Knowledge Translation

Below is a highly selective list of helpful resources related to knowledge translation (KT). Reading the selection of articles below will give those new to the field a good overview of the key issues in knowledge translation, knowledge utilization and knowledge brokering, from both a high-income and a low-income context.

The pdf for every article can be accessed at the end of the citation <pdf>. Note I have put little commentary here and inserted instead what I felt to be sound quotations from the article. Articles are available here without any permission whatsoever.

Campbell S et al. The Research Matters’ Knowledge Translation Toolkit. International Development Research Centre, 2008. <pdf>

Gives an overview of KT and some of its major techniques, including: involving decision-makers in the research process; knowledge management; context mapping; evaluative thinking; developing communications strategies; print media; creating a two-page policy brief; systematic reviews; open access; the conference 2.0 (organization and presentations); and “tapping technology”. Quotations:

• “What is Knowledge Translation? Reduced to its essence, knowledge translation (KT) is the middle, meeting ground between two fundamentally different processes: those of research and those of action. KT connects the purity of science with the pragmatism of policy, relying upon vibrant partnerships, collaborations and, above all, personal contact between researchers and research-users to achieve more evidence-informed decisions and more decision-informed evidence.”

NOTE: This is the original version of the toolkit. A subsequent version has been produced and may be found via your favourite search engine.

Choi B et al. Can scientists and policy makers work together? Journal of Epidemiology and Community Health. 59, 2005. <pdf>

This is a strong think piece that tells a story and asks incisive questions. Interesting quotations from this article include:

• “evidence-based policy does not always work. For example, it has been reported that many scientists are skeptical about the extent to which research is used, and that many policy-makers are skeptical about the usefulness of research. This is because scientists and policy-makers have different mentalities: for example, their goals, attitudes towards information, languages, perception of time, and career paths differ. The imperatives that drive scientists and policy-makers are also different, along with their production processes and what they consider to be good evidence.

• “researchers search for truth, by using a rational model.”

• “policymakers search for compromise, by using an intuitive model.”

• “the skills required of policy-makers in the future will probably be different because the world of public administration is changing. How about a chief knowledge officer? Each organization needs to manage knowledge as well as it manages its other resources – think of a chief administrative officer or a chief executive officer. Why should a policymaker talk to a scientist who may not even understand the policy question? Just give the chief knowledge officer a call.”

CHSRF. “The Theory and Practice of Knowledge Brokering in Canada’s Health System: a report based on a CHSRF national consultation and a literature review”. 2003. <pdf>

Good overview of the concept of knowledge brokering and how it has played out in Canada. Quotes include:

• “brokering: a process that stimulates the creation of effective new research by linking researchers and users of information early, helping to identify issues, and encouraging all parties to work together on solving problems. Brokering encourages a continuous exchange on many levels – from sharing experiences and searching out existing knowledge to turning management problems into workable questions for researchers to study.”

• “any number of people can be involved in knowledge brokering. It could be an ‘official’ knowledge-transfer worker who includes bringing researchers and decision-makers together as part of disseminating research, a self-starter on the front lines of the healthcare system personally searching out ways to deliver better care, a researcher who takes the trouble to contact administrators either because new findings could improve the system or because she wants to hear about their priorities, or a deputy minister who hires both an analyst to research policy decisions and a communications expert to make evidence more coherent and easy to use.”

Dobbins M, DeCorby K, Twiddy T. “A Knowledge Transfer Strategy for Public Health Decision Makers”. Worldviews on Evidence-Based Nursing. 1: 2, 2004. <pdf>

An excellent study of policy-makers’ needs, based on a large qualitative survey. These needs imply that researchers must pay attention to the variables of:

• “time: any attempt at KT must address significant time issues.

• credibility: decision makers wanted to receive research evidence from sources they considered credible to avoid spending time appraising its methodological quality and merit. Once credibility was established, decision makers were more likely to trust subsequent information received from that particular source. Although the establishment of credibility occurred in many ways, decision makers most often relied on recognizability or familiarity of logos, authors’ names, recommendations of peers, and source of the research.

