Introduction
Co-creation | “Co-creation - collaborative knowledge generation by academics working alongside other stakeholder - reflects a “Mode 2″ relationship (knowledge production rather than knowledge translation) between universities and society. Co-creation is widely believed to increase research impact … Co-creation emerged independently in several fields, including business studies (“value co-creation”), design science (“experience-based co-design”), computer science (“technology co-design”), and community development (“participatory research”). Key success principles included (1) a systems perspective (assuming emergence, local adaptation, and nonlinearity); (2) the framing of research as a creative enterprise with human experience at its core; and (3) an emphasis on process (the framing of the program, the nature of relationships, and governance and facilitation arrangements, especially the style of leadership and how conflict is managed).” [5] “…refers to the active involvement of end-users in various stages of the production process … However, the main difference in the definitions between co-creation and co-production is that, in line with the work of Vargo and Lusch (2004, the cocreation literature puts more emphasis on co-creation as value” [6, 7] |
Co-production | “…process through which inputs used to produce a good or service are contributed by individuals who are not ‘in’ the same organization” [8] “…co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours. Where activities are co-produced in this way, both services and neighbourhoods become far more effective agents of change.” [9] |
Decision-makers | “Decision-makers in the health services field can range from frontline health providers to administrators to ministers of health.” [10] “An individual who makes decisions about, or influences, health policies or practices. Decision makers can be practitioners, educators, health care administrators, elected officials (Exception: Federal elected officials), and individuals within the media, health charities, patient user groups or the private sector. They can work at the local community, municipal, provincial or national level. Decision makers are those individuals who are likely to be able to make use of the results of the research.” [11] |
Dissemination | “Dissemination goes well beyond simply making research available through the traditional vehicles of journal publication and academic conference presentations. It involves a process of extracting the main messages or key implications derived from research results and communicating them to targeted groups of decision-makers and other stakeholders in a way that encourages them to factor the research implications into their work. Face-to-face communication is encouraged whenever possible.” [10] “Dissemination involves identifying the appropriate audience for research findings, and tailoring the research message and the medium to the audience to ensure optimal awareness and understanding of the message.” [12] |
Engaged Scholarship | “connecting the rich resources of the university to our most pressing social, civic and ethical problems.” [13] “…collaborative form of inquiry in which academics and practitioners leverage their different perspectives and competencies to coproduce knowledge about a complex problem or phenomenon that exists under conditions of uncertainty found in the world … Our argument for engaged scholarship is based on the concept of arbitrage-a strategy of exploiting differences in the kinds of knowledge that scholars and practitioners can contribute on a problem of interest.” [14] |
Implementation Science | “…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 and care.” [15] |
Integrated Knowledge Translation | “…represents a different way of doing research and involves active collaboration between researchers and research users in all parts of the research process, including the shaping of the research questions, decisions about the methods involvement in the data collection and tools development, interpretation of the findings and dissemination and implementation of the research results” [16] “…a way of approaching research to increase the chances that the results will be applicable to the population under study. It is a paradigm shift that focuses on engagement with end users and the context in which they work. Essentially it is a collaborative way of conducting research that involves researchers and knowledge-users, sometimes from multiple communities (e.g. clinicians, managers, policy makers, patients) working together as partners in the research process.” [17] “…a model of collaborative research, where researchers work with knowledge users who identify a problem and have the authority to implement the research recommendations” [18] “In integrated KT, stakeholders or potential research knowledge users are engaged in the entire research process. By doing integrated KT, researchers and research users work together to shape the research process by collaborating to determine the research questions, deciding on the methodology, being involved in data collection and tools development, interpreting the findings, and helping disseminate the research results. This approach, also known by such terms as collaborative research, action-oriented research, and co-production of knowledge, should produce research findings that are more likely be relevant to and used by the end users.” [19] |
Knowledge Exchange | “Knowledge exchange is collaborative problem-solving between researchers and decision-makers that happens through linkage and exchange. Effective knowledge exchange involves interaction between decision-makers and researchers and results in mutual learning through the process of planning, producing, disseminating, and applying existing or new research in decision-making.” [10] “The exchange of knowledge refers to the interaction between the knowledge user and the researcher, resulting in mutual learning.” [11] “…knowledge exchange refers to the interaction between knowledge-users (those who can inform their decision-making with research) and researchers (the knowledge producers) that result in mutual learning and knowledge use.” [12] |
