Knowledge translation is the use of knowledge in health care decision making

Objective

To provide an overview of the science and practice of knowledge translation.

Study Design

Narrative review outlining what knowledge translation is and a framework for its use.

Results

Knowledge translation is defined as the use of knowledge in practice and decision making by the public, patients, health care professionals, managers, and policy makers. Failures to use research evidence to inform decision making are apparent across all these key decision maker groups. There are several proposed theories and frameworks for achieving knowledge translation. A conceptual framework developed by Graham et al., termed the knowledge-to-action cycle, provides an approach that builds on the commonalities found in an assessment of planned action theories.

Conclusions

Review of the evidence base for the science and practice of knowledge translation has identified several gaps including the need to develop valid strategies for assessing the determinants of knowledge use and for evaluating sustainability of knowledge translation interventions.     

Exploring conceptualizations of knowledge translation,transfer and exchange across public health in one UK region: a qualitative mapping study

Objectives

Knowledge translation (KT) is becoming common vocabulary, but as a concept it is not clearly defined. Many related terms exist; these are often used interchangeably and given multiple interpretations. While there is a growing body of literature exploring these concepts, using it to inform public health practice, strategy, research and education is challenging given the range of sources and need for local ‘contextual fit’. This study explores how various public health stakeholders make sense of, and experience, KT and related concepts.

Study design

A qualitative mapping study using a phenomenographic approach.

Methods

Thirty-four academics, students and practitioners working in public health across the north east of England participated in six focus groups and five one-to-one interviews. Discussions were audio-recorded, transcribed and analysed using a thematic framework approach. The framework drew on findings from reviews of the existing literature, whilst allowing unanticipated issues to emerge.

Results

Three main themes were identified from the stakeholder discussions:

(i)

Definitions: there was some agreement in terms of meanings and interpretations of core concepts relating to KT, although stakeholders spoke of the differing ‘languages’ across disciplines and sectors;

(ii)

Process issues: access to funding, targeted messages, the nature of the evidence base, and wider contextual factors were identified as barriers or facilitators to KT; and

(iii)

People: various KT roles and responsibilities were highlighted for the different stakeholder groups.

Conclusions

This study has enabled further development of theoretical understandings of the KT discourses at play in public health, and identified the ways in which these may be bound by discipline and context. Ironically, the findings suggest that terms such as knowledge translation, transfer and exchange are seen as themselves requiring translation, or at least debate and discussion.     

Using interactive workshops to prompt knowledge exchange: a realist evaluation of a knowledge to action initiative

Introduction

Interactive workshops are often the default mechanism for sharing knowledge across professional and sector boundaries; yet we understand little about if, and how, they work. Between 2009 and 2011, the Research to Reality programme in North East England ran eight stand-alone facilitated multi-agency workshops focused on priority public health issues. Local authorities, the health service, and academe collaborated on the programme to share latest evidence and best practice

Methods

A realist evaluation asked the overarching question ‘what worked where, for whom, and under what conditions’ regarding the knowledge exchange (KE) mechanisms underpinning any changes. Data were collected from fifty-one interviews, six observations, and analysis of programme documentation.

Results

191 delegates attended (local authority 46%, NHS 24%, academia 22%, third sector 6%, other 2%). The programme theory was that awareness raising and critical discussion would facilitate ownership and evidence uptake. KE activity included: research digests, academic and senior practitioner presentations, and facilitated round-table discussions. Joint action planning was used to prompt informed follow-up action. Participants valued the digests, expert input, opportunities for discussion, networking and ‘space to think’. However, within a few months, sustainability was lost. There was no evidence of direct changes to practice. Multiple barriers to research utilization emerged.

Discussion

The findings suggest that in pressured contexts exacerbated by structural reform providing evidence summaries, input from academic and practice experts, conversational spaces and personal action planning are necessary to create enthusiasm on the day, but are insufficient to prompt practice change in the medium term. The findings question makes assumptions about the instrumental, linear use of knowledge and of change focused on individuals as a driver for organizational change. Delegates' views of ‘what would work’ are shared. Mechanisms that would enhance interactive formats are discussed.     

