Processes and mechanisms for
contextualizing scientific evidence –
Moving from HTA to HTPA?
Véronique Déry MD MSc, Sylvie Beauchamp PhD,
Reiner Banken MD MSc, Lise-Ann Davignon MSc
From Evidence to Policy To Practice.
2006 CCOHTA Invitational Symposium.
Ottawa, April 3, 2006.
Outline
• The Canadian Health Technology
Strategy
• Concepts, processes and tools for
contextualizing scientific evidence at
AETMIS
• An understanding of HTPA
• Conclusions
The Canadian Health Technology
Strategy (HTS) 1.0
• HTS 1.0 proposes moving beyond the
traditional notion of HTA.
• Traditional HTA focuses on providing
evidence to support policy decisions (…)
• A wider spectrum of evidence is required
commensurate with the true broad nature of
policy development.
• An HTPA process is specific to a jurisdiction.
• Each jurisdiction needs structures to (…)
contextualize the products of HTPA to its
environment (…)
What is in a context?
Context
Etymology: Middle English, weaving together of
words, from Latin contextus connection of words,
coherence
1.the parts of a discourse that surround a word or
passage and can throw light on its meaning
2. the interrelated conditions in which something
exists or occurs
Merriam-Webster Online Dictionary http://www.mw.com/dictionary/context
Contextualization in
HTA: A definition
Scientific method that brings forward the
different perspectives of key informants
on components of a context to construct
a multidimensional representation of the
issues involved.
Source : Adapted from Mucchielli A.Dictionnaire des méthodes
qualitatives en sciences humaines et sociales.Armand Colin. Paris,2005.
Concepts of contextualization
practice at AETMIS
Contextualizing assessments
Literature
Formal and Informal
Interactions with
Stakeholders and
Decision-makers
Literature Review
and Critical Analysis
Contextual data
Defining / Refining the Assessment
Question (s) and Dimensions
Context
The scope of contextualization
Interdisciplinary
Approach
Issues in
decision-making
Multidimensional
Perspective
HTA QUESTIONS
Scientific
Analysis
Conclusions
Context
Analysis
Recommendations
ContextualizationThe new kid on the block
Scientific evidence and
contextualization as the building
blocks of the assessments at AETMIS
SCIENTIFIC ANALYSIS
• DIMENSIONS
- Technical performance
- Efficacy
- Effectiveness
- Safety
- C/E, …
• APPROACHES
- Search strategy
- Inclusion/exclusion
- Level of evidence
- Quality of evidence,…
Can it work ?
CONTEXTUALIZATION
• DIMENSIONS
- Feasibility
. Acceptability
. Capacity
. Compliance
- Implementation (costs, consequences,…)
• APPROACHES
- Determination of internal DM context
- Determination of external DM context
. Jurisdictional
. Extra-jurisdictional
Does it work ?
Should we do it?
How should we do it?
Source : AETMIS, 2006; Dobrow MJ et al. Social Science and Medicine 2004; 58:207-217.
The building blocks of
contextualization
INTERNAL DECISION-MAKING
(DM) CONTEXT
EXTERNAL DECISION-MAKING
(DM) CONTEXT
• Purpose/Objectives of DM (Why?)
• Structure of DM process (Who?)
• Process used for DM and role of
actors (How?)
• Position of actors (status, DM
influence, beliefs,…) (How?)
JURISDICTIONAL
• Disease pattern specific
• Stakeholder specific (actors,
influence, position, practices, norms,
values,…)
• Economic, legal, ethical, political,
organizational, social issues
•
•
EXTRAJURISDICTIONAL
SCIENTIFIC CONTEXTUALIZATION
ANALYSIS
Source : AETMIS, 2006; Dobrow MJ et al. Social Science
and Medicine 2004; 58:207-217.
Principles of contextualization
–Each key informant has his own definition of the issues.
–The context can be assessed according to elements judged to
be relevant.
–Methods of qualitative research allow to understand without
explaining.
–Previous context knowledge determines the exhaustivity of data
collection.
–Data triangulation allows a synthesis of divergent and
convergent definitions.
–Deliberation to attain consensus is not essential, could even be
detrimental…
–The multidimensional representation allows to formulate
recommendations that take into account the overall situation.
Sources : Mucchielli A. Dictionnaire des méthodes qualitatives en sciences humaines et sociales
Paris, Armand Colin; 2005. Leys M. International Journal of Technology Assessment in Health Care
2003; 19(2):317-329.
Continuum of informal data,
contextualization and qualitative
research
Informal
data
Contextualization
Qualitative
Research
Qualitative Methods: rigour,
coherence, data collection,
validation
Diversification
of perspectives
Consensus and
saturation
Differences between qualitative
research and contextualization
Approach
Characteristic
Qualitative
Research
Contextualization
Production of new
knowledge
Informing a
multidimensional decision
Selection of
key
informants
According to the research
question
According to the
assessment question, the
context of HT use, and
the imperatives of
decision-making
Analysis
Qualitative linked to the
Qualitative linked to the
assessment question and
research question and the
the constitutive elements
theoretical framework
of the context
Expected
results
Saturation point of
information
Objective
Diversity of perspectives
Similarities between contextualization
and qualitative research
Characteristic
Similarity
Rigour
According to same quality
standards*
Coherence
In all steps of the process
Data
Validation
(i.e., credibility, transferability,
dependability, confirmability **)
Most analysis done with words
(i.e., beliefs, opinions, representations,
expressed needs, …)
Interjudge and triangulation
* Different quality assurance (QA) frameworks exist and are used according to specific needs.
**As an example, some QA standards are presented. Source : Leys M. International Journal of Technology
Assessment in Health Care 2003; 19(2):317-329.
Documenting interactions:
A first step for
rigorous contextualisation
Tool for contextualization :
the record of interaction
Objectives:
• To document the process of
contextualization
• To log the decisions made by the
HTA practitioners (milieu, key
informants, methods)
• To plan the next steps of
contextualization
Tool for contextualization:
the record of interaction
•
•
•
•
Date of event/date of entry
Description of key informant
Objectives of interaction
Methods of data collection
–
–
–
–
Informal meeting
Semi directed interview
Field observation
Other
• Summary
• Next steps
• Name of assesser(s)
Source : Adapted from Miles MB. Huberman AM, Analyse des données qualitatives.
Éditions du renouveau pédagogique. Bruxelles, 2003.
Moving from HTA to HTPA ?
Decision-making
Systematic
Review
Contextualization
Field
Evaluation
Outcome
Research
Health Technology
Policy Analysis
Conclusions
• Scientific credibility of an HTA (HTPA) depends on the rigour
of its scientific processes.
• Social credibility of an HTA (HTPA) relies on proper
contextualization.
• While not feasible for all HTAs (HTPAs) notably because of
time constraints due to decision-making timelines,
contextualization contributes to the perceived relevance and
utility of HTA (HTPA) (in Quebec).
• Contextualization shares common grounds with qualitative
research in terms of its methods and approaches for
assuring rigour, coherence, validation, …
• Contextual validity should be an important methodological
issue in HTA (HTPA) as is analytical or clinical validity.
• Contextualization, combined with systematic reviews, field
evaluations and outcome research, could form the basis of
the newer concept of HTPA in Canada.
Agence d’évaluation des technologies et des modes
d’intervention en santé
2021 Union Ave., Suite 1040
Montréal (Québec)
H3A 2S9
www.aetmis.gouv.qc.ca