Knowledge Translation Process Research Articles

Quality improvement of community pharmacy services: a prioritisation exercise.

ObjectivesEffective strategies are needed to translate knowledge (evidence) into practice to improve the quality of community pharmacy services. We report the first step of a novel knowledge translation process which involved the systematic identification and prioritisation of community pharmacy services in Scotland which were perceived to require improvement and/or guideline development.MethodsThis process involved three stages and a stakeholder group comprising community pharmacists, policy makers, lay and pharmacy organisation representatives. A modified nominal group technique (NGT) was used for topic generation (August 2013) followed by an electronic Delphi survey (eDelphi), October–December 2013) and topic rationalisation (December 2013) based on feasibility, acceptability, and potential impact for practice improvement.Key findingsIn total, 63 items were identified during the modified NGT which were categorised into 20 topics to form the starting point of the eDelphi. In total, 74 individuals (mostly community pharmacists) indicated an interest in the eDelphi, which achieved response rates of 63.5%, 67.6%, and 70.3%, respectively in Rounds 1, 2, and 3. Consensus was achieved with six topics: promoting the appropriate sale and supply of over‐the‐counter medicines; patient counselling for prescribed medication; pharmaceutical care to promote medication adherence; promotion and delivery of a Minor Ailment Scheme; pharmaceutical care of vulnerable patients; and effective use of community pharmacy workforce. Of these, the priority topic selected for the next stage of the programme was promoting the appropriate sale and supply of over‐the‐counter medicines.ConclusionsThis study adopted a systematic, inclusive, and rapid approach to identify priorities for community pharmacy practice improvement in Scotland.

Perceptions of health technology assessment knowledge translation in China: a qualitative study on HTA researchers and policy-makers

Although health technology assessment (HTA) has existed in China since the 1980s, the integration of HTA and policy-making is still in its infancy. Knowledge translation (KT) can play an important role in facilitating evidence-based policy-making. This study aims to describe the process of KT from researches to policy-makers and identifying the main determinants of the use of HTA evidence in policy-making in China. Researchers' and health policy-makers' perceptions of HTA KT were identified, using a grounded theory analysis approach. A theoretical framework consisting of four domains emerged to represent researchers' and policy-makers' perceptions of KT from HTA to policy making. Health policy-makers and researchers identified several determinants of KT, including HTA KT processes, alignment between research and decision-making and features of HTA research and health decisions, communication between policy-makers and HTA researchers, and support and resources for KT (organisational support, researchers' and health policy-makers' personal relationships and macro environment support).

Perceptions of health technology assessment knowledge translation in China: a qualitative study on HTA researchers and policy-makers

Although health technology assessment (HTA) has existed in China since the 1980s, the integration of HTA and policy-making is still in its infancy. Knowledge translation (KT) can play an important role in facilitating evidence-based policy-making. This study aims to describe the process of KT from researches to policy-makers and identifying the main determinants of the use of HTA evidence in policy-making in China. Researchers' and health policy-makers' perceptions of HTA KT were identified, using a grounded theory analysis approach. A theoretical framework consisting of four domains emerged to represent researchers' and policy-makers' perceptions of KT from HTA to policy making. Health policy-makers and researchers identified several determinants of KT, including HTA KT processes, alignment between research and decision-making and features of HTA research and health decisions, communication between policy-makers and HTA researchers, and support and resources for KT (organisational support, researchers' and health policy-makers' personal relationships and macro environment support).

Knowledge Translation for Cardiovascular Disease Research and Management in Japan.

Knowledge translation is an essential and emerging arena in healthcare research. It is the process of aiding the application of research knowledge into clinical practice or policymaking. Individuals at all levels of the health care system, including patients, healthcare professionals, and policymakers, are affected by the gaps that exist between research evidence and practice; the process of knowledge translation plays a role in bridging these gaps and incorporating high-quality clinical research into decision-making. Cardiovascular disease (CVD) management is a crucial area of healthcare where information gaps are known to exist. Although Japan has one of the lowest risks and mortality rates from CVDs, an increasing trend of cardiovascular incidence and changes in the risk factor conditions have been observed in recent years. This article provides an overview of knowledge translation and its importance in the cardiovascular health of the Japanese population, and describes the key steps of a typical knowledge translation strategy.

Case Series of a Knowledge Translation Intervention to Increase Upper Limb Exercise in Stroke Rehabilitation.