Knowledge Translation | “…a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.” [19] “This process takes place within a complex system of interactions between researchers and knowledge users that may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.” [20] |
Knowledge to Action Process | “The Knowledge to Action Process conceptualizes the relationship between knowledge creation and action, with each concept comprised of ideal phases or categories. A knowledge creation “funnel” conveys the idea that knowledge needs to be increasingly distilled before it is ready for application. The action part of the process can be thought of as a cycle leading to implementation or application of knowledge. In contrast to the knowledge funnel, the action cycle represents the activities that may be needed for knowledge application.” [19] “… IKT is about an exchange of knowledge between relevant stakeholders that results in action. To achieve this, appropriate relationships must be cultivated. The first step in this process is to identify the relevant stakeholders and to establish a common understanding of KTA [Knowledge to Action]. It is our hope that this discussion and clarification of terms, along with our presentation of a conceptual map for the KTA process, will help knowledge producers and users understand the nature of the terrain so that they can find their way through the complex, iterative, and organic process of knowledge translation.” [21] |
Knowledge Synthesis | “A synthesis is an evaluation or analysis of research evidence and expert opinion on a specific topic to aid in decision-making or help decision-makers in the development of policies. It can help place the results of a single study in context by providing the overall body of research evidence. There are many forms of synthesis, ranging from very formal systematic reviews, like those carried out by the Cochrane Collaboration, to informal literature reviews.” [10] “…means the contextualization and integration of research findings of individual research studies within the larger body of knowledge on the topic. A synthesis must be reproducible and transparent in its methods, using quantitative and/or qualitative methods. It could take the form of a systematic review, follow the methods developed by the Cochrane Collaboration, result from a consensus conference or expert panel or synthesize qualitative or quantitative results. Realist syntheses, narrative syntheses, meta-analyses, meta-syntheses and practice guidelines are all forms of synthesis.” [11] |
Knowledge Use | “…process by which specific research-based knowledge (science) is implemented in practice.” [22] |
Knowledge Users | “…an individual who is likely to be able to use the knowledge generated through research to make informed decisions about health policies, programs and/or practices. A knowledge-user’s level of engagement in the research process may vary in intensity and complexity depending on the nature of the research and his/her information needs. A knowledge-user can be, but is not limited to, a practitioner, policy-maker, educator, decision-maker, health care administrator, community leader, or an individual in a health charity, patient group, private sector organization, or media outlet.” [11] Individuals, groups, or organisations (including patients, healthcare providers, caregivers, communities, funders, organisations and policy-makers/decision-makers, managers, researchers, trainees, industry, media/journalists) that would be considered the beneficiaries of research or who are positioned to use the research to inform their decisions about policies, programmes, treatments, interventions and practices [17, 22] |
Linkage and Exchange | “…the process of ongoing interaction, collaboration and exchange of ideas between the researcher and decision-maker communities. In a specific research collaboration, it involves working together before, during and after the research program.” [10] |
Mode 2 Research | “[Research that is] socially distributed, application-oriented, trans-disciplinary and subject to multiple accountabilities” [23] “[Research that is] based on the needs of end users in the health care system and is arguably a more socially accountable form of knowledge production” [24] |
Partners | Knowledge users, decision-makers, stakeholders, end-users, service-users, consumers, community members, community of interest, citizens, industry, groups, funders engaged in the research process |
Participatory Research | “…systematic inquiry, with the collaboration of those affected by the issue being studied, for the purposes of education andtaking action or effecting social change” [25] “…an umbrella term for a school of approaches that share a core philosophy of inclusivity and of recognizing the value of engaging in the research process (rather than including only as subjects of the research) those who are intended to be the beneficiaries, users, and stakeholders of the research. Among the approaches included within this rubric are community-based participatory research, participatory rural appraisal, empowerment evaluation, participatory action research … and forms of action research embracing a participatory philosophy” [26] |
Research Partnerships | “…individuals, groups or organizations engaged in collaborative research activity involving at least one researcher (e.g., individual affiliated with an academic institution), and any stakeholder actively engaged in any part of the research process (e.g., decision or policy maker, health care administrator or leader, community agency, charities, network, patients etc.) Such arrangements might or might not be formalized at the institutional level through a memorandum of understanding.” [27] |
