Knowledge Translation: Introduction to Models, Strategies, and Measures
Introduction
Knowledge translation (KT) is a complex and multidimensional concept that demands a comprehensive understanding of its mechanisms, methods, and measurements, as well as of its influencing factors at the individual and contextual levels—and the interaction between both those levels. This literature review, although not intended to be an in-depth or systematic review of any one aspect of knowledge translation, is designed to bring together several aspects of it from selected literature for the purpose of raising awareness, connecting thoughts and perspectives, and stimulating ideas and questions about knowledge translation for future research of this area of inquiry in rehabilitation. The body of work included in this review was selected from frequently cited and thought-provoking literature and represents a variety of thoughts and approaches that are applicable to knowledge translation.
This paper begins by presenting the definitions of knowledge translation and discussing several models that, together, can be used to delineate components and understand mechanisms necessary for successful knowledge translation. Then the knowledge translation strategies and their effectiveness are explored based on the literature drawn from other health-care fields in addition to rehabilitation. Finally, several methods and approaches to measure the use of research knowledge in various dimensions are presented.
Definitions of Knowledge Translation
Knowledge translation (KT) is a relatively new term coined by the Canadian Institutes of Health Research (CIHR) in 2000. CIHR defined KT 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" (CIHR, 2005, para. 2).
Since then, a few other definitions of KT have been developed. Adapted from the CIHR definition, the Knowledge Translation Program, Faculty of Medicine, University of Toronto (2004), stated its definition of knowledge translation as "the effective and timely incorporation of evidence-based information into the practices of health professionals in such a way as to effect optimal health care outcomes and maximize the potential of the health system."
The World Health Organization (WHO) (2005) also adapted the CIHR’s definition and defined KT as "the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health."
At around the same time, the National Institute on Disability and Rehabilitation Research (NIDRR) developed a working definition of KT in its long-range plan for 2005–2009. NIDRR refers to KT as "the multidimensional, active process of ensuring that new knowledge gained through the course of research ultimately improves the lives of people with disabilities, and furthers their participation in society" (NIDRR, 2005).
Most recently, the National Center for the Dissemination of Disability Research (NCDDR) proposed another working definition of KT as "the collaborative and systematic review, assessment, identification, aggregation, and practical application of high-quality disability and rehabilitation research by key stakeholders (i.e., consumers, researchers, practitioners, and policymakers) for the purpose of improving the lives of individuals with disabilities" (NCDDR, 2005).
Characteristics of Knowledge Translation
A prominent characteristic of KT, as indicated by CIHR (2004), is that it encompasses all steps between the creation of new knowledge and its application to yield beneficial outcomes for society. Essentially, KT is an interactive process underpinned by effective exchanges between researchers who create new knowledge and those who use it. As stated by CIHR, bringing users and creators of knowledge together during all stages of the research cycle is fundamental to successful KT.
Knowledge in KT has an implicit meaning as research-based knowledge. CIHR envisioned that KT strategies can help define research questions and hypotheses, select appropriate research methods, conduct the research itself, interpret and contextualize the research findings, and apply the findings to resolve practical issues and problems. As outlined by CIHR (2004), continuing dialogues, interactions, and partnerships within and between different groups of knowledge creators and users for all stages of the research process are integral parts of KT. Examples of different interactive groups are as follows:
- Researchers within and across research disciplines
- Policymakers, planners, and managers throughout the health-care, public-health, and health public-policy systems
- Health-care providers in formal and informal systems of care
- General public, patient groups, and those who help to shape their views and/or represent their interests, including the media, educators, nongovernmental organizations, and the voluntary sector
- The private sector, including venture capital firms, manufacturers, and distributors
CIHR (2004) stated that the process of KT includes knowledge dissemination, communication, technology transfer, ethical context, knowledge management, knowledge utilization, two-way exchange between researchers and those who apply knowledge, implementation research, technology assessment, synthesis of results with the global context, and development of consensus guidelines. Therefore, KT appears to be a larger construct that encompasses most previously existing concepts related to moving knowledge to use. It is the newest conceptual development that seems to be more comprehensive, more sophisticated, and highly embedded in the actual contexts in which the knowledge applications will eventually occur.
Overall, the characteristics of KT can be summarized in a nonranked order as follows:
- KT includes all steps between the creation of new knowledge and its application.
- KT needs multidirectional communications.
- KT is an interactive process.
- KT requires ongoing collaborations among relevant parties.
- KT includes multiple activities.
- KT is a nonlinear process.
- KT emphasizes the use of research-generated knowledge (that may be used in conjunction with other types of knowledge).
- KT involves diverse knowledge-user groups.
- KT is user- and context-specific.
- KT is impact-oriented.
- KT is an interdisciplinary process.
Knowledge Translation and Evidence-Based Practice
Knowledge translation (KT) is a term increasingly used in health-care fields to represent a process of moving what we learned through research to the actual applications of such knowledge in a variety of practice settings and circumstances. In rehabilitation, the interest in KT (and other concepts about moving research-based knowledge into practice) appears to coincide with the growing engagement in the evidence-based practice (EBP) approach, in which practitioners make practice decisions based on the integration of the research evidence with clinical expertise and the patient’s unique values and circumstances (Straus, Richardson, Glasziou, & Haynes, 2005). Despite a strong endorsement for EBP in rehabilitation and other health-care fields, the use of research for practice continues to be lacking (e.g., Bennett et al., 2003; Meline & Paradiso, 2003; Metcalfe, Lewin, Wisher, Perry, Bannigan, & Moffett, 2001; Turner & Whitfield, 1997). This difficulty has led to increased awareness of the complexity of this process, quests to understand its mechanisms, and attempts to develop strategies that could increase its success.
In past literature, scholars have had different takes on the interchangeable use of KT and other similarly focused terminologies. Some have used KT and other terms interchangeably (e.g., Jacobson, Butterill, & Goering, 2003), whereas others have attempted to tease out the differences between KT and other terms (e.g., Johnson, 2005; Kerner, 2006). That debate lies outside the scope of this paper and will not be discussed here. According to the CIHR’s framework, KT encompasses other related concepts that come before it, and the discussion in this paper will follow that theme, treating related concepts as parts of KT.
Next Section: Knowledge Translation Models