Sibbald, S. L., Ziegler, B. R., Maskell, R., & Schouten, K. (2020). Implementation of Interprofessional Team-Based Care: A Cross-Case Analysis. Journal of interprofessional care, 1–8. https://doi.org/10.1080/13561820.2020.1803228
Sibbald, S., Schouten, K., Sedig, K., Maskell, R., & Licskai, C. (2020). Key Characteristics and Critical Junctures for Successful Interprofessional Networks in Healthcare - A Case Study. BMC Health Services Research, 20(10). Doi: 10.1186/s12913-020-06656-z.
The use of networks in healthcare has been steadily increasing over the past decade. Healthcare networks reduce fragmented care, support coordination amongst providers and patients, improve health system efficiencies, support better patient care and improve overall satisfaction of both patients and healthcare professionals. There has been little research to date on the implementation, development and use of small localized networks. This paper describes lessons learned from a successful small localized primary care network in Southwestern Ontario that developed and implemented a regional respiratory care program (The ARGI Respiratory Health Program - ARGI is a not-for-profit corporation leading the implementation and evaluation of a respiratory health program. Respiratory therapists (who have a certified respiratory educators designation), care for patients from all seven of the network’s FHTs. Patients rostered within the network of FHTs that have been diagnosed with a chronic respiratory disease are referred by their family physicians to the program. The RTs are integrated into the FHTs, and work in a triad along with patients and providers to educate and empower patients in self-management techniques, create exacerbation action plans, and act as a liaison between the patient’s care providers. ARGI uses an eTool designed specifically for use by the network to assist care delivery, choosing education topics, and outcome tracking. RTs are hired by ARGI and are contracted to the participating FHTs in the network.).
This study used an exploratory case study approach. Data from four participant groups was collected using focus groups, observations, interviews and document analysis to develop a rich understanding of the multiple perspectives associated with the network.
This network’s success can be described by four characteristics (growth mindset and quality improvement focus; clear team roles that are strengths-based; shared leadership, shared success; and transparent communication); and five critical junctures (acknowledge a shared need; create a common vision that is flexible and adaptable depending on the context; facilitate empowerment; receive external validation; and demonstrate the impacts and success of their work).
Networks are used in healthcare to act as integrative, interdisciplinary tools to connect individuals with the aim of improving processes and outcomes. We have identified four general lessons to be learned from a successful small and localized network: importance of clear, flexible, and strengths-based roles; need for shared goals and vision; value of team support and empowerment; and commitment to feedback and evaluations. Insight from this study can be used to support the development and successful implementation of other similar locally developed networks.
Boland, L., Brosseau, L., Caspar, S., Graham, I.D., Hutchinson, A.M., Kothari., A., McNamara, K., Angel, M., & Stacey, D. (2020). Reporting Health Research Translation and Impact in the Curriculum Vitae: A Survey. Implementation Science Communications, 1(1), 1-11.
Increasingly, health researchers must demonstrate the impact and real-life applications of their research. We investigated how health researchers with expertise in knowledge translation report research translation activities and impact on their curriculum vitae (CV).
We conducted a cross-sectional survey of health researchers with expertise in knowledge translation as we anticipated best practices in CV reporting from this specialized group. Our survey asked participants about their reporting of research translation and impact activities on their CVs, intention to report, and barriers and facilitators to reporting such activities on their CVs. We calculated univariate descriptive statistics for all quantitative data. Linear regression models determined predictors of researchers’ intention to report research translation and impact activities on their CVs. We analyzed open-ended qualitative responses using content analysis.
One hundred and fifty-three health researchers responded to the survey (response rate = 29%). Most respondents were Canadian, were female, and had a doctoral degree. Eighty-two percent indicated they reported at least one research translation and/or impact indicator on their CVs. Of those, health researchers commonly reported the following: advisory/regulatory committee membership related to research program (83%), research translation award(s) (61%), and academic performance assessments (59%). Researchers least commonly indicated the following: citation metric scores (31%), summaries of impact (21%), and requests to use research materials and/or products (19%). Fewer than half of the health researchers intended to report knowledge translation (43%) and impact (33%) on their CVs. Strong beliefs about capabilities and consequences of reporting research translation and/or impact were significant predictors of intention. Main barriers were as follows: CV templates do not include research translation and impact activities, participants perceived employers do not value research translation and impact activities, and lack of metrics to evaluate research translation and impact. Ninety-six percent were unaware of a CV template formatted to include research translation and/or impact reporting.