Stakeholders | Individuals, groups or organisations with shared interest in the research; may be in the geographic locality of the research setting or may be affected by the environmental effects of the research but may not necessarily use the generated knowledge [11] |
Methods
Study design
Setting
Data collection
Research team and reflexivity
Personal characteristics
Team members (n = 15) | Gender | Country | Credentials | Position |
---|---|---|---|---|
TN | F | Canada | PhD | Postdoctoral Fellow |
IDG | M | Canada | PhD, FCAHS, FNYAM, FRSC | Professor |
KJM | F | Canada | MSc | PhD Candidate/Clinician Scientist |
SB | F | Canada | PhD | Professor |
MC | F | Australia | PhD | Professor |
CAS | F | Canada | CM, PhD, RN, FCAHS, FAAN | Professor |
AK | F | Canada | PhD | Professor |
JL | M | Canada | MD, PhD | Professor |
ACM | F | Canada | CM, MD FCAHS FRCPC (Hon) | Professor |
MM | F | Canada | PhD, RN | Professor |
DP | M | Canada | PhD | Professor |
VR | F | Canada | PhD, RN, BSN, MS | Professor |
MJR | F | Canada | RN RM PhD FRSE | Professor |
JS | M | Ireland | PhD | Professor |
NW | F | United States | DrPH, MPH | Professor |
Participant selection (n = 17)
Participants (n = 17) | Gender | Country | Approach |
---|---|---|---|
1 | M | Canada | IKT, CP, PR |
2 | M | Canada | IKT |
3 | F | Canada | IKT, ES, CP |
4 | F | Canada | Did not align with a specific approach |
5 | F | United Kingdom | Did not align with a specific approach |
6 | F | Canada | IKT |
7 | M | Canada | Did not align with a specific approach |
8 | M | Ireland | PR |
9 | F | Canada | PR |
10 | F | Canada | Did not align with a specific approach |
11 | F | Canada | Mode 2, IKT |
12 | F | Canada | CP |
13 | F | Canada | IKT |
14 | F | Australia | PR |
15 | F | Canada | PR |
16 | M | Canada | IKT |
17 | F | United States | PR |
Relationship with participants
Analysis and findings
Data analysis
Factor | Integrated knowledge translation | Engaged scholarship | Mode 2 research | Co-production | Participatory research |
---|---|---|---|---|---|
Orientation | |||||
Scope | Research, Implementation [16] | Research/teaching scholarship [44] | Research | Research | Research |
Original purpose/intent | A collaborative approach between researchers and knowledge users to increase the chances that research findings will be applicable to those under study [16] | A participative research process that expands the capabilities of scholars to gather perspectives of key stakeholders and study complex problems; the ultimate aim is to create knowledge that advances science and practice, and is more penetrating and insightful than that which is done in isolation [45] | To bring awareness to the production of knowledge within context, by increasing the flexibility to mix, coalesce and reformulate rapidly, increase the diversity of included partners, seek awareness of what the end-users see as the issues to enhance the usability and social accountability of the research, broaden the sphere of what constitutes knowledge [23] | Provides a new way of understanding and evaluating hybrid, heterogeneous arrangements that extend well beyond traditional conceptualisations of political science (policy), economics; co-production is the active involvement of consumers in various stages of the knowledge production process [46] (interchangeable with co-creation) | To address community issues in a collaborative, consultative, democratic, reflective, reflexive, dialogical and improvement-oriented fashion that builds capacity and creates actionable, ownership of findings [47]; it mobilises living knowledge of people connected together in their context and creates a common understanding of ways to act for the common good [48] |
Primary motivation | Explicit focus on increasing knowledge use and impact [16] | Explicit focus on reconnecting academia with societal needs, education for democracy, civic responsibility/engagement and public scholarship [44] | Explicit focus on increasing the effectiveness and efficiency of public services by involving consumers in the development and delivery processes | Explicit focus on social and environmental justice and a desire for impact change, particularly to benefit underserved/vulnerable citizens and communities | |
Epistemological stance | Neutral [44] Social constructionism [49] | Relational ontology (emphasis on interrelationships and co-constitution) or the conjoined production of one nature-culture [54]; epistemology is unstable and still evolving Some discussion of neo-materialist underpinnings | Pluralist interpretivist perspective (Aristotelian praxis, hermeneutics, constructivism, constructionism, critical theory, existentialism, pragmatism, process philosophies and phenomenology) (Northern Tradition) [55, 56] Critical pedagogy (Southern Tradition), aspects of pragmatism, pluralism, egalitarianism, Liberation theology [48] Extended epistemology of “practical knowing” [55] (experiential, presentational, propositional and practical ways of knowing) | ||
Theoretical underpinnings | Initial Context for IKT: Planned Action/Change Theory [57] (set of logically interrelated concepts that systematically explain the means by which and predicts how planned change occurs in a specific environment, and helps planners control variables that increase or decrease likelihood for change); deliberate change engineering in social systems | Engaged Scholarship Diamond Model links data to theory (designed by the researcher, through engaged scholarship) [57] | Policy theory | Ostrom’s policy theory underlies the concept of co-production [8] | Lewin: iterative, collaborative action–reflection cycles (problem awareness, shifts in understanding, formulation of a plan of action, transformative action and progressive iterative learning, and cementing new behaviour based on effective corrective action) [48], a mode of embedded, collective self-inquiry |
