Knowledge Translation: Research Into Practice Ian D Graham, PhD FCAHS University of Ottawa Ottawa Hospital Research Institute August 9, 2012

Learning Objectives To review conceptualizations of knowledge translation To consider a translational framework To better understand the knowledge to action process

The Problem

What do we really mean by translation of research into practice? Knowledge to action (KTA) Knowledge Translation (KT) Knowledge Exchange (KE) Knowledge Transfer (KT) Commercialization Implementation Translational Research T1, T2, T3….. Research Translation

Different conceptualizations of translation

Translational Research Westfall, J. M. et al. JAMA 2007;297:

Khoury et al (2010)

Knowledge Translation KT is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products and strengthen the health care system. This process takes place within a complex system of interactions between researchers and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user. (adapted from

Essentially Two kinds of KT End of grant KT Integrated KT  The researcher develops and implements a plan for making knowledge users aware of the knowledge generated through a research project  Research approaches that engage potential knowledge-users as partners in the research process.  requires a collaborative or participatory approach to research that is action oriented and is solutions and impact focused (Mode 2).  For example, the researcher(s) and knowledge-user partner(s) jointly define the research question, and are involved in interpreting and applying the findings

End of project KT A broad spectrum of activities including: Diffusion Diffusion (let it happen) Dissemination Dissemination (help it happen)   activities that tailor the message and medium to a specific audience Application/Implementation Application/Implementation (make it happen)   moving research into practice/policy in cases where the strength of evidence is sufficient   use of a conceptual model to guide application is recommended

Integrated KT a way of doing research involves engaging and integrating research end users into the research process Collaborative, participatory, action oriented, community based research, engaged scholarship, mode 2 knowledge production, co-production of knowledge End users can be: –Policy- and decision-makers from the community to the federal level, the public, industry, clinicians, health system managers, even whole communities –Researchers from different pillars, disciplines, teams, countries

Why integrated KT research? Through partnerships, the research is strengthened: end-user involved in developing the research question = solutions-based research that is relevant end user participation in the research process = confidence in the results and in the researchers end-user (patients, health system decision makers, clinicians) engagement means readiness for the results and willingness to move those results into practice = impact (improved health care and outcomes)

So what is KT? It comprises research, the science of translation, and doing translation (ie the practice of translation) Translation research includes: focusing on the translation gaps and doing research in a collaborative fashion (iKT) Science of translation (implementation research) is about: Studying the determinants of knowledge use and effective methods of promoting the uptake of knowledge The practice of translation is about: Closing the gap between what we know and what we do (the reducing the know-do gap) Making users aware of knowledge and facilitating their use of it to improve health and health care systems Transforming evidence into practice (moving knowledge into action)

A Translational Framework

KnowledgeTranslation Impact KT Practice Application Research informing decision making Dissemination Transl ational Resea rch Translational gap researchIntegrated KT research Implementation research Health & Social Systems impacts Economic impacts Health impacts KT Research Advances in knowledge

KnowledgeTranslation Impact KT Practice Application Research informing decision making Dissemination Transl ational Resea rch Translational gap research Integrated KT research Implementation research Health & Social Systems impacts Economic impacts Health impacts KT Research Advances in knowledge

Translational Research Gaps Unmet user needs Impact DiscoveryInnovationBest practice Application/widesprea d use T4T0 T1 T2 T3 Knowledge Synthesis

Translational gap research Translational gapsResearch needed T0- Translation to discovery- from identified unmet user needs for knowledge to discovery Priority setting research, Needs-based assessment, epidemiology, synthesis T1- Translation to humans- from discovery to (clinical) innovation First in humans, early phase clinical trials, proof of principle studies, synthesis T2- Translation to best practice for patients/system- from (clinical) innovation to recommendations/guidelines/policy Patient oriented research, later phase clinical trials, comparative effectiveness, HTA, knowledge synthesis & guidelines development research T3- Translation to practice- from guidelines to widespread use/implementation Implementation science, quality improvement science, organization and system change science, scaling up science, synthesis T4- Translation to impact at population level- from widespread use to impact (measuring impact) Population based research, population health research, epidemiology, evaluation science, synthesis

KnowledgeTranslation Impact KT Practice Application Research informing decision making Dissemination Transl ational Resea rch Translational gap research Integrated KT research Implementation research Health & Social Systems impacts Economic impacts Health impacts KT Research Advances in knowledge

Integrated Knowledge Translation Research a way of doing research involves engaging and integrating research end users into the research process is a way of thinking about conducting research to make the results applicable to the population under study… is a paradigm shift that focuses on engagement with the field and end-users (aligned with participative science and collaborative research).