Knowledge translation and impact indicators on the CV are inconsistently reported by our sample of health researchers. Modifiable barriers should be addressed to support more consistent reporting of such activities, including providing a CV template that includes research translation and impact as well as clear metrics to quantify them.
Boland, L., Kothari, A., McCutcheon, C., & Graham, I.D. (2020). Building an Integrated Knowledge Translation (IKT) Evidence Base: Colloquium Proceedings and Research Direction. Health Research Policy and Systems, 18(1), 8.
In 2017, the Integrated Knowledge Translation Research Network issued a call to its members for concept papers to further define IKT, outline an IKT research agenda, and inform the Integrated Knowledge Translation Research Network’s special meeting entitled, Integrated Knowledge Translation State of the Science Colloquium, in Ottawa, Canada (2018). At the colloquium, authors presented concept papers and discussed knowledge-gaps for a research agenda and implications for advancing the IKT field. We took detailed field notes, audio-recorded the meeting and analysed the data using qualitative content analysis.
Twenty-four participants attended the meeting, including researchers (n = 11), trainees (n = 6) and knowledge users (n = 7). Seven overarching categories emerged from these proceedings – IKT theory, IKT methods, IKT process, promoting partnership, definitions and distinctions of key IKT terms, capacity-building, and role of funders. Within these categories, priorities identified for future IKT research included: (1) improving clarity about research co-production/IKT theories and frameworks; (2) describing the process for engaging knowledge users; and (3) identifying research co-production/IKT outcomes and methods for evaluation.
The Integrated Knowledge Translation State of the Science Colloquium initiated a research agenda to advance IKT science and practice. Next steps will focus on building a theoretical and evidence base for IKT.
Canas, E., Shoemaker, J.K., & Kothari, A. (2020). Promising Points for Intervention in Re-imagining Partnered Research in Health Services Comment on “Experience of Health Leadership in Partnering with University-Based Researchers in Canada”. International Journal of Health Policy and Management, 10(10), 1-3, 10.34172/ijhpm.2020.24.
Nguyen, T., Graham, I.D, Mrklas, K.J., Bowen, S., Cargo, M., Estabrooks, C.A., Kothari, A., Lavis, J.A., Macaulay, A.C., MacLeod, M., Phipps, D., Ramsden, V., Renfrew, M.J., Salsberg, J., & Wallerstein, N. (2020). How does Integrated Knowledge Translation (IKT) Compare to Other Collaborative Research Approaches to Generating and Translating Knowledge? Learning From Experts in the Field. Health Research Policy and Systems. 18(35). https://doi.org/10.1186/s12961-020-0539-6
Research funders in Canada and abroad have made substantial investments in supporting collaborative research approaches to generating and translating knowledge as it is believed to increase knowledge use. Canadian health research funders have advocated for the use of integrated knowledge translation (IKT) in health research, however, there is limited research around how IKT compares to other collaborative research approaches. Our objective was to better understand how IKT compares with engaged scholarship, Mode 2 research, co-production and participatory research by identifying the differences and similarities among them in order to provide conceptual clarity and reduce researcher and knowledge user confusion about these common approaches.
We employed a qualitative descriptive method using interview data to better understand experts’ perspectives and experiences on collaborative research approaches. Participants’ responses were analysed through thematic analysis to elicit core themes. The analysis was centred around the concept of IKT, as it is the most recent approach; IKT was then compared and contrasted with engaged scholarship, Mode 2 research, co-production and participatory research. As this was an iterative process, data triangulation and member-checking were conducted with participants to ensure accuracy of the emergent themes and analysis process.
Differences were noted in the orientation (i.e. original purpose), historical roots (i.e. disciplinary origin) and partnership/engagement (i.e. role of partners etc.). Similarities among the approaches included (1) true partnerships rather than simple engagement, (2) focus on essential components and processes rather than labels, (3) collaborative research orientations rather than research methods, (4) core values and principles, and (5) extensive time and financial investment. Core values and principles among the approaches included co-creation, reciprocity, trust, fostering relationships, respect, co-learning, active participation, and shared decision-making in the generation and application of knowledge. All approaches require extensive time and financial investment to develop and maintain true partnerships.
This qualitative study is the first to systematically synthesise experts’ perspectives and experiences in a comparison of collaborative research approaches. This work contributes to developing a shared understanding of collaborative research approaches to facilitate conceptual clarity in use, reporting, indexing and communication among researchers, trainees, knowledge users and stakeholders to advance IKT and implementation science.
