Background
With an increased awareness of the need for evidence-informed decision making in public health, knowledge management strategies need to be employed to ensure information is easily accessible [
1], tailored and targeted [
2], effectively disseminated [
3] and shared among knowledge users [
1].
Knowledge management is central to evidence-informed decision making, as it involves organisations and/or individuals creating, accessing, exchanging and translating knowledge (both explicit and tacit), usually in order to apply it to a particular policy or program challenge [
4,
5]. As the sheer volume of online information and knowledge resources increases, there is a need to have systems and tools that help policy, program and service decision makers manage this knowledge effectively [
6‐
8].
Web portals are emerging as one information technology system capable of facilitating knowledge management, as they can help people to find the information they need, when they need it. Portals have evolved from simply being an efficient web tool for the one-way retrieval and transfer of information, to a platform for two-way collaboration and exchange among people in different organisations or professions, i.e. knowledge portals or knowledge exchange portals (KEPs) [
9‐
11].
It appears that KEPs can facilitate knowledge management through three core activities, depending on their available design features and functions [
11‐
13]: (i) knowledge access, by providing a single integrated point of access to a variety of relevant organisational or topic-specific information; (ii) knowledge creation, by creating and maintaining knowledge directories about portal generated content; and (iii) knowledge transfer and exchange, by facilitating information sharing and distribution and providing collaborative features that help to foster communities of practice.
A growing body of literature [
14,
15] suggests that communication technologies (e.g. video conferencing, virtual communities of practice and online interactive applications such as discussion forums and wikis) may be particularly relevant to the field of public health, where multidisciplinary team working and sharing of tacit and explicit knowledge is likely to increase the efficiency and effectiveness of policies, programs and services.
However, KEPs are a relatively new form of online communication technology and from a design perspective, it is still not clear which features and functions work best to support knowledge management in public health. We therefore conducted a systematic review of the literature to better understand the nature of these portals and their contribution to knowledge management in public health, with the aim of informing future development of portals in this field.
Discussion
While the published literature in this field is still evolving, this review demonstrates a wide variety of ways that KEPs can support knowledge management processes in public health. Public health KEPs may contain evidence libraries or registries, provide access to a range of epidemiological and demographic data, enable creation of new online content (e.g. health promotion plans) and/or maintain online communities of practice for sharing of knowledge about public health policies, programs or services. One RCT [
20] has demonstrated that KEPs in combination with tailored messaging services can be effective at facilitating the use of evidence in policies and programs. However, there are several key factors that potential funders must keep in mind when designing and maintaining portals for a public health audience. Further robust performance evaluation of KEPs is needed to establish which design features best support knowledge management, as they can be a resource intensive investment.
In our review, we found that features supporting the process of knowledge access (e.g. key word searching of portal content) and knowledge creation (e.g. sign up and user profiles, as well as online planning tools) were the most popular design features in public health KEPs. The studies conducted by Lee et al. [
11] and Goh et al. [
13] previously confirmed this finding in a large sample of healthcare and government portals respectively across North America and the Asia Pacific. Lee et al. [
11] further suggested that the design of KEPs could be improved by enhancing the number and type of collaborative features that support knowledge transfer and exchange. Formative evaluation studies identified in this review reported two common user needs for KEP design, easily accessible and searchable information [
22,
25] (preferably systematic reviews or quality assessed and summarised research studies or examples of best practice) and collaborative features (e.g. wikis, blogs, discussion forms etc.) that enabled targeted and interactive communication between public health policy makers and practitioners [
19,
32].
In terms of KEP usage or uptake, the reviewed studies revealed that while portal use may increase over time, retaining users remains a problem [
23,
24]. However by remaining responsive to user needs and providing active ‘push’ (e.g. tailored emails or newsletters) or ‘pull’ (e.g. content-specific webinars) knowledge translation or exchange functionality through the portal, funders or owners may entice repeat visits from users [
21]. Furthermore, the utility of web usage statistics remains limited, unless longitudinal data are available to compare trends over time [
34,
35]. It has also been suggested [
36] that web usage metrics for web portals should be different to that of websites and should include repeat use (same users accessing the portal), stickiness (length of time each user spends per visit) and frequency of use (number of unique visits per user per time period).
