Whither knowledge translation: An international research agenda

Transcription

1 Whither knowledge translation 1 Whither knowledge translation: An international research agenda Ian D Graham a, Jacqueline Tetroe b a Vice President Knowledge Translation Canadian Institutes of Health Research, Ottawa, Canada b Senior Policy Analyst Knowledge Translation Canadian Institutes of Health Research, Ottawa, Canada

2 Whither knowledge translation 2 Whither knowledge translation: An international research agenda The excellent papers in this supplement by Estabrooks, Cummings, Midodzi, Adewale and colleagues and the insightful commentaries by Titler, Sales, Bucknall, Dopson, and Rycroft-Malone illustrate the need for, and value of, focused research on knowledge translation (KT) theory, methods, and measures. The supplement when taken as a whole provides an inkling of what might be achieved if there were an international KT research agenda and if collaborative interdisciplinary teams from around the globe focused on specific lines of KT inquiry. While not wanting to take anything away from the important contributions Estabrooks and colleagues have made, just image what more might have resulted had the research team originally included Titler, Sales, Bucknall, Dopson and Rycroft-Malone with their diverse and complementary perspectives, methods and theories. Another reason for developing such an international research agenda relates to the infancy of the field and the relatively sparse number of researchers focusing on this area. Such a research agenda would not only generate dialogue and debate about what constitutes the core of the field and how KT science should evolve, it could focus limited resources on the areas most in need of attention and create the impetus for KT researchers and KT research groups to work together and thereby be better positioned to be able to make significant discoveries and advances. In the same way that the human genome project focused attention on dividing up the task of mapping the genome, an international KT research agenda might allow KT researchers both to avoid duplication of effort and to allow ongoing work to inform future research and implementation endeavours. So the million dollar question is, what might an international KT research agenda look like? Many of the contributors to this supplement have already suggested some topics for the agenda. We would like to reiterate some of these and offer a few others. These ideas are only intended to generate discussion. A truly international research agenda should result from international dialogue and debate. As with any new and emerging field, there is a need to develop common understanding of terms and concepts as several of the contributors to this supplement

3 Whither knowledge translation 3 have noted (eg Sales, Rycroft-Malone). This is best exemplified by the lack of clarity that is generated by the numerous terms used to define this new field. The terms knowledge translation, knowledge transfer, knowledge exchange, implementation, research utilization, dissemination and diffusion, along with many others (Graham et al, 2006) are often used interchangeably when in fact there may be subtle but important differences between the terms. The significance of the difference between knowledge use and research use being a case in point. As the studies by Estabrooks and colleagues were funded by the Canadian Institutes of Health Research (CIHR), it may be useful to note that CIHR is Canada s premier health research funding agency. It was created in 2000 with a mandate to excel, according to international standards of scientific excellence, in the creation of new knowledge and its translation into improved health, more effective health services and products, and a strengthened Canadian health care system (Canadian Institutes of Health Research, 2004). CIHR subsequently coined the term knowledge translation and defined it as: 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 (Canadian Institutes of Health Research, 2005). While some consider this definition rather complex, each of the words in the definition were carefully chosen and have implications for what is meant by the judicious translation of research into practice and policy. Synthesis is used to emphasize the importance of understanding how the results from a single research study mesh with the larger body of knowledge/research on the topic. It is only by conducting synthesis of the global literature that the effectiveness of most interventions/practices can be truly determined. The exchange of knowledge refers to the interaction between the research user and the research producer that result in mutual learning. Ethically sound application of knowledge implies that the findings being applied are consistent with ethical principles and norms, social values as well as legal and other regulatory frameworks. The term application is used to refer to the iterative process by which research findings are put to use. We see from this definition that the purpose of KT is ultimately to improve the health care system and health of individualsmaking monitoring and evaluation of KT outcomes implicit aspects of the process. For

