Community-Based Knowledge Translation: Unexplored Opportunities Kothari, A., Armstrong, R. (2011). Community-based knowledge translation: Unexplored opportunities. Implementation Science, 6(59), 1-6. doi:10.1186/1748-5908-6-59 http://www.implementationscience.com/content/6/1/59 Abstract Background: Knowledge translation is an interactive process of knowledge exchange between health researchers and knowledge users. Given that the health system is broad in scope, it is important to reflect on how definitions and applications of knowledge translation might differ by setting and focus. Community-based organizations and their practitioners share common characteristics related to their setting, the evidence used in this setting, and anticipated outcomes that are not, in our experience, satisfactorily reflected in current knowledge translation approaches, frameworks, or tools. Discussion: Community-based organizations face a distinctive set of challenges and concerns related to engaging in the knowledge translation process, suggesting a unique perspective on knowledge translation in these settings. Specifically, community-based organizations tend to value the process of working in collaboration with multi-sector stakeholders in order to achieve an outcome. A feature of such community-based collaborations is the way in which ‘evidence’ is conceptualized or defined by these partners, which may in turn influence the degree to which generalizable research evidence in particular is relevant and useful when balanced against more contextually-informed knowledge, such as tacit knowledge. Related to the issues of evidence and context is the desire for local information. For knowledge translation researchers, developing processes to assist community-based organizations to adapt research findings to local circumstances may be the most helpful way to advance decision making in this area. A final characteristic shared by community-based organizations is involvement in advocacy activities, a function that has been virtually ignored in traditional knowledge translation approaches. Summary: This commentary is intended to stimulate further discussion in the area of community-based knowledge translation. Knowledge translation, and exchange, between communities, community-based organizations, decision makers, and researchers is likely to be beneficial when ensuring that ‘evidence’ meets the needs of all end users and that decisions are based on both relevant research and community requirements. Further exploratory work is needed to identify alternative methods for evaluating these strategies when applied within community-based settings. This article is predicated on the position that community organizations (public health departments, community health centres, local health authorities as well as voluntary sector organizations) are important players in the broader health system but that KT scholarship has been focused on researchers, governments and practitioners. The unique role and circumstance of community organizations has an impact on how KT might best be undertaken in community settings. KT has primarily been considered in a clinical setting where an individual’s health outcome and change in individual (i.e. practitioner) behaviour is the primary goal. Community settings are concerned with the health of populations and communities, value collaboration and organizational as well as individual behaviours. In this setting KT seeks to explore how collaborations acquire, assess, adapt and apply evidence. The nature of what is considered evidence might also differ. These differences are illustrated in Table 2 in the paper. In discussing the nature of evidence, the authors state, “Community-based organizations regularly engage in their own research — needs assessments, capacity/asset mapping, focus groups, surveys — with target populations. This type of research has been recently criticized for not being related to the broader literature base or not mapping well onto ‘evidence hierarchies’ (RCTs, et al.). We wonder, in contrast, if the preference for local information stems from epistemological differences, concerns about generalizability related to RCTs, or the lack of expertise and resources required to access the formal literature. In our experience, the information from local research efforts is highly valued for its contextual relevance, and is perhaps more likely to be put into action through health programs. For KT researchers, developing processes to assist community-based organizations to adapt research to local circumstances may be the most helpful way to advance decision making in this area. Further, increasing the rigor of local research may result in building a culture supportive of evidence-informed decision making.” I can’t help but be struck by this paternalistic view of the types of research undertaken and evidence generated by community organizations. Many community organizations don’t care about epistemological differences but they do care about their local communities and citizens and they care about the relevance and applicability of evidence. KT researchers might be able to help community organizations adapt evidence to local opportunities but don’t forget that knowledge mobilization is a two way street (more like a multidirectional intersection). Local evidence can help inform KT scholarship and academic research as well. The evaluation of KT outcomes may be more complex in community settings. “Measuring the change in ‘practice’ of a collaboration — a KT outcome — is difficult to carry out. Even if measuring the change in ‘practice’ of a collaboration is feasible, measuring change at the community level is difficult. Multiple factors contribute to prevention and health promotion outcomes, making it difficult to establish a link between a KT strategy and improved community health.” A unique feature of community based KT is the impact of evidence upon advocacy. The authors claim, “Specifically, advocacy has not yet been framed as an outcome related to the utilization of knowledge. Traditional KT outcomes tend to be related to Weiss’ conceptual, instrumental, or symbolic use of research, or a staged approach to the utilization of research. Re-conceptualizing advocacy as a KT activity presents a tremendous opportunity to introduce sound evidence into the lobbying and ultimately the policy-making process.” The authors suggest a role for KT researchers might be to develop trusting relationships and then explore the “opportunities and options for using evidence in advocacy purposes“. Maybe but you can’t publish advocacy in peer reviewed literature. There is also a very intriguing but under developed thought in this paper. “In a sense, community-based organizations may act as brokers between researchers and communities.” This suggests that if the end goal of research is impact upon the lives of citizens then community organizations may be the intermediaries between research and impact. If this is the case (and I believe it is) then the impact of knowledge mobilization efforts need to be measured at the level of community partners. Those research informed services, products and programs offered by community partners then have an impact on the lives of citizens. The impact of research is measured by changes in our partners. The impacts of those changes are measured by changes in the lives of citizens. But back to the paper…which ends with something that leaves me shaking my head. “We note that the extensive community-based participatory research (CBPR) body of work provides an excellent starting point for working with community members and evidence. For example, this literature points to the importance of structures, processes, relationships, and principles emerging from CBPR studies that could inform future KT initiatives. Yet, we know little about how to carry out effective KT when related to community collaborations with, within, and between health agencies. Further research should seek to identify and address partnership barriers and develop solutions that enable exchange.” Well if this literature is an important starting point then why didn’t they start with it? CBPR generates evidence that informs decision making. CBPR is KT and KT in the community setting is CBPR. See above for comments on privilege and paternalism. Questions for brokers: One author is from Western University (London, Ontario) and the other is from the University of Melbourne (Australia). I have previously (here and here) commented on the hypocrisy of academic researchers promoting trust and relationships with community partners but continuing to propagate these silos by not recognizing community partners as co-authors. If you are an academic researcher what steps are you taking to create equity between academic and community partners (for more on equity in research relationships see the transcript for a tweet chat held July 25, 2013). Steve Martin (likely not the comedic actor) wrote about five roles for community partners: informant, recipient, endorser, commissioner, co-researcher [Martin, S. 2010. Co-production of social research: strategies for engaged scholarship. Public Money and Management 30 (4): 211-218. 10.1080/09540962.2010.492180]. Co-production only happens when community partners are co-researchers. Think about your research collaborations. If you’re a community partner what role do you play and how are you recognized for that role? What role do you think your academic research partner thinks you play? Advocacy: Advocacy is an important element for community organizations. Although their scholarship is supposed to be objective academic researchers may also become involved in advocacy because academic tenure provides the opportunity (and the obligation) to be critical of existing structures, a role that is not without ideology. But what role should academic institutions play in advocacy? Should an academic research institution take a political position? Can university based knowledge mobilization units really be honest (i.e. unbiased) brokers? For more on honest brokers see Pielke, R.A. (2007). The Honest Broker: Making Sense of Science in Policy and Politics. Cambridge University Press, Cambridge. ResearchImpact-RéseauImpactRecherche (RIR) is producing this journal club series as a way to make 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 this open access article. Then come back to this post and join the journal club by posting your comments.