Knowledge translation in the context of the Asia Pacific region.

Abstract

The 2018 World Federation of Occupational Therapists (WFOT) Congress is an important event that enables and promotes the dissemination of research evidence, leading to knowledge translation into practice. The gap between research knowledge and change in practice in response to this knowledge is often an intractable one. Changing practice may be characterised by the need to overcome the status quo, and the need to understand clearly what the research evidence recommends and in what circumstances. There will always be some limitations in translating research evidence to the clinical environments, rather than interpreting research findings in a controlled research environment. Knowledge translation is defined as a process of synthesising primary research knowledge, disseminating it, exchanging it and applying it to improve health (Canadian Institutes of Health Research (2007)). In each country, even with a shared understanding of health service provision and clinical standards, the process of knowledge translation is a complex one, where numerous forms of knowledge are needed to change practice, such as experiential, tacit and strategic knowledge (Bennett, 2017). When considering a disparate region such as the Asia Pacific, the complexity of the knowledge translation process in advancing occupational therapy practice across the region is multiplied. This editorial aims to encourage readers to look beyond our own shores in appreciating the significance of knowledge translation in our own broader region and the role that Australia has in contributing to the advancement in evidence based occupational therapy in this context. The WFOT Asia Pacific Occupational Therapy Regional Group was formed in 2006 and currently consists of 16 member countries, including Australia. The countries in this regional group vary considerably in the size of their populations, the resources available to them, and the reach of their occupational therapy services and occupational therapy educational programmes (see Table 1). Several countries are missing from Table 1 (e.g. China, Vietnam, Nepal, Laos, Cambodia, Papua New Guinea, Myanmar) despite their high populations and health needs, and there remains significant development work to establish occupational therapy in these countries and support this through WFOT. The challenge is huge, as five of the top 10 most populous countries in the world are located in the Asia Pacific Region (China, India, Indonesia, Pakistan and Bangladesh). Whereas many Asia Pacific countries are still establishing WFOT-approved educational programmes to build an occupational therapy workforce to meet their local needs, Australia has a role in supporting and educating the workforce in this region. Australian universities are enrolling more international occupational therapy students, however this is not without its challenges (Yu, Brown & Farnworth, 2017). These students often need more support both within the classroom and during professional education placements to overcome language difficulties and cultural differences to meet mandatory professional competencies, including being an evidence-based practitioner. Many of these international students will return to their home countries to become leaders and advocates, playing an important role in knowledge translation and the uptake of evidence-based practice. In addition to the sheer size of the Asia Pacific populations (which is an obvious barrier to knowledge translation), there is an enormous diversity of history, traditions, cultures and values about health and wellbeing represented across the Asia Pacific region. Knowledge created in one cultural setting may not be relevant or as valued in another setting. Furthermore, there may be limited resources available to develop new knowledge or implement this in occupational therapy practice that is culturally relevant. Two theories provide a way of thinking about knowledge translation across international boundaries which are relevant to the WFOT Asia Pacific Occupational Therapy Regional Group. The Diffusion of Innovations theory (Sanson-Fisher, 2004) identifies relative advantage (how an innovation is perceived by users as better than current practice), compatibility (whether or not an innovation is consistent with occupational therapy values and meets clinicians’ needs), complexity (how difficult it is for clinicians to understand or use the innovation), trial-ability (how clinician's perceive that the innovation can be trialled in practice) and observability (how tangible the results are for using the innovation) as key issues to address to implement new knowledge into practice (Sanson-Fisher). The Re-AIM framework (Glasgow, Vogt & Boles, 1999) defines this process as: reach (who adheres to the innovation); efficacy (do the benefits outweigh the barriers to adopting the innovation); adoption (the representativeness of the clinicians who adopt the innovation); implementation (the extent to which the innovation is being used as intended); and maintenance (how sustainable the use of the innovation is in practice). Clearly, applying and tailoring research knowledge to local conditions across the Asia Pacific region is a complex process that will require a programme of implementation research to monitor the uptake and adaptation of any new interventions. The Knowledge-To-Action Process in the context of occupational therapy practice proposed by Metzler and Metz (2010), emphasises the value of the knowledge of the occupational therapist in mediating the use of client knowledge with the best and most relevant research knowledge to enact solutions to specific occupational performance issues in practice. This will involve adapting research and therapist knowledge to the client context and tailoring practice accordingly. It will also involve assessing barriers and supports of research knowledge use in the local context, where the environment may dictate what knowledge can be used and applied effectively. In the Asia Pacific region this may work both ways. For instance, our WFOT colleagues may have difficulty adapting Australian research findings to their client context due to a range of barriers, and equally so, Australian occupational therapists may have difficulty applying research findings from the Asia Pacific region into their practice. The WFOT have developed a list of research priorities to guide research efforts for members of the international occupational therapy community (World Federation of Occupational Therapists et al., 2017). There was a remarkable consensus relating to the importance of the final eight research priorities developed across the 87 WFOT member countries who contributed to the Delphi process. The second highest rated research priority was evidence-based practice and research translation. This priority is defined as how occupational therapists practice in relation to the evidence available, and how the evidence base related to practice is understood and accessed. This includes identifying effective interventions to assist occupational therapists to change their practice, exploring attitudes to evidence-based practice and knowledge translation, and developing clinical practice guidelines relevant to different practice areas and environments. This can only be achieved through collaboration and exchange of ideas and resources. Due to the inherent challenges of knowledge translation for occupational therapists across the Asia Pacific region, research partnerships will be essential to promote change in practice. The last Asia Pacific Occupational Therapy Symposium held in Taiwan in 2017 was attended by over 850 delegates, with the majority of presentations from Taiwan, Japan, the Philippines, China (Hong Kong Special Administrative Region and Macau Special Administration Region included) and Singapore. This is a rich environment to explore international dialogue and connections. The next WFOT Asia Pacific Occupational Therapy Regional Group Conference will be held in the Philippines in November 2020 and will provide similar opportunities to translate new research knowledge across the Asia Pacific region. Australia has an important role to play in supporting their Asia Pacific neighbours to engage in knowledge translation activities, including contributing to establishing knowledge through research collaboration, supporting conferences to disseminate evidence and educating international students to establish an occupational therapy workforce. The Australian Occupational Therapy Journal plays an important role in disseminating the findings of research conducted by those within the Asia Pacific region as well as informing therapists practising in the region.