Is it Time to Drop the ‘Knowledge Translation’ Metaphor? A Critical Literature Review

Greenhalgh, T., Wieringa, S. (2011). Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review. Journal of the Royal Society of Medicine, 104, 501-509. DOI 10.1258/jrsm.2011.110285
The literature on ‘knowledge translation’ presents challenges for the reviewer because different terms have been used to describe the generation, sharing and application of knowledge and different research approaches embrace different philosophical positions on what knowledge is. We present a narrative review of this literature which deliberately sought to highlight rather than resolve tensions between these different framings. Our findings suggest that while ‘translation’ is a widely used metaphor in medicine, it constrains how we conceptualise and study the link between knowledge and practice. The ‘translation’ metaphor has, arguably, led to particular difficulties in the fields of ‘evidence-based management’ and ‘evidence-based policymaking’ – where it seems that knowledge obstinately refuses to be driven unproblematically into practice. Many non-medical disciplines such as philosophy, sociology and organization science conceptualise knowledge very differently, as being (for example) ‘created’, ‘constructed’, ’embodied’, ‘performed’ and ‘collectively negotiated’ – and also as being value-laden and tending to serve the vested interests of dominant elites. We propose that applying this wider range of metaphors and models would allow us to research the link between knowledge and practice in more creative and critical ways. We conclude that research should move beyond a narrow focus on the ‘know-do gap’ to cover a richer agenda, including: (a) the situation specific practical wisdom (phronesis) that underpins clinical judgment; (b) the tacit knowledge that is built and shared among practitioners (‘mindlines’); (c) the complex links between power and knowledge; and (d) approaches to facilitating macro-level knowledge partnerships between researchers, practitioners, policymakers and commercial interests.
This is a different type of article for the Journal Club. There is little in this article that will directly help your knowledge mobilization (KMb) practice (instrumental research use) but there is a lot here to get you thinking about your KMb practice (conceptual research use, thank you Sandra Nutley). This paper unpacks the term knowledge translation, traces the origins of the over packing to the foundations of how we conceive of knowledge (“epistemology)” and grounds this thinking in the teachings of Aristotle.
Knowledge translation has a global definition adopted by the World Health Organization following a meeting in 2005: “the synthesis, exchange and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and advancing people’s health”.  WHO identified “push” and “pull” enablers and barriers to effective KT.  The authors point out a number of problematic assumptions underlying this definition:

  • Knowledge equates with objective, impersonal research findings – a form of what Aristotle called “episteme”. Knowledge is seen as unproblematically separable from the scientists who generate it and the practitioners who may use it.
  • There is presumed to be a ‘know-do gap’ between scientific facts and practice. This implies that knowledge and practice can be cleanly separated both empirically and analytically.
  • Practice consists more or less of a series of rational decisions on which scientific research findings can be brought to bear.

If we accept these assumptions then it is feasible for knowledge to be translated into action.
However, the authors point out that for Aristotle, knowledge included not only episteme (facts) but also techne (skill) and phronesis (a form of practical wisdom). Practitioners need to know not only what (episteme) but how (techne) and have wisdom (prhonesis) to know how to apply what. The authors point out that facts are context dependent and need tacit knowledge for successful implementation or application. They point out that “knowledge translation cannot be viewed as a politically neutral exercise in the transmission of facts”.
Table 1 provides an analysis of a number of concepts related to KT with the implications for the link between research and practice. Of relevance to knowledge brokers are the concepts of Community of Practice (CoP) and Engaged Scholarship. The authors propose that in Communities of Practice knowledge is “contiguous” with practice and that in Engaged Scholarship knowledge emerges from collaborative practice. This is relevant to members of CoP such as the Southern Ontario KTE Community of Practice and the knowledge brokers in ResearchImpact-RéseauImpactRecherche where understanding (“knowledge”) arises from our own practice. However, our KMb practice supports engaged scholarship where we broker collaborative research relationships from which co-created knowledge emerges. Knowledge derived from engaged scholarship is Mode 2 knowledge which the authors define as “research which emerges from active, two-way partnerships between researchers, decision-makers, funders, industry and other stakeholders”.
Drawing examples from education and management, the authors point out that the “know – do gap” will never be bridged through knowledge translation, actionable messages or incentives to use evidence. From education the authors recommend “personal praxis” – the reflexive consideration, individually and collectively, of how one has performed (or should perform) in particular cases and situations.”
Key points for brokers’ discussion:

  1. The authors are invoking a postmodern view of knowledge in which knowledge is not absolute. How does this affect our ability to broker relationships that provide “evidence” to decision makers? Are non-academic partners ready to understand the contexts of evidence and are they looking at the university as an “honest broker” of evidence that must be “factual” if derived from rigourous scientific study? For more on post-modern discussions of KMb check out: Watkins, J.M. (1994-1995) A postmodern critical theory of research use. Knowledge & Policy. 7(4):55-78 (not open access).
  2. While as brokers we need to consider the evidence on KMb to inform our practice we also need to practice “personal praxis”. How much do you critically reflect on your KMb practice? How do you evaluate and articulate your success? How do you know this success is the best success you can achieve? While we extoll the virtues of evidence-based practice, there is much to learn from practice-based evidence.  We have a lot of knowledge as practitioners. Don’t be afraid to share yours and find or create a KMb CoP to help with your critical, personal praxis.
  3. Do terms really matter? Sure there are epistemological challenges with the term knowledge translation, but similarly with mobilization, management, exchange, interaction etc. And there are problems with the term “knowledge” as well.  We understand that “knowing” is context dependent and there are many forms of knowledge that can and should inform any decision and that knowledge is best made ready for action when it is co-created with end users. If we understand this then what does it matter what we call it?
  4. Furthermore, terms go beyond meaning and can have brand power. The authors point out challenges with knowledge translation. But CIHR has knowledge translation in its legislation “the objective of the CIHR is to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians”. If CIHR wanted to adopt another term thy might have to change their federal legislation. Terms have meaning beyond their definition.
  5. Aristotle had it right 2300 years ago. Knowledge is context and practice dependent. How does your KMb practice embrace practice based and tacit knowledge as well as codified knowledge and other forms of knowing?

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. If you’re a community member seek a colleague at your local university to obtain this article for you. Then come back to this post and join the journal club by posting your comments.