Integrating knowledge generation with knowledge diffusion and utilization: a case study analysis of the Consortium for Applied Research and Evaluation in Mental Health

Scoping review of peer reviewed publications addressing rehabilitation for people sustaining traumatic spinal cord injury

Study Design: Scoping review Objective: To study the design, clinical setting and outcome measures used in spinal cord injury rehabilitation publications. Methods: A literature search on PubMed and Medline was conducted focusing on articles published between 1990-2016 and using "traumatic SCI", "functional outcomes", "rehabilitation", "work" and "return to work" as outcomes. Studies were categorized based on design (intervention, including RCTs vs. non-intervention studies), settings (inpatient vs. outpatient vs. transition), and outcome measures used (impairment vs. function vs. participation/integration vs. quality of life vs. symptoms). Work-related studies were categorized independently. Results: Five hundred forty-four articles met the inclusion criteria. Of these, 234 were interventional studies, including 23 RCTs. Studies were evenly divided among inpatient, outpatient and transition settings. Of the 234 interventional studies, 143 used functional evaluations. Sixty-one different functional instruments were used, with a predominant use of the Functional Independence Measure (61 times) and an additional use of SCI-specific measures, i.e. Spinal Cord Independence Measure and Craig Handicap Assessment and Reporting Technique (13 times each). Fifty-one studies measured mobility, while only three measured hand functions. The work-related sub-analysis revealed 32 intervention studies (no RCTs), of which 15 used functional evaluations and only three focused on tetraplegia. Conclusion: Our study revealed a paucity of intervention trials and RCTs, indicating a dearth of knowledge that would be needed to establish evidence-based practice guidelines. This is particularly true for tetraplegia. While standard measures of function were frequently used, providing valuable data, there is no consensus about what exact outcome measure to use. Using newer measurement techniques, for instance based on the application of item response theory, should be considered to enhance uniformity.

Scoping review of clinical rehabilitation research pertaining to traumatic brain injury: 1990-2016

INTRODUCTION

Understanding the impact of disease on function and improving functional outcomes is an important goal of rehabilitation. This scoping review analyzes 25 years of published traumatic brain injury (TBI) clinical rehabilitation research (CRR) to determine the frequency with which function is a research goal.

METHODS

The review protocol was prepared by experienced clinical researchers in the field. We used these search terms: "moderate traumatic brain injury" and "severe traumatic brain injury" and "functional outcomes"; and "rehabilitation" and "educational outcomes" or "cognition" or "community roles" or "community integration" "behavior" or "neuropsychology" or "quality of life", or "vocational outcomes" or "work" or "return to work". Publications from January 1, 1990-December 31, 2016 were included.

RESULTS

1,815 articles met initial criteria, of which 202 were intervention studies, 84 were randomized controlled trials and 353 prospective non-intervention studies. The combination of intervention and prospective non-intervention studies (n = 555) were analyzed for the kind of measurement tools used. Impairment measures (60%) and symptom measures (43%) either singly or in combination were most frequently used. Measures of function were employed in fewer than 30%. For single outcomes, 95 publications used impairment measures, 60 used symptoms and only18 used function. There were 117 studies that used neurocognitive measures. Participation/societal integration evaluation tools were used for community integration(n = 77) employment (n = 50) and independent living status (n = 37).

DISCUSSION

This scoping review identifies a need for additional types of clinical research in the field of TBI CRR. Much of the research is aimed at mitigating impairment and controlling symptoms rather than promoting function. Future efforts by the CRR community studying TBI should address this need.

A Review on Community-Based Knowledge Transfer and Exchange (KTE) Initiatives for Promoting Well-Being in Older Adults

Knowledge transfer and exchange (KTE) processes can facilitate evidence-informed community-based care for seniors, but understanding effective KTE in gerontology is limited. A scoping review was conducted to evaluate the current state of KTE in the community-based sector for seniors. Twelve articles met the inclusion criteria, which addressed a broad variety of topics including caregiving, elder abuse, falls prevention, home-rehabilitation, hospice and dementia care. Studies evaluated KTE practices (n = 8), developed a KTE intervention (n = 3), or explored research uptake (n = 1). Community-based initiatives for seniors informed by KTE processes are scarce, requiring further efforts at the research, practice and policy levels.

