Exploring the Function and Effectiveness of Knowledge Brokers as Facilitators of Knowledge Translation in Health-Related Settings

Bornbaum C. C., Kornas, K. Peirson, K. & Rosella, L. C. (2015). Exploring the function and effectiveness of knowledge brokers as facilitators of knowledge translation in health-related settings: A systematic review and thematic analysis. Implementation Science, 10, 162. DOI 10.1186/s13012-015-0351-9. http://www.implementationscience.com/content/10/1/162
Background: Knowledge brokers (KBs) work collaboratively with key stakeholders to facilitate the transfer and exchange of information in a given context. Currently, there is a perceived lack of evidence about the effectiveness of knowledge brokering and the factors that influence its success as a knowledge translation (KT) mechanism. Thus, the goal of this review was to systematically gather evidence regarding the nature of knowledge brokering in health-related settings and determine if KBs effectively contributed to KT in these settings.
Methods: A systematic review was conducted using a search strategy designed by a health research librarian. Eight electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, ERIC, Scopus, SocINDEX, and Health Business Elite) and relevant grey literature sources were searched using English language restrictions. Two reviewers independently screened the abstracts, reviewed full-text articles, extracted data, and performed quality assessments. Analysis included a confirmatory thematic approach. To be included, studies must have occurred in a health-related setting, reported on an actual application of knowledge brokering, and be available in English.
Results: In total, 7935 records were located. Following removal of duplicates, 6936 abstracts were screened and 240 full-text articles were reviewed. Ultimately, 29 articles, representing 22 unique studies, were included in the thematic analysis. Qualitative (n = 18), quantitative (n = 1), and mixed methods (n = 6) designs were represented in addition to grey literature sources (n = 4). Findings indicated that KBs performed a diverse range of tasks across multiple health-related settings; results supported the KB role as a ‘knowledge manager’, ‘linkage agent’, and ‘capacity builder’. Our systematic review explored outcome data from a subset of studies (n = 8) for evidence of changes in knowledge, skills, and policies or practices related to knowledge brokering. Two studies met standards for acceptable methodological rigour; thus, findings were inconclusive regarding KB effectiveness.
Conclusions: As knowledge managers, linkage agents, and capacity builders, KBs performed many and varied tasks to transfer and exchange information across health-related stakeholders, settings, and sectors. How effectively they fulfilled their role in facilitating KT processes is unclear; further rigourous research is required to answer this question and discern the potential impact of KBs on education, practice, and policy.
There are two important take home messages from this article:

  1. There’s nothing really new because this is a systematic review so it reviews stuff we already know but puts it all in one place
  2. We don’t actually know if anything we do is useful

To summarize: for knowledge mobilization practitioners there’s nothing new and we don’t know if we are actually accomplishing anything.
At least that’s what the researchers tell us…maybe the practitioners will have another interpretation.
The authors did a systematic review to: 1) perform a thematic analysis against an established framework of knowledge broker (KB) activities (knowledge management, linkage and exchange, and capacity building) and 2) determine if there is evidence of effectiveness of these KB activities.
This paper reviewed stuff we already know (published papers in their systematic review) and compared against an established framework (thank you Vicky Ward) that we also already knew. So it’s not surprising there isn’t much new this paper. Nonetheless Table 1 provides a useful Classification of knowledge brokering tasks according to activity domains. Table 1 identifies the following 10 tasks and breaks them down into a total of 39 activities. These high level tasks include:

  1. Identify, engage and connect to stakeholders
  2. Facilitate collaboration
  3. Identify and obtain relevant information
  4. Facilitate development of analytic and interpretive skills
  5. Create tailored knowledge products
  6. Project coordination
  7. Support communications and information sharing
  8. Network development, maintenance and facilitation
  9. Facilitate and evaluate change
  10. Support sustainability

None of these 10 tasks are new but I didn’t know I did 39 different things to accomplish these 10. I’m not sure I want to know this level of detail as it can appear intimidating. This was the case with research covered in this journal club which surveyed KB at U. Edinburgh and identified that the many varied tasks (among other things) created dissatisfaction for KBs and their roles. My personal view is that given job security (which the U. Edinburgh KBs did not have) this diversity of functions becomes an attractive feature of the job. It’s certainly never a dull day on the job for most KBs!
Then the authors queried the papers in their systematic review and found only two that had the methodological rigour to provide evidence of KBs having effectively facilitated KT in health-related settings. One study reported a positive effect of the KB strategy on stakeholders’ knowledge and practices while the other did not identify a statistically significant effect on stakeholders’ practices. The latter study was an RCT of a KB strategy. The KB arm failed to produce any additional benefits than the RCT arm that provided only systematic reviews or targeted messages. This led the authors to conclude that there is insufficient evidence to determine if KB functions are effective in facilitating knowledge mobilization.
This is reminiscent of another systematic review in this journal club that showed that in a review of 373 trials, many thousands of health professionals the best you get was a 6% improvement in practice.
While there may not be much methodologically rigorous evidence about the impact or effectiveness of KB functions there is a ton of literature (academic and grey literature) that describes positive outcomes from KB activities. This literature does not employ the gold standard RCT nor does it necessarily compare KB benefits across different settings.
But here’s my question…how many anecdotes does it take to create evidence?
As a practitioner I want to be informed by evidence but I accept that there are many forms of evidence including practice based evidence and evidence from lived experience. I value RCT derived evidence. I also value the evidence from knowledge mobilization practices in my ResearchImpactcolleague’s universities, in the DRUSSA universities and in theNABI universities, as examples. And there are many more.
Questions for brokers:

  1. How many anecdotes does it take to create evidence to inform your practice?
  2. With an abundance of practice based evidence and a dearth of academically rigorous evidence how do you evaluate your work?
  3. For discussion: With the dearth of academically rigorous evidence about the effectiveness of KB functions academic researchers should stop telling us what we already know and actually do new research to generate the new evidence about the effectiveness (or lack thereof) of KB.

RIR is producing this journal club series as a way to make the evidence on KMb more accessible to knowledge brokers and to create on line discussion about research on knowledge mobilization. It is designed for knowledge brokers and other knowledge mobilization stakeholders. Read the article. Then come back to this post and join the journal club by posting your comments.

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