Aug 4, 2017

Lost in translation

The Canadian Institute of Health Research defines knowledge translation as:

Knowledge Translation is defined as a dynamic and iterative process that includes 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 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 (Graham, 2010).

Government of Canada, Canadian Institutes of Health Research, Public, Government and Institute Affairs. "About us." Government of Canada, Canadian Institutes of Health Research, Public, Government and Institute Affairs,. N.p., 28 July 2016. Web. 04 Aug. 2017.

In a 2012 article Grimshaw et al. (PMC3462671) addressed the concept and evidence of knowledge translation. One of the first points they raised was the interaction between individual studies, systematic reviews, and the knowledge translation targets.

The increased focus on knowledge translation has frequently emphasised individual studies as the unit for knowledge translation. While this may be appropriate when the targets for knowledge translation are other researchers or research funders (who need to be aware of primary research results), we argue that this is inappropriate when the targets for knowledge translation are consumers, healthcare professionals, and/or policy makers. This is because individual studies rarely, by themselves, provide sufficient evidence for practice and policy changes. In fact, individual studies may be misleading due to bias in their conduct or random variations in their findings, although some exceptionally large randomised trials may be sufficiently persuasive by themselves to warrant practice or policy change, e.g., the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) [12] and the International Study of Infarct Survival 2 (ISIS-2) Trial [13].


We suggest that the results of individual studies need to be interpreted within the context of global evidence before deciding whether it is ready for knowledge translation. In other words, the basic unit of knowledge translation should be up-to-date systematic reviews or other syntheses of the global evidence. Greater emphasis on the results of systematic reviews would increase the ‘signal to noise’ of knowledge translation activities and may increase the likelihood of their success. Over the last twenty years, healthcare research funders and healthcare systems have made considerable investments in knowledge syntheses, especially those targeting the needs of healthcare practitioners and patients. Examples include the substantial number of publicly funded national guideline and health technology programs, The Cochrane Collaboration [17], and the US funded Evidence-based Practice Centers [18].

A research knowledge infrastructure is the most desirable approach to knowledge translation in a healthcare system, Grimshaw et al. state:

A more appropriate approach to effective and sustainable knowledge translation may be the development of research knowledge infrastructures by healthcare systems that address the needs of their various stakeholders (e.g., consumers, practitioners, managers, and policy makers). Ellen and colleagues define research knowledge infrastructure as any instrument (i.e., programs, tools, devices) implemented in a healthcare system in order to facilitate access, dissemination, exchange, and/or use of evidence [25]. Components of research knowledge infrastructures are classified into two broad categories: technological and organizational. Technological components include electronic databases and search engines. Organizational components include documentation specialists, data analysts, knowledge brokers (i.e., individuals who manage the collaboration between an organization, external information, and knowledge producers and users), and training programs (to assist with activities such as searching for information, quality appraisal, adaption and use of the research findings) [25, 26].

There can be barriers to the process of knowledge translation:

Common barriers across target groups include issues relating to knowledge management, such as the sheer volume of research evidence currently produced, access to research evidence sources, time to read evidence sources and skills to appraise and understand research evidence. Over the past twenty years, there has been substantial investment by many healthcare systems to address these knowledge management barriers. For example, the conduct of systematic reviews and development of clinical practice guidelines to reduce the volume of research evidence and the time needed to read evidence sources; investment in electronic libraries of health and public access evidence sources to improve access to research evidence; and the development of critical appraisal skills tools and training to improve research literacy skills.

However while better knowledge management is necessary, it is unlikely by itself to be sufficient to ensure knowledge translation because of barriers working at different levels of healthcare systems, many of which operate at levels beyond the control of an individual practitioner. For example, barriers may operate at other levels of a healthcare system including: structural barriers (e.g. financial disincentives), organizational barriers (e.g. inappropriate skill mix, lack of facilities or equipment), peer group barriers (e.g. local standards of care not in line with desired practice), professional (e.g. knowledge, attitudes and skills) and professional-patient interaction barriers (e.g. communication and information processing issues). Evidence in support of this can be found in a structured review of healthcare professionals’ views on engagement in quality improvement activities [31]. In this review, Davies and colleagues concluded that many of the barriers to participating in quality improvement activities identified by professionals arise from problems related to working effectively between and across health professions. This means that although knowledge management resources (e.g., more time and more resources) may be necessary and even helpful, they are unlikely to be sufficient to overcome the other ‘organizational’ barriers professionals face to engage in quality improvement (and knowledge translation) activities [31].


Individuals involved in knowledge translation need to: identify modifiable and non-modifiable barriers relating to behavior; identify potential adopters and practice environments; and prioritise which barriers to target based upon consideration of ‘mission critical’ barriers. Furthermore, the potential for addressing these barriers through knowledge translation activities (based upon consideration of the likely mechanisms of action of interventions) and the resources available for knowledge translation activities also needs to be addressed.

Knowledge translation is not a one-size-fits-all process, it is complex and involves different phases of the healthcare system. It also requires lots of effort to determine its effectiveness, barriers, and failures.

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1. You should attempt to re-express your target’s position so clearly, vividly, and fairly that your target says, “Thanks, I wish I’d thought of putting it that way.
2. You should list any points of agreement (especially if they are not matters of general or widespread agreement).
3. You should mention anything you have learned from your target.
4. Only then are you permitted to say so much as a word of rebuttal or criticism.
Daniel Dennett, Intuition pumps and other tools for thinking.

Valid criticism is doing you a favor. - Carl Sagan