Deliberative Dialogues Between Policy Makers and Researchers in Canada and Australia

Knowledge translation (KT) and implementation science are growing fields in Canada, Australia, and worldwide. Many audiences are targeted as KT knowledge users—policy makers represent one key knowledge user in the health care field. The need for policy makers to understand research and for researchers to understand policy processes is commonly recognized. There is also increasing interest in health policy that focuses on KT as a framework for understanding the use of evidence and, in particular, describing the influence of research on policy along with concepts of coproduction and user involvement. With relationship building central to successful evidence-informed policy, this article explores deliberative dialogue as a potential approach to enhancing KT. It describes two examples of researcher efforts to cultivate relationships and contacts with policy and decision makers via such dialogues and illustrates the inherent opportunities and challenges of doing so.

"Exploring knowledge-user experiences in integrated knowledge translation: a biomedical investigation of the causes and consequences of food allergy"

PLAIN ENGLISH SUMMARY

Food allergy is a serious public health problem in Canada and other high-income countries, as it is potentially life threatening and severely impacts the quality of life for individuals and their families. Yet, many questions still remain as to its origins and determinants, and the best practices for treatment. Formed to tackle these very questions, the GET-FACTS research study centers on a novel concept in biomedical research: in order to make this science useful, knowledge creation must include meaningful interactions with knowledge-users. With this, knowledge-users are present at every stage of the research and are crucial, central and equal contributors. This study reflects on the early part of that journey from the perspective of the knowledge-users. We conducted interviews with all non-scientist members of the GET-FACTS steering committee, representing Canadian organizations that deal with patient advocacy and policy with regards to food allergy. Steering committee members had a clear sense that scientists and knowledge-users are equally responsible for putting knowledge into action and the importance of consulting and integrating knowledge-users throughout research. They also have high expectations for the GET-FACTS integrated process; that this model of doing science will create better scientists (e.g. improve communication skills) and make the scientific output more useful and relevant. Our work highlights both the unique contributions that knowledge-users can offer to knowledge creation as well as the challenges of trying to unify members from such different communities (policy/advocacy and biomedical science). There remains a real need to develop more touch points and opportunities for collaboration if true integration is to be achieved. Despite the obstacles, this model can help change the way knowledge is created in the biomedical world.

BACKGROUND

Despite the burden of food allergic disease many questions remain as to its origins, determinants and best practices for treatment. Formed to tackle these very questions, the GET-FACTS (Genetics, Environment and Therapies: Food Allergy Clinical Tolerance Studies) research study centers around a novel concept in biomedical research: in order to make this science useful, knowledge creation must include meaningful interactions with knowledge-users, known as Integrated Knowledge Translation (IKT). In IKT, knowledge-users are present at every stage of the research and are crucial, central and equal contributors. This paper contributes to this exciting form of research by reflecting on the beginning of that journey from the perspective of the knowledge-users.

METHODS

Semi structured in-depth interviews were conducted in year 2 of the 5 year GET-FACTS project with all (n = 9) non-scientist members of the GET-FACTS steering committee, representing Canadian organizations that deal with patient advocacy and policy with regards to food allergy. Transcripts were coded and organized by themes developed both deductively and inductively.

RESULTS

Steering committee members indicated a clear sense that scientists and knowledge-users are equally responsible for the translation of knowledge into action and the importance of consulting and integrating knowledge-users throughout research. Overall, these knowledge-users have very high expectations for the GET-FACTS IKT process; they feel that this model of doing science will create better scientists (e.g. improve communication skills) and make the resulting science more useful and relevant; indeed, they reported that this model of knowledge creation can be paradigm shifting.

CONCLUSIONS

This study highlights both the unique contributions that knowledge-users can offer to knowledge creation as well as the challenges of trying to unify members from such different communities (policy/advocacy and biomedical science). While our steering committee has a strong conceptual grasp on IKT and vision for their contributions, execution is not without challenges. There remains a real need to develop more touch points and opportunities for collaboration if true integration is to be achieved. Despite the obstacles, the GET-FACTS IKT model represents a new approach to knowledge creation in Canadian biomedical research and can help foster a culture of openness to participant involvement.