It is important to note that while web usage statistics provide a quantitative indication of knowledge access, monitoring usage patterns does not infer evidence-informed decision making in public health. Performance evaluation models that help to measure how portals are assisting in knowledge management activity [
37,
38] are still in development and no one model has been shown to be superior. Dobbin et al. [
20] found that organisations with a high research culture responded best to the use of a KEP in combination with tailored and targeted messages, whereas organisations with a low research culture responded best to a knowledge broker in terms of facilitating the implementation of public health policies and programs. However it is important to remember that other barriers or facilitators for evidence-informed decision making exist [
39,
40] e.g. organisational culture, leadership, workforce and skills development etc.; and that KEPs are only one tool to link various silos of knowledge and people (internally within organisations and externally between organisations) and only one successful component of a knowledge management strategy.
This review also suggests some potential success factors that might be taken into consideration when designing, developing and maintaining a KEP for a public health audience. These include ensuring the portal has a user-centric design, promotional and funding strategies are sustainable and that online knowledge transfer and exchange activity remains beneficial for users.
Limitations
Our search strategy was limited to articles published in English only. Given that the information communication technology sector is rapidly evolving in some developing countries (e.g. India, China and Brazil), we may have missed inclusion of articles published in other languages. Due to the difficulties associated with key word searching and comprehensively searching the grey literature, it is impossible to say we identified every eligible article for review; however our review process was systematic and covered a long time period. The findings of our review could be used with validity by public health staff that are considering designing and developing a KEP.
Conclusion
KEPs can have design features that enable integrated access to relevant content and resources in one location, the sharing and distribution of tailored information and for bringing people together for knowledge exchange. Formative evaluation studies suggest that users want easily accessible and succinct information and collaborative features for knowledge exchange. Web usage studies reveal that while portal usage may increase over time, retention of portal users remains a problem. Evidence suggests that KEPs in combination with other knowledge management strategies can influence evidence-informed decision making in public health. However for the design of KEPs in this field to evolve based on the best available evidence, there needs to be more performance evaluation of KEPs in order to justify the resource investment over time.
Acknowledgements
The first author was employed as part of the NSW Public Health Officer Training Program, funded by the NSW Ministry of Health. This project work was part of the Centre for Informing Policy with Evidence from Research (CIPHER). CIPHER is a joint project of the Sax Institute; Australasian Cochrane Centre, Monash University; the University of Newcastle; The University of New South Wales, The University of Technology Sydney; the Research Unit for Research Utilisation, University of St Andrews and University of Edinburgh; and the University of Western Sydney. CIPHER is funded as an Australian National Health and Medical Research Council (NHMRC) Centre of Research Excellence (APP1001436) located within the Sax Institute and administered by the University of Western Sydney.
Competing interests
Dr Holly Seale holds an NHMRC Australian based Public Health Training Fellowship (1012631). Payment for presentations: Dr Seale has received funding from Sanofi Pasteur, GSK and CSL Biotherapies for investigator driven research and for conference presentations.
Authors’ contributions
EQ lead the design and conduct of the systematic literature review, including evaluating all articles for inclusion in the review, drafted the manuscript and finalised the manuscript with all authors for submission. CHS assisted in the conduct of the systematic literature review, including the evaluation of articles for inclusion in the review and in drafting and finalising the manuscript for submission. DC assisted in the conduct of the systematic literature review, including the evaluation of articles for inclusion in the review and in drafting and finalising the manuscript for submission. HS provided guidance in the conduct of the systematic literature review and participated in drafting and finalising the manuscript for submission. AM provided guidance in the conduct of the systematic literature review and participated in drafting and finalising the manuscript for submission. All authors read and approved the final manuscript.