Moving knowledge into action for more effective practice, programmes and policy: protocol for a research programme on integrated knowledge translation

Health research is conducted with the expectation that it advances knowledge and eventually translates into improved health systems and population health. However, research findings are often caught in the know-do gap: they are not acted upon in a timely way or not applied at all. The failure to put research findings into action is therefore a major societal issue and contributes to the estimated $200B (USD) of wasted research funding because the full potential of research was not realized [1].

The magnitude of the know-do gap has stimulated governments and research funders around the globe to recognize the importance of the active translation of research into action [2]. Where historically the problem of research underutilization was considered simply a dissemination failure (knowledge users unaware of research), some now suggest this gap results from knowledge production failures (not producing research addressing knowledge user problems).

A widely recognized and accepted tenet of knowledge translation is the integration of knowledge users throughout the research process. Integrated knowledge translation (IKT) is advanced as a way to increase the relevance, applicability and impact of results [3, 4]. It shares common principles with many collaborative research approaches: co-production of knowledge, participatory research, linkage and exchange, Mode 2 knowledge production, engaged scholarship and community-based participatory research [5‐10].

This approach proposes researcher/knowledge user collaboration as a key step in achieving societal impact and a way for society to speak to science. IKT shifts from a paradigm where the researcher is expert to one where researchers and knowledge users are both experts bringing complementary knowledge and skills to the team. They collaborate on issue-driven research with the expectation the research will generate implementable solutions to long-standing problems [11]. With IKT, the knowledge users work with researchers throughout the research process, starting with identification of the research question—they are actively engaged in the governance, priority setting and conduct of the research. Knowledge users represent all those who would be able to use research results to inform their decisions (clinicians, managers, policy makers, patients/families and others). Increasingly, stakeholders (governments, funders, researchers, health system managers and policy makers, patients and clinicians) are showing interest in the idea that IKT generates greater and faster societal impact. Stakeholders include all those with an interest in the issue or research, some of whom (knowledge users) are in a position to make direct use of the research in decision-making while other stakeholders are not but nevertheless want the issues and problems addressed.

Research funders have also been considering how to increase the impact of the research that they fund and their role in knowledge translation [2, 12‐14]. ‘Integrated knowledge translation’ is a Canadian research funder innovation, initially advanced by the Canadian Health Services Research Foundation [6] and referred to as Knowledge Exchange in the late 1990s/early 2000s. The concept was adopted and refined at the Canadian Institutes of Health Research which coined the term integrated knowledge translation in the first decade of 2000s [15]. To promote the concept of partnered research, these organizations created funding opportunities that required collaboration between researchers and knowledge users. The Canadian Institutes of Health Research launched several funding initiatives promoting IKT (e.g. Partnerships for Health System Improvement, Knowledge Synthesis, Knowledge to Action, Community Based Research on HIV/IADs, Industry-Partnered Collaborative Research funding opportunities [16, 17] and Canadian Institutes of Health Research’s (CIHR’s) Strategy for Patient-Oriented Research competitions) [18]. Alberta Innovates (formerly Alberta Innovates: Health Solutions), a provincial research funding agency, initiated Partnership for Research and Health Innovation in the Health System and the Collaborative Research and Innovation Opportunities to encourage collaboration between researchers and knowledge users and to help translate research into improved health [19]. Similar funding competitions exist globally (of note is the Patient-Centered Outcomes Research Institute in the USA that only funds collaborative research) [20]. Funders have also created centres mandated to promote knowledge user engagement, accelerate research application and more efficiently harvest research benefits (e.g. Australian Academic Health Centres, Dutch Academic Collaborative Centres, UK Academic Health Science Centres, UK Collaborations for Leadership in Applied Health Research and Care—CLAHRC) [21‐25]. Interest in this concept has also been demonstrated recently by publication of papers and commentaries on the topic in at least one journal [3, 26‐31].

Although IKT is broadly accepted, the actual research supporting it is limited and there is uncertainty about how best to conduct and support IKT. A limited number of scoping, realist and other reviews suggest there is value of researchers and knowledge users working collaboratively and others are underway [32‐35]. Emerging scholarship focusing on participatory action research [8, 36], the UK CLAHRCs [37‐42] and CIHR’s evaluation of its IKT programmes [43, 44], is beginning to support the claims that IKT may lead to increased knowledge user capacity to use research; produce research that is more useful to knowledge users; increase the use of research in practice, health systems and policy decisions; and improve patient and health system outcomes. Studies are appearing describing how research partnerships work [45‐47]. There is some evidence to suggest that in these collaborative research partnerships, researchers are the ones who benefit more by learning about the knowledge users’ context [11, 48]. Other studies reveal engagement of knowledge users can influence researchers’ approaches to research and the review of grants [49, 50]. However, the evidence is not yet conclusive on the impacts of IKT. At least one survey study failed to find an association between researcher/knowledge user engagement and research utility [51], suggesting that the factors determining effective IKT have yet to be clearly identified. Knowledge of IKT among researchers varies [52], and there is limited evidence about how researchers and knowledge users should go about collaborating. Despite the slim evidence base, stakeholder enthusiasm for IKT continues to grow. The expectation of enhanced impacts from IKT has seldom been critically assessed nor has the research partnering process been systematically studied. In response, Gagliardi and colleagues have recently suggested a research agenda for IKT [53].

