Knowledge Translation
Knowledge Translation:
new term to describe an old
problem
Knowledge Translation
definition - CHSRF
Knowledge translation (KT) refers to the assessment, review and implementation of
scientific research evidence. KT goes beyond traditional dissemination – it is an ongoing
iterative process of engagement which is the best predictor for seeing the findings applied
(Lomas 2000). KT is about moving research into action – closing the gap between knowing
and doing. KT is the science of methods to integrate and simplify knowledge into usable
formats and of the barriers and enablers inherent the process for organizations and
individuals. The focus is on the processes that affect how evidence is generated,
communicated, and utilized as well as the barriers and enablers in different contexts.
Researchers and stakeholders collaborate to identify and solve every-day problems. KT is
vital because the creation of new knowledge does not (on its own) lead to
implementation or impacts on health and secondly, we need to be accountable, so it is
crucial to show the benefits of taxpayer dollars in health research by moving research into
policy, programs and practice. But the mechanisms are not straightforward and must be
tailored to the specific context. KT terminology abounds in the literature and on
websites. For example, Graham et al (2006) identified 29 different related KT terms. This
glossary includes a range of definitions and terms used by key global organisations and
individuals in the field, however others may define the terms differently. Different KT
approaches (e.g., end-of-grant KT; integrated KT) have differing inherent values about the
process of knowledge production, so such premises may guide researchers in their
selection. This glossary is not an exhaustive list, rather is a starting point for readers who
wish to engage with the scientific field of knowledge translation.
Sources:
Lomas, J. (2000) Using ‘Linkage and Exchange’ to Move Research into Policy at a Canadian
Foundation. Health Affairs 19(3): 236–40.
CIHR (2010) More about Knowledge Translation. Ottawa, ON: Canadian Institutes of
Health Research http://www.cihr-irsc.gc.ca/e/39033.html accessed Oct 25, 2010
Greenhalgh T, Robert G, Macfarlane F, Bate P & Kyriakidou O. (2004). Diffusions of
innovations in service organizations: systematic review and recommendations.
Milbank Quarterly 82(4):581-629.
Graham, I.D., J. Logan, M.B. Harrison, S.E. Strauss, J., Tetroe, W. Caswell & N. Robinson.
(2006). Lost in Knowledge Translation: Time for a Map? Journal of Continuing
Education in the Health Professions 26(1): 13–24.
Estabrooks, C.A., Thompson, D.S., Lovely, J. Jacque., E, & Hofmeyer, A. (2006) A Guide to
Knowledge Translation Theory. Journal of Continuing Education in the Health
Professions, 26(1): 25-36.
Lapaige, V. (2010) “Integrated knowledge translation” for globally oriented public health
practitioners and scientists: Framing together a sustainable transfrontier knowledge
translation vision. Journal of Multidisciplinary Healthcare, 3:33-47.
Knowledge translation is a new term to describe a problem identified decades ago,
specifically the haphazard uptake and the underutilization of evidence-based research
which has been described as the gap between what is known” and “what is currently
done” in practice.
Sources:
Davis, D., Evans, M., Jadad, A., Perrier, L., Rath, D., Ryan, D., et al. (2003). The case for
knowledge translation: Shortening the journey from evidence to effect. British
Medical Journal, 327(7405), 33–35.
Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: Effective
implementation of change in patients’ care. Lancet, 362(9391), 1225–1230.
Schuster, M.A., McGlynn, E.A., Brook, R.H. (1998). How Good Is the Quality of Health Care
in the United States? Milbank Quarterly 76:517-64.
Grol, R. (2000). Twenty years of implementation research. Family Practice, 17, S32–S35.
Knowledge translation and exchange (KTE) - formerly knowledge transfer:
“Knowledge exchange is collaborative problem-solving between researchers and decision
makers that happens through linkage and exchange. Effective knowledge exchange
involves interaction between decision makers and researchers and results in mutual
learning through the process of planning, producing, disseminating, and applying existing
or new research in decision-making.”