A need for an augmented review when reviewing rehabilitation research

There is a need for additional strategies for performing systematic reviews (SRs) to improve translation of findings into practice and to influence health policy. SRs critically appraise research methodology and determine level of evidence of research findings. The standard type of SR identifies randomized controlled trials (RCTs) as providing the most valid data and highest level of evidence. RCTs are not among the most frequently used research design in disability and health research. RCTs usually measure impairments for the primary research outcome rather than improved function, participation or societal integration. It forces a choice between "validity" and "utility/relevance." Other approaches have effectively been used to assess the validity of alternative research designs, whose outcomes focus on function and patient-reported outcomes. We propose that utilizing existing evaluation tools that measure knowledge, dissemination and utility of findings, may help improve the translation of findings into practice and health policy.

Bridging the gap between science and policy: an international survey of scientists and policy makers in China and Canada

Background

Bridging the gap between science and policy is an important task in evidence-informed policy making. The objective of this study is to prioritize ways to bridge the gap.

Methods

The study was based on an online survey of high-ranking scientists and policy makers who have a senior position in universities and governments in the health sector in China and Canada. The sampling frame comprised of universities with schools of public health and medicine and various levels of government in health and public health. Participants included university presidents and professors, and government deputy ministers, directors general and directors working in the health field. Fourteen strategies were presented to the participants for ranking as current ways and ideal ways in the future to bridge the gap between science and policy.

Results

Over a 3-month survey period, there were 121 participants in China and 86 in Canada with response rates of 30.0 and 15.9 %, respectively. The top strategies selected by respondents included focus on policy (conducting research that focuses on policy questions), science-policy forums, and policy briefs, both as current ways and ideal ways to bridge the gap between science and policy. Conferences were considered a priority strategy as a current way, but not an ideal way in the future. Canadian participants were more in favor of using information technology (web-based portals and email updates) than their Chinese counterparts. Among Canadian participants, two strategies that were ranked low as current ways (collaboration in study design and collaboration in analysis) became a priority as ideal ways. This could signal a change in thinking in shifting the focus from the “back end” or “downstream” (knowledge dissemination) of the knowledge transfer process to the “front end” or “upstream” (knowledge generation).

Conclusions

Our international study has confirmed a number of previously reported priority strategies to bridge the gap between science and policy. More importantly, our study has contributed to the future work on evidence-based policy making by comparing the responses from China and Canada and the current and ideal way for the future. Our study shows that the concept and strategies of bridging the gap between science and policy are not static but varying in space and evolving over time.

Pathways to Advancing Aging Policy-Relevant Research in Academic Settings

Policy-level changes have a significant influence on the health and well-being of aging populations. Yet there is often a gap between scientific knowledge and policy action. Although previous research has identified barriers and facilitators to effective knowledge translation, little attention has been given to the role of academic institutions in knowledge generation. This exploratory focus group study examines barriers and pathways to developing and maintaining an aging policy-relevant research agenda in academic settings, and additional challenges associated with minority group membership in this pursuit. Participants were personally committed to conducting policy-relevant research despite institutional barriers such as fewer funding opportunities and less value attributed to their research, particularly in the context of tenure and promotion. Although many viewed their research as an opportunity to make a difference, especially for underserved older adult populations, a number of minority group participants expressed that their policy research interests were marginalized. Participants offer individual and institutional-level strategies for addressing barriers, including collaborating with community members and colleagues and engaging mentors within and outside of their academic institutions. Reframing the valuation of policy research through the diversification of funding and publishing opportunities can better support scholars engaged in aging policy-relevant research.

New directions in evidence-based policy research: a critical analysis of the literature

Despite 40 years of research into evidence-based policy (EBP) and a continued drive from both policymakers and researchers to increase research uptake in policy, barriers to the use of evidence are persistently identified in the literature. However, it is not clear what explains this persistence - whether they represent real factors, or if they are artefacts of approaches used to study EBP. Based on an updated review, this paper analyses this literature to explain persistent barriers and facilitators. We critically describe the literature in terms of its theoretical underpinnings, definitions of 'evidence', methods, and underlying assumptions of research in the field, and aim to illuminate the EBP discourse by comparison with approaches from other fields. Much of the research in this area is theoretically naive, focusing primarily on the uptake of research evidence as opposed to evidence defined more broadly, and privileging academics' research priorities over those of policymakers. Little empirical data analysing the processes or impact of evidence use in policy is available to inform researchers or decision-makers. EBP research often assumes that policymakers do not use evidence and that more evidence - meaning research evidence - use would benefit policymakers and populations. We argue that these assumptions are unsupported, biasing much of EBP research. The agenda of 'getting evidence into policy' has side-lined the empirical description and analysis of how research and policy actually interact in vivo. Rather than asking how research evidence can be made more influential, academics should aim to understand what influences and constitutes policy, and produce more critically and theoretically informed studies of decision-making. We question the main assumptions made by EBP researchers, explore the implications of doing so, and propose new directions for EBP research, and health policy.

