This Guide outlines some emerging developments within the field of knowledge translation and exchange (KTE) to support policy making in health.
Knowledge translation defined
KE [Knowledge Exchange] is a process that aims to get research knowledge into action; it has an 'applied' focus, where research knowledge is translated into either decision-making or practice settings. KE interventions are necessary because traditionally research has been underutilised in applied settings - there is a gap between the knowledge produced and its effective deployment in a use context.
Australian Primary Health Care Research Institute (APHCRI). (2011). Knowledge Exchange Report, Canberra. [PDF 302KB]
Models of knowledge translation and exchange for policy making
Researchers are encouraged to actively disseminate their work and there has been a drive to increase the uptake of research by policy makers. 'Push' models of knowledge translation1 are based on dissemination strategies. They assume a linear process whereby information is collated and synthesised by a research team, communicated to a potential user and then used.
There is a trend towards 'Pull' models of knowledge translation designed to support the way policy makers need to use the research evidence at different stages of the policy making process. This includes convening meetings with researchers, seeking 'experts' and commissioning syntheses.
In Australia, the Sax Institute provides support for NSW Department of Health policy makers. The Sax Institute approach involves contacting appropriate knowledge brokers from their list of experienced and trained people with experience in research and policy. The knowledge broker facilitates a meeting of researchers and policy makers and manages the process synthesising evidence which meets the needs of the policy makers.
In Canada, the SUPPORT Project developed a set of SUPPORT Tools3 for evidence‑informed policymaking. The tools provide guidance for policy makers on many aspects of accessing and using research evidence and also address the need for contextual information about local conditions, resource use and costs, stakeholder opinion and implementation considerations. Examples include:
- 'Policy Briefs' which package the best available systematic reviews and local evidence on high priority issues; and
- 'Policy Dialogues' which are interactive knowledge sharing events that allow research evidence to be brought together with the views, experiences and tacit knowledge of those who will be involved in, or affected by, future decisions.
The SUPPORT tools have been applied by the McMaster Health Forum in Canada, where examples of Policy Briefs and reports from Policy Dialogues can be found.
Interaction and Network Models
Interaction models are based on the idea that knowledge is exchanged through interpersonal contact.
The Linkage and Exchange2 model that was developed in Canada proposes the involvement of policy makers and other stakeholders as advisors and consultants in research projects. This ensures that research is informed by policy needs and that potential users have a personal interest in using the research findings.
Knowledge Brokering is also used to refer to the processes and activities of individuals and organisations which act as intermediaries between researchers and policy makers to support evidence-informed policy making. Knowledge Brokers may use push, pull or interaction approaches (Lomas 2011).
In recognition that knowledge is exchanged through networks, there are also a number of facilitated network and community of practice models which encourage informal knowledge exchange and diffusion of knowledge between members.
A Systems model
A number of alternative models are starting to emerge which recognise the complexity of the relationship between research and the policy making process.
Parent et al4 have developed a systems model of knowledge translation to enhance system wide capacities which will lead to greater research use in policy making. The capacities that a social system needs for successful knowledge translation are:
- generative capacity: the ability to discover knowledge, based on the system's intellectual capital present among members, research infrastructure and alliances
- disseminative capacity: the ability to contextualize, format, adapt, translate and diffuse knowledge through a social network and to build commitment from stakeholders
- absorptive capacity: the ability to recognise the value of new external knowledge and apply it to address relevant issues for a system
- adaptive and responsive capacity: the ability to continuously learn and renew elements of the knowledge transfer system for continuous change and improvement.