Theory implicit/explicit | Explicit within the KTA process, implicit as a stand-alone concept | Implicit | Implicit (fragmented, evolving) | Explicit | Explicit |
Historical roots | |||||
Geographic origin | Canada | United States | United Kingdom/Europe, later United States | United States, United Kingdom (post 2000) | United States United Kingdom, South America |
Disciplinary origin | Health/Medicine/Nursing | Education | Philosophy | Economics, Public policy | Social sciences (Psychology in North America, Community Development, Education in South America) |
Health research vs. other research | Health Research/Medicine/Nursing | General research | General research | Civil rights and social care | Civil rights and social sciences |
Disciplinary background of early developers | Health Research Funders (CHSRF and CIHR), Canada Jonathan Lomas, CEO CHSRF (1997), Canada Ian Graham, VP Knowledge Translation (2007), Canada | Ernest Boyer, President of the Carnegie Foundation/Educator (1996), United States Andrew Van de Ven- Educator (2006), United States | Michael Gibbons, Physicist (1994) United Kingdom/Europe Helga Nowotny, Educator (2003) Europe | Elinor Ostrom, Economist (1978), United States Edgar Cahn, Civil rights law professor (2001), United States | Kurt Lewin, Psychologist (1946), United States/United Kingdom: ‘Northern Tradition’ Paulo Freire, Educator/Philosopher (1970), South America: ‘Southern Tradition’ |
Partnership/engagement | |||||
Unique features | Only approach with roots in a health research and subsequently developed within health research and implementation contexts Term ‘knowledge users’ is unique to IKT (i.e. explicit focus on policy-makers/decision-makers positioned to influence change or implement the generated knowledge | Originally developed in an academic setting driven by university researchers in the United States Explicit inclusion of student partners, institutional agreements Embraces and equally emphasises all forms of scholarship (discovery, integration, application and teaching); cutting across teaching, research and service | Originally developed by educators in the United Kingdom and Europe Explicit inclusion of industry/private sector involvement as a partner; only approach to explicitly consider for-profit partnerships | Originally developed by an economist in the United States Explicit inclusion of patients (as consumers of health services), who can be considered ‘temporarily marginalised’ | Originally developed in social sciences by a psychologist (Northern tradition) and an educator/philosopher (Southern Tradition) in the United States Explicit focus on social justice, power and emancipation as common outcomes Explicit focus on researcher’s humility Capacity-building is an intentional outcome |
What partners are called | ‘Knowledge user’, ‘Health system decision-makers’, ‘policy-makers’, ‘administrators’, ‘clinical leaders’, ‘patients’ | ‘Stakeholders’, ‘public members’, ‘communities’, ‘organisations’, ‘society’, ‘students’, ‘citizens’ | ‘End-users’, ‘industry’ | ‘Consumers’, ‘service users’, ‘citizens’ | ‘Community members’, ‘community of interest’, ‘citizens’, ‘community groups’, ‘partners’ |
Role of partners | ‘Knowledge users’, particularly policy-makers/decision-makers and those positioned to use generated knowledge to impact change Role is negotiated (equal or equitable power and authority throughout the research process) | ‘Stakeholders’ contribute diverse perspectives/’xpertise and work with researchers to resolve the conflicts that rise from them to lead to higher levels of understanding | ‘End-users’ are actively engaged from the outset to ensure research agenda and objectives meet societal needs | ‘Consumers’ are actively engaged as change agents (differing capabilities and interests, which sometimes may require finding synergies or trade-offs among them) in the planning and delivery of public services ‘Co-producers’ are recipients and shapers of service/goods; they may have differing capabilities and/or skills that require trade-offs/synergies | ‘Community members’ (experts in lived experiences and ability to use results to influence/make local changes) and researchers (facilitators with expertise in research design/obtaining funding etc.) work together to solve a given issue |
Power sharing | Equal or equitable role, power and authority throughout the research process | Leveraging expertise of stakeholders and researchers (‘arbitrage’) in co-creation of knowledge | Non-hierarchical relationship between end-users and researchers in co-reaction of knowledge | Shift in power towards service users to improve planning and delivery of public services | Empowerment and capacity-building of communities to have an equal or equitable role, power and authority throughout the research process |
Results
Differences among the approaches
IKT
“We use this term [IKT] because Ian [Graham] so effectively popularized it in Canada.” (P2)
“For me IKT must include policy makers/managers who are in positions to use the results to change policies or make decisions. Effective IKT requires inclusion of policy makers and decision makers from the beginning to help shape the question(s) and to recognize they have a very important role to play in using results to make a difference. Participatory and community-based participatory research etc. do not state this explicitly. Ian Graham with IKT shifted my insight to realize the importance of getting policy/decision makers to be involved (small or big policy people) if you want to make an impact (consciously aware for IKT).” (P9).