• reliability: decision-makers strongly supported a KT strategy that provided them with regular updates of new research in their area(s) of interest…decision-makers also indicated that knowing what to expect in terms of the amount of information they will receive was an important component of reliability.

• quality of research information: had to be current and provide a publication date; was framed within the local, provincial or national context; was jargon-free and transparent; reported what worked and what didn’t; listed recommendations ranked in order of effectiveness; included cost analyses.

• timing: decision-makers were more receptive to receiving and using research evidence when it directly related to issues on which they were currently working.

• applicability: decision-makers wanted recommendations for practice and policy clearly spelled out with the supporting research evidence directly aligned with each recommendation… it was important that at least some of the recommendations be focused on policy development or alteration.

• accessibility: access to additional information, such as the full document, had to occur smoothly and quickly to be of use to decision-makers. It was very important to decision-makers that they received information only in their area(s) of interest so that most or all of what they received was relevant to their particular role(s).

• customizability: decision-makers reported using research evidence for the following: cutting and pasting for presentations, passing on to colleagues, printing for their own use, saving and filing electronically, composing a briefing note, or presenting at stakeholder meetings.

• mode of delivery: electronic format was the preference, but there were still instances in which decision-makers wanted a hard copy – for a very long document or when they needed to post/share a piece of information.

• accessibility: continued to be a barrier. For examples, a number of decision-makers indicated they did not have ready access to the Internet and did not have access to other technology such as high-speed printers. In addition, access to librarians…to assist with searching, retrieval and interpretation varied.

• training: desired in knowledge management, critical appraisal skills…also interested in learning how to effectively incorporate research evidence into decision-making and practice by learning more about critical appraisal, organizational change theory and knowledge brokering.

• customization: it will be important to build flexibility into the KT strategy so as to provide decision-makers with sufficient choice and control over the content, format, and delivery of research evidence.”

Ginsburg L et al. Revisiting interaction in knowledge translation. Implementation Science. 2: 34, 2007. <pdf>

Particularly useful in highlighting the social dimension of KT. Quotation:

• “… both research utilization and knowledge translation are highly social processes that are more successful in the presence of positive social interactions between communities. In fact, it is often suggested that relationships and face-to-face contact are more important to effective research utilization than the quality, methods, content of a research study, or its ‘fit’ with a decisionmakers’ expressed need for the research. This has to do with the fact that the determinants of research utilization are often organizational or political, and only rarely rational.

Hammersley M. Is the evidence-based practice movement doing more good than harm? Reflections on Iain Chalmers’ case for research-based policy making and practice. Evidence & Policy. Vol 1:1, 2005. <pdf>

Another good thinkpiece (part of a wider debate) that discusses some of the different elements and definitions of “evidence,” along with some of the limitations of research. Quotations:

• “research cannot supply all the information that practitioners require in order to engage in good practice, and because (as already noted) research findings must always be interpreted and are never free from potential error. Moreover, the various sources of knowledge on which practical judgement relies are often not commensurable; they cannot be ‘weighed’ in terms of the same scale. A more complex process is required; for example, knowledge from personal experience and from new research evidence must each be evaluated in its own terms, and then combined in some way that takes account of their distinctive characteristics as sources of knowledge.”

• “portraying research as showing ‘what works’ can serve as an ideological device that closes down proper discussion about the relative weight that should be given to different…goals. While research can provide evidence about the consequences of various policies, on its own it cannot tell us what is the best thing to do, either in general terms or in particular cases.”

Hammersley M. Is the evidence-based practice movement doing more good than harm? Reflections on Iain Chalmers’ case for research-based policy making and practice. Evidence & Policy. Vol 1:1, 2005. <pdf>

Another good thinkpiece (part of a wider debate) that discusses some of the different elements and definitions of “evidence,” along with some of the limitations of research. Quotations:

• “research cannot supply all the information that practitioners require in order to engage in good practice, and because (as already noted) research findings must always be interpreted and are never free from potential error. Moreover, the various sources of knowledge on which practical judgement relies are often not commensurable; they cannot be ‘weighed’ in terms of the same scale. A more complex process is required; for example, knowledge from personal experience and from new research evidence must each be evaluated in its own terms, and then combined in some way that takes account of their distinctive characteristics as sources of knowledge.”

