Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

One of the most consistent findings from clinical and health services research is the failure to translate research into practice and policy. As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare and are exposed to unnecessary risks of iatrogenic harms, and healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs. Over the last decade, there has been increasing international policy and research attention on how to reduce the evidence-practice and policy gap. In this paper, we summarise the current concepts and evidence to guide knowledge translation activities, defined as T2 research (the translation of new clinical knowledge into improved health). We structure the article around five key questions: what should be transferred; to whom should research knowledge be transferred; by whom should research knowledge be transferred; how should research knowledge be transferred; and, with what effect should research knowledge be transferred? We suggest that the basic unit of knowledge translation should usually be up-to-date systematic reviews or other syntheses of research findings. Knowledge translators need to identify the key messages for different target audiences and to fashion these in language and knowledge translation products that are easily assimilated by different audiences. The relative importance of knowledge translation to different target audiences will vary by the type of research and appropriate endpoints of knowledge translation may vary across different stakeholder groups. There are a large number of planned knowledge translation models, derived from different disciplinary, contextual (i.e., setting), and target audience viewpoints. Most of these suggest that planned knowledge translation for healthcare professionals and consumers is more likely to be successful if the choice of knowledge translation strategy is informed by an assessment of the likely barriers and facilitators. Although our evidence on the likely effectiveness of different strategies to overcome specific barriers remains incomplete, there is a range of informative systematic reviews of interventions aimed at healthcare professionals and consumers (i.e., patients, family members, and informal carers) and of factors important to research use by policy makers. There is a substantial (if incomplete) evidence base to guide choice of knowledge translation activities targeting healthcare professionals and consumers. The evidence base on the effects of different knowledge translation approaches targeting healthcare policy makers and senior managers is much weaker but there are a profusion of innovative approaches that warrant further evaluation.

https://link.springer.com/content/pdf/10.1186%2F1748-5908-7-50.pdf

Knowledge translation of research findings

In October 2006, the Chief Medical Officer (CMO) of England asked Professor Sir John Tooke to chair a High Level Group on Clinical Effectiveness in response to the chapter 'Waste not, want not' in the CMOs 2005 annual report 'On the State of the Public Health'. The high level group made recommendations to the CMO to address possible ways forward to improve clinical effectiveness in the UK National Health Service (NHS) and promote clinical engagement to deliver this. The report contained a short section on research needs that emerged from the process of writing the report, but in order to more fully identify the relevant research agenda Professor Sir John Tooke asked Professor Martin Eccles to convene an expert group – the Clinical Effectiveness Research Agenda Group (CERAG) – to define the research agenda. The CERAG's terms of reference were 'to further elaborate the research agenda in relation to pursuing clinically effective practice within the (UK) National Health Service'. This editorial presents the summary of the CERAG report and recommendations.

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An implementation research agenda

Transferring health care research into policy and practice is a messy and complex process which both policymakers and researchers can struggle with. A potential solution is to use individuals or organisations as knowledge brokers. Using a range of literature, this paper explains the theory behind knowledge brokering, identifies three models of brokering and explores the challenges of brokering. We suggest that clarifying these factors is a significant step towards planning well designed and rigorously evaluated brokering interventions. We also suggest that a clearly defined theoretical framework could help us to find out more about how brokering works and its effectiveness.

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Knowledge Brokering: The missing link in the evidence to action chain?

Integrated knowledge translation (IKT) refers to collaboration between researchers and decision-makers. While advocated as an approach for enhancing the relevance and use of research, IKT is challenging and inconsistently applied. This study sought to inform future IKT practice and research by synthesizing studies that empirically evaluated IKT and identifying knowledge gaps. We performed a scoping review. We searched MEDLINE, EMBASE, and the Cochrane Library from 2005 to 2014 for English language studies that evaluated IKT interventions involving researchers and organizational or policy-level decision-makers. Data were extracted on study characteristics, IKT intervention (theory, content, mode, duration, frequency, personnel, participants, timing from initiation, initiator, source of funding, decision-maker involvement), and enablers, barriers, and outcomes reported by studies. We performed content analysis and reported summary statistics. Thirteen studies were eligible after screening 14,754 titles and reviewing 106 full-text studies. Details about IKT activities were poorly reported, and none were formally based on theory. Studies varied in the number and type of interactions between researchers and decision-makers; meetings were the most common format. All studies reported barriers and facilitators. Studies reported a range of positive and sub-optimal outcomes. Outcomes did not appear to be associated with initiator of the partnership, dedicated funding, partnership maturity, nature of decision-maker involvement, presence or absence of enablers or barriers, or the number of different IKT activities. The IKT strategies that achieve beneficial outcomes remain unknown. We generated a summary of IKT approaches, enablers, barriers, conditions, and outcomes that can serve as the basis for a future review or for planning ongoing primary research. Future research can contribute to three identified knowledge gaps by examining (1) how different IKT strategies influence outcomes, (2) the relationship between the logic or theory underlying IKT interventions and beneficial outcomes, and (3) when and how decision-makers should be involved in the research process. Future IKT initiatives should more systematically plan and document their design and implementation, and evaluations should report the findings with sufficient detail to reveal how IKT was associated with outcomes.