The proposed research will build the science base for IKT, determine its effectiveness at increasing research use and identify best practices and appropriate conditions for conducting IKT to achieve the greatest impact on research use. The goals, objectives and outputs of the 7-year research programme are described in Table 1.

The approach to this Canadian Institutes of Health Research 7-year foundation grant is interdisciplinary and cross-sectoral, using multiple and mixed methods that best reflect the complex and social nature of research partnerships. Knowledge users are full members on the research programme and individual project teams and will continue to be actively involved in every step of the research process. To allow the research programme to be more inclusive than those listed on this proposal, the programme is organized as a researcher/knowledge user network known as the Integrated Knowledge Translation Research Network: Doing Research with the People Who Use it (https://​iktrn.​ohri.​ca).The network has been specifically designed to include researchers interested in IKT who include early career, mid-career and senior researchers (referred to as IKT experts, currently n = 40); IKT trainees (currently n = 16), knowledge user experts from research funding agencies; charities; health services and health authorities and other organizations (currently n = 31); and a methods resource group comprising knowledge translation and implementation science experts (currently n = 11). When feasible to do so, we will use an IKT approach within the projects to expand the team’s experiential knowledge of IKT mechanisms. All projects are guided by programme goals and objectives. Table 2 presents the programme work streams along with their objectives, rationale, research questions, level of partnerships and outputs.

Several knowledge syntheses are proposed to increase understanding of the concept of IKT (projects 1a–b), how IKT works and with what impact (projects 1c–d) and to identify tools to evaluate the partnering process (project 1e). A novel aspect of the research is that three initial multiple-case studies (projects 2a–c) anchor the programme during the first half of the grant. The case studies are both retrospective and prospective and will provide data and knowledge on how IKT works, its impact and the degree of engagement required to optimise impact. The case studies will provide insight into IKT partnerships at two levels:

The case studies will be complemented with other projects focusing on other aspects of IKT and other programme objectives. For example, project 3a is intended to capture the network members’ and organizations’ experiential knowledge about working in an IKT way while project 3b is about network members reflecting on the field and identifying where the science should focus. Several studies focus on funder programmes to promote research undertaken using an IKT approach (projects 4a–d). Other studies focus on the perspective of an organization that becomes the partner in an IKT project (projects 5a–b) or the perspective of the researcher or university (projects 6a–b). Project 7 is designed to develop and test an IKT questionnaire. Finally, projects 8a–d are about IKT tools and developing training modules for researchers and knowledge users. We anticipate that research questions generated from projects will subsequently be embedded into future case studies as this will be an efficient way to study these topics without having to launch new stand-alone studies.

More case studies will be added as the grant proceeds. Several knowledge user partners are already identifying opportunities to study IKT ‘in the field’, and the project structure enables timely incorporation of these opportunities into the programme. In years 2–3 of the grant, future case studies will be initiated. Initial criteria for selecting new projects will include addressing knowledge gaps identified in the programme’s ongoing studies, prioritization of future studies by knowledge users and the Advisory Committee and feasibility. Towards year 4, intervention studies will be launched to test theory-based strategies to improve research partnering and build health organization capacity for research partnering and research use.

Finally, a meta-synthesis of findings from all projects will be completed to discern patterns and differences between different knowledge user groups (patients, clinicians, managers, policy makers), organizations (healthcare delivery institutions, health authorities, ministries of health, health research funders) and contexts and to develop materials to facilitate IKT and uptake of the findings. Team members are very interested in executives/managers, who have great potential to activate organizational change for research-informed decision-making but are understudied.

We have proposed the first interdisciplinary, systematic and programmatic research endeavor and network focusing on IKT. The research programme was developed and will be executed with knowledge user organization executives, managers, policy makers, clinicians and patients. We will ground the programme in knowledge generated through systematic, scoping and realist reviews. Taking advantage of our pre-existing productive relationships with provincial, national and international organizations, we will use ongoing and future natural IKT experiments as multiple case studies in order to study IKT in depth. Case studies will be retrospective and prospective as the 7-year grant timeline will enable us to undertake prospective longitudinal studies of IKT. We will study, in real time, the initiation of partnerships, funding processes, the research lifecycle and then outcomes/impact post project. In the latter years of the programme, we anticipate that these living laboratories [71] will also facilitate testing of strategies to improve the efficiency and effectiveness of the IKT approach. The research will also provide scientific evidence on how to reliably and validly measure collaborative research partnerships and their impacts. Built into the programme is a vibrant training and mentoring environment for trainees and researchers interested in the science of IKT and its application.

By conducting a meta-synthesis of multiple case studies and other strategic studies undertaken during the early years of the programme, we will be able to demonstrate how IKT works, under which circumstances and with which knowledge user groups. We will determine what IKT can and cannot do and learn how researchers and knowledge users develop and maintain research partnerships. When available, we will assess the impact of IKT on health system and patient outcomes. We will also ascertain how to promote IKT among knowledge users/knowledge user organizations and researchers. Significant potential and timely opportunities exist for improving how IKT is practiced and supported. By better understanding IKT, developing instruments to measure it and its impact, and designing effective strategies that support IKT, we will be positioned to improve knowledge translation and more thoroughly reap the benefits of research.