• “portraying research as showing ‘what works’ can serve as an ideological device that closes down proper discussion about the relative weight that should be given to different…goals. While research can provide evidence about the consequences of various policies, on its own it cannot tell us what is the best thing to do, either in general terms or in particular cases.”

Innvaer S et al. Health policy-makers’ perceptions of their use of evidence: a systematic review.Journal of Health Services Research & Policy. 7: 4, 2002. <pdf>

This is the only systematic review that synthesizes work on the research-policy interface. As a result, it is widely cited. Quotations:

• the most commonly mentioned facilitators of the use of research evidence in policy-making were: personal contact between researchers and policy-makers (13/24); timeliness and relevance of the research (13/24); research that included a summary with clear recommendations (11/24); good quality research (6/24); research that confirmed current policy or endorsed self-interest (6/24); community pressure or client demand for research (4/24); research that included effectiveness data (3/24

• The most commonly mentioned barriers were: absence of personal contact between researchers and policy-makers (11/24); lack of timeliness or relevance of research (9/24); mutual mistrust, including perceived political naivety of researchers and scientific naivety of policy-makers (8/24); power and budget struggles (7/24); poor quality of research (6/24); political instability or high turnover of policy-making staff (5/24).

• “researchers who wish to increase the use of the results of their research should: have personal and close two-way communication with decision-makers; provide decision-makers with a brief summary of their research with clear policy recommendations; ensure that their research is perceived as timely, relevant and of high quality; include effectiveness data; argue that the results of their research are relevant to current policy and demands from the community. They should avoid getting involved in power and budget struggles and be aware of the high turnover of policy-making staff. Of course if the aim is to increase appropriate (direct or enlightening) use of research rather than selective use, these strategies will often not be effective, as well as being difficult to implement.”

Jackson-Bowers E, Kalucy I, McIntyre E. Focus on Knowledge Brokering. Primary Health Care Research & Information Service. December 2006. <pdf>

Another good overview of the concept of knowledge brokering. Quotations:

• knowledge brokers “make connections; they’re trustworthy subject experts with a high level of credibility….they vary greatly in seniority, background and other characteristics. They may be respected and trusted opinion leaders or champions, academics, policy officers, or communications specialists. They may be employed part time or full time, by joint funding bodies, or as consultants. They may be located in an intermediary organization or at the centre of a network. Knowledge brokers can focus their work at network, project, program or issues level. The knowledge brokering role can also include research synthesis, providing research summaries in ordinary language, convening seminars and meetings, maintaining links and networks, maintaining a repository and databases and locating policy-relevant research.”

Lavis J et al. SUPPORT tools for evidence-informed health policymaking (STP) 14. Organizing and using policy dialogues to support evidence-informed policymaking. Health Research Policy and Systems. 7(suppl1), 2009. <pdf>

This is part of an 18 paper series on evidence-informed health policy-making. All papers have great utility for understanding core KT principles and can be found at http://www.health-policy-systems.com/supplements/7/S1. Quotations:

• “in recent years there has been growing interest in identifying interactive knowledge-sharing mechanisms that allow for a bringing together of research evidence and the views, experiences and tacit knowledge of those who will be involved in or affected by future decisions about a high-priority issue. This interest has likely been fueled by a number of developments: 1) the recognition of the need for locally contextualized ‘decision support’ for policymakers and other stakeholders; 2) the recognition that research evidence is only one input to their decision-making processes; 3) the recognition that many stakeholders can add significant value to these processes; and 4) the recognition that many stakeholders can take action to address high-priority issues, not just policymakers.”

• “policy dialogues directly support: 1) interactions between researchers and policymakers (as well as among a broader range of stakeholders who can also take action); 2) the timely identification and interpretation of the available research evidence (when organized on an urgent basis to address a high-priority issue); and 3) the ‘real time’ identification of an accordance between research evidence and policymakers’ (and other stakeholders’) beliefs, values, interests or political goals and strategies.”