Current approaches to upper limb rehabilitation are not sufficient to drive neural reorganization and maximize recovery after stroke. To address this evidence-practice gap, a knowledge translation intervention using the Behaviour Change Wheel was developed. The intervention involves collaboratively working with stroke therapy teams to change their practice and increase therapy intensity by therapists prescribing supplementary self-directed arm exercise. The purposes of this case series are: (1) to provide an illustrative example of how a research-informed process changed clinical practice and (2) to report on staff members' and patients' perceptions of the utility of the developed intervention. A participatory action research approach was used in 3 stroke rehabilitation units in the United Kingdom. The intervention aimed to change 4 therapist-level behaviors: (1) screening patients for suitability for supplementary self-directed arm exercise, (2) provision of exercises, (3) involving family and caregivers in assisting with exercises, and (4) monitoring and progressing exercises. Data on changes in practice were collected by therapy teams using a bespoke audit tool. Utility of the intervention was explored in qualitative interviews with patients and staff. Components of the intervention were successfully embedded in 2 of the 3 stroke units. At these sites, almost all admitted patients were screened for suitability for supplementary self-directed exercise. Exercises were provided to 77%, 70%, and 88% of suitable patients across the 3 sites. Involving family and caregivers and monitoring and progressing exercises were not performed consistently. This case series is an example of how a rigorous research-informed knowledge translation process resulted in practice change. Research is needed to demonstrate that these changes can translate into increased intensity of upper limb exercise and affect patient outcomes.

Research Publication Ethics and Research Utilization

Background and Aim: and research publication are widely used and has become a global concern. In the matter of Utilization, World Health Organization report on knowledge for better health (2004) has emphasized that research reports should be an exact reflection of the development of the researches that resulted in health improvement and equality. publication and diffusion is one part of the changing of internal knowledge to social knowledge, knowledge transfer and utilization. The findings of the published researches are a new base for further researches and may be utilized. Hence, this study aimed to explain ethical considerations in research publication and utilization. Materials and Methods: In this review main key words: Research ethics and Research or ethics were searched in PubMed, scholar. Google, SID and Magiran databases. Then, related articles were analyzed. Ethical Considerations: Honesty and integrity were observed during review and citation. Results: In this study after reviewing of the breaches of publication including Data Fabrication and Falsification, Redundant Publication, Duplication Publication, Illegitimate Authorship and Plagiarism, the ethical principles in research publication were analyzed, and then necessity of research utilization as an essential step for knowledge translation was argued. Honesty in all aspects of research, accountability in the conduct of research, Professional courtesy and fairness in working with others, and good stewardship of research on behalf of others are four principles that introduced as the foundations of ethical research. After this we focused on the four conditions for authorship and conflict of interests. The recommended authorship criteria includes: 1. Substantial contributions to the conception or design of the work; or the acquisition or collection, analysis, or interpretation of data for the work; and 2. Drafting or revising the work critically for important intellectual content; and 3. Final approval for publishing; and 4. Accountability for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately examined and answered. In addition to being accountable for the parts of the work he or she has done, an author should be able to identify responsibilities of each co-authors as much as authors should have confidence in the integrity of the contribution of their co-authors. Meeting of all four criteria for authorship is necessary, and all who meet the four criteria should be considered as authors. Those who do not meet all four criteria should be acknowledged in related section. A conflict of interest exists when an author (or the author institution), referee or editor has financial or personal relationships with other people or organizations that inappropriately influence the author's actions (bias). Because of its effect, all participants in the process of compilation, review and publication including authors should disclose all relationships that could lead to a conflict of interest. Disclosure of these relationships is especially important in connection with editorials and review articles, because it is more difficult to detect bias in them rather than original articles. The disclosed information about conflicts of interest and financial interest can be used as a basis for decision-making by the editorial staff and appropriately publish it. Finally, we identified the rule of on time research diffusion, and no lag or delay in research publication and utilization as one of the most important ethical considerations. According to knowledge translation process, to develop and carry out a research project based on the needs and research priorities will improve the utilization of research. In knowledge translation process, despite of Knowledge Transfer, all of the research activities from formation of the “Research question to change involves, and doesn’t begin just at the end of the study begins. Conclusion: In order to cover knowledge gaps and provide the scientific evidence needed in clinical decisions as well as health policy, the researchers have obligate to diffuse and publish their findings based on ethical principles, timely. The findings indicates on the need to revise the National Directory of Ethics in Medical scholarly works, educating and capacity building for its enforcement and also necessity of adding the subtitle of research utilization to its matters. Please cite this article as: Akrami F, Bahadoran Z. Publication Ethics and Utilization. Med Ethics J 2016; 10(37): 81-89.

Using Knowledge Translation to Craft "Sticky" Social Media Health Messages That Provoke Interest, Raise Awareness, Impart Knowledge, and Inspire Change.

