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Editor: Danielle Simpson |
Closing the Gap: A Look at Knowledge Translation
By Rachel Thomason
Knowledge Translation (KT) is the bridge that connects what we know with how that knowledge can be used. It encompasses the entire process of creating new knowledge and applying that knowledge to current health care practice. Because this concept is so broad, the Canadian Institutes for Health Research (CIHR) has defined KT as the “dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the healthcare system.” This definition has been widely accepted by the scientific community.
KT itself can also be examined. Researchers closely study the methods used for closing the knowledge-to-action gap and of the barriers and facilitators that are inherent in the process.
Why is Knowledge Translation Important and What Does it Mean for Researchers?
In order for research to produce its intended benefit, it must be applied in the correct context. CIHR’s knowledge-to-action cycle describes KT as a process with various steps needed to synthesize knowledge, identify gaps in care, then design and evaluate appropriate strategies to improve care.
Since the impact of research begins with the widespread use of effective interventions, there is a growing realization that instead of focusing on the discovery of new therapies, understanding how to implement consistent delivery of existing ones is just as important.
Applying what we know to action is essential for all research, but knowledge translation is also an intricate process that can sometimes be confusing, especially when distinguishing between the practice and the science of KT. Dr. Onil Bhattacharyya, Assistant Professor and Research Scholar at the DFCM explains that “the science of KT is the understanding what the best approach is to improving care in a given setting. However, the practice of KT is the effective implementation of approaches to improve quality of care.”
Closing the gap between knowledge and practice is a vital piece of the puzzle that requires further investment and study to increase the effectiveness and efficiency of the Canadian health system. Dr. Bhattacharyya goes on to say that “with the increase in healthcare costs, the use of existing treatments is more affordable and as effective.”
Dr. Melanie Barwick is the Scientific Director of Knowledge Translation in the Child Health Evaluative Sciences program at The Hospital for Sick Children’s Research Institute. Referring to the CIHR and the Canadian Health Services Research Foundation, she says that “these organizations have been instrumental in making knowledge translation a priority on the research agenda. They have been moving in the direction that will require most researchers to include a knowledge translation plan in their funding proposal. Researchers will have to explain how their findings will be shared with the health care system and how the results will be shared with the public.”
Furthermore, the CIHR Act says that “the objective of CIHR is to excel … in the creation of new knowledge and its translation into improved health for Canadians,” placing KT at the centre of CIHR’s mandate.
Funded KT Research
The CIHR and the Canadian Foundation for Innovation (CFI) jointly fund KT Canada, a clinical research initiative that includes researchers from six different universities across Canada. A KT Canada project led by Dr. Bhattacharyya is developing a tool to improve the efficiency of clinical practice guidelines.
KT Canada was established with several goals in mind: to improve how research results are communicated; to develop a consensus on KT terminology and methods for measuring success; to evaluate various KT approaches, such as clinical decision rules; to create web-based quizzes and workshops; and to find ways in which KT efforts can have a lasting impact across the continuum of care by engaging health professionals, community members and various health decision-making groups.
And last year, the Health Services Research Program formed a partnership with the Ontario Institute for Cancer Research and Cancer Care Ontario and established the Knowledge Translation Research Network (KT-Net). Dr. Eva Grunfeld, the Research Program Director at the DFCM, is KT-Net’s Principal Investigator. KT-Net is a province wide network of researchers with a shared objective to accelerate the translation of research into policy and practice. It is clear that a greater focus on research accountability from funding agencies and the federal governments has made it increasingly important to show the benefits of health research by transferring research into policy, programs and practice.
What Barriers Exist for KT?
Until recently, KT has largely been ignored and under-funded. Furthermore, it is a complex discipline where measurement of impact is difficult and context has a large influence on the effect of interventions. When attempting to apply KT research to clinical practice, it is challenging to know which KT interventions to choose, for which audience, in what circumstances and for what goal.
One challenge facing the KT field is the development of a sound knowledge base to make reliable recommendations. There is large variation in interventions which have the same name (like audit and feedback) and measured impact across various contexts of practice so that it is hard to come to general conclusions. The other is ensuring that best practices in KT interventions are widely implemented. Creating knowledge that can be applied to a wide population is extremely difficult. Another challenge is convincing institutions and health systems to adopt effective measures to improve care.“There is often a desire for change, but not always the interest to see if efforts have made a difference in care,” says Dr.Bhattacharyya. The time lapse between generation of new knowledge and its uptake in routine practice is gradually shortening, but continued investment in KT is needed for the health system to realize its potential and for the science of delivery to catch up with the science of discovery.
Overcoming the Obstacles
The good news for researchers is that CIHR is committed to funding KT and other agencies are following in their footsteps. Meeting, Planning and Dissemination (MPD) grants, KT operating grants and special calls for KT grants are available. This support also means that your operating budget could include a KT specialist and KT tools. And if your research project is successful, you can apply for KT supplemental funding after the end of your grant.
You can also establish collaborative relationships with the people you hope to reach with your research. Developing partnerships with your audience early on, whether they are policy makers, for profit organizations or the public, will help you translate your research into action.
The KT community is building on recognized evidence at a steady pace. And with the development of workshops, such as the Hospital for Sick Children’s two-day Scientist Knowledge Translation Training Course (SKTT); and KT learning modules and guides available through CIHR, you will develop a better understanding for KT and the ability to apply the practice of KT to your research.
Tips for Future Research
Before beginning a research proposal, you should think about the KT goals that you hope to accomplish with your project. Ask yourself who you are aiming to inform. Who is your audience and what behavior are you trying to change? What KT methods are appropriate for your audience?
Dr. Barwick discussed these questions when she taught a half-day SKTT Workshop in October at the DFCM. A KT manual was provided, along with a KT planning template to help researchers organize their KT plan. KT relevance and strategies were talked about, but a recurring message from Dr. Barwick was that your project should have a champion. The champion, a peer or expert who is knowledgeable, credible and well-connected, is essential for moving your research into practice. Though the four-hour workshop was not enough time to learn everything about KT, the workshop planted the seed for future awareness and opportunities.
Learn more about the Scientist Knowledge Translation Training Course (SKTT Workshop) and other KT tools
Learn more about KT funding opportunities at CIHR
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