Knowledge translation is a fundamental scientific paradigm, aiming to close the gap between research and practice. Although health researchers and pharmaceutical companies do not hesitate to invest a fortune in research areas, such as biomedical research, clinical trials, risk management, and professional development; data shows that healthcare systems worldwide fail to provide affordable services and effective treatment to patients. In fact, it can take up to 20 years for research knowledge collected via randomized controlled trials to be implemented in practice. The underutilization of evidence-based knowledge across medical settings and the growing complexity of today’s healthcare systems can result in unnecessary risks and skyrocketing costs. For instance, patients in the US receive only 55% of recommended care, and approximately 20%-30% of patients across the globe receive care that is not needed (Grimshaw et al., 2012).
The know-do gap in research has been recognized as a major obstacle to improved health outcomes and drug development. Consequently, numerous initiatives have been created to reduce this gap and tackle processes, such as quality assurance, technology transfer, innovation diffusion, evidence-informed policy, and implementation research. Although such terms are overlapping, the definition of “knowledge translation” has gained currency across Canada and the rest of the world.
Knowledge translation – also known as research utilization in Europe and dissemination or uptake in the US – refers to the process of transferring scientific knowledge, or what we’ve learned through research, into practice (Straus, Tetroe & Graham, 2011). To be more precise, the Canadian Institutes of Health Research defines this process as “a dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products and strengthen the healthcare system.” Knowledge translation is not only about the passive transfer of evidence for clinical research but the optimal utilization of evidence-based data across different levels of the healthcare system (e.g., consumers, healthcare professionals, researchers, and policymakers).The importance of knowledge translation in healthcare is immense. Despite the relatively new terminology, knowledge translation can be traced back to the beginning of the last century when sociologist Gabriel Tarde attempted to explain the nature of innovation diffusion (Grimshaw et al., 2012). Evidence proves that conducting research and publishing the results is not enough for an innovation or a medical intervention to be implemented into practice. To provide an example, although clinical trials show that statins can benefit post-stroke patients, statins are rarely prescribed in practice. Moreover, policymaking processes seldom include citable research or evidence from systematic reviews.
Knowledge translation research can enhance knowledge uptake and target numerous barriers to behavior and policy change at different levels of the healthcare system (e.g., lack of integrated information, poor standards of care, patients’ attitudes). Note that one of the main challenges is the lack of knowledge management skills, such as insufficient time to read and the inability to appraise the huge volume of research publications.
To overcome barriers to behavior change, knowledge translation researchers must determine the know-do gap and explore the context of knowledge uptake in order to implement and assess effective research strategies in practice (Straus, Tetroe & Graham, 2011). As stated above, effective models should target all those involved in healthcare decision-making (e.g., patients, clinicians, policymakers, researchers, the public) and should consider the knowledge being disseminated (e.g., clinical, biomedical). Understanding the barriers and the context of knowledge translation is one of the first steps towards closing the know-do gap in healthcare.
Knowledge Translation: Factors to Consider
What should be transferred? In the vast labyrinths of scientific research, the numbers of research publications and contradicting data are increasing. As clinicians, consumers, and policymakers often lack the time and skills needed to appraise research publications and individual studies; systematic reviews become the most effective methods to transfer knowledge and evidence-based data. Note that programs, such as the Cochrane Collaboration, aim to help healthcare practitioners and consumers access easy-to-comprehend knowledge syntheses.
To whom? Knowledge translation should reach all levels of the healthcare system, with target audiences depending on the context of research. For example, regulatory bodies and pharmaceutical companies might benefit from research sufficient to warrant a drug’s withdrawal from the market, while patients and providers might benefit from data demonstrating advantages from a treatment. The key messages should be easy to comprehend by different audiences (e.g., policy briefs for policymakers).
By whom? Messenger credibility is another vital fact to consider in knowledge translation, which can be supported via an authoritative endorsement by a respected figure or a research group. Messages can be transferred by an individual (e.g., researcher), organization, or healthcare system. Knowledge infrastructures also play a crucial role; they can be divided into technological (e.g., search engines) and organizational components (e.g., data analysts). (Grimshaw et al., 2012).After identifying the know-do gap, researchers must assess barriers to knowledge translation and adapt knowledge to the local context. Barriers, which often obstruct different levels of the healthcare system, can be identified via surveys, focus groups, interviews, or observations. Common barriers impact different healthcare levels: structural (e.g., financial restraints), organizational (e.g., lack of equipment), peer-group (e.g., poor standards of care), professionals (e.g., skills), professional-patients interaction (e.g., communication). To provide an example, as professionals often overestimate their performance by approximately 20%-30%, individual capacities, training, and motivations should be explored further (Llopis et al., 2018).