BackgroundIn Australia, there is growing use of technology supported knowledge translation (KT) strategies such as social media and mobile apps in health promotion and in Indigenous health. However, little is known about how individuals use technologies and the evidence base for the impact of these health interventions on health behavior change is meager.ObjectiveThe objective of our study was to examine how Facebook is used to promote health messages to Indigenous people and discuss how KT can support planning and implementing health messages to ensure chosen strategies are fit for the purpose and achieve impact.MethodsA desktop audit of health promotion campaigns on smoking prevention and cessation for Australian Indigenous people using Facebook was conducted.ResultsOur audit identified 13 out of 21 eligible campaigns that used Facebook. Facebook pages with the highest number of likes (more than 5000) were linked to a website and to other social media applications and demonstrated stickiness characteristics by posting frequently (triggers and unexpected), recruiting sporting or public personalities to promote campaigns (social currency and public), recruiting Indigenous people from the local region (stories and emotion), and sharing stories and experiences based on real-life events (credible and practical value).ConclusionsKT planning may support campaigns to identify and select KT strategies that are best suited and well-aligned to the campaign’s goals, messages, and target audiences. KT planning can also help mitigate unforeseen and expected risks, reduce unwarranted costs and expenses, achieve goals, and limit the peer pressure of using strategies that may not be fit for purpose. One of the main challenges in using KT systems and processes involves coming to an adequate conceptualization of the KT process itself.

Building capacity for knowledge translation in occupational therapy: learning through participatory action research.

BackgroundThere has been widespread acknowledgement of the need to build capacity in knowledge translation however much of the existing work focuses on building capacity amongst researchers rather than with clinicians directly. This paper’s aim is to describe a research project for developing a knowledge translation capacity building program for occupational therapy clinicians.MethodsParticipatory action research methods were used to both develop and evaluate the knowledge translation capacity-building program. Participants were occupational therapists from a large metropolitan hospital in Australia. Researchers and clinicians worked together to use the action cycle of the Knowledge to Action Framework to increase use of knowledge translation itself within the department in general, within their clinical teams, and to facilitate knowledge translation becoming part of the department’s culture. Barriers and enablers to using knowledge translation were identified through a survey based on the Theoretical Domains Framework and through focus groups. Multiple interventions were used to develop a knowledge translation capacity-building program.ResultsFifty-two occupational therapists participated initially, but only 20 across the first 18 months of the project. Barriers and enablers were identified across all domains of the Theoretical Domains Framework. Interventions selected to address these barriers or facilitate enablers were categorised into ten different categories: educational outreach; teams working on clinical knowledge translation case studies; identifying time blocks for knowledge translation; mentoring; leadership strategies; communication strategies; documentation and resources to support knowledge translation; funding a knowledge translation champion one day per week; setting goals for knowledge translation; and knowledge translation reporting strategies. Use of these strategies was, and continues to be monitored. Participants continue to be actively involved in learning and shaping the knowledge translation program across the department and within their specific clinical areas.ConclusionTo build capacity for knowledge translation, it is important to involve clinicians. The action cycle of the Knowledge to Action framework is a useful guide to introduce the knowledge translation process to clinicians. It may be used to engage the department as a whole, and facilitate the learning and application of knowledge translation within specific clinical areas. Research evaluating this knowledge translation program is being conducted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0771-5) contains supplementary material, which is available to authorized users.

Knowledge translation: the basics for public health professionals

Knowledge translation (KT) in Public Health involves the use of scientific evidence by decision makers when generating health policies directed to accelerate the benefits resulting from research and innovation in health system and ultimately people´s health. In this paper we review the definitions and conceptual frameworks related to systematization of KT processes. The different approaches to KT share the concept that KT is composed by two main elements: a product (information) developed through scientific method with a friendly format for the target public and an action devoted to support or promote a health related practice using the aforementioned product. The understanding and application of KT is a key element for effective use of knowledge in decision making.

Implementation of evidence‐based health care using action research: An emancipatory approach

The aim of the study is to discuss the emancipatory approach to action research as an appropriate methodology for workers' meaningful implementation of evidence-based health care. Implementation of evidence-based health care using action research is well supported by the literature. There are various approaches to action research, and they are coherent with the objectives and methods elected to develop the investigation. It is not clear which approach of action research is responsible for meaningful worker engagement in changing praxis. This is a discussion paper based on our experiences and supported by literature on collective health. Health care is defined as a social praxis, dependent upon the capitalist mode of production in which health workers engage themselves in a labour process that has negative (as alienation) as well as positive (as creativity) meanings. Emancipatory changes of social praxis through implementation of evidence-based health care require that participants understand the positive and negative meanings of their work and engage health workers in a conscious and intentional collaborative educational process. Implementation of evidence-based health care through emancipatory action research is capable of overcoming alienation and changing social practice through a participatory meaningful process of knowledge translation