4 Whither knowledge translation 4 CIHR, KT is about turning knowledge generated by research into action or reducing the know-do gap. Perhaps this conceptualization of the term knowledge translation could guide our work both within Canada and within an international research agenda. In any case, whatever terms are used, the field must clearly define what counts as the legitimate research jurisdiction of the field and what the scope of research within the field should be. The international KT research agenda could also tackle the thorny problem of developing a common understanding of terminology and taxonomies for describing the attributes or characteristics of innovations (knowledge/evidence), KT interventions, and context (including types of organizations). As Titler pointed out, this will provide researchers with common concepts and vocabulary and also permit better comparability across studies and a more systematic understanding of the process of change. Related to the need for common terminology is the need for common approaches to measurement as indicated by both Estabrooks et al and Cummings et al. Much work needs to be done to develop standardized and valid outcome measures of knowledge/research use (actual and self-reported measures, dichotomous vs multiple category vs continuous variables). Similarly, validated measures of potential predictor variables related to the knowledge/research users and context measures would provide invaluable tools for the KT researcher toolkit (Estabrooks, Bucknall, Dopson). These will not be not be trivial endeavours as it will involve many theoretical and methodological challenges. At the same time, considerable work is needed in the area of theory use and development including the testing and refining of the current KT theories and examining the applicability of theories from fields outside of health. In her commentary, Rycroft- Malone offers many wise suggestions for a theory-informed KT research agenda. As Estabrooks and colleagues paper demonstrates, another area that has implications for both theory and measurement relates to the complexity of knowledge/research use, the interaction of the effects at multiple levels (eg, the individual, the unit, and the hospital) and the need to simultaneously consider the individual and group level when measuring and predicting knowledge/research use. From a theoretical perspective this means the acknowledgement and potential integration of psychological (individual) theories of change with sociological and organizational (group) theories

5 Whither knowledge translation 5 (Dopson) to tease out the influences on individuals and groups at multiple levels. This work would require interdisciplinary collaboration to move the field forward. Another area that would benefit from placement on the international research agenda is the systematic development and testing of KT interventions (Titler, Rycroft- Malone). While not raised in this supplement, the development of common approaches to reliably assess barriers to knowledge/research use is urgently needed. Presumably KT interventions that address barriers to knowledge/research use will be more successful than ones that fail to target known barriers. However, without valid measures for conducting barriers assessments it will be difficult to determine the relationships between barriers, potential knowledge users, and the context or setting in which the decisions to use the knowledge takes place. Nor will we be any further ahead in knowing whether tailoring interventions to barriers results in greater knowledge use. As Titler and Rycroft- Malone note, much more research needs to focus on developing theory based KT interventions and on testing their effectiveness. As Titler also suggests, there is a need to obtain international consensus on a set of core concepts and related measures to use in implementation studies as well as developing a central data repository for implementation studies. We would take this a step further, and suggest that this repository could also be a place to register as well as report on implementation studies. The effect of culture and of different health services governance systems on the process of KT has not yet been well investigated but international collaboration and an international research agenda could increase the opportunity investigate this. Crosscultural and cross-national studies would facilitate the identification of differences and similarities in the role of context and of the individual in knowledge/research use (Titler). Given that KT is a processual phenomena (Dopson) that is dynamic and interactive (Graham and Logan, 2004; Logan and Graham, 1999), it will only be by conducting longitudinal studies that we will truly capture its unfolding nature over-time. While crosssectional studies are important for advancing our knowledge of some aspects of KT (as the current supplement demonstrates), the time has come to move beyond the static view of KT and embrace the changing nature of context and individual decision making. There

6 Whither knowledge translation 6 will be many theoretical and methodological challenges that such longitudinal KT studies will pose. Finally, while not specifically a research issue, the creation of an annual international KT research meeting would do much to advance KT science and practice. An international meeting devoted exclusively to KT would provide a meeting place and forum for KT researchers and KT practitioners to get together and exchange perspectives, share research in progress, cultivate collaborations, and of course develop and execute a KT research agenda. Knowledge translation science is a young field with great promise to improve health and health care by providing direction on how to efficiently facilitate the uptake of research findings and other forms of knowledge. As is often the case when new fields develop, we do not currently have sufficient research capacity to address every burning issue in KT. As evidenced by Estabrooks and her colleagues in Edmonton and the authors of the commentaries in this supplement, there are pockets of strong KT researchers doing important work in many countries around the world. With the development of an international KT research agenda, these pockets of expertise might be able to systematically focus on key research areas and accelerate the advancement of KT science. Such a research agenda could also be used by health research funders to prioritize KT research areas that urgently need to be funded.

7 Whither knowledge translation 7 References Canadian Institutes of Health Research. (2004). An overview of CIHR. Retrieved April 12, 2007 from Canadian Institutes of Health Research. (2005). About knowledge translation. Retrieved April 12, 2007 from Graham, I.D., Logan, J., Harrison, M.B., Straus, 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, Graham, I.D., & Logan, J. (2004). Innovations in knowledge transfer and continuity of care. Canadian Journal of Nursing Research, 36, Logan, J., & Graham, I.D. (1998). Toward a comprehensive interdisciplinary model of health care research use. Science Communication 20,