Decision maker
Knowledge Translation
definition - CIHR
Synthesis
Dissemination
Source:
Canadian Health Services Research Foundation (CHSRF)
http://www.chsrf.ca/keys/glossary_e.php Retrieved October 25, 2010.
“Decision makers in the health services field can range from frontline health providers to
administrators to ministers of health. However, the Foundation works with two particular
groups of decision makers — managers and policy makers. These individuals often work in
health services organizations such as hospitals and regional health authorities, as well as
ministries of health and relevant regulatory agencies.”
Source:
Canadian Health Services Research Foundation (CHSRF)
http://www.chsrf.ca/keys/glossary_e.php Retrieved October 25, 2010.
Knowledge translation is “a dynamic and iterative process that includes synthesis,
dissemination, exchange and ethically sound application of knowledge to improve the
health of Canadians, provide more effective health services and products and strengthen
the health care system.”
Sources:
CIHR (2004) Knowledge translation strategy 2004 – 2009: Innovation in action. Ottawa,
ON: Canadian Institutes of Health Research. http://www.cihr-irsc.gc.ca/e/29418.html
Tetroe, J. (2007). Knowledge Translation at the Canadian Institutes of Health Research: A
Primer. Focus Technical Brief No. 18. Austin, TX: National Center for the
Dissemination of Disability Research. Retrieved October 25, 2010.
http://www.ncddr.org/kt/products/focus/focus18/
CIHR (2010) states, “Synthesis, in this context, means the contextualization and
integration of research findings of individual research studies within the larger body of
knowledge on the topic. 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 or synthesize qualitative or quantitative results.
Realist syntheses, narrative syntheses, meta-analyses, meta-syntheses and practice
guidelines are all forms of synthesis.” Resources related to synthesis are available.
Another definition of synthesis is provided by CHSRF as, “an evaluation or analysis of
research evidence and expert opinion on a specific topic to aid in decision-making or help
decision makers in the development of policies. It can help place the results of a single
study in context by providing the overall body of research evidence. There are many
forms of synthesis, ranging from very formal systematic reviews, like those carried out by
the Cochrane Collaboration, to informal literature reviews. The Foundation conducts
syntheses aimed at making "best practice" recommendations for a specific area of
management or policy development.”
Sources:
CIHR (2010) More about Knowledge Translation. Ottawa, ON: Canadian Institutes of
Health Research http://www.cihr-irsc.gc.ca/e/39033.html
Canadian Health Services Research Foundation (CHSRF)
http://www.chsrf.ca/keys/glossary_e.php Retrieved October 25, 2010
CIHR (2010) suggests dissemination “involves identifying the appropriate audience and
tailoring the message and medium to the audience. Dissemination activities can include
such things as summaries for / briefings to stakeholders, educational sessions with
patients, practitioners and/or policy makers, engaging knowledge users in developing and
executing dissemination/implementation plan, tools creation, and media engagement.”
CHSRF provides the following definition, “Dissemination goes well beyond simply making
research available through the traditional vehicles of journal publication and academic
conference presentations. It involves a process of extracting the main messages or key
implications derived from research results and communicating them to targeted groups of
decision makers and other stakeholders in a way that encourages them to factor the
research implications into their work. Face-to-face communication is encouraged
whenever possible.”
Sources:
CIHR (2010) More about Knowledge Translation. Ottawa, ON: Canadian Institutes of
Exchange
Ethically-sound application
of knowledge
Knowledge-to-action process
Knowledge user
Knowledge Translation
(end-of-grant)
Knowledge Translation
Health Research http://www.cihr-irsc.gc.ca/e/39033.html Accessed Oct 18, 2010
Canadian Health Services Research Foundation (CHSRF)
http://www.chsrf.ca/keys/glossary_e.php Retrieved October 25, 2010
CIHR (2010) states, “The exchange of knowledge refers to the interaction between the
knowledge user and the researcher, resulting in mutual learning. According to CHSRF,
knowledge exchange is "collaborative problem-solving between researchers and decision
makers that happens through linkage and exchange. Effective knowledge exchange
involves interaction between knowledge users and researchers and results in mutual
learning through the process of planning, producing, disseminating, and applying existing
or new research in decision-making." Another definition is provided by CHSRF, “Linkage
and exchange is the process of ongoing interaction, collaboration, and exchange of ideas
between researcher and decision-maker communities. In research collaborations, it
involves working together before, during, and after the research program.”