Lavis J et al. Evidence-informed health policy: 1. Synthesis of findings from a multi-method study of organizations that support the use of research evidence. Implementation Science. 3:53, 2008. <pdf>

This has particular relevance to the idea of a “knowledge translation platform” – a national-level entity with the aim of brokering ideas, individuals and institutions in the generation, synthesis and application of knowledge. Quotations:

• “seven recommendations emerged for those involved in establishing or leading organizations that support the use of research evidence in developing health policy:

1. collaborate with other organizations: examples from other countries were helpful in establishing their organization; should seek support from similar existing organizations or networks, whether through informal interactions, study tours, mentoring relationships, twinning, partnerships or network memberships; working within national networks, and more generally collaborating rather than competing with other bodies, was a commonly cited strength

2. establish strong links with policymakers and involve stakeholders in the work: high proportion of GSUs involved target users in the selection of topics or the services undertaken; nearly all organizations need to use personal communications with decision-makers; close relationship with policy-makers a strength though also an Ojo: bringing with it the related challenge of managing the conflicts of interest that can emerge in any close relationship between researchers and policymakers.

3. be independent and manage conflicts of interest among those involved in the work: independence is essential; the presence of conflicts of interest is repeatedly cited as one of two key organizational weaknesses

4. build capacity among those working in the organization

5. use good methods and be transparent in the work: though using systematic and transparent methods brings with it a related challenge, namely the time-consuming nature of an evidence-based approach.

6. start small, have a clear audience and scope, and address important questions: the most commonly cited weakness is a lack of resources, both financial and human

7. be attentive to implementation considerations even if implementation is not a remit: less than half of all organizations provided a summary of take-home messages in their products.”

Lavis J et al. Assessing country-level efforts to link research to action. Bulletin of the World Health Organization. 84, 2006. <pdf>

This was (and remains) a highly influential piece on publication, outlining what has now come to be accepted as the four general/theoretical models of KT: push, pull, exchange, and integrated. An excellent read.

Lavis J et al. Working Within and Beyond the Cochrane Collaboration to Make Systematic Reviews More Useful to Healthcare Managers and Policy Makers. Healthcare Policy. 1: 2, 2006. <pdf>

Systematic reviews are emerging as one strong science-based KT tool – for synthesizing and presenting the leading, multidisciplinary thinking on any particular issue or question. Quotations:

• “we offer three reasons for augmenting the stock of investigator-driven systematic reviews with reviews that involve healthcare managers and policy-makers. First, a systematic review of the factors that influenced the use of research evidence in healthcare policy-making identified that individual-level interactions between researchers and healthcare policymakers increased the prospects for research use in policy-making…third, involving managers and policy-makers in the SR could enhance the public accountability of researchers when they derive take-home messages from research, which is a type of accountability that has been noticeably lacking.”

• “researchers who are interested in the methodology of SRs []need to start thinking about:

• evaluating alternative approaches to involving healthcare managers and policymakers in the SR process

• evaluating alternative approaches to addressing the different types of questions asked by healthcare managers and policy-makers, with a particular focus on such issues as the trade-offs involved in allowing the question to change as the SR progresses, drawing a purposive sample of studies…

• evaluating alternative approaches to providing information about the contextual factors that may affect a review’s local applicability

• evaluating alternative approaches to developing user-friendly ‘front-ends’ for reviews, with a particular focus on the optimal structured format for these ‘front-ends’; and

• evaluating alternative approaches for retrieving SRs of health services and policy research and SRs for questions other than ‘What works?’.”

Lomas J. 1997. Improving research dissemination and uptake in the health sector: beyond the sound of one hand clapping. McMaster University Centre for Health Economics and Policy Analysis. Policy Commentary C97-1, November 1997. <pdf>

This is one of the first papers on KT, and it is as relevant and insightful today as it was in 1997. Quotations:

• “the unit of research transfer should rarely be the single study but should, rather, be the summary and synthesis of knowledge across the entire spectrum of stages in the process. Just as decision-makers in the legislative and administrative levels decry premature adoption by clinicians of innovations based on single or limited studies, so too should all decision-makers be skeptical of responding to the findings of a single study emanating from only one of multiple stages in the research process.”