A study protocol for applying the co-creating knowledge translation framework to a population health study

BACKGROUND

Population health research can generate significant outcomes for communities, while Knowledge Translation (KT) aims to expressly maximize the outcomes of knowledge producing activity. Yet the two approaches are seldom explicitly combined as part of the research process. A population health study in Port Lincoln, South Australia offered the opportunity to develop and apply the co-KT Framework to the entire research process. This is a new framework to facilitate knowledge formation collaboratively between researchers and communities throughout a research to intervention implementation process.

DESIGN

This study employs a five step framework (the co-KT Framework) that is formulated from engaged scholarship and action research principles. By following the steps a knowledge base will be cumulatively co-created with the study population that is useful to the research aims. Step 1 is the initiating of contact between the researcher and the study contexts, and the framing of the research issue, achieved through a systematic data collection tool. Step 2 refines the research issue and the knowledge base by building into it context specific details and conducting knowledge exchange events. Step 3 involves interpreting and analysing the knowledge base, and integrating evidence to inform intervention development. In Step 4 the intervention will be piloted and evaluated. Step 5 is the completion of the research process where outcomes for improvement will be instituted as regular practice with the facilitation of the community.In summary, the model uses an iterative knowledge construction mechanism that is complemented by external evidence to design interventions to address health priorities within the community.

DISCUSSION

This is a systematic approach that operationalises the translational cycle using a framework for KT practice. It begins with the local context as its foundation for knowledge creation and ends with the development of contextually applicable interventions. It will be of interest to those involved in KT research, participatory action research, population health research and health care systems studies. The co-KT Framework is a method for embedding the principles of KT into all stages of a community-based research process, in which research questions are framed by emergent data from each previous stage.

Knowledge translation within a population health study: how do you do it?

BACKGROUND

Despite the considerable and growing body of knowledge translation (KT) literature, there are few methodologies sufficiently detailed to guide an integrated KT research approach for a population health study. This paper argues for a clearly articulated collaborative KT approach to be embedded within the research design from the outset.

DISCUSSION

Population health studies are complex in their own right, and strategies to engage the local community in adopting new interventions are often fraught with considerable challenges. In order to maximise the impact of population health research, more explicit KT strategies need to be developed from the outset. We present four propositions, arising from our work in developing a KT framework for a population health study. These cover the need for an explicit theory-informed conceptual framework; formalizing collaborative approaches within the design; making explicit the roles of both the stakeholders and the researchers; and clarifying what counts as evidence. From our deliberations on these propositions, our own co-creating (co-KT) Framework emerged in which KT is defined as both a theoretical and practical framework for actioning the intent of researchers and communities to co-create, refine, implement and evaluate the impact of new knowledge that is sensitive to the context (values, norms and tacit knowledge) where it is generated and used. The co-KT Framework has five steps. These include initial contact and framing the issue; refining and testing knowledge; interpreting, contextualising and adapting knowledge to the local context; implementing and evaluating; and finally, the embedding and translating of new knowledge into practice.

SUMMARY

Although descriptions of how to incorporate KT into research designs are increasing, current theoretical and operational frameworks do not generally span a holistic process from knowledge co-creation to knowledge application and implementation within one project. Population health studies may have greater health impact when KT is incorporated early and explicitly into the research design. This, we argue, will require that particular attention be paid to collaborative approaches, stakeholder identification and engagement, the nature and sources of evidence used, and the role of the research team working with the local study community.

Identifying research priorities for health care priority setting: a collaborative effort between managers and researchers

Background

To date there has been relatively little published about how research priorities are set, and even less about methods by which decision-makers can be engaged in defining a relevant and appropriate research agenda. We report on a recent effort in British Columbia to have researchers and decision-makers jointly establish an agenda for future research into questions of resource allocation.