Sources:
CIHR (2010) More about Knowledge Translation. Ottawa, ON: Canadian Institutes of
Health Research http://www.cihr-irsc.gc.ca/e/39033.html accessed Oct 18, 2010
Canadian Health Services Research Foundation (CHSRF)
http://www.chsrf.ca/keys/glossary_e.php Retrieved October 25, 2010
“Ethically-sound KT activities for improved health are those that are consistent with
ethical principles and norms, social values, as well as taking into account the complex and
possibly competing legal and other regulatory frameworks. The term application is used
to refer to the iterative process between people by which knowledge is put into practice.”
Source:
CIHR (2010) More about Knowledge Translation. Ottawa, ON: Canadian Institutes of
Health Research http://www.cihr-irsc.gc.ca/e/39033.html accessed Oct 18, 2010
The Knowledge to Action Process conceptualizes the relationship between knowledge
creation and action. The action part of the process can be thought of as a cycle leading to
implementation or application of knowledge. Access this diagram at the following link:
Source:
CIHR (2010) More about Knowledge Translation. Ottawa, ON: Canadian Institutes of
Health Research http://www.cihr-irsc.gc.ca/e/39033.html accessed Oct 18, 2010
We are all users of knowledge in our daily lives. In the healthcare context, a knowledge
user is a person:
who is likely to be able to use the knowledge generated through research in order
to make informed decisions about health policies, programs and/or practices;
whose level of engagement in the research process may vary in intensity and
complexity depending on the nature of the research and their information needs;
who can be, but is not limited to, a practitioner, policy-maker, educator, decisionmaker, health care administrator, community leader, or an individual in a health
charity, patient group, private sector organization or a media outlet.
Source:
CIHR (2010) More about Knowledge Translation. Ottawa, ON: Canadian Institutes of
Health Research http://www.cihr-irsc.gc.ca/e/39033.html accessed Oct 18, 2010
Covers the diffusion, dissemination and application of knowledge that researchers
undertake once the findings from a project are available. A plan is implemented for
making users aware of the knowledge that was gained in the project, so includes typical
dissemination and communication activities such as publications in peer-reviewed
journals and conference presentations. End-of-grant KT can also involve messages that
are tailored to specific audiences such as summary briefing notes for stakeholders,
interactive educational sessions with patients, practitioners and policy-makers, media or
using knowledge brokers.
Source:
CIHR (2010) Knowledge To Action: An end of grant knowledge translation casebook. More
about Knowledge Translation. Ottawa, ON: Canadian Institutes of Health Research
http://www.cihr-irsc.gc.ca/e/documents/cihr_kt_casebook_2010_e.pdf
accessed October 25, 2010
A way of doing research that involves decision makers/knowledge-users - usually as
(integrated)
Deliberative or interactive
model of Knowledge
Translation
Deliberative process
Diffusion
Innovation
Mode 1
Mode 11
members of the research team - in all stages of the research process. CIHR explains, “In
integrated KT, stakeholders or potential research knowledge users are engaged in the
entire research process. By doing integrated KT, researchers and research users work
together to shape the research process by collaborating to determine the research
questions, deciding on the methodology, being involved in data collection and tools
development, interpreting the findings, and helping disseminate the research results. This
approach, also known by such terms as collaborative research, action-oriented research,
and co-production of knowledge, should produce research findings that are more likely be
relevant to and used by the end users.” Lapaige (2010, p. 34) argues that “integrated KT
refers to both a process and its result.”
Sources:
CIHR (2010) More about Knowledge Translation. Ottawa, ON: Canadian Institutes of
Health Research http://www.cihr-irsc.gc.ca/e/39033.html accessed Oct 18, 2010
Lapaige, V. (2010) “Integrated knowledge translation” for globally oriented public health
practitioners and scientists: Framing together a sustainable transfrontier knowledge
translation vision. Journal of Multidisciplinary Healthcare, 3:33-47.
