Knowledge TranslationWhat is it and how are we doing it?

Cheryl Cook, Research Associate

Geriatric Medicine Research

Dalhousie University/Capital Health

Halifax, NS

What is Knowledge Translation (KT)?

“ Knowledge translation is the exchange, synthesis and ethically-sound application of knowledge - within a complex system of interactions among researchers and users - to accelerate the capture of the benefits of research for Canadians through improved health, more effective services and products, and a strengthened health care system.”

(CIHR)

Perhaps we could makethat a bit simpler for you…

The Elevator Pitch:

"...methods for closing the gaps from knowledge to practice."

(Straus et al, CMAJ 2009; 181:165-8)

What do we mean by ‘Knowledge’?

Evidence based research.

That’s simple.

It may seem simple, but people sometimes lose sight of the most fundamental part:

You must be translating knowledge and there must be a practical use for that knowledge.

So that was your elevator pitch for KT, but if you have a few extra floors, there are some other things about KT that you should know

8 things you should know about good KT.

KT involves every step from the creation of new knowledge to producing beneficial products, services and tools for the public.

KT is a loop; the end leads back to the beginning.KT is interdisciplinary and is a collaboration between all involved parties.KT can involve health care providers, the general public, the government,

NGO’s/the voluntary sector, and the private sector.KT includes many different activities.KT focuses on research-generated knowledge, but may incorporate other

types of knowledge with this.KT is user and context specific.KT is impact-oriented.

adapted from Sudsawad 2007

Bonus fact: there are over 90 terms in use for KT.

What is the common thread?

“…the move beyond simple dissemination of knowledge to use of knowledge.”

Straus et al, J of Clin Epi, 64 (2011) 6-10

The Knowledge to Action Cycle(CIHR)

We’ll break that down for you.

Knowledge creation

1. Knowledge inquiry.2. Knowledge synthesis.3. Knowledge tools, products.

These three are typically represented as a funnel, with inquiry, the largest part, at the top.

This is narrowed by the synthesis of information, and then further narrowed into the products/tools.

The needs of the knowledge users can be incorporated into every stage in the funnel, allowing for customization of the work.

The Action Cycle (knowledge application)

1. Identify the problem as well as the knowledge needed to address this .2. Adapt the knowledge to the local context.3. Assess barriers and facilitators related to the knowledge to be adopted, the potential adopters, and the context in which the knowledge

will be used. 4. Develop and execute the plan and any strategies to promote awareness and use of the knowledge. 5. Monitor knowledge use to determine effectiveness of the plan in order to adjust them if necessary6. Evaluate the impact of using the knowledge to determine if it has effected the desired outcomes.7. Make a plan to sustain the use of the knowledge over time.

Why do KT?

Evidence informed decision-making.

©XKCD

Don’t we already use evidence?

The evidence says we are not using evidence.

Of eight policy making processes studied in Canada, only four were using evidence in at least one stage of their process.

Lavis et al, 2002

Types of KT

End of grant KT: the researcher develops and implements a plan for making knowledge users aware of the findings from a research project once available.

Integrated KT (IKT) : Researchers and knowledge users work together to identify research questions, decide on methodology, interpret findings, and disseminate findings. IKT aims to produce research results that are highly relevant and likely to be used by knowledge users to improve health and the health system.

CIHR

http://www.cihr-irsc.gc.ca/e/38654.html

The Canadian Institutes for Health Research describes two types of KT: end of grant and integrated.

The Challenge of Integrated KT

Creating collaborative research with knowledge users requires skills that are new to many researchers or research groups:

Building relationships w/outside groups.

Maintaining these relationships through balanced partnerships.

Managing challenges such as competing agendas.

Helping Integrated KT along.

Knowledge brokers: a bridge between researchers and knowledge user groups.

These can be formally hired/contracted, but many groups or organization already have one or two people within them who are formally or informally working in this role.

Networks: bringing varied groups togetherFace to face, digital, formal or informal networks can stimulate and make

possible connections that might not otherwise happen. Networks can work around an area of common interest or a common goal.

Gagnon, ML. J of Clin Epi 64 (2011) 25-31

Wait….what is your expected outcome?

This is worth talking about.

Do you want to make a change?Are you looking for a change in attitude?Do you want a change in behaviour? Practice? Policy?

Do you want to support a change? Are you looking to bolster something that is already underway?

Collaborating with your target audience from the beginning can help you craft achievable, useful outcomes.

Let's look at some of the elements of KT.

An important first step in KT: Knowledge Synthesis (KS)

Making decisions based on the results of one study means your decisions are only as good as that study.

“… 'the contextualization and integration of research findings of individual research studies within the larger body of knowledge on the topic.”

CIHR http://www.cihr-irsc.gc.ca/e/39033.htm

Components of a good KS

‘A synthesis must be reproducible and transparent in its methods, using quantitative and/or qualitative methods. It could take the form of a systematic review; follow the methods developed by The Cochrane Collaboration; result from a consensus conference or expert panel and may synthesize qualitative or quantitative results. Realist syntheses, narrative syntheses, meta-analyses, meta-syntheses and practice guidelines are all forms of synthesis.‘

CIHR http://www.cihr-irsc.gc.ca/e/39033.htm

Another very important part of KT: Dissemination

A useful taxonomy:

1. Diffusion2. Dissemination3. Implementation

Lomas J. Ann NY Acad Sci. 1993, 703:226-37

Diffusion

Passive

Often unplanned and uncontrolled

Examples: Publishing a paper in an academic journal, going to a conference with a poster.

Dissemination

You target and tailor what you are communicating to the specific audience you are trying to reach.

This approach can be more or less active .

Less active: You have completed research and you translate the results into brochures, videos etc. for the public.

More active: tailoring a small workshop to disseminate results, get feedback etc.

Implementation

The most active of all three, it “…involves systematic efforts to encourage adoption of the research findings by overcoming barriers to their use.”

Gagnon, ML. J of Clin Epi 64 (2011) 25-31

6 things you should know about good dissemination.

1. It should have local context. 2. It should use good quality research. 3. It should be clear. 4. It should be tailored to its audience in content

and delivery.5. It should be action oriented.6. It needs an evaluation component.

Gagnon, ML. J of Clin Epi 64 (2011) 25-31

5 things to consider when planning dissemination.

1. What is your message? 2. Who is your audience and what are their needs? 3. Who is your messenger? Are they credible?4. What is your transfer method?5. What is your expected outcome?

The bit that often gets overlooked:Evaluation

“KT promotes the uptake of evidence based practices but the methods used to promote these practices are often not evidence-based themselves.”

Bhattacharyya et al, J Clin Epi 64 (2011) 32-40

Evaluation is hard.

If you are engaged in KT, especially IKT, you have many groups and levels to consider when trying to evaluate your KT uptake.

It is often as complicated as the original research itself, requiring internal and external validity checks, bias control etc.

KT takes considerable time and money, thus it deserves rigorous evaluation.

One more thought…

The KT Imperative

“We must be careful to avoid the ‘knowledge translation imperative’ that all knowledge must be translated into action. Instead we need to ensure that there is a mature and valid evidence base before we expend substantial resources on implementation of this evidence.”

Straus et al, J Clin Epi 64 (2011) 6-10

For more information on KT and research at GMR:

http://geriatricresearch.medicine.dal.ca/ gmru@dal.ca