“IKT involves decision makers in many stages of the research process (generation of research). Decision makers who are partners have some kind of power to help implement the findings (chosen specially because of their position/power not because they are disempowered).” (P13)
Engaged scholarship
“Engaged scholarship is unique as it engages all forms of scholarship - not only ‘discovery’ research, which is how research is often defined in the academic setting. It also recognizes and urges valuing of integration of research, finding applications for research (as well as teaching).” (P10)
Mode 2 research
Co-production
Participatory research
Similarities among the approaches
True partnerships rather than simple engagement
“In a true partnership (and this reflects an engaged scholarship perspective), all perspectives/expertise are considered equally valuable – but different. We do not expect knowledge users to be researchers or bring research expertise, for example. All partners are involved from the earliest stage of the research (e.g. determining priority topics and research questions) in meaningful ways. Importantly, power is shared. Partnership involves creating an environment where diverse perspectives, including differences, are discussed in depth, resulting in a higher level of understanding.” (P10)
“Engagement refers more to consulting, whereas partnership implies a stronger and tighter relationship.” (P13)
Focus on essential components and process rather than labels
“It’s all about working together to solve problems that matter to people and making a difference. It’s about making sure the benefits of the research are applied and the outcomes realized to make things better.” (P16)
“[It’s] not so much what we call it but it’s what we do.” (P8)
“I have found, over the years, that there are all sorts of new methods or approach that purport to be different, but often are marginally so. They may be coined as something different in order for someone to be seen to create something new, or to be able to sell an approach. Often it is repackaging with a new name. People want to label things and then they promote it.” (P4)
“My overall comment is that the similarities outweigh the differences. In my opinion the KEY item is the level of true partnership throughout all phases of the research” and “[I’m] not excited by all this academic terminology, [I] feel strongly that the key issue is equity of team members; it may vary from project to project. How the team decides to work … it depends on all your other factors: research question; the funding source that drives a lot of this; expertise of the team; who you’ve got on the team; it depends on length of the projects; who owns the research and who can access it; every team is different, it is not a cookie cutter approach.” (P9)
Collaborative research approaches rather than research methods
“I use the same theory/principles – i.e. the research end users and researchers come together to develop the question, develop the protocol and complete the study, interpret results, disseminate strategies. All team members are equal partners.” (P12)
Core values and principles
“Inclusion of knowledge users is one of the core principles or values. People want to be heard and a healthcare system that is responsive to their needs and not the needs of researchers.” (P16)
“Involving patients and communities; principles are the same involving patients in shared decisions making for clinical care and for research.” (P9)
“The goal of answering questions of mutual concern, engagement with the ideas and the work, and motivation to collectively enable change are closely linked to the co-creation/co-production model. This work model may not be ideal for all projects, but in health care it is ideal for most.” (P3)
Extensive time and financial investment
“Research that is co-created takes time, patience, energy and commitment. The engagement of individuals/patients, organizations and/or communities has become increasingly important in all aspects of the research process. Research that is co-created with individuals/patients, organizations and/or communities is designed to improve health and well-being and to minimize health disparities” (P15)
“It took a long time for me to be ready to undertake such work [collaborative work] due to time and resources.” (P11)