Integrated KT — Breaking Down Barriers Between Health Researchers and End Users

By Leah Crockett

A while back, we posted about practicing judicious end-of-grant KT. Another commonly practiced form of knowledge translation (KT) is integrated KT.

What is Integrated KT?

Integrated KT is an approach to research that involves engaging research end users as collaborators throughout the entire research process. This is thought to result in research that is more applicable, useful and translatable to end users. Research end users can include (among others) people with lived experience of a health condition, their families and caregivers, health care organization and system decision-makers, and health professionals.

As we’ve discussed previously, moving research results into everyday health care practice is a long and painstaking process, the consequences of which include substandard care for patients and a great deal of research waste. The knowledge-to-action gap is traditionally thought of from a knowledge adoption angle — that is, a lack of research uptake by research users. On the flip side, integrated KT views this gap from the angle of knowledge production, where there may be a mismatch between the priorities of researchers and those of end users. Essentially, we often ask the wrong questions when end users aren’t involved in developing the research question.

For example, one study looking at research priorities of patients with osteoarthritis found that most patients wanted more research done on physiotherapy, surgery, and assessment of educational coping strategies. Only 9% wanted more research on drugs, yet 80% of osteoporosis randomized controlled trials were drug evaluations. Health professionals also report gaps in the usefulness of research evidence. For example, a study looking at physiotherapists treating individuals at high risk for falls found that in practice, physiotherapists often used an individualized approach to prescribing exercises to their patients, rather than “off-the-shelf” exercise programs, which are commonly the focus of fall prevention research.

So, at least in theory, meaningfully engaging with your end-users from the very beginning — when setting your research priorities all the way through to the development of KT tools and dissemination of your results — helps to ensure that:

• Research aligns with the priorities of end-users;
• Relationships are developed between researchers and end-users;
• Knowledge is co-created by researchers and end-users; and
• There’s a sense of ownership and a better chance that research will be used in practice.

A Need for Evaluation

Integrated KT is increasingly being considered a gold-standard approach to making sure research is used in practice. However, there are a number of KT approaches that lack data on their effectiveness. Integrated KT also falls into this camp.

Many existing studies fail to describe or evaluate the process or outcomes of engaging end users throughout the research process. For example, a recent review of studies using integrated KT with decision makers found just 13 publications where the process or outcome of integrated KT was evaluated. Of these, few studies explicitly reported how decision makers were involved throughout the research process, so the authors were ultimately unable to pin-point characteristics that lead to beneficial outcomes. Similarly, another review with a broader range of end-users in rehabilitation research found that a number of practices were used to engage end-users throughout the research process, but that no studies evaluated the strategies used or described how they were chosen.

As the Old Saying Goes…

As we often hear in the conclusions section, further studies are needed — to increase our understanding of the effectiveness of integrated KT. For those of us who take an integrated KT approach to conducting research, how can we better report on and evaluate this process to push this agenda forward?

About the Author

Leah Crockett is a doctoral student in the Department of Community Health Sciences at the University of Manitoba.