For the successful utilization of research knowledge, behavior change interventions should be selected and tailored according to the local context. Grimshaw et al. (2012) systematized the following interventions divided into three categories: 1) professional behavior change strategies; 2) knowledge translation interventions focusing on consumers; 3) knowledge translation initiatives focusing on policymakers:
1) Professional behavior change strategies encompass a large number of tools and models:
- Printed educational materials: Such materials can include scientific publications, audio-visual materials, and practice guidelines. They can be distributed at a relatively low cost and across a wide range of settings.
- Educational meetings: From didactic meetings and lectures to interactive workshops and traineeships, educational meetings can target different barriers to knowledge translation (e.g., professional-peer levels and attitudes). Such approaches are feasible in most medical settings.
- Educational outreach: Educational outreach is another effective method, which can be conducted by a trained person in order to change a simple physician’s behavior (e.g., drug prescribing).
- Local opinion leaders: With a unique and innovative approach and strong social networks, opinion leaders play a crucial role in knowledge translation. Leaders can easily influence people and change their behavior in medical settings.
- Audit and feedback: Audit and feedback obtained from patients, databases, and medical records are essential in transparent medical care.
- Computerized reminders: Computerized reminders are also integrated into care. Although such tools provide mix data, reminders can help professionals determine aspects such as drug dosage and side effects.
- Tailored interventions: Tailored interventions can be used to change aspects, such as poor information management, clinical uncertainty, lack of competence, perceptions of liability, patient expectations, financial disincentives, administrative constraints, and standards of practice.
- Multifaceted interventions: Multifaceted interventions can include two or more of the behavior change strategies indicated above.
2) Knowledge translation interventions focusing on consumers can be divided into three models: interventions to facilitate communication and decision-making; strategies to support behavior change; and techniques to educate consumers:
- Decision aids: Decision aids are used to facilitate communication and decision-making. Moreover, data shows that such tools can reduce decision conflict.
- Personalized-risk communication: Written, spoken, or visual personalized-risk communication can be implemented to enhance doctor-patient relationships.
- Communication before consultation: Communication before the consultation is also used to facilitate interactions and informed decision-making. Evidence shows that such strategies increase question asking and satisfaction.
- Interactive apps: Applications are used to support behavior change. Additionally, they show an increase in knowledge acquisition and social support.
- Contracts: Such behavior change interventions can be utilized to increase adherence to medical procedures and regimes. They can also benefit prevention initiatives.
- Medication adherence strategies: Such behavior change strategies can include calls or written material and improve short-term medication adherence treatments.
- New behavior change tools: Novel methods, such as feedback on imaging and DNA-based risk assessment, can be effective behavior change interventions, specifically in smoking cessation programs.
- Written material: Written information is an effective method to educate consumers and increase knowledge of medicines and interventions.
- Self-management interventions: Such models can also educate consumers and improve pain and fatigue self-management.
3) Strategies focusing on policymakers and senior health service managers seem to receive relatively low attention in research:
- Push strategies: Push strategies aim to educate policy-makers and provide clear and easy-to-understand syntheses of scientific publications and statistical data.
- Tailored interventions: Tailored messages, access to online registries, and seminars can improve knowledge translation, and decision-making.
- Pull activities and training: Such strategies can create an appetite for medical research and knowledge uptake.
- Exchange activities, such as co-funding, can help researchers and policymakers build new relationships and promote knowledge translation.