The deliberative, or interactive, model of knowledge translation promotes exchanges and
cooperation between researchers, public health actors, members of civil society, and all
other interested parties, throughout the research process. By promoting the
co‐production and co‐interpretation of research, this model ensures the democratization
of research knowledge and increases the likelihood of its being implemented.
Sources:
Weiss, C. H. (1979). The many meanings of research utilization. Public Administration
Review, September‐October, 426‐431.
Gauvin, François‐Pierre (2010) Deliberative Processes and Knowledge Translation.
National Collaborating Centre for Healthy Public Policy. Québéc, Canada
http://www.ncchpp.ca
Deliberative processes are thinking processes about the way decisions are made. This
process allows individuals to receive and exchange information, to critically examine an
issue, and to negotiate an agreed position that can inform decision making.
Source:
Gauvin, François‐Pierre (2010) Deliberative Processes and Knowledge Translation.
National Collaborating Centre for Healthy Public Policy. Québéc, Canada
http://www.ncchpp.ca accessed October 18, 2010
"The process by which an innovation is communicated through certain channels over time
among members of a social system."
Source:
Rogers EM. (1995) Diffusion of Innovations. New York: Free Press. p. 5.
“Idea, practice, or object that is perceived as new by an individual or other unit of
adoption.”
Source:
Rogers EM. (1995) Diffusion of Innovations. New York: Free Press. p. 11.
Mode I knowledge production reflects the traditional, academic norms of scholarship in
the disciplines and institutions which researchers work. Academic tenure and promotion
are based on high impact, peer-reviewed publication. It is a mode of knowledge
production whose foundations rest on principles of scientific expertise, peer review, and
non-interference. Mode 1 activities are consistent with Boyer’s scholarship of discovery
that generates new knowledge or challenges current knowledge in a discipline.
Sources:
Gibbons, M., Limoges, C., Nowotny, H., Schwartzman, S., Scott, P. (1994). The New
Production of Knowledge. Sage, London.
Nowotny, H., Scott, P., Gibbons, M. (2001). Re-thinking Science: Knowledge and the Public
in an Age of Uncertainty. Polity Press, Cambridge, MA.
Boyer, E.L. (1990). Scholarship Reconsidered: Priorities of the Professoriate. Carnegie
Foundation for the Advancement of Teaching, New York.
Mode II knowledge production activities involves building meaningful and sustainable
relationships with end users non-hierarchical relationships with research end-users
Integration scholarship
Application scholarship
Quality of care
Communities of practice
Social Capital
known as stakeholders (e.g., industry, government policy-makers, health care decisionmakers) to collaborate on a research issue situated in a specific health care context. In
this sense, Mode II knowledge production is based on the needs of end users in the
healthcare system. Lapaige (2010, p. 36) argues that “Mode 11 is based on the
assumption that science can no longer be confined to the university….Mode 11 contrasts
with Mode 1 of knowledge production whose substance was science confined within
disciplinary boundaries. A Mode 11 perspective argues for co-operation by researchers
for resolving critical problems in a changing global context.”
Sources:
Nowotny, H., Scott, P., Gibbons, M., 2001. Re-thinking Science: Knowledge and the Public
in an Age of Uncertainty. Polity Press, Cambridge, MA.
Lapaige, V. (2010) “Integrated knowledge translation” for globally oriented public health
practitioners and scientists: Framing together a sustainable transfrontier knowledge
translation vision. Journal of Multidisciplinary Healthcare, 3:33-47.
Is closely related to the interprofessional debates; it is about building connections across
disciplines and shaping a more coherent and integrated use of knowledge. Integration
work is creative connectedness and interpretation and synthesis, so is closely related to
discovery, but poses somewhat different questions in terms of meaning and impact.
Researchers locate their discovery work, or that of others, into broader intellectual
patterns, thus moving beyond the disciplinary silos to build interdisciplinary partnerships
with capacity to respond to multi-focal, complex human problems. Moreover, funding
bodies are increasingly supportive of collaborative, integrated partnerships and teams as
a way to generate knowledge and new KT approaches.