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Integrated knowledge translation (IKT) in health care: a scoping review

Health and health care research has the potential to improve people's health, the delivery of health care, and patients' outcomes. Despite the well-documented cases in which publication alone was sufficient to move research into practice very quickly (Beral, Bull, and Reeves 2005; Hersh, Stefanick, and Stafford 2004), the incorporation of research findings into health policy and routine clinical practice is often unpredictable and can be slow and haphazard (AHRQ 2001), thereby diminishing the return to society from investments in research. Effective and efficient means, therefore, are required to realize the benefits of such investments, and as a result, health-funding agencies are increasingly interested in the process of knowledge translation.

Knowledge translation is a term that is used frequently and rather loosely and has been defined in different ways. A recent Google search (“definition knowledge translation”), restricted to Canadian web pages, yielded 1,350,000 hits. Many websites cite the definition developed by the Canadian Institutes of Health Research (CIHR, the organization that funded this study): “the exchange, synthesis and ethically-sound application of knowledge—within a complex system of interactions between 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” (see http://www.cihr-irsc.gc.ca/e/29418.html, accessed September 20, 2007). In their view, knowledge translation is a broad concept encompassing all the steps between the creation of new knowledge and its application in the real world. Although other terms are used, including knowledge transfer, dissemination, research use, and implementation research (Graham et al. 2006), we shall use the term knowledge translation (KT) in this article because it was introduced by the CIHR and because we used it throughout our research protocol.

Lomas (1993) offered a useful categorization of knowledge translation activities that groups them into three conceptually distinct types: diffusion, dissemination, and implementation. He defined diffusion as those efforts that are passive and unplanned. In this category of knowledge translation activities, the onus is on the potential adopter to seek out the information. Dissemination is an active process to spread the message that involves targeting and tailoring the evidence and the message to a particular target audience. Although these strategies raise awareness and may influence attitudes, they may or may not change the behavior of the target audience. Implementation is an even more active process that involves systematic efforts to encourage adoption of the evidence by identifying and overcoming barriers. An alternative way of thinking about knowledge translation is based on the degree of engagement with the potential audience. In this conceptualization, activities are considered to be “push,” concentrating on diffusion and efforts to disseminate to a broad audience; “pull,” focused on the needs of users, thereby creating an appetite for research results (Lavis, McLeod, and Gildiner 2003); or “linkage and exchange,” building and maintaining relationships in order to exchange knowledge and ideas (Canadian Health Services Research Foundation 1999; Lomas 2000).

The process of KT in health research depends on the activities of a wide range of actors, including health professionals, researchers, the public, policymakers, and research funders (Grimshaw, Ward, and Eccles 2001). KT often requires a range of interventions of varying complexity and resource intensiveness, targeting different levels of health care systems as well as different audiences (Lomas 1997). There has been, however, relatively little empirical research on the actual or potential knowledge translation roles, responsibilities, and activities of the different actors.

A review of the effectiveness of guideline dissemination and implementation strategies directed at health professionals (Grimshaw et al. 2004) found median effect sizes ranging from 8.1 to 14.1 percent for individual strategies targeting behavior change in practitioners (e.g., audit and feedback, or academic detailing). The strategies identified were of variable effectiveness and were used in many different settings, making it impossible to predict which would work best in a given context. Furthermore, despite the growing body of evidence (Heap and Parikh 2005) regarding how new ideas disseminate through an industry, the dissemination of knowledge produced by health researchers (Ramlogan et al. 2005) has received relatively less attention. But a recent survey of applied health researchers conducted by Graham and his colleagues (Graham, Grimshaw, et al. 2005) indicated that researchers were most successful and confident when disseminating the results of their research to their academic colleagues. Most were less successful, however, in disseminating these results to other target audiences, even when they felt that their results were of considerable importance to both the public and decision makers. When considering the public's role in the KT process, it seems intuitively obvious that the media can and do play an important role in influencing the public in matters of health and health care (see, e.g., Grilli, Ramsay, and Minozzi 1998; Petrella et al. 2005), but little is known about how to harness and control this potential KT vehicle. Policymakers also are important actors in the KT realm. A systematic review of health policymakers' perceptions of their use of evidence in making policy decisions (Innvaer et al. 2002) suggested that decision makers might make more use of research results if there were more linkage and exchange between the research and the policy world and if researchers answered the kinds of questions that policymakers asked, in a time frame useful to them.

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Cassandra Porter

Papers

Health Research Funding Agencies' Support and Promotion of Knowledge Translation: An International Study