Walugembe, D, R., Sibbald, S., Le Bei M. J., & Kothari, A. (2020). Sustainability of Public Health Interventions: Where Are The Gaps?. Health Research Policy and Systems, 17(8). https://doi.org/10.1186/s12961-018-0405-y
Graham, I.D., McCutcheon, C., & Kothari, A. Exploring the Frontiers of Research Co-production: The Integrated Knowledge Translation Research Network Concept Papers. (2019). Health Research Policy and Systems, 17(88). https://doi.org/10.1186/s12961-019-0501-7
Sibbald, S.L., Kang, H. & Graham, I.D. Collaborative Health Research Partnerships: A Survey Of Researcher And Knowledge-User Attitudes and Perceptions. (2019). Health Research Policy and Systems, 17(92). https://doi.org/10.1186/s12961-019-0485-3
Integrated knowledge translation describes the process of partnered research between different stakeholders with the goal of producing research that ultimately achieves a greater impact when put into practice. A better understanding of research partnerships and integrated knowledge translation has implications for future partnerships and collaborative initiatives in practice. Our research describes and expands upon previous work done to identify barriers and attitudes toward collaboration in the context of research funding opportunities that required researcher–knowledge-user partnerships.
A survey was sent out to researchers funded by the Canadian Institutes of Health Research and knowledge-users who worked collaboratively on their research projects. There were two mirror versions of the survey, one for researchers and one for knowledge-users. Descriptive statistics, χ2 analysis and Mann–Whitney U analysis were used to understand the processes, barriers, perceived impact and sustainability of the partnerships.
The results revealed that, although there were differences in the roles of researchers and knowledge-users, both groups felt very positive towards their partnerships. Some of the barriers identified as inhibiting effective partnerships were resource constraints (funding/time) and differences in contribution and involvement amongst team members. Despite these barriers, both researchers and knowledge-users felt that the partnership was not only sustainable, but also helped create an impact.
Our results provide useful information for funding agencies launching opportunities requiring or encouraging collaborative research projects between researchers and knowledge-users.
Glegg, S. M., Jenkins, E., & Kothari, A. (2019). How The Study of Networks Informs Knowledge Translation and Implementation: A Scoping Review. Implementation Science, 14(34). https://doi.org/10.1186/s13012-019-0879-1
To date, implementation science has focused largely on identifying the individual and organizational barriers, processes, and outcomes of knowledge translation (KT) (including implementation efforts). Social network analysis (SNA) has the potential to augment our understanding of KT success by applying a network lens that examines the influence of relationships and social structures on research use and intervention acceptability by health professionals. The purpose of this review was to comprehensively map the ways in which SNA methodologies have been applied to the study of KT with respect to health professional networks.
Systematic scoping review methodology involved searching five academic databases for primary research on KT that employed quantitative SNA methods, and inclusion screening using predetermined criteria. Data extraction included information on study aim, population, variables, network properties, theory use, and data collection methods. Descriptive statistics and chronology charting preceded theoretical analysis of findings
Twenty-seven retained articles describing 19 cross-sectional and 2 longitudinal studies reported on 28 structural properties, with degree centrality, tie characteristics (e.g., homophily, reciprocity), and whole network density being most frequent. Eleven studies examined physician-only networks, 9 focused on interprofessional networks, and 1 reported on a nurse practitioner network. Diffusion of innovation, social contagion, and social influence theories were most commonly applied.
Emerging interest in SNA for KT- and implementation-related research is evident. The included articles focused on individual level evidence-based decision-making: we recommend also applying SNA to meso- or macro-level KT activities. SNA research that expands the range of professions under study, examines network dynamics over time, extends the depth of analysis of the role of network structure on KT processes and outcomes, and employs mixed methods to triangulate findings, is needed to advance the field. SNA is a valuable approach for evaluating key network characteristics, structures and positions of relevance to KT, implementation, and evidence informed practice. Examining how network structure influences connections and the implications of those holding prominent network positions can provide insights to improve network-based KT processes.
Masood, S., Kothari, A., & Regan, S. (2019). The Use of Research in Public Health Policy: A Systematic Review. Evidence & Policy: A Journal of Research, Debate and Practice. 17(1), 7-43. https://doi.org/10.1332/174426418X15193814624487
The use of robust research findings in public health policy has been strongly encouraged for bridging the evidence-policy gap. To assess and further promote evidence uptake, understanding how research evidence is being used by decision makers is very important. This systematic review examined primary studies exploring the use of research evidence in public health policy published between 2010 and January 2016; this work extended Orton et al’s (2011) review that covered studies published between 1980 and March 2010. The current systematic review incorporated 16 studies, representing 864 individuals, that provided insight into five topics pertaining to public health policy decision making: 1) the extent to which research evidence is used; 2) types of research evidence used; 3) the process of using research evidence; 4) factors other than research influencing decisions; and 5) barriers to and facilitators of evidence use. Relevant studies were identified using five different information sources including 14 electronic databases, websites of key organisations, forward citation search, reverse citation search, and internet search engines. Eligibility and methodological quality were assessed independently by two reviewers. The primary author conducted data extraction and the remaining authors reviewed the extraction results. Due to study heterogeneity, data were synthesised and findings were reported using a narrative approach. Findings aligned with previous literature to show that various types of research evidence are being accessed in public health policymaking. Further, challenges and enablers exist at multiple levels of the system, suggesting that use of research evidence is a complex, interdependent process.