Factors influencing the effectiveness of interventions to reduce racial and ethnic disparities in health care

Reducing racial and ethnic disparities in health care has become an important policy goal in the United States and other countries, but evidence to inform interventions to address disparities is limited. The objective of this study was to identify important dimensions of interventions to reduce health care disparities. We used qualitative research methods to examine interventions aimed at improving diabetes and/or cardiovascular care for patients from racial and ethnic minority groups within five health care organizations. We interviewed 36 key informants and conducted a thematic analysis to identify important features of these interventions. Key elements of interventions included two contextual factors (external accountability and alignment of incentives to reduce disparities) and four factors related to the organization or intervention itself (organizational commitment, population health focus, use of data to inform solutions, and a comprehensive approach to quality). Consideration of these elements could improve the design, implementation, and evaluation of future interventions to address racial and ethnic disparities in health care.     

Health research funding agencies' support and promotion of knowledge translation: an international study

CONTEXT: The process of knowledge translation (KT) in health research depends on the activities of a wide range of actors, including health professionals, researchers, the public, policymakers, and research funders. Little is known, however, about health research funding agencies' support and promotion of KT. Our team asked thirty-three agencies from Australia, Canada, France, the Netherlands, Scandinavia, the United Kingdom, and the United States about their role in promoting the results of the research they fund. METHODS: Semistructured interviews were conducted with a sample of key informants from applied health funding agencies identified by the investigators. The interviews were supplemented with information from the agencies' websites. The final coding was derived from an iterative thematic analysis. FINDINGS: There was a lack of clarity between agencies as to what is meant by KT and how it is operationalized. Agencies also varied in their degree of engagement in this process. The agencies' abilities to create a pull for research findings; to engage in linkage and exchange between agencies, researchers, and decision makers; and to push results to various audiences differed as well. Finally, the evaluation of the effectiveness of KT strategies remains a methodological challenge. CONCLUSIONS: Funding agencies need to think about both their conceptual framework and their operational definition of KT, so that it is clear what is and what is not considered to be KT, and adjust their funding opportunities and activities accordingly. While we have cataloged the range of knowledge translation activities conducted across these agencies, little is known about their effectiveness and so a greater emphasis on evaluation is needed. It would appear that "best practice" for funding agencies is an elusive concept depending on the particular agency's size, context, mandate, financial considerations, and governance structure.     

我国卫生技术评估研究成果向决策转化的理论模型构建

在目前我国深入医药卫生体制改革的时代背景下,卫生技术评估领域开展了大量研究,如何顺利地实现相关研究成果向卫生政策的转化,成为亟待解决的重要问题。本文主要从知识转化的定义入手,回顾了在研究和实践中较多运用的三个知识转化理论模型,在此基础上提出了我国卫生技术评估研究成果向决策转化的理论模型,重点挖掘研究方和决策方影响转化的因素,并为促进研究成果的决策转化提出增进研究方和决策方之间的沟通交流、建立研究成果向决策转化的激励机制等建议。     

Staging data: theatre as a tool for analysis and knowledge transfer in health research

Over the past several decades, researchers have taken an interest in theatre as a unique method of analysing data and translating findings. Because of its ability to communicate research findings in an emotive and embodied manner, theatre holds particular potential for health research, which often engages complex questions of the human condition. In order to evaluate the research potential of theatre, this article critically examines examples of evaluated health research studies that have used theatre for the purposes of data analysis or translation. We examine these studies from two perspectives. First, the literature is divided and categorized into four theatre genres: (1) non-theatrical performances; (2) ethnodramas, which can be interactive or non-interactive; (3) theatrical research-based performances; and (4) fictional theatrical performances. This categorization highlights the importance of these genres of theatre and provides an analysis of the benefits and disadvantages of each, thus providing insight into how theatre may be most effectively utilized in health research. Second, we explore the efficacy of using theatre for the purposes of data analysis and knowledge transfer, and critically examine potential approaches to the evaluation of such endeavours.     