Source:
Boyer, E.L. (1990) Scholarship Reconsidered: Priorities of the Professoriate. Carnegie
Foundation for the Advancement of Teaching, New York.
Requires that researchers build bridges and collaborative relationships with other
disciplines, decision and policy-makers and communities in order to apply theory to solve
every-day problems. This iterative process by which knowledge is put into practice
involves dynamic engagement and translation of new knowledge in practical
interventions to solve real world problems experienced by individuals and society.
Source:
Boyer, E.L. (1990) Scholarship Reconsidered: Priorities of the Professoriate. Carnegie
Foundation for the Advancement of Teaching, New York.
“The degree to which health services for individuals and populations increase the
likelihood of desired health outcomes and are consistent with current professional
knowledge”.
Source:
IOM (1990). Medicare: A Strategy for Quality Assurance, Volume I. Institute of Medicine,
Washington, DC: National Academy Press. page 21
http://www.nap.edu/catalog.php?record_id=1547
"Communities of practice are groups of people who share a concern or a passion for
something they do and learn how to do it better as they interact regularly."
These people don’t necessarily work together every day, but they meet because they find
value in their interactions. They typically share information, insight, and advice. They help
each other solve problems. They discuss their situations, ponder common issues, explore
ideas, and act as sounding boards. They may create tools, standards, generic designs,
manuals, and other documents—or they may simply develop a tacit understanding that
they share. They become bound by the value that they find in learning together.
Source:
Wenger, E. (1998). Communities of practice: learning, meaning, and identity. Cambridge
University Press.
Social capital is defined as norms (cooperation, trust, communication) and networks
(bonding, bridging, linking) that enable people to act collectively and share resources
(knowledge, favours information) for productive purposes (Woolcock & Narayan 2000).
Social capital adds value to individuals and groups. Through informal connections that
individuals make in their networks (e.g., community of practice) and in the formal process
Implementation science
Knowledge brokering
Knowledge transfer and
exchange
Meta-analysis
Meta-synthesis
Organizational factors
of sharing their expertise, learning from others, and participating in the group, members
are said to be acquiring social capital or a trust that members build between themselves
and others that can lead to better communication and then action.
Sources:
Woolcock, M. & Narayan (2000) Social Capital: Implications for Development Theory,
Research, and Policy. World Bank Research Observer, 15, 225-250.
Wenger, E. (1998). Communities of practice: learning, meaning, and identity. Cambridge
University Press.
"Scientific methods to promote the systematic uptake of clinical research findings and
other evidence-based practices into routine practice and, hence, to improve the quality
and effectiveness of health care."
Sources:
Foy, R., Eccles, M. & Grimshaw, J. (2001). Why does primary care need more
implementation research? Family Practice 18:353-355.
Graham, I.D., Logan, J., Harrison, M.B., Strauss, S.E., Tetroe, J., Caswell W. & Robinson, N.
(2006). Lost in Knowledge Translation: Time for a Map? Journal of Continuing
Education in the Health Professions 26(1): 13–24.
“Knowledge brokering links researchers and decision makers, facilitating their interaction
so that they are able to better understand each other's goals and professional culture,
influence each other's work, forge new partnerships, and use research-based evidence.
Brokering is ultimately about supporting evidence-based decision-making in the
organization, management, and delivery of health services. A knowledge broker is an
individual or an organization that engages in knowledge brokering.”
Source:
Canadian Health Services Research Foundation (CHSRF)
http://www.chsrf.ca/keys/glossary_e.php Retrieved October 21, 2010.
"A systematic approach to capture, collect and share tacit knowledge in order for it to
become explicit knowledge. By doing so, this process allows for individuals and/or
organizations to access and utilize essential information, which previously was known
intrinsically to only one or a small group of people."
Five key principles for KTE:
What? Key messages must be clear, compelling ideas supported by a body of
rigorous research.
To Whom? The interaction should be specific to the audience.
By Whom? The messenger must be considered credible by the audience
How? Interactive engagement between the messenger and the audience is ideal
With what effect? Performance measures must be audience specific and
appropriate to the context.
