Knowledge transfer or knowledge in action: an unavoidable challenge
Director of Cochrane Argentina
Director of the Argentine Cochrane Center-Institute of Clinical and Healthcare Effectiveness (IECS-CONICET)
Independent Researcher, National Council of Scientific and Technical Research (CONICET)
Knowledge transfer (KT) is defined by the set of activities aimed at the dissemination of knowledge, experiences and skills in order to facilitate the application and use of knowledge. Unlike the simple transmission of knowledge, which is only directed toward disclosure or teaching, the transfer aims to incorporate knowledge into a value chain. It allows the knowledge coming from scientific advances to be put into practice, so it can also be called implementation or knowledge for action.
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Regarding its application in healthcare, KT involves three systems: 1) synthesis and transfer, 2) support, and 3) delivery. The synthesis and transfer system refers to scientific evidence, appropriately classified by its certainty1, available for use in practice by health professionals through an satisfactory organizational system. The support system refers to the creation of the ability in the professionals to improve the infrastructure, skills and motivation of the human resources, requiring training and technical assistance. The delivery system provides guidance for the execution of a program in a specific location, so that the target population receives the benefit.2-4
Ian Graham, vice president of KT of the Canadian Institutes of Health Research (CIHR), recently redefined it as a dynamic and iterative process that includes synthesis, dissemination and exchange between researchers and those who use the knowledge, and the ethical application of knowledge to improve health, provide effective health services and strengthen the health system.5 The incorporated ethical dimension highlights the need for a detailed message appropriate to the target audience.
Why so much interest in the concept and the KT process? The main reason is that the creation of new knowledge does not lead, by itself, to widespread adoption or an impact on health. We must rely on good KT practice, considering the ten most important steps:
1. Identify the problem and the need for change
2. Identify change agents
3. Identify the target audience
4. Evaluate barriers
5. Systematically review the evidence and/or develop innovation
6. Customize and develop the intervention
9. Maintain the change
To guarantee success, it is essential to guarantee the agreement of all participants on the need for change, on the methods and the evaluation of impact and on those responsible for each component. Although the process has been thoroughly studied, it is not usually easy, especially when researchers seem to be from Venus and the knowledge users from Mars.6 It is in these cases that the full application of the different KT models can make a difference. “Push” models are aimed at improving dissemination by researchers, customized for each recipient. “Pull” models focus on improving the capacity of the receiver to make a critical evaluation. Likewise, the actions of connecting and exchange allow the creation of new relationships, for example between researchers and health decision-makers, who can act as partners in applying for subsidies. Trained knowledge agents can even be used to facilitate these relationships.
But if we truly intend to improve patient care and outcomes, it is critical to both adapt it to the local context and promote a participatory approach. In fact, more and more research funders are shifting from the typical actions of dissemination and communication at the end of a research project (such as conferences and peer-reviewed journals) to the concept of “integrated KT” that creates a collaborative research process between researchers and the users of the research. This involves jointly establishing the research questions, deciding the methodology, participating in the collection of data and development of tools, interpreting the findings and helping in the dissemination of research results. This approach, also known as participatory action research, action-oriented research or co-production of knowledge, would produce more relevant research findings for the final recipients.5
In the Institute of Clinical and Healthcare Effectiveness (IECS) in Argentina, we share this transition towards integrated KT models. We have had positive experiences of KT at the end of research, such as a policy dialogue on the prioritization of interventions for the control of the Aedes aegypti mosquito in Latin America and the Caribbean7, reported by summaries of evidence for decision makers8 of a systematic review of control strategies of the vector and a qualitative study with key reporters from the region.9,10 Regarding “integrated KT”, it is worth highlighting the experience acquired by our group in projects for the control of tobacco and, more recently, control of sugar-laden drinks in Latin America, which included the early participation of all interested parties and that concluded with the production of detailed customized packages of evidence and cost-effectiveness evaluations for decision-makers.
Although it is necessary to measure and attribute the impact of each stage of the KT, it must be recognized that it is a difficult task that is still under development, which can use bibliometric analysis, case studies, interviews, surveys or analysis of administrative databases, among other methods. For reasons which are not entirely clear, these experiences are not usually reported in our region. When we studied the uptake of KT through publications indexed in PubMed, the results of Latin America were well below the other regions of the world.6 Even so, we can highlight relevant examples such as EvipNet Americas, designed to promote the systematic use of high-quality research in the formulation of policies in the healthcare field.11 Likewise, the ProVac initiative was launched to provide technical cooperation in the promotion of evidence-based decision-making before the introduction of new vaccines.
To summarize, we can say that the implementation of evidence-based decision-making is a participatory process that always requires an important element of local adaptation. We must develop new methodologies to monitor and evaluate the overall effectiveness of KT interventions and also improve the dissemination of the most successful KT projects in the region to promote an increase in their uptake.
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1. Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383-394.
2. Moullin JC, Sabater-Hernandez D, Fernandez-Llimos F, Benrimoj SI. A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework. Health Res Policy Syst. 2015;13:16.
3. Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41(3-4):327-350.
4. Wandersman A, Duffy J, Flaspohler P, et al. Bridging the gap between prevention research and practice: the interactive systems framework for dissemination and implementation. Am J Community Psychol. 2008;41(3-4):171-181.
5. Tetroe J. Knowledge translation at the Canadian Institutes of Health Research: A Primer. In: National Centre for the Dissemination of Disability Research (NCDDR); 2007.
6. Ciapponi A. Knowledge Translation in Latin America. Paper presented at: XXIII Cochrane Colloquium. Challenges to evidence-based health and Cochrane. Knowledge Translation (KT) Symposium; 23-27 October 2016, 2016; Seoul, Korea.
7. Ciapponi A, Bardach A, Alcaraz A, et al. Workshop for priority-setting in Aedes aegypti control interventions in Latin America and the Caribbean: a policy dialogue %J Cadernos de Saúde Pública. 2019;35.
8. Rosenbaum SE, Glenton C, Wiysonge CS, et al. Evidence summaries tailored to health policy-makers in low- and middle-income countries. Bull World Health Organ. 2011;89(1):54-61.
9. Bardach AE, Garcia-Perdomo HA, Alcaraz A, et al. Interventions for the control of Aedes aegypti in Latin America and the Caribbean: Systematic Review and Meta-Analysis. Trop Med Int Health. 2019;24(5):1360-2276.
10. Tapia-López E, Bardach A, Ciapponi A, et al. Experiencias, barreras y facilitadores en la implementación de intervenciones de control del Aedes aegypti en América Latina y Caribe: estudio cualitativo. Cadernos de Saúde Pública. 2019;35(5):e00092618.
11. Velázquez G. EVIPNet Americas (Evidence-informed Policy Networks en América Latina y el Caribe) un modelo de gestión. Memorias del Instituto de Investigaciones en Ciencias de la Salud. 2007;5:03-04.