With numerous barriers and a variety of interventions, knowledge translation becomes a complex process that should be monitored effectively. Outcomes and practical impact should be assessed on a regular basis to sustain continued knowledge use and exchange. Closing the know-do gap in medical research is essential as failure to transfer research findings into practice contributes to more than $200 billion of wasted funding and poor health outcomes (Graham, Kothari & McCutcheon, 2018).To enhance dissemination and improve health outcomes, Web 2.0 technologies are becoming intergraded part of knowledge translation (Bernhardt, Mays & Kreuter, 2011). Web 2.0 technologies refer to apps and Internet-based tools with user-centered designs that facilitate interactive information sharing. One of the main features of such technologies is that users can create content and exercise control through such digital tools. In contrast to passive Web 1.0 technologies, Web 2.0 tools empower users and their role in digital healthcare (Valdez et al., 2016). Such tools have been implemented by numerous federal agencies, such as the Centers for Disease Control and Prevention, and engage prospective end-users from different directions. Users can either share one-to-one communication or engage in interactive communication (e.g., online forums). Web 2.0 tools can overcome geographical barriers and allow users to form partnerships through conferences, virtual meetings, and calls. Success stories and influencers can also reshape the uptake of knowledge and highlight the demand for evidence-based medicine.
Note that to promote research products and increase the accessibility of services, smart tagging and search engine optimization are common strategies to create content based on search engine indexing. Buttons or badges (defined as graphics with embedded links for information), widgets or gadgets (defined as applications that can be displayed from one site to another), and RSS feeds (defined as updated content of interest) are also used to engage users and promote knowledge translation.
Some of the most prominent types of new media and Web 2.0 technologies for knowledge translation include:
- Social networking platforms (e.g., Facebook): Facebook is one of the most influential social networking websites, which can increase user engagement, patient recruitment, and knowledge uptake. As the platform is easily accessible and engaging, it’s no surprise Facebook has 1.44 billion active monthly users. Additional tools, such as targeted advertising (Isaacson et al., 2018), can help family caregivers and patients access high-quality resources and educational tools.
- Microblogs (e.g., Twitter): Twitter is another influential network consisting of 140-character tweets, which can foster eHealth communication and dialog-based strategies. More than 53% of the Internet population report having Twitter accounts; there are more than 500 million tweets a day in more than 33 different languages. In Saudi Arabia, for instance, out of 18 million Internet users, 60% report having Twitter accounts (Albalawi & Sixsmith, 2015). Interestingly, 77% of life scientists use social media, and 85% of them admit that digital communication can influence their decisions.
- Blogs (e.g., WordPress): WordPress is perhaps the most popular open-source blogging platform, which can foster community-engaged research as it allows users to create web pages. Data shows there are more than 60.1 million new posts each month and more than 409 million views. In fact, blogs on research topics can have higher traffic than digital journal articles (Lord et al., 2019).
- Sharing websites (e.g., YouTube): Audio and video tools (e.g., podcasts) can capture talks and training sessions and be successfully disseminated through sharing platforms, such as YouTube. Note that short YouTube videos with engaging key messages seem to be highly beneficial in knowledge translation and decision-making. Harrison et al. (2016) employed a brief consumer-targeted YouTube video on vaccination pain treatments for babies, which showed to have an extensive reach over 12 months.
- Wikis (e.g., Wikipedia): Wikis allow stakeholders to raise awareness of evidence-based practices and make research findings more relevant beyond borders and settings. Digital dissemination channels also allow access to updated information and success stories.
Knowledge translation is paramount to closing the gap between research and practice. The underutilization of evidence-based data results in poor health outcomes and unnecessary expenditures. For instance, despite the high level of funding in the US, Americans experience poorer health outcomes compared to other developed nations. Knowledge translation research aims to foster the optimal utilization of evidence-based information (e.g., systematic reviews) at different levels of the healthcare system (e.g., professionals, consumers, and policymakers).
To enhance knowledge uptake, knowledge translation researchers should understand the context of knowledge translation and target a wide variety of barriers to behavior change (e.g., lack of knowledge management skills), which will help them close the know-do gap in medical research. Successful interventions include printed materials, audits, interactive apps, contracts, pull activities, push strategies, and much more. One of the most popular strategies to enhance knowledge dissemination is the use of new media and Web 2.0 tools, such as social networking platforms, blogs, and sharing websites.
In the end, knowledge translation is an ongoing process that involves the frequent assessment of interventions, outcomes, and practical impact. Continued knowledge use and exchange are essential in closing the know-do gap in research. Because moving research knowledge into practice settings can improve health outcomes and reduce waste in research!
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