Grimshaw, J. M., Eccles, M. P., Lavis, J. N., Hill, S. J. & Squires, J. E. (2012). Knowledge translation of research findings. Implementation Science,7(50), 1-17. http://www.implementationscience.com/content/7/1/50
Abstract
Background: One of the most consistent findings from clinical and health services research is the failure to translate research into practice and policy. As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare and are exposed to unnecessary risks of iatrogenic harms, and healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs. Over the last decade, there has been increasing international policy and research attention on how to reduce the evidence-practice and policy gap. In this paper, we summarise the current concepts and evidence to guide knowledge translation activities, defined as T2 research (the translation of new clinical knowledge into improved health). We structure the article around five key questions: what should be transferred; to whom should research knowledge be transferred; by whom should research knowledge be transferred; how should research knowledge be transferred; and, with what effect should research knowledge be transferred?
Discussion: We suggest that the basic unit of knowledge translation should usually be up-to-date systematic reviews or other syntheses of research findings. Knowledge translators need to identify the key messages for different target audiences and to fashion these in language and knowledge translation products that are easily assimilated by different audiences. The relative importance of knowledge translation to different target audiences will vary by the type of research and appropriate endpoints of knowledge translation may vary across different stakeholder groups. There are a large number of planned knowledge translation models, derived from different disciplinary, contextual (i.e., setting), and target audience viewpoints. Most of these suggest that planned knowledge translation for healthcare professionals and consumers is more likely to be successful if the choice of knowledge translation strategy is informed by an assessment of the likely barriers and facilitators. Although our evidence on the likely effectiveness of different strategies to overcome specific barriers remains incomplete, there is a range of informative systematic reviews of interventions aimed at healthcare professionals and consumers (i.e., patients, family members, and informal carers) and of factors important to research use by policy makers.
Summary: There is a substantial (if incomplete) evidence base to guide choice of knowledge translation activities targeting healthcare professionals and consumers. The evidence base on the effects of different knowledge translation approaches targeting healthcare policy makers and senior managers is much weaker but there are a profusion of innovative approaches that warrant further evaluation.
This paper seeks to improve our understanding of knowledge translation (KT) from clinical research into improved health. It is focused around five questions that John Lavis has previously asked.
- What should be transferred?
- To whom should research knowledge be transferred?
- By whom should research knowledge be transferred?
- How should research knowledge be transferred?
- With what effect should research knowledge be transferred?
What should be transferred? The authors are definitive on this one. « The basic unit of knowledge translation should be up-to-date systematic reviews or other syntheses of the global evidence« . There are growing compendiums of systematic reviews, the archetypes of which are the Cochrane Collaboration mainly for health sciences and the Campbell Collaboration for systematic reviews in education, crime and justice and social welfare. This article and many others argue against the use of single studies to inform practice decisions. The authors are not wrong. Systematic reviews are the most robust form of evidence to inform decisions. But there are some challenges to systematic reviews:
- Who funds systematic reviews? While CIHR has the occasional systematic review competition they are not part of traditional research funding schemes. A systematic review is expensive and time consuming. CIHR systematic review grants are $100,000 for one year. Then you have to get the systematic review published because the validity is enhanced when peer reviewed. That takes another year or more. So now your systematic review is reviewing evidence that is at least 2 years old, which hardly qualifies it as « up to date« .
- Who does systematic reviews? While you can publish your systematic review it is has been challenged as not being original scholarship. This is likely a contentious view as many academics do undertake systematic reviews. But I have never seen a systematic review take the place of a graduate thesis and it may not make for a productive post-doctoral fellowship.
- Where is the evidence that systematic reviews are effectively used to inform health care decisions? They are produced and posted on Cochrane, Campbell and other systematic review sites. But are they used and does that use have an impact?
An exclusive focus on systematic reviews also misses opportunities to broker around research expertise to support co-production. I would argue that the systematic review may be the most robust unit of transfer for evidence but that brokering of research expertise, not evidence, is an important unit of transfer. And when brokering a relationship the research expertise is inherently facilitated in context (thank you PARIHS framework) so may have fewer (or at least different) barriers than transferring evidence.
To whom should research knowledge be transferred?The answer is pretty much everyone including researchers, industry, health administrators, policy makers, patients and practitioners.
By whom should research knowledge be transferred?Credibility is important to successful KT. The authors state that « researchers typically carry the responsibility for conducting knowledge translation. They should, however, only be the messenger when they have credibility with the target audience, possess the skills and experience needed to transfer the research knowledge at hand, and have time and resources to do so. » KT is a suite of skills that is emerging into a profession. While researchers play an important role in KT many do not have the skills and experience that the authors point out is required. There is no mention of knowledge brokers in this section about who should be transferring the research knowledge. There is a very brief mention of « knowledge translation targeting professionals » under the With What Effect section. However, there is much time spent discussing various on line resources which the authors then go on to correctly point out that « this access is necessary but not sufficient to ensure knowledge translation. » Researchers who may not have the skills and electronic resources that are necessary but not sufficient to be effective and no mention of knowledge translation professionals…discuss.
How should research knowledge be transferred? The authors recommend that KT be planned and that barriers to KT be assessed before choosing KT interventions. The interventions discussed come from systematic reviews of studies of those interventions. They include 1) printed educational materials; 2) educational meetings; 3) education outreach; 4) local opinion leaders; 5) audit and feedback; 6) computerized reminders; 6) tailored interventions. Together these reviews studied 373 different trials of KT interventions. In 150 of the trials there were a total of 26,000 health professionals surveyed.
And here’s the shocking thing that the article doesn’t reflect on at all. The greatest impact on practice change identified for any intervention was a 6% improvement in practice. 373 trials. Many thousands of health professionals. And a 6% improvement in practice was the best you could get…again…discuss.
With what effect should research knowledge be transferred? The authors point out that there are many factors that go into health care decisions and research evidence is only one of those factors. They point out that health decisions are evidence informed not evidence based. This would have been a great place to speak about all our efforts producing a 6% benefit.
Questions for brokers:
- How do you plan for your KT? One resource that we use in our KMb practice is the KT planning template developed by Melanie Barwick.
- This paper presents ideal scenarios with systematic reviews of evidence and a variety of interventions. Real life isn’t ideal (which may explain the 6% intervention effect!). How do we not let ideal be the enemy of good? Is there good we can still do in KT without being ideal?
- If the best we can get is 6% improvement why do we bother?
ResearchImpact-RéseauImpactRecherche is producing this journal club series as a way to make the evidence and research on knowledge mobilization 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 articles. Then come back to this post and join the journal club by posting your comments.