KnowledgeTranslation Impact KT Practice Application Research informing decision making Dissemination Transl ational Resea rch Translational gap researchIntegrated KT research Implementation research Health & Social Systems impacts Economic impacts Health impacts KT Research Advances in knowledge

Implementation Science scientific study of methods to promote the uptake of research findings into routine healthcare in clinical, organisational or policy contexts. –determinants of knowledge use –effectiveness of methods and interventions to promote knowledge use (uptake of effective practices and abandonment of ineffective ones) field is theoretically pluralistic and uses mixed methods strong social science/behavioural science influence on the field

KnowledgeTranslation Impact KT Practice Application Research informing decision making Dissemination Transl ational Resea rch Translational gap researchIntegrated KT research Implementation research Health & Social Systems impacts Economic impacts Health impacts KT Research Advances in knowledge

Dissemination(help it happen) Dissemination (help it happen) (activities that tailor the message and medium to a specific audience) Tailored summary/briefings to stakeholders Educational sessions with patients, practitioners and/or policy makers Engaging knowledge users in developing & executing dissemination/implementation plan Tools creation Media engagement Use of knowledge brokers

KnowledgeTranslation Impact KT Practice Application Research informing decision making Dissemination Transl ational Resea rch Translational gap researchIntegrated KT research Implementation research Health & Social Systems impacts Economic impacts Health impacts KT Research Advances in knowledge

Application(make it happen) Application (make it happen) (moving research into practice in cases where the strength of evidence is sufficient) Understanding the context/environment where research is to be applied Identifying barriers to the uptake of the research findings Adapting knowledge, tailoring messages and interventions to promote uptake Evaluating the implementation process and outcomes Working within a conceptual framework

One conceptual framework to consider The Knowledge to Action Cycle Based on a concept analysis of 31 planned action theories See Graham et al: Lost in Knowledge Translation: Time for a Map? for details (

Monitor Knowledge Use Sustain Knowledge Use Evaluate Outcomes Adapt Knowledge to Local Context to Local Context Assess Barriers/ Assess Barriers/ Supports to Supports to Knowledge Use Knowledge Use Select, Tailor, Select, Tailor, Implement Interventions Identify Problem Identify Problem Identify, Review, Identify, Review, Select Knowledge Select Knowledge Start here Start here Application cycle Application cycle

Products/Tools Synthesis Knowledge Inquiry Tailoring Knowledge KNOWLEDGE CREATION

Monitor Knowledge Use Sustain Knowledge Use Evaluate Outcomes Adapt Knowledge to Local Context to Local Context Assess Barriers/ Assess Barriers/ Supports to Supports to Knowledge Use Knowledge Use Select, Tailor, Select, Tailor, Implement Interventions Identify Problem Identify Problem Identify, Review, Identify, Review, Select Knowledge Select Knowledge Products/Tools Synthesis Knowledge Inquiry Tailoring Knowledge KNOWLEDGE CREATION

Lessons learned:  Moving research-to-practice is an iterative process of using external evidence and producing local ‘evidence’ for planning, implementing and evaluating  Successful implementation requires strategic alliances between researchers & health setting (co-production of knowledge) population health principles needs-based planning working at both clinical and health services levels

More lessons learned: In moving research-to-practice the role of the researcher is to: create & facilitate a strategic alliance and a solutions- focused collaboration bring science of synthesis to practice use rigorous methods for each step (organizational planning, guideline appraisal & adoption, evaluation of the implementation) use a conceptual framework to underpin the research and KT

More lessons learned: In moving research-to-practice the role of the knowledge-users (e.g. providers and policy makers) is to: Identify the problem and engage researchers in developing the research questions Create and facilitate the strategic alliance and solutions-focused collaboration Bring their practice-based knowledge and experience to bear Apply the findings

KT: closing the gap between evidence and action How to close the gap between research-to-practice:  Focus more attention on the organizational and environmental context for change  set targets for change  monitor uptake of the research and evaluate the health and system outcomes/impact  keep it simple  focus on a few important targets, practical indicators

Research Translation Impact Translational Practice Application Research informing decision making Dissemination Transla tional Resear ch Translational gap researchIntegrated translational research Implementation research Health & Social Systems impacts Economic impacts Health impacts Translational Research Advances in knowledge

Your reflections on the learning objectives To review conceptualizations of KT To consider a translational framework To better understand the knowledge to action process

I have been impressed with the urgency of doing. Knowing is not enough; we must apply. Being willing is not enough; we must do Leonardo da Vinci