What’s in a Name?
Knowledge Translation Nomenclature
By Leah Crockett
If you searched the academic literature you’d find more than 100 definitions or words used to describe how to move knowledge into action — what we refer to in this blog as KT.
Look up ten papers on the subject, and you’ll find ten similar (but not identical) definitions. There’s little consistency across applied research funding agencies either, with 33 such agencies using over 29 different terms. In fact, KT terminology is used variably not just within countries, but around the world and across disciplines.
This plethora of semantic differences and real nuances can create chaos in the literature — a veritable Tower of Babel. To help bring the science together, we’ll break down 10 of the most common terms used to describe the process of moving knowledge into action (sorry, we aren’t going to jump down the rabbit hole and tackle all 100!).
First, our Definition of Knowledge Translation
Derived from the Canadian Institutes of Health Research’s (CIHR) definition of knowledge translation, we at the George & Fay Yee Centre for Healthcare Innovation (CHI) conceptualize KT as a spectrum of activities:
“Knowledge Translation is the synthesis, dissemination, exchange and ethically-sound application of knowledge to improve health, health service delivery, and the healthcare system.”
1. Research Utilization
Research utilization has long-standing roots in the nursing literature dating back to the 1980s. The term refers to:
“The process in which specific research-based (scientific) knowledge is implemented into practice.” [1]
Research utilization recognizes that new evidence and technologies emerge daily that can influence clinical practice. As Squires and colleagues summarize, research utilization has been conceptualized in the field of nursing in four ways [2]:
- Instrumental: the concrete application of research into clinical practice;
- Conceptual: changing one’s thinking, without necessarily changing practice;
- Persuasive: the use of research as a political or persuasive tool; and
- Overall: the use of research in any way.
2. Evidence-Based Practice
Evidence-based practice is just as it sounds:
Using the best available research evidence in combination with clinical expertise to guide practice.
This term is often used synonymously with evidence-based medicine, evidence-based nursing, and evidence-informed practice. In the field of nursing, evidence-based practice represents a paradigm shift from research utilization to one that is broader and focuses on the synthesis and critique of research studies and designs. Of course, there are numerous definitions of evidence-based practice which vary depending on the discipline. For an example, check out “definitions galore” by the Canadian Nurses Association.
3. Dissemination and Implementation Research
Dissemination and implementation research (referred to in short as D&I research) shows up mainly in the United States and United Kingdom. D&I research is the term used by funders such as the Centres for Disease Control and Prevention (CDC), who define it as:
“A growing field of study that examines the process by which scientific evidence is adopted, implemented, and sustained in typical community or clinical settings.”
Meanwhile, the National Institutes of Health (NIH), defines D&I research as “How evidence-based practices, interventions, and policies are effectively translated to and used in real-world settings like hospitals, schools, and communities.”
In a recent Advanced Knowledge Translation course offered internally here at CHI, we explored the D&I research literature using Oxford University Press’s Dissemination and Implementation Research in Health textbook, where we found a number of similarities and differences between D&I research and KT. The book defines D&I research as: “an active process that supports movement of evidence-based effective health care and prevention strategies or programs from the clinical or public health knowledge base into routine use.”
In an article describing D&I research approaches and terminology, Glasgow and colleagues from various National Health institutes in the US [3] describe the different modes of research — from T0 (“identification of a problem and the ‘discovery’ of an opportunity or approach to tackle a health issue”) to T4 (“evaluation of the effectiveness and cost-effectiveness of such interventions in the “real world” and in diverse populations”).
The overlap of D&I research definitions with translational research, which we compare to KT in another blog, reinforces how these various terms often describe the same thing: moving evidence into practice, in various contexts, fields of research and geographical locations.
4. Quality Improvement
As outlined in the Straus et al.’s seminal text, Knowledge Translation in Health Care, quality improvement (QI) is defined as:
“The degree in which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”
However, while both KT and QI might have the same overarching goal (improving patient care), they don’t necessarily share the same objectives. QI often focuses on processes related to safety, efficiency, timeliness and person-centred care (such as “soft skills” of change management principles, and the Plan-Do-Study-Act cycle for testing changes).
QI does not always focus on whether or not professional knowledge, behaviours and practices are current and effective. As such, QI tends to be localized in nature and focuses on addressing how care is delivered in real-time within a specific location or system, whereas KT usually has a broader scope that focuses on the application of research methods and principles across settings [4]. However, the methods of each can often overlap, and lend to the overall advancement of both fields.
5. Implementation Science
Implementation science refers to:
“The scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services.” [5]
A kind of ‘meta’ concept of knowledge translation, implementation science or implementation research refers to studying what we do within KT to ultimately improve our evidence base and grow the field of KT as a whole in terms of its methods, theories, best practices, and implementation strategies at the level of patients, healthcare providers, organizations, and policy. It also considers what works, for whom and under what circumstances, and how interventions can be adapted and scaled up in ways that are accessible and equitable.
6. Knowledge Brokering
Knowledge brokering is seen as:
A way to bridge the various knowledge, belief, value and practice gaps between researchers and knowledge users.
Organizations or people act as intermediaries — knowledge brokers— to facilitate two-way interactions between researchers and knowledge users, and bridge the knowledge to practice gap. To learn more about knowledge brokers, check out our series of blog posts on the topic.