Methods

The researchers enlisted decision-maker partners from each of British Columbia's six health authorities. Three forums were held, at which researchers and decision-makers from various levels in the health authorities considered possible research areas related to three key focus areas: (1) generation and use of decision criteria and measurement of 'benefit' against such criteria; (2) identification of so-called 'disinvestment' opportunities; and (3) evaluation of the effectiveness of priority setting procedures. Detailed notes were taken from each forum and synthesized into a set of qualitative themes.

Results

Forum participants suggested that future research into healthcare priority setting would benefit from studies that were longitudinal, comparative, and/or interdisciplinary. As well, participants identified two broad theme areas in which specific research projects were deemed desirable. First, future research might usefully consider how formal priority setting and resource allocation projects are situated within a larger organizational and political context. Second, additional research efforts should be devoted to better understanding and improving the actual implementation of priority setting frameworks, particularly with respect to issues of change management and the resolution of impediments to action on recommendations for resource allocation.

Conclusion

We were able to validate the importance of initial areas posed to the group and observed emergence of additional concerns and directions of critical importance to these decision-makers at this time. It is likely that the results are broadly applicable to other healthcare contexts. The implementation of this research agenda in British Columbia will depend upon the ability of the researchers and decision-makers to develop particular projects that fit within the constraints of existing funding opportunities. The process of engagement itself had benefits in terms of connecting decision-makers with their peers and sparking increased interest in the use and refinement of priority setting frameworks.

Stakeholder engagement opportunities in systematic reviews: knowledge transfer for policy and practice

Knowledge transfer and exchange is the process of increasing the awareness and use of research evidence in policy or practice decision making by nonresearch audiences or stakeholders. One way to accomplish this end is through ongoing interaction between researchers and interested nonresearch audiences, which provides an opportunity for the two groups to learn more about one another. The purpose of this article is to describe and discuss various stakeholder engagement opportunities that we employ throughout the stages of conducting a systematic review, to increase knowledge utilization within these audiences. Systematic reviews of the literature on a particular topic can provide an unbiased overview of the state of the literature. The engagement opportunities we have identified are topic consultation, feedback meetings during the review, member of review team, and involvement in dissemination. The potential benefits of including stakeholders in the process of a systematic review include increased relevance, clarity, and awareness of systematic review findings. A further benefit is the potential for increased dissemination of the findings. Challenges that researchers face are that stakeholder interactions can be time- and resource-intensive, it can be difficult balancing stakeholder desires with scientific rigor, and stakeholders may have difficulties accepting findings with which they do not agree. Despite these challenges we have included stakeholder involvement as a permanent step in the procedure of conducting a systematic review.

Knowledge transfer and exchange: review and synthesis of the literature

Knowledge transfer and exchange (KTE) is as an interactive process involving the interchange of knowledge between research users and researcher producers. Despite many strategies for KTE, it is not clear which ones should be used in which contexts. This article is a review and synthesis of the KTE literature on health care policy. The review examined and summarized KTE's current evidence base for KTE. It found that about 20 percent of the studies reported on a real-world application of a KTE strategy, and fewer had been formally evaluated. At this time there is an inadequate evidence base for doing "evidence-based" KTE for health policy decision making. Either KTE must be reconceptualized, or strategies must be evaluated more rigorously to produce a richer evidence base for future activity.

The development and introduction of an in-patient student law services for persons with serious mental illness: a case study

There is a need to provide legal assistance to persons who suffer with serious mental illness for legal problems over and above problems associated with mental illness. This paper describes a single-case study of the development and introduction of a pilot of a hospital-based, legal service, in partnership with The University of Western Ontario Faculty of Law. The data sources included direct observation and documentation. Law students provide legal services reflecting the application of a therapeutic jurisprudence approach. Interprofessional education and training occurs with law, medical, nursing and other students, and professionals on the principles and scholarship of therapeutic jurisprudence, mental illness and legal rights. A programmatic organizational template, the program logic model, was used to conceptualize the activities, and process, short-term, long-term and ultimate objectives, and indicators. The four core activities were: (1) patient access point to law students; (2) supervision of law students at the London Health Sciences Centre; (3) intake and access to other services, and (4) teaching and additional training of law and other students, physicians and other health caregivers. The development, issues and challenges of the introduction of an in-patient student law service is described.