Challenges in knowledge translation and exchange
The field of knowledge translation suffers from a wide diversity of terms and a lack of consensus on meanings. A recent analysis identified 100 similar terms.5
Evaluation of knowledge translation initiatives
A 2007 systematic review found that "despite the rhetoric and growing perception in health research circles of the 'value' of KTE [knowledge transfer and exchange], there is actually very little evidence that can actually inform what KTE strategies will work in what contexts…..[and] there is insufficient evidence for conducting 'evidence-based' KTE for health policy making".6
Getting research used vs the needs of policy makers
Most knowledge translation research is conducted from the perspective of the researchers and how to achieve greater use of research. A recent development has been a shift towards looking at the needs of policy makers and how these can be supported.7,8
Lobbying and knowledge brokering
From the policy makers' perspectives, it cannot be assumed that individual researchers or their intermediaries provide unbiased selections of evidence as each may have their own agenda and vested interests. It is argued that by seeking to intervene in the political process, knowledge brokering meets all the definitional requirements of lobbying.9
Applying the results of single research studies
Paradoxically, encouraging the use of evidence from individual research projects does not encourage the careful consideration of the totality of the evidence by policy makers.10,11,12
Canadian developers of the Linkage and Exchange model are changing focus,3,7 and the ethics of pushing the results of single studies has been questioned, stating that:
Results from a single research study should be contextualized within a synthesis of global research results before extra-ordinary dissemination or implementation efforts are undertaken - hence the importance of synthesis.13
What is evidence?
The evidence-based policy movement which has been informed by developments in evidence-based medicine may be incompatible with policy making processes and the inputs required.7,14,15,16
The Two Communities theory
The research and policy worlds are viewed as distinct, with different cultures and priorities; the task of knowledge brokering is to bridge this gap. Analysis of the use of research in a number of examples of Australian health policy making17,18 has led to this assumption being reconsidered.19,20
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- Lavis J, Robertson D, Woodside J, et al. (2003). How can research organisations more effectively transfer research knowledge to decision makers? The Millbank Quarterly, 81(2), 221–248.
- Lomas J. (2000). Using 'linkage and exchange' to move research into policy at a Canadian foundation. Health Affairs (Millwood), 19(3), 236–240.
- Lavis J, Oxman A, Lewin S, Fretheim A. (2009). SUPPORT Tools for evidence‑informed policy making (STP) Health Research Policy and Systems, 7(Suppl 1 S14 (16 December 2009)).
- Parent R, Roy M, St Jacques D. (2007). A systems based dynamic knowledge transfer capacity model. Journal of Knowledge Management, 11(6), 81–93.
- McKibbon KA, Lokker C, Wilczynski NL, Ciliska D, Dobbins M, Davis DA, et al. (2010). A cross-sectional study of the number and frequency of terms used to refer to knowledge translation in a body of health literature in 2006: a Tower of Babel? Implementation Science 5, 16.
- Mitton C, Adair C, McKenzie E, Patten S, Waye Perry B. (2007). Knowledge transfer and exchange: Review and synthesis of the literature. The MIllbank Quarterly, 85(4), 729–768.
- Lomas J, Brown A. (2009). Research and advice giving: A functional view of evidence‑informed policy advice in a Canadian Ministry of Health. The Milbank Quarterly 87(4), 903–926.
- Campbell D, Redman S, Jorm L, Cooke M, Zwi A, Rychetnik L. (2009). Increasing use of evidence in health policy: practice and views of policy makers and researchers. Australian and New Zealand Health Policy, 6(21).
- Sin CH. (2008). The role of intermediaries in getting evidence into policy and practice: some useful lessons from examining consultancy–client relationships. Evidence & Policy 4(1), 85–103.
- Innvaer S, Vist G, Trommald M, Oxman A. (2002). Health policy-makers' perceptions of their use of evidence: a systematic review. J Health Serv Res Policy, 7(4), 239–244.
- Hanney, S. (2004). Personal interaction with researchers or detached synthesis of the evidence: Modelling the health policy paradox. Evaluation and Research in Evaluation, 18(1&2), 72–82.
- Contandriopoulos D, Brousselle A, Kêdoté N. (2008). Evaluating Interventions Aimed at Promoting Information Utilization in Organizations and Systems. Healthcare Policy / Politiques de Santé, 4(1), 89–107.
- Canadian Institutes of Health Research. (2009). PowerPoint Presentation: About Knowledge Translation at CIHR: Canadian Institutes of Health Research. Retrieved November 2017
- Lewis S. (2007). Toward a general theory of indifference to research based evidence. Journal Health Services Research and Policy, 12(3), 166–172.