Taking a patient-oriented approach in exercise interventions for pregnant women: a commentary

Taking a patient-oriented approach to developing lifestyle interventions includes incorporating the patient into the program’s design, delivery, and evaluation. This commentary assumes that a patient-oriented approach has not yet been implemented and tested in exercise-based interventions designed for pregnant women. We outline and define a patient-oriented approach to conduct exercise-based research and review previous physical activity interventions designed for pregnant women to determine whether a patient-oriented approach was applied. In addition, pregnant women living with obesity may have unique barriers to engaging in prenatal exercise interventions that have not been previously addressed, such as having experienced weight stigma before pregnancy in healthcare and fitness settings. We propose suggestions for future trials to effectively take a patient-oriented approach when designing and implementing prenatal exercise interventions to address patient-informed barriers and incorporate suggested facilitators for physical activity. Given that prenatal activity levels are low and pregnant women may have unique barriers to engaging in exercise interventions, a patient-oriented approach may be an effective strategy to improve inclusivity and equity and, as a result, increase uptake and adherence to the intervention.     

Deliberative dialogues as a mechanism for knowledge translation and exchange in health systems decision-making

Models that describe the key features and intended effects of specific knowledge translation and exchange (KTE) interventions are much less prominent than models that provide a more general understanding of KTE. Our aim was to develop a model in order to describe the key features and intended effects of deliberative dialogues used as a KTE strategy and to understand how deliberative dialogues can support evidence-informed policymaking. By using critical interpretive synthesis, we identified 17 papers representing four fields of enquiry and integrated our findings into a model. The key features described in the model are: 1) an appropriate (i.e., conducive to the particular dialogue) meeting environment; 2) an appropriate mix of participants; and, 3) an appropriate use of research evidence. These features combine to create three types of intended effects: 1) short-term individual-level; 3) medium-term community/organizational-level; and, 3) long-term system-level. The concept of capacity building helps to explain the relationship between features and effects. The model is a useful contribution to the KTE field because it is a practical tool that could be used to guide the development and evaluation of deliberative dialogues in order to understand more about achieving particular outcomes in relation to specific issues or contexts.     

Identifying research priorities for health care priority setting: a collaborative effort between managers and researchers

Background  

To date there has been relatively little published about how research priorities are set, and even less about methods by which decision-makers can be engaged in defining a relevant and appropriate research agenda. We report on a recent effort in British Columbia to have researchers and decision-makers jointly establish an agenda for future research into questions of resource allocation.     

Assessing the evaluability of complex public health interventions: five questions for researchers, funders, and policymakers

Context: Evidence to support government programs to improve public health often is weak. Recognition of this “knowledge gap” has led to calls for more and better evaluation, but decisions about priorities for evaluation also need to be addressed in regard to financial restraint. Methods: Using England's Healthy Community Challenge Fund as a case study, this article presents a set of questions to stimulate and structure debate among researchers, funders, and policymakers and help make decisions about evaluation within and between complex public health interventions as they evolve from initial concept to dissemination of full‐scale intervention packages. Findings: This approach can be used to identify the types of knowledge that might be generated from any evaluation, given the strength of evidence available in response to each of five questions, and to support a more systematic consideration of resource allocation decisions, depending on the types of knowledge required. Conclusions: The principles of this approach may be generalizable, and should be tested and refined for other complex public health and wider social interventions.     

The nature of evidence resources and knowledge translation for health promotion practitioners

Governments and other public health agencies have become increasingly interested in evidence-informed policy and practice. Translating research evidence into programmatic change has proved challenging and the evidence around how to effectively promote and facilitate this process is still relatively limited. This paper presents the findings from an evaluation of a series of evidence-based health promotion resources commissioned by the Victorian Department of Human Services. The evaluation used qualitative methods to explore how practitioners for whom the resources were intended, viewed and used them. Document and literature review and analysis, and a series of key informant interviews and focus groups were conducted. The findings clearly demonstrate that the resources are unlikely to act as agents for change unless they are linked to a knowledge management process that includes practitioner engagement. This paper also considers the potential role of knowledge brokers in helping to identify and translate evidence into practice.     