Sibbald, S. L., & Sibbald, R.W. Creating a Community Driven Bioethics Network. (2019). Journal of Integrated Care, 27(1), 15-25.
The South West Health Ethics Network (SWHEN) was created to bring together health care providers from a variety of health care settings across a geographical region. SWHEN’s mission was to connect health professionals who have an interest in ethical issues. SWHEN’s target participants are people with an interest in this field regardless of the individual’s capacity within an ethics profession. While other ethics networks exist, few of these expand beyond a narrow scope of ethics professionals (clinical ethicists). The preliminary vision in bringing together this group was to create a regional collaborative to educate, share lessons and begin to create a common approach to ethics issues in our region. Ethics networks increase collaboration and the exchange of resources, information and ideas among clinical ethicists. As a result, they address many of the ethical dilemmas faced in integrated care and facilitate the success of these systems in providing coordinated patient care. The paper aims to discuss these issues.
A Delphi consensus building approach was conducted to determine goals and priorities of the network.
Several priorities and counter priorities were discussed. In the end, the network was stifled by three major challenges: resource sharing, balance of network priorities and individual needs, and leadership.
While the journey to creating a sustainable network is long and complex, it is still worth the struggles. Network members remained connected through e-platforms, and the meetings have increased our region’s cohesiveness around ethics. We remain cautiously optimistic of SWHENs future and acknowledge that our initial plan may have shifted but our achievements are still meaningful and worthwhile.
Oliver, K., Kothari, A., & Mays, N. (2019). The Dark Side of Coproduction: Do The Costs Outweigh The Benefits For Health Research? Health Research Policy and Systems, 17(33). https://doi.org/10.1186/s12961-019-0432-3
Coproduction, a collaborative model of research that includes stakeholders in the research process, has been widely advocated as a means of facilitating research use and impact. We summarise the arguments in favour of coproduction, the different approaches to establishing coproductive work and their costs, and offer some advice as to when and how to consider coproduction.
Despite the multiplicity of reasons and incentives to coproduce, there is little consensus about what coproduction is, why we do it, what effects we are trying to achieve, or the best coproduction techniques to achieve policy, practice or population health change. Furthermore, coproduction is not free risk or cost. Tensions can arise throughout coproduced research processes between the different interests involved. We identify five types of costs associated with coproduced research affecting the research itself, the research process, professional risks for researchers and stakeholders, personal risks for researchers and stakeholders, and risks to the wider cause of scholarship. Yet, these costs are rarely referred to in the literature, which generally calls for greater inclusion of stakeholders in research processes, focusing exclusively on potential positives. There are few tools to help researchers avoid or alleviate risks to themselves and their stakeholders.
First, we recommend identifying specific motivations for coproduction and clarifying exactly which outcomes are required for whom for any particular piece of research. Second, we suggest selecting strategies specifically designed to enable these outcomes to be achieved, and properly evaluated. Finally, in the absence of strong evidence about the impact and process of coproduction, we advise a cautious approach to coproduction. This would involve conscious and reflective research practice, evaluation of how coproduced research practices change outcomes, and exploration of the costs and benefits of coproduction. We propose some preliminary advice to help decide when coproduction is likely to be more or less useful.
Boland, L., Kothari, A., McCutcheon, C., & Graham, I.D. (2019). For the Integrated Knowledge Translation Research Network: A comment on 'Shifting implementation science theory to empower primary care practices'. Annals of Family Medicine. 17(1), 250-256.
