Thoughts from the Front Lines: Why I’m Passionate About KT Research
By Kathryn Sibley
I first entered the scholarly field of knowledge translation (KT) almost 10 years ago — well behind the pioneers of the field, but at a time when the larger health research community was just starting to recognize the need to study and invest in these processes. Fast forward to today, when I have gained some experience with KT theories and the evidence base, and I am regularly called on for my so-called “expertise”. But after all this time, what my experience has taught me is that (1) there is still so much that we don’t know, and (2) the answers I am called upon to provide are often not yet available.
For example, I’m often asked to consult on KT activities where the researchers involved already have an idea in mind of what they want to do. But in many cases, those KT plans are generated without any consideration of the theoretical literature or evidence base, reflecting a relatively uninformed approach. And the evidence paints an interesting picture.
On one hand, many studies have explored how to optimize health care and health services based on scientific evidence. The Cochrane Effective Practice and Organization of Care (EPOC) Group conducts systematic reviews of interventions intended to improve health professional practice and the delivery of health services, and they have identified over 7,000 studies trying to figure this out. [1]
But on the other hand, what many of these studies tell us is what doesn’t work. For example, printed education materials (PEMs)— defined as distribution of published or printed recommendations for clinical care (e.g. clinical practice guidelines) — have been studied in dozens of randomized trials. [1] They typically target knowledge and practice gaps among individual healthcare providers. But do they address these gaps? In a 2015 meta-analysis of the effect of PEMs on primary care physician knowledge, behaviour, and patient outcomes from 26 studies, there were no significant effects on physician knowledge, behaviour, or patient outcomes. That’s quite telling — but if I had a nickel for everyone who wanted to make a one-page handout… So buyer beware. It’s critical to understand the limitations of PEMs alone if your KT goal is adoption of a behaviour.
The case of the knowledge broker is another example. Knowledge brokers are specialized KT practitioners who facilitate the process of knowledge exchange and adoption, and there is a lot of interest in knowledge brokering at the moment. But the reality is that there is very little data on the effectiveness of knowledge brokers (which I can report based on a recent systematic review exploring this). [2] That’s not to say that knowledge brokering has no positive effect, but that we don’t know what that effect actually is. I can’t make any evidence-informed recommendation about whether someone should adopt one. What I can recommend is that we study the effectiveness of knowledge brokers (and other KT-related activities and roles) through rigorously designed scientific methods.
So, if you ask for my humble “expert” opinion, there isn’t one so-called KT approach that doesn’t require more effectiveness research (okay, maybe audit and feedback, which has 140 trials and demonstrated effectiveness). [3] Otherwise, fill in the blank with your KT effort, and it needs to be studied. We need to recognize this gap and address it through continued research. This requires patience, but playing the KT long-game will result in more evidence-informed decision making. Which — if I’m not mistaken — is what KT is all about!
References
- Grimshaw J, et al. Knowledge translation of research findings. Implement Sci. 2012;7:50.
- Bornbaum C, et al. Exploring the function and effectiveness of knowledge brokers as facilitators of knowledge translation in health-related settings: a systematic review and thematic analysis. Implement Sci, 2015;10:162.
- Ivers NM, et al. No more ‘business as usual’ with audit and feedback interventions: towards an agenda for a reinvigorated intervention. Implement Sci, 2014; 9:14.
About the Author
Dr. Kathryn Sibley is the Director of Knowledge Translation at the George & Fay Yee Centre for Healthcare Innovation (CHI), Canada Research Chair in Integrated Knowledge Translation in Rehabilitation Sciences, and Assistant Professor in Community Health Sciences at the University of Manitoba.