卫生政策循证方法探讨：如何在特定环境下评价政策干预效果

政策干预主要体现在政策执行过程中,其受外部环境和内部环境的影响.卫生政策实施的外部环境包括自然环境和社会环境,内部条件包括政策本身、政策执行主体、政策执行客体和政策执行资源,对政策效果进行评价时除了要考虑这些环境因素外,还应该考虑科研研究的局限.系统综述评价一个卫生政策干预措施的效果方法:首先,应该判断政策措施有效还是无效;其次,应该判断政策干预措施与什么相比是有效的;第三,应该判断政策干预措施对谁有效;第四,判断政策干预措施效果的大小.     

Systematic review of stepped wedge cluster randomized trials shows that design is particularly used to evaluate interventions during routine implementation

Objective

To describe the application of the stepped wedge cluster randomized controlled trial (CRCT) design.

Study Design and Setting

Systematic review. We searched Medline, Embase, PsycINFO, HMIC, CINAHL, Cochrane Library, Web of Knowledge, and Current Controlled Trials Register for articles published up to January 2010. Stepped wedge CRCTs from all fields of research were included. Two authors independently reviewed and extracted data from the studies.

Results

Twenty-five studies were included in the review. Motivations for using the design included ethical, logistical, financial, social, and political acceptability and methodological reasons. Most studies were evaluating an intervention during routine implementation. For most of the included studies, there was also a belief or empirical evidence suggesting that the intervention would do more good than harm. There was variation in data analysis methods and insufficient quality of reporting.

Conclusions

The stepped wedge CRCT design has been mainly used for evaluating interventions during routine implementation, particularly for interventions that have been shown to be effective in more controlled research settings, or where there is lack of evidence of effectiveness but there is a strong belief that they will do more good than harm. There is need for consistent data analysis and reporting.     

From "our world" to the "real world": Exploring the views and behaviour of policy-influential Australian public health researchers

Research and researchers influence the genesis and development of public health policy in limited but essential ways. Surveys and interviews with 36 peer-nominated "highly influential" Australian public health researchers found they engaged in a breadth of strategies that included rigorous but targeted research design, multilateral collaboration, multiple methods of research dissemination and promotion (including tactical use of the media), and purposeful development of bridging relationships. Researchers' ability to understand the worlds of research, policy and the media and to speak their languages (or to work with others who fulfilled this role) was a key factor. Advocacy was seen as fundamental by some but was disparaged by others. Influential behaviours were guided by values and beliefs about the principles underlying traditional science and the contrasting ethos of contemporary research. This study may help researchers consider their own policy-related roles, strategies and relationships in the context of increasing calls for research that serves economic and/or social goals.     

Review of 128 quality of care mechanisms: A framework and mapping for health system stewards

Health system stewards have the critical task to identify quality of care deficiencies and resolve underlying system limitations. Despite a growing evidence-base on the effectiveness of certain mechanisms for improving quality of care, frameworks to facilitate the oversight function of stewards and the use of mechanisms to improve outcomes remain underdeveloped. This review set out to catalogue a wide range of quality of care mechanisms and evidence on their effectiveness, and to map these in a framework along two dimensions: (i) governance subfunctions; and (ii) targets of quality of care mechanisms. To identify quality of care mechanisms, a series of searches were run in Health Systems Evidence and PubMed. Additional grey literature was reviewed. A total of 128 quality of care mechanisms were identified. For each mechanism, searches were carried out for systematic reviews on their effectiveness. These findings were mapped in the framework defined. The mapping illustrates the range and evidence for mechanisms varies and is more developed for some target areas such as the health workforce. Across the governance sub-functions, more mechanisms and with evidence of effectiveness are found for setting priorities and standards and organizing and monitoring for action. This framework can support system stewards to map the quality of care mechanisms used in their systems and to uncover opportunities for optimization backed by systems thinking.