Knowledge translation and exchange
In recent years the terms knowledge transfer and exchange, evidence-based decision-making, and evidence-informed health policy have become commonly used, but with little consensus on their definition, how they occur, or can be promoted [
1,
2]. Furthermore, significant resources and time are invested in the production of research evidence that, if effectively transferred, could be used to inform policy and practice decisions and subsequently improve patient and population health outcomes [
3]. In October 1994, the Prime Minister of Canada launched the National Forum on Health to involve and inform Canadians and to advise the federal government on innovative ways to improve the health system and the health of Canada's people. A key recommendation arising from the National Forum on Health [
4] was the development of an evidence-informed health care system in Canada where policies and clinical decisions are influenced by high quality research knowledge. As a result, considerable research inquiry has focused on understanding the processes of evidence-informed decision-making, as well as on how to facilitate it.
In order to move toward an evidence-informed health care system, significant environmental changes are required. At a minimum, researchers must become more effective communicators of their research findings, gain a better appreciation of the context in which decision-makers function, and build more collaborative relationships with policy-makers, decision-makers and practitioners [
3,
5,
6]. In addition, policy-makers, decision-makers and practitioners must become more receptive to the inclusion of the best available research evidence in the decision-making process, and be willing to collaborate with researchers to ensure that relevant and applicable research is conducted [
7‐
9].
The knowledge transfer field in health care, while relatively young compared to other empirical fields, has evolved significantly in the past 40 years. It has identified barriers and facilitators of knowledge transfer, determined the effectiveness of dissemination strategies, explored decision-making processes and organizational capacity for change, and evaluated collaborative efforts to bring producers and users of research evidence together to develop, implement and interpret research evidence. Consistent barriers across all settings include lack of available time, lack of access to current research literature, limited critical appraisal skills, excessive literature to review, work environments that do not support research transfer and uptake, lack of decision-making authority to implement research results, organizational decision-making processes that are not conducive to research transfer and uptake, resistance to change, and limited resources for implementation [
10‐
17].
While the process is complex and constantly changing, several generalizations about knowledge transfer and exchange (KTE) can be made. Traditional passive strategies used alone are relatively ineffective [
18,
19]. Strategies that are more interactive and involve face-to-face contact show promising results with a variety of target populations [
12,
20‐
23]. Involvement of decision-makers in the research process has been shown to be associated with higher degrees of uptake [
24]. When the results or 'messages' of research results are tailored to the specific needs of decision-makers then perceived uptake is higher [
3,
25,
26]. An emerging hypothesis is that a combination of strategies, resulting in an interactive, multi-component KTE program that reinforces relationships between research producers and users, and reaches potential users on multiple levels, may be most effective in achieving an evidence-informed health care system [
27].
The CanChild Centre for Childhood Disability Research at McMaster University, funded since 1989 by the Ontario Ministry of Health and Long-Term Care, implements interactive, multi-component interventions that reinforce relationships between research producers and potential users. Two main goals of CanChild are to provide effective leadership and innovation in childhood disability research and information transfer, and to impact on knowledge, practice, services, and policy in childhood disability through programmatic research and research transfer [
28]. CanChild accomplishes these goals by working collaboratively with community agencies, including all members of the Ontario Children's Treatment Centres (CTCs) and the Ontario Community Care Access Centres (CCACs), and to a modest extent the District Health Councils of Ontario.
Since its inception, CanChild has worked in partnership with all of the CTCs in Ontario. The CTCs provide developmental therapies and family-based services to children with a variety of developmental disabilities and their families [
29]. More recently, CanChild has started working collaboratively with the CCACs of Ontario, which have become increasingly involved in the provision of services to children with disabilities. CCACs offer an access point to Ontario's long-term care system by: assessing and arranging for visiting health and professional services in people's homes; assessing, authorizing, and arranging for the provision of school health support services for children; providing information and referrals to the public about other community agencies and services available to them; and coordinating services such as nursing, physiotherapy, occupational therapy, speech-language therapy, dietician services, social work, personal support and homemaking [
30]. The District Health Councils provide advice to the Ontario Ministry of Health and Long-Term Care on health needs and other health matters in their geographic areas. They also play an important role in the provision of health care information in their communities, as well as promote the integration of health services and identify health planning needs [
31].
All three types of organizations were approached to participate in this study to explore different decision-makers' perspectives on knowledge translation. These organizations were chosen because they are all involved in developing services for children with disabilities, but have different relationships with CanChild. For example, at the time of this study there existed a longstanding partnership between the CTCs and CanChild, including a focused program of KTE between the two organizations. While CanChild had a working relationship with the CCACs, the relationship was in its infancy, and at the time of this study there had been fewer opportunities to promote the transfer and uptake of research information by CCACs. In addition, at the time of this study there was no formal, established relationship between the DHCs and CanChild. It was expected that variations in the respective missions and existing relationships with CanChild would provide interesting observations related to the uptake of research evidence in decision-making.
Among the most consistent issue identified by those working in the childhood disability field is the need for information that is of high quality, synthesized, easy to use, and easy to access [
32]. In its attempt to address these information needs, CanChild reviewed the KTE literature to assist in the development of a KTE program that would facilitate relationships between research producers and users, and promote evidence-informed decision-making and practice [
3,
5,
33‐
36]. Their review of the literature and interaction with the CTCs led to the adoption of these guiding principles. The dissemination source must be perceived as competent, credible, and trustworthy. The content must be perceived as relevant, usable, methodologically sound, and comprehensive to users. The medium must be accessible, user-friendly, and clearly understandable. Finally, the intended user must perceive the relevance of the materials to their own needs, and understand it in the context of their work.
These principles guided the development of the research dissemination program, which aims to enhance the incorporation of CanChild's and others' research evidence into policy and program decision-making [
37]. A major objective is to facilitate the transfer and uptake of this research evidence specifically by CTCs and CCACs. The program is centered on the "Keeping Current" materials. These are brief 'bottom-line' systematic reviews of issues that have been assessed as being important 'hot topics' in the childhood disability field. They are written in plain language, are three to five pages in length, and can be read easily and quickly. Through Impact Surveys carried out by CanChild it has been shown that the 'Keeping Current' format is one that decision-makers and clinicians appreciate, and it has influenced thinking about issues and use of information [
32]. While some evaluation has been conducted on this program, CanChild investigators have never systematically studied what information, in what formats, people want and need in their roles as clinicians, managers, directors, and CEOs. It is timely to evaluate the impact of such a program so that knowledge gained from this strategy can be used to enhance CanChild's program as well as inform KT strategies for other research-producing organizations.
It is understood that research uptake varies significantly across decision-making levels (i.e., CEOs, directors, managers, clinicians) Therefore, in this study it was recognized that responses would vary not only across the three organizational types, but also among the different decision-maker levels. For example, CEOs and senior managers/directors could utilize research evidence in decisions related to broad organizational policies concerning service provision or in recommendations for provincial health policies. Middle managers could use research evidence to inform decisions related to program planning. Clinicians could use research evidence to inform clinical practice, and senior health planners could use research evidence to inform recommendations for local and provincial resource allocation and service provision. Regardless of the decision type, it was expected that research evidence would be used by all participants in some way to make decisions during the study.
The purpose of this study was to undertake a systematic assessment of the need for research-based information by decision-makers working in community-based organizations. It is part of a more comprehensive knowledge transfer and exchange strategy that seeks to understand both the content required and the format/methods by which such information should be presented.