Source:
Lavis, J. N., Robertson, D., Woodside, J. M., Mcleod, C. B., & Abelson, J. (2003). How can
research organizations more effectively transfer research knowledge to decision
makers? Milbank Quarterly, 81(2), 221–248.
"Systematic review that uses quantitative methods to synthesize and summarize results."
Source:
Straus, SE., Richardson, WS., Glasziou, P. & Haynes, R (2005) Evidence-Based Medicine:
rd
How to Practice and Teach EBM, 3 ed Elsevier Churchill Livingstone pg. 281
"Entails a comparison, translation, and analysis of original findings from which new
interpretations are generated, encompassing and distilling the meanings in the
constituent studies."
Source:
Zimmer, L. (2006) Qualitative meta-synthesis: a question of dialoguing with text. Journal
of Advanced Nursing 53(3), 311-318
“Those factors or characteristics of the organization that influence the diffusion of
innovations or the utilization of research by practitioners (e.g. administrative support,
access to research, size, complexity, staffing, organizational culture, etc.).”
Source:
http://www.kusp.ualberta.ca/en/Resources/Glossary.aspx accessed 25 October 2010
Individual factors
Utilization
Research utilization
Conceptual research
utilization
Instrumental research
utilization
Capacity and capacity
building
Summary
Dissemination strategy
“Those characteristics of the individual that influence the utilization of research by
practitioners. Examples of characteristics thought to be relevant include: age, education
level, autonomy, problem solving ability, open-mindedness, etc.”
Source:
http://www.kusp.ualberta.ca/en/Resources/Glossary.aspx accessed 25 October 2010
“Focused on assisting with the actual adoption process after dissemination and diffusion
have occurred. When the term utilization is used in the context of "research utilization", it
usually refers to a complex problem solving, critical thinking, and decision-making process
undertaken by clinicians and not just the use of research in an instrumental way.”
Source:
http://www.kusp.ualberta.ca/en/Resources/Glossary.aspx accessed 25 October 2010
“Specific kind of knowledge utilization whereby the knowledge has a research base to
substantiate it. It is a complex process in which knowledge, in the form of research, is
transformed from the findings of one or more studies into instrumental, conceptual, or
persuasive utilization.”
Source:
http://www.kusp.ualberta.ca/en/Resources/Glossary.aspx accessed 25 October 2010
“Research findings from one or more studies that may change one’s thinking but not
necessarily one’s particular or observable action.”
Source:
http://www.kusp.ualberta.ca/en/Resources/Glossary.aspx accessed 25 October 2010
“Concrete application of the research, which is normally translated into a material and
usable form, such as a protocol or set of guidelines.”
Source:
http://www.kusp.ualberta.ca/en/Resources/Glossary.aspx accessed 25 October 2010
“In knowledge exchange, capacity is the set of skills, structures, and processes, as well as
the organizational culture that allows, encourages, and rewards knowledge exchange. The
Foundation works to build the capacity of decision-making and research organizations to
achieve knowledge exchange in order to make decisions on the basis of research and
other evidence.”
Source:
Canadian Health Services Research Foundation (CHSRF)
http://www.chsrf.ca/keys/glossary_e.php Retrieved October 25, 2010.
“Summaries are a less formal way of pulling research together, generally using a more
conversational [plain language] tone. Where a formal synthesis can be considered to be
the creation of new knowledge, a summary clearly pulls together main messages from a
number of published sources.”
Source:
Canadian Health Services Research Foundation (CHSRF)
http://www.chsrf.ca/keys/glossary_e.php Retrieved October 25, 2010.
“Is an evolving plan begun in advance of a research program that aims to:
extract clear, simple, and active main messages or key implications from research
results;
identify credible "carriers" of the message; pinpoint key decision-maker audiences for
the messages; and
develop ways to deliver messages that are appropriate to audiences being targeted
and that encourage them to factor the research implications into their work.
Face-to-face communication is encouraged whenever possible.”
Source:
Canadian Health Services Research Foundation (CHSRF)
http://www.chsrf.ca/keys/glossary_e.php Retrieved October 25, 2010.