les données (entretiens qualitatifs, questionnaires d’évaluation et observations sur le terrain). Les résultats montrent que les stratégies de TC ont été appréciées par les acteurs car elles ont permis l’apprentissage de nouvelles connaissances et ont représenté une opportunité importante de réseautage afin d’apprendre les uns des autres. Cependant, ces différentes expériences ont mis en lumière plusieurs enjeux tels que le pouvoir décisionnel des acteurs parfois limité, la présence déficiente des décideurs politiques aux activités ainsi que les ressources et incitatifs organisationnels souvent restreints. La présence d’un leadership fort pour assurer une mise en œuvre efficace, le renforcement des relations de partenariat, le développement des compétences en communication et la possibilité d’offrir un accompagnement à long terme aux acteurs représentent également des défis importants pour assurer une mise en œuvre efficace des activités de transfert de connaissances. Davantage d’études sont nécessaires pour mettre en œuvre des stratégies de TC et évaluer leur efficacité. En se basant sur les résultats de la thèse, certaines recommandations générales peuvent être formulées. Par exemple, il apparait important que les stratégies de TC soient en cohérence avec les besoins et ressources des milieux, qu’elles visent le renforcement des capacités et incluent un processus évaluatif en temps réel afin que les stratégies soient adaptées au contexte. En conclusion, la thèse contribue à l’avancement des connaissances sur le TC en santé mondiale en proposant un modèle conceptuel à expérimenter pour guider le développement et la mise en œuvre des stratégies de TC. / The use of research-based evidence (RBE) is essential for informing health policies, programs and practices, especially in low-income countries where population health indicators are still alarming. However, there are still few studies to understand how to improve knowledge translation (KT) processes and research utilisation, especially in West Africa. Thus, this thesis aims to advance the body of knowledge by evaluating different KT strategies in public health implemented in Burkina Faso as part of a research program Équité-Santé (2012-2017). These KT strategies were intended to create exchange opportunities between researchers and potential RBE users and thus reduce the gap between health research knowledge and its use. Three different KT strategies were studied: 1) a research dissemination workshop, 2) a deliberative workshop and 3) a knowledge brokering strategy. They involved a diversity of health system actors such as researchers, policymakers, health professionals and representatives of non-governmental organizations and civil society. An evaluation of the implementation and effects was conducted for both workshops and only an evaluation of the implementation process was conducted for the knowledge brokering strategy, because the initiative came to an early end. Complementary methodological approaches were mobilized during evaluation and different data collection tools were used (qualitative interviews, evaluation questionnaires and field observations). The evaluation results show that stakeholders have appreciated the KT strategies because they learned new knowledge and had a networking opportunity to learn from each other. However, these experiences have brought to light several issues such as the actors’ limited decision-making authority, weak engagement of political actors as well as scarce resources and organizational incentives. The presence of a strong leadership during implementation, partnership synergy, continuous communication skills’ development and long-term support to stakeholder also represent important challenges to assure an effective implementation of KT strategies. More studies are needed to implement KT strategies and evaluate their effectiveness. Based on the results, some general recommendations can be made. For example, it appears important that KT strategies are in line with stakeholders’ needs and resources, facilitate capacity building and include a real-time evaluative process to enable KT strategies to be constantly adapted to the implementation context. In conclusion, the thesis contributes to the advancement of knowledge about KT in global health by proposing a conceptual model to be considered and experimented during KT development and implementation.

En Haïti, la sécurité routière est un problème de santé publique important, causant plus de blessés et de morts que le système de santé du pays ne peut prendre en charge. Afin d’améliorer la sécurité routière, des stratégies de transfert de connaissances (TC) sont nécessaires pour promouvoir l’élaboration de politiques basées sur les connaissances issues de la recherche (CIR). Une stratégie de TC a été élaborée pour partager avec des acteurs clés les résultats de trois récentes études sur la sécurité routière en Haïti. L’objectif de la présente recherche était d’évaluer l’appréciation, le contenu et l’impact sur l’utilisation des connaissances de cette stratégie. L’étude a utilisé un devis mixte, employant deux questionnaires quantitatifs (n = 13/16) deux à trois mois après un atelier délibératif au coeur de la stratégie et des entretiens qualitatifs (n = 12/16) ont été menés sept à neuf mois post-atelier. L’atelier a généralement été apprécié par les participants, notamment pour la qualité des données présentées et pour son approche multidisciplinaire. Cependant, ils ont été déçus par l’absence de décideurs, et par le nombre et la variété limités de parties prenantes présentes. Même si les participants ont rapporté une forte volonté d’utiliser les connaissances présentées, l’atelier a eu un effet limité sur leur utilisation. Cette étude met en évidence le potentiel des ateliers délibératifs intégrés à une stratégie de TC dans les pays à revenu faible et intermédiaire, ainsi que l’importance d’inclure les décideurs dans le processus. Cette recherche aboutie à une série de recommandations pour de futurs ateliers, afin d’augmenter leur impact sur l’utilisation des connaissances et de promouvoir la prise de décision basée sur des CIR. / In Haiti, road safety is an important public health issue, causing more deaths and injuries that the country’s health system can provide for. Knowledge transfer (KT) strategies are needed to promote evidence-based policy-making (EBDM) to improve road safety. A KT strategy was developed to share with key actors the results of three recent studies about road safety in Haiti. The present research’s purpose was to evaluate the appreciation, the content, and the impact on knowledge use by key actors of this KT strategy. This research used a mixed-method design, using quantitative questionnaires (n = 13/16) two to three months following the workshop at the center of this strategy, and qualitative interviews (n = 12/16) seven to nine months post-workshop. The workshop was generally appreciated by participants, especially for the quality of the data presented and its multidisciplinary approach. However, they were disappointed by the absence of decision-makers and by the limited number and variety of stakeholders present. Even though the participants reported a strong will to do so, the workshop had limited effect on knowledge use. This study highlighted the potential of deliberative workshops as a knowledge transfer strategy in LMICs, as well as the importance to include policy-makers in the process. This research also resulted in certain recommendations for future workshops, in the objective of increasing knowledge use and of promoting evidence-based decision-making.