• “legislative decision-makers consist of politicians, bureaucrats and various interest groups engaged in the highly visible process of public policy

• the needs of this audience are mostly related to problem identification, policy ideas, the validity of previous or potential policy assumptions, explication of causal models, and broad syntheses rather than specific studies – what might be termed health policy analysis.

• decision-making at this level is more about defining manageable problems than it is about selecting solutions.

• “administrative decision-makers consist of program managers, regional administrators, executives and board members of institutions, and other more locality-based decision-makers. For this audience the more applied health services research and sometimes clinical research is of use to make their less publicly scrutinized allocational and organizational decisions.

• they are likely to be specialists of some kind in the health care sector…synthesized knowledge around a concrete issue, provided within the time-frame of the decision-process is of most use to them. It is not uncommon for an admin decision-maker to establish a number of trusted contacts upon whom he or she can rely as a source of research information it is needed.”

• “clinical decision-makers consist only partly of the individual practitioners caring for patients. Of equal or greater importance in recent years are all the officials and panel members of specialty societies, third party insurers, and other groups developing clinical guidelines and other ‘directives’ that have become the fledgling legislative framework for clinical practice.

• they have, perhaps, the most circumscribed needs of the three audiences described so far – data on safety, clinical effectiveness, cost-effectiveness, and patient acceptance are of greatest concern to them.”

Lomas J. “Using ‘Linkage and Exchange’ to move research into policy at a Canadian Foundation’”. Health Affairs. 19:3, 2000. <pdf>

This is another formative piece, particularly in its elaboration of the “exchange” element of KT (which has prompted some, notably the CHSRF to adopt the term “knowledge translation and exchange”. This provides a simple, concise overview of the five core components of building in linkage and exchange at the CHSRF: setting priorities;funding programmes; assessing applications; conducting research; and communicating research.

Lomas J et al. “Conceptualizing and Combining Evidence for Health System Guidance”. Final Report. CHSRF, 2005. <pdf>

This outstanding paper provides an overview of deliberative dialogues, the different types of evidence, and steps to sound KT practices at the system level. Quotations:

• “if the goal of a given guidance-producing exercise is not the creation of a ‘pure’ aspirational standard but the development of context-sensitive guidance, a significant challenge remains – how to combine colloquial evidence with the scientific evidence to enable a final conclusion to be reached in a way that gives due weight to each of the different forms of evidence…what is needed rather than technical weighting is some form of deliberative process with appropriate representation of interests made explicit for the categories of evidence.”

• “evidence is inherently uncertain, dynamic, complex, contestable, and rarely complete. Therefore, for it to become part of guidance, some form of deliberative process is likely required to assess the relative merits and limitation of the evidence in light of the issue at hand. This deliberative process must be able to combine and interpret the population of evidence (however defined) for the purpose intended.”

Lomas J. Using Research to Inform Healthcare Managers’ and Policy Makers’ Questions: From Summative to Interpretive Synthesis. Healthcare Policy. 1:1, 2005. <pdf>

Quotations:

•“a major challenge is in moving from purely researcher-driven processes, which summarize research, to co-production processes, which allow managers and policy-makers to join with researchers in interpreting implications for the healthcare system.”

• in addition to the question “what works to reduce problem x?’ managers and policy-makers appear to have at least two other types of questions:

1.What do we know about problem x? this is the general interest question of the decision-maker. Is it a problem/ If so, what is causing it, how extensive is it, who is it affecting and what are some feasible options to address it?

2.What will be/now are the issues around doing action y? This is the context question, sometimes asked before embarking on action plans, sometimes after, to aid in finding remedies to the unforeseen. Who opposes, who supports and why? What else is affected, and how (side effects)? What else should we do in concert with this action?

Almost every household has an unsolved Rubiks Cube but you can esily solve it learning a few algorithms.