- Bowen S, Erickson T, Martens P, Crockett S. (2009). More Than "Using Research": The Real Challenges in Promoting Evidence-Informed Decision-Making. Healthcare Policy / Politiques de Santé, 4(3), 87–102.
- Russell J, Greenhalgh T, Byrne E, McDonnell J. (2008). Recognizing rhetoric in healthcare policy analysis. Journal Health Services Research and Policy, 13(1).
- Gibson B. (2003). Beyond two communities. In V. Lin and B. Gibson (Eds.), Evidence-Based Health Policy: Problems and Possibilities (pp. 18–32). Melbourne: Oxford University Press.
- Gibson B. (2004). From Transfer to Transformation: Rethinking the Relationship between Research and Policy. Paper presented at the PhD Thesis 2004.
- World Health Organization. (2007). Sound Choices: enhancing capacity for evidence‑informed health policy. Geneva: World Health Organization.
- Naccarella L. (2008). Optimising The Contextualisation Of Evidence For Primary Care Policy Making. Canbera: Australian Primary Health Care Research Institute & The University of Melbourne.
- Greenhalgh T, Russell J. (2005). Reframing evidence synthesis as rhetorical action in the policy making drama. Healthcare Policy, 1(1), 31–39.
- Stevens A. (2007). Survival of the ideas that fit: an evolutionary analogy for the use of evidence in policy. Social Policy and Society, 6(1), 25–35.
- Tenbensel T, Davis P. (2009). Public health sciences and policy in high income countries. In R. Detels, R. Beaglehole, M. Landsang & M. Giulford (Eds.), Oxford Texbook of Public Health (pp. 796-809). Oxford University Press.
- Lewis J. (2009). Understanding policy influence and the public health agenda. NSW Public Health Bulletin, 20(7-8), 125–129.
- Greenhalgh T, Robert G, McFarlaine F, Bate P, Kyriakidou O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly, 82(4), 581–629.
- Lomas J. (2007). Formalised Informality: An action plan to spread proven health innovations. A position paper prepared for the New Zealand Ministry of Health. Wellngton: New Zealand Ministry of Health.
- Lomas J. (2007). CHSRF Knowledge Transfer: Decision support: A new approach to making the best healthcare management and policy choices. Healthcare Quarterly, 10(3), 16–19.
- McCaughey D, Bruning N. (2010). Rationality versus reality: the challenges of evidence-based decision making for health policy makers. Implementation Science, 5(1 M ), 39.
- Sabatier P. (1987). Knowledge, policy oriented learning and policy change: An advocacy coalition framework. Science Communication, 8(4), 649.
- Wilson P, Petticrew M. (2008). Why promote the findings of single research studies? BMJ, 336, 722.
- Thompson GN, Estabrooks CA, Degner LF. (2006). Clarifying the concepts in knowledge transfer: a literature review. J Adv Nurs, 53(6), 691–701.
- Walter I, Nutley S, Davies H. (2003). Developing a Taxonomy of Interventions used to Increase the Impact of Research, Discussion Paper 3, Research Unit for Research Utilisation, University of St Andrews. Retrieved November 2017. [PDF 262 KB]
- Gabbay J, Le May A. (2004). Evidence‑based guidelines or collectively constructed "mindlines?" Ethnographic study of knowledge management in primary care. BMJ, 329(7473), 1013.
- Amara N, Ouimet M, Landry R. (2004). New Evidence on Instrumental, Conceptual, and Symbolic Utilization of University Research in Government Agencies. Science Communication, 26(1), 75–106.
- Kothari A, Birch S, Charles C. (2005). "Interaction" and research utilisation in health policies and programs: Does it work? Health Policy, 71, 117–125.
Primary Health Care Research & Information Service (2017). PHCRIS Getting Started Guides: Introduction to... Knowledge translation. From http://www.phcris.org.au/guides/knowledgetranslation.php (Accessed 19 Nov 2017)