7. Knowledge Transfer
The term Knowledge Transfer has been used in the literature since the 1950s, and usually refers to:
A one-way transfer of knowledge from researcher to user.
Often referred to as knowledge push, dissemination, or even tech transfer, knowledge transfer often results in limited knowledge uptake, because as we know from Pat’s article, People Aren’t Vulcans, knowledge alone rarely leads to behaviour change.
7b. — and Exchange
Knowledge Transfer is often paired with the term ‘exchange’, to read “knowledge transfer and exchange” (KTE), which is more focused on a two-way process of information. For example, CanChild defines knowledge transfer as “a process by which relevant research information is made available and accessible for practice, planning, and policy-making through interactive engagement with audiences”. In Canada, there is a growing community of practice focused on knowledge transfer and exchange, appropriately named the KTECOP, founded in 2006.
8. Integrated Knowledge Translation
Often referred to as linkage and exchange, integrated knowledge translation (iKT) refers to the two-way interaction between researchers and knowledge-users (those who are likely to use research findings in practice, or be impacted by research findings) to produce research that is more relevant and applicable. Members of the IKT Research Network of Canada define iKT as:
“A model of collaborative research, where researchers work with knowledge users who identify a problem and have the authority to implement the research recommendations.” [5]
This involves users of information (i.e. patients and the public, healthcare providers, policy makers) as active participants, moving beyond stakeholders as participants to become collaborators and partners in research. For more on the use of iKT in healthcare, check out this 2016 scoping review by Gagliardi and colleagues.
9. Knowledge Mobilization
The term knowledge mobilization (KMb) is often used in the social sciences and humanities fields in Canada and the UK to describe work that facilitates real-world impact of research on policy and society. Often funded by the Social Sciences and Humanities Research Council (SSHRC) in Canada, KMb refers to the process of adapting knowledge to increase research uptake and inform decisions, while also connecting researchers and their work to organizations and communities outside the university. KMb has a focus on interactions between researchers and knowledge users, and a focus on intermediaries (such as knowledge brokers).
The SSHRC defines knowledge mobilization as:
“The reciprocal and complementary flow and uptake of research knowledge between researchers, knowledge brokers and knowledge users — both within and beyond academia — in such a way that may benefit users and create positive impacts within Canada and/or internationally, and, ultimately, has the potential to enhance the profile, reach and impact of social sciences and humanities research.”
In general, KT and KMb can be used interchangebly — however, KT generally refers to research in the biomedical and clinical realms of healthcare while KMb is generally used in social sciences and humanities research.
Research Impact Canada (RIC) is a network of 17 Canadian universities focused on KMb that is “committed to maximizing the impact of academic research for the public good in local and global communities”.
10. K*
As you can see, a number of these concepts overlap and relate to overarching umbrella terms such as KT, KMb, and D&I research. To reflect this, yet another term was used, K*, to aggregate the numerous terms used to describe the processes of moving knowledge to practice and policy. You can read more about these thoughts from this concept report published back in 2012.
Editor’s Choice: Knowledge Translation
Of all the terms, KT is the one that has gained prominence in health research in Canada and has been adopted by CIHR and other funding agencies worldwide. KT is often used in the health professions and refers to a spectrum of activities which can be modified based on goals, purpose, context and audience.
The National Center for the Dissemination of Disability Research (NCDDR) and the World Health Organization (WHO) have produced slight variations of the CIHR definition to which we subscribe. However, all focus on addressing the gap between what is known and the implementation of this knowledge by key stakeholders to improve health outcomes and the healthcare system.
Finding a Common Language
The field of KT is still growing and becoming more prominent both globally and across research fields. With growth comes evolution, including new terms, definitions, and concepts, resulting in significant variation in different contexts and ‘camps’.
Because of this, many have argued that for the science and practice to advance, coming to a common language across disciplines is essential. The division of language can slow the growth of the field overall and make it difficult for researchers to learn from each other’s work, collaborate across boundaries, or conduct syntheses of effective practices.
What do you think? Do we need to create a synthesis of terms and definitions? Or is this diversity healthy for a growing field? Let us know in the comments or on Twitter @KnowledgeNudge.
References
- Estabrooks et al. Measuring Knowledge Utilization in Healthcare. Presentation in Session: Translation Research. 2004 July 21.
- Squires et al. Individual determinants of research utilization by nurses: a systematic review update. Implement Sci. 2011;6:1.
- Glasgow et al. National Institutes of Health Approaches to Dissemination and Implementation Science: Current and Future Directions. Am J Public Health. 2012;102(7):1274–81.
- Straus SE, Tetroe J & Graham ID. Knowledge Translation in Health Care: Moving from Evidence to Practice. 2010, BMJ Books, Wiley-Blackwell.
- Kothari A, McCutcheon C & Graham ID (for the IKT Research Network). Defining Integrated Knowledge Translation and Moving Forward: A Response to Recent Commentaries. Int J Health Policy Manag. 2017;6(5):299–300.
About the Author
Leah Crockett is a doctoral student in the Department of Community Health Sciences at the University of Manitoba. Find her on Twitter: @leahkcrockett.