Masood, S., Kothari, A., & Regan, S. (2019). The Use of Research in Public Health Policy: A Systematic Review. Evidence and Policy, 16(1), 7-43. https://doi.org/10.1332/174426418X15193814624487
Kothari, A., & Sibbald, S. (2018). Using Complexity to Simplify Knowledge Translation. International Journal of Health, Policy, & Management, 7(6), 563–565. https://doi.org/10.15171/ijhpm.2017.139
Verma, J.Y., Amar, C., Sibbald, S.L, & Rocker, G.M. (2018). Improving Care for Advanced COPD Through Practice Change: Experiences of Participation in a Canadian Spread Collaborative. Chronic Respiratory Disease, 15(1), 5–18. https://doi.org/10.1177/1479972317712720
Chronic obstructive pulmonary disease (COPD) is a leading cause of death, morbidity, and health-care spending. The Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ has proved highly beneficial for patients and the health-care system. With direct investment of <$1-million CAD, a pan-Canadian quality improvement collaborative (QIC) supported the spread of INSPIRED to 19 teams in the 10 Canadian provinces contingent upon participation in evaluation. The collaborative evaluation followed a mixed-methods summative approach relying on collated quantitative data, team documents, and surveys sent to core members of the 19 teams. Survey questions included a series of multiple-choice responses, Likert scale ratings, and open-ended questions. The qualitative evaluation entailed key informant interviews and focus groups undertaken between February and April 2016 post-collaborative. Teams reported that the year-long QIC helped bring focus to a needed, though often overlooked area of improvement, facilitating innovation spread. They report examples of new work practices as well as unanticipated cultural change (given the short QIC time frame). Most teams gained new skills in quality improvement (QI) and evidence-based medicine, showing progress in their ability to measure and implement COPD care improvements. Teams felt networking with other teams across the country toward a common solution as well as learning from a team of clinical innovators and evidence-based innovation were critical to their success. Factors affecting sustainability included local leadership support, involvement of frontline clinicians, and sharing milestones to motivate continued QI. The INSPIRED QIC enabled teams across Canada to adapt and implement a new COPD care model for high users of health-care with rapid improvements to work practices, cultural change, and skill sets, and at relatively low cost.
The potential use, influence and impact of health research is seldom fully realised. This stubborn problem has caused burgeoning global interest in research aiming to address the implementation ‘gap’ and factors inhibiting the uptake of scientific evidence. Scholars and practitioners have questioned the nature of evidence used and required for healthcare, highlighting the complex ways in which knowledge is formed, shared and modified in practice and policy. This has led to rapid expansion, expertise and innovation in the field of knowledge mobilisation and funding for experimentation into the effectiveness of different knowledge mobilisation models. One approach gaining prominence involves stakeholders (e.g. researchers, practitioners, service users, policy-makers, managers and carers) in the co-production, and application, of knowledge for practice, policy and research (frequently termed integrated knowledge translation in Canada). Its popularity stems largely from its potential to address dilemmas inherent in the implementation of knowledge generated using more reductionist methods. However, despite increasing recognition, demands for co-produced research to illustrate its worth are becoming pressing while the means to do so remain challenging. This is due not only to the diversity of approaches to co-production and their application, but also to the ways through which different stakeholders conceptualise, measure, reward and use research. While research co-production can lead to demonstrable benefits such as policy or practice change, it may also have more diffuse and subtle impact on relationships, knowledge sharing, and in engendering culture shifts and research capacity-building. These relatively intangible outcomes are harder to measure and require new emphases and tools. This opinion paper uses six Canadian and United Kingdom case studies to explore the principles and practice of co-production and illustrate how it can influence interactions between research, policy and practice, and benefit diverse stakeholders. In doing so, we identify a continuum of co-production processes. We propose and illustrate the use of a new ‘social model of impact’ and framework to capture multi-layered and potentially transformative impacts of co-produced research. We make recommendations for future directions in research co-production and impact measurement.
Hoekstra, F., Ginis, K. A. M., Allan, V., Kothari, A., & Gainforth, H. L. (2018). Evaluating the Impact of a Network of Research Partnerships: A Longitudinal Multiple Case Study Protocol. Health research policy and systems, 16(107). https://doi.org/10.1186/s12961-018-0377-y
Conducting and/or disseminating research together with community stakeholders (e.g. policy-makers, practitioners, community organisations, patients) is a promising approach to generating relevant and impactful research. However, creating strong and successful partnerships between researchers and stakeholders is complex. Thus far, an in-depth understanding of how, when and why these research partnerships are successful is lacking. The aim of this study is to evaluate and explain the outcomes and impacts of a national network of researchers and community stakeholders over time in order to gain a better understanding of how, when and why research partnerships are successful (or not).
This longitudinal multiple case study will use data from the Canadian Disability Participation Project, a large national network of researchers and community stakeholders working together to enhance community participation among people with physical disabilities. To maximise the impact of research conducted within the Canadian Disability Participation Project network, researchers are supported in developing and implementing knowledge translation plans. The components of the RE-AIM framework (reach, effectiveness, adoption, implementation and maintenance) will guide this study. Data will be collected from different perspectives (researchers, stakeholders) using different methods (logs, surveys, timeline interviews) at different time points during the years 2018–2021. A combination of data analysis methods, including network analysis and cluster analysis, will be used to study the RE-AIM components. Qualitative data will be used to supplement the findings and further understand the variation in the RE-AIM components over time and across groups.
The outcomes, impacts and processes of conducting and disseminating research together with community stakeholders will be extensively studied. The longitudinal design of this study will provide a unique opportunity to examine research partnerships over time and understand the underlying processes using a variety of innovative research methods (e.g. network analyses, timeline interviews). This study will contribute to opening the ‘black box’ of doing successful and impactful health research in partnership with community stakeholders.
Graham, I.D., Kothari, A., & McCutcheon, C. (2018). Moving Knowledge to Action For More Effective Practice, Programmes and Policy: Protocol For a Research Programme on Integrated Knowledge Translation. Implementation science, 13(1), 22. https://doi.org/10.1186/s13012-017-0700-
Health research is conducted with the expectation that it advances knowledge and eventually translates into improved health systems and population health. However, research findings are often caught in the know-do gap: they are not acted upon in a timely way or not applied at all. Integrated knowledge translation (IKT) is advanced as a way to increase the relevance, applicability and impact of research. With IKT, knowledge users work with researchers throughout the research process, starting with identification of the research question. Knowledge users represent those who would be able to use research results to inform their decisions (e.g. clinicians, managers, policy makers, patients/families and others). Stakeholders are increasingly interested in the idea that IKT generates greater and faster societal impact. Stakeholders are all those who are interested in the use of research results but may not necessarily use them for their own decision-making (e.g. governments, funders, researchers, health system managers and policy makers, patients and clinicians). Although IKT is broadly accepted, the actual research supporting it is limited and there is uncertainty about how best to conduct and support IKT. This paper presents a protocol for a programme of research testing the assumption that engaging the users of research in phases of its production leads to (a) greater appreciation of and capacity to use research; (b) the production of more relevant, useful and applicable research that results in greater impact; and (c) conditions under which it is more likely that research results will influence policy, managerial and clinical decision-making.
The research programme will adopt an interdisciplinary, international, cross-sector approach, using multiple and mixed methods to reflect the complex and social nature of research partnerships. We will use ongoing and future natural IKT experiments as multiple cases to study IKT in depth, and we will take advantage of the team’s existing relationships with provincial, national and international organizations. Case studies will be retrospective and prospective, and the 7-year grant period will enable longitudinal studies. The initiation of partnerships, funding processes, the research lifecycle and then outcomes/impacts post project will be studied in real time. These living laboratories will also allow testing of strategies to improve the efficiency and effectiveness of the IKT approach.
This is the first interdisciplinary, systematic and programmatic research study on IKT. The research will provide scientific evidence on how to reliably and validly measure collaborative research partnerships and their impacts. The proposed research will build the science base for IKT, assess its relationship with research use and identify best practices and appropriate conditions for conducting IKT to achieve the greatest impact. It will also train and mentor the next generation of IKT researchers.
Salter, K.J., & Kothari, A. (2014). Using Realist Evaluation To Open The Black Box of Knowledge Translation: A State-of-the-Art Review. Implementation Science, 9(115). https://doi.org/10.1186/s13012-014-0115-y.
In knowledge translation, complex interventions may be implemented in the attempt to improve uptake of research-based knowledge in practice. Traditional evaluation efforts that focus on aggregate effectiveness represent an oversimplification of both the environment and the interventions themselves. However, theory-based approaches to evaluation, such as realist evaluation (RE), may be better-suited to examination of complex knowledge translation interventions with a view to understanding what works, for whom, and under what conditions. It is the aim of the present state-of-the-art review to examine current literature with regard to the use of RE in the assessment of knowledge translation interventions implemented within healthcare environments.
Multiple online databases were searched from 1997 through June 2013. Primary studies examining the application or implementation of knowledge translation interventions within healthcare settings and using RE were selected for inclusion. Varying applications of RE across studies were examined in terms of a) reporting of core elements of RE, and b) potential feasibility of this evaluation method.
A total of 14 studies (6 study protocols), published between 2007 and 2013, were identified for inclusion. Projects were initiated in a variety of healthcare settings and represented a range of interventions. While a majority of authors mentioned context (C), mechanism (M) and outcome (O), a minority reported the development of C-M-O configurations or testable hypotheses based on these configurations. Four completed studies reported results that included refinement of proposed C-M-O configurations and offered explanations within the RE framework. In the few studies offering insight regarding challenges associated with the use of RE, difficulties were expressed regarding the definition of both mechanisms and contextual factors. Overall, RE was perceived as time-consuming and resource intensive.
The use of RE in knowledge translation is relatively new; however, theory-building approaches to the examination of complex interventions in this area may be increasing as researchers attempt to identify what works, for whom and under what circumstances. Completion of the RE cycle may be challenging, particularly in the development of C-M-O configurations; however, as researchers approach challenges and explore innovations in its application, rich and detailed accounts may improve feasibility.
MacGregor, J.C.D., Wathen, C.N., Kothari, A., Hundal, P.K., & Naimi, A. (2014). Strategies to Promote Uptake and Use of Intimate Partner Violence and Child Maltreatment Knowledge: An Integrative Review. BMC public health, 14, 862. https://doi.org/10.1186/1471-2458-14-862
Intimate partner violence (IPV) and child maltreatment (CM) are major social and public health problems. Knowledge translation (KT) of best available research evidence has been suggested as a strategy to improve the care of those exposed to violence, however research on how best to promote the uptake and use of IPV and CM evidence for policy and practice is limited. Our research asked: 1) What is the extent of IPV/CM-specific KT research? 2) What KT strategies effectively translate IPV/CM knowledge? and 3) What are the barriers and facilitators relevant to translating IPV/CM-specific knowledge?
We conducted an integrative review to summarize and synthesize the available evidence regarding IPV/CM-specific KT research. We employed multiple search methods, including database searches of Embase, CINAHL, ERIC, PsycInfo, Sociological Abstracts, and Medline (through April, 2013). Eligibility and quality assessments for each article were conducted by at least two team members. Included articles were analyzed quantitatively using descriptive statistics and qualitatively using descriptive content analysis.
Of 1230 identified articles, 62 were included in the review, including 5 review articles. KT strategies were generally successful at improving various knowledge/attitude and behavioural/behavioural intention outcomes, but the heterogeneity among KT strategies, recipients, study designs and measured outcomes made it difficult to draw specific conclusions. Four key themes were identified: existing measurement tools and promising/effective KT strategies are underused, KT efforts are rarely linked to health-related outcomes for those exposed to violence, there is a lack of evidence regarding the long-term effectiveness of KT interventions, and authors’ inferences about barriers, facilitators, and effective/ineffective KT strategies are often not supported by data. The emotional and sometimes contested nature of the knowledge appears to be an important barrier unique to IPV/CM KT.
To direct future KT in this area, we present a guiding framework that highlights the need for implementers to use/adapt promising KT strategies that carefully consider contextual factors, including the fact that content in IPV/CM may be more difficult to engage with than other health topics. The framework also provides guidance regarding use of measurement tools and designs to more effectively evaluate and report on KT efforts.
Wathen, C., MacGregor, J., Sibbald, S., & MacMillan, L. (2013). Exploring the Uptake and Framing of Research Evidence on Universal Screening for Intimate Partner Violence Against Women: A Knowledge Translation Case Study. Health Research Policy and Systems, 11(13). https://doi.org/10.1186/1478-4505-11-13
Significant emphasis is currently placed on the need to enhance health care decision-making with research-derived evidence. While much has been written on specific strategies to enable these “knowledge-to-action” processes, there is less empirical evidence regarding what happens when knowledge translation (KT) processes do not proceed as planned. The present paper provides a KT case study using the area of health care screening for intimate partner violence (IPV).
A modified citation analysis method was used, beginning with a comprehensive search (August 2009 to October 2012) to capture scholarly and grey literature, and news reports citing a specific randomized controlled trial published in a major medical journal on the effectiveness of screening women, in health care settings, for exposure to IPV. Results of the searches were extracted, coded and analysed using a multi-step mixed qualitative and quantitative content analysis process.
The trial was cited in 147 citations from 112 different sources in journal articles, commentaries, books, and government and news reports. The trial also formed part of the evidence base for several national-level practice guidelines and policy statements. The most common interpretations of the trial were “no benefit of screening”, “no harms of screening”, or both. Variation existed in how these findings were represented, ranging from summaries of the findings, to privileging one outcome over others, and to critical qualifications, especially with regard to methodological rigour of the trial. Of note, interpretations were not always internally consistent, with the same evidence used in sometimes contradictory ways within the same source.
Our findings provide empirical data on the and its potential for multiple, often unanticipated, uses. They have implications for evidence is used and interpreted in policy and practice, particularly in contested knowledge areas.
Sibbald, S.L., Wathen, C.N., Kothari, A., & Day, A.M.B. (2013). Knowledge Flow & Exchange in Interdisciplinary Primary Health Care Teams: An Exploratory Study. Journal of the Medical Library Association, 101(2), 128-137. http://dx.doi.org/10.3163/1536-5050.101.2.008
Improving the process of evidence-based practice in primary health care requires an understanding of information exchange among colleagues. This study explored how clinically oriented research knowledge flows through multidisciplinary primary health care teams (PHCTs) and influences clinical decisions.
Methods: This was an exploratory mixed-methods study with members of six PHCTs in Ontario, Canada. Quantitative data were collected using a questionnaire and analyzed with social network analysis (SNA) using UCINet. Qualitative data were collected using semi-structured interviews and analyzed with content analysis procedures using NVivo8.
It was found that obtaining research knowledge was perceived to be a shared responsibility among team members, whereas its application in patient care was seen as the responsibility of the team leader, usually the senior physician. PHCT members acknowledged the need for resources for information access, synthesis, interpretation, or management.
Information sharing in interdisciplinary teams is a complex and multifaceted process. Specific interventions need to be improved such as formalizing modes of communication, better organizing knowledge-sharing activities, and improving the active use of allied health professionals. Despite movement toward team-based models, senior physicians are often gatekeepers of uptake of new evidence and changes in practice.
Kothari, A., Wathen, C.N. (2013). A Critical Second Look at Integrated Knowledge Translation. Health Policy, 109, 189-191. http://dx.doi.org/10.1016/j.healthpol.2012.11.004.
Kothari, A., Rudman, D., Dobbins, M., Rouse, M., Sibbald, S. & Edwards, N. (2012). The Use of Tacit and Explicit Knowledge in Public Health: A Qualitative Study. Implementation Science, 7(20). https://doi.org/10.1186/1748-5908-7-20
Planning a public health initiative is both a science and an art. Public health practitioners work in a complex, often time-constrained environment, where formal research literature can be unavailable or uncertain. Consequently, public health practitioners often draw upon other forms of knowledge.
Through use of one-on-one interviews and focus groups, we aimed to gain a better understanding of how tacit knowledge is used to inform program initiatives in public health. This study was designed as a narrative inquiry, which is based on the assumption that we make sense of the world by telling stories. Four public health units were purposively selected for maximum variation, based on geography and academic affiliation.
Analysis revealed different ways in which tacit knowledge was used to plan the public health program or initiative, including discovering the opportunity, bringing a team together, and working out program details (such as partnering, funding).
The findings of this study demonstrate that tacit knowledge is drawn upon, and embedded within, various stages of the process of program planning in public health. The results will be useful in guiding the development of future knowledge translation strategies for public health organizations and decision makers.
Graham, I.D., Malone-Rycroft, J., Kothari, A., and McCutcheon, C. (Eds.). Research co-production for use. Hoboken, NJ: Wiley. In progress – contract confirmed.
Sibbald, S.L., Kothari, A., Steinberg, M., and Bryant, B. Working in teams in public health. In Kawachi, I., Lang, I., and Ricciardi, W. (Eds). Oxford handbook of public health practice 4e (Ch. 7.4). Oxford University Press. In press.
Peter, N., Kothari, A., Lewis, K., Faubert, C., Graham, I. Paper presentation: How do advisory councils mobilize knowledge to inform strategic planning and action through integrated knowledge translation? (Cancelled due to COVID-19). The Knowledge Utilization (KU) Colloquium. Bergen, Norway, July 2020.
Zendo, S., Rudman D., Le Ber, M.J., Lewkowitz, S., and Kothari, A. Oral Presentation: Mobilizing narratives for policy & social change – A critical interpretive synthesis of literature. (Cancelled due to COVID-19). Qualitatives 2020. London, ON, June 24-26, 2020.
Kothari, A., Le Ber., M.J., Simpson, S., Zendo, S., Lui, J., Martino, J., Contursi, M, L., and Berman, H. Panel Presentation: Integrated knowledge translation: Evaluating knowledge co-creation and network engagement within a community-university research partnership. (Cancelled due to COVID-19). Congress 2020, Association for Nonprofit and Social Economy Research (ANSER-ARES). London, ON, May 30-June 5, 2020.
Scurr, T., Kothari, A., Ganann, R., Murray, N., Agarwal, G., Terry, A., and Valaitis, R. Evaluating the Incorporation of Community Tenants as Key Stakeholders in a Deliberative Dialogue (Postponed due to COVID-19). Legacy 2020 Research Conference. London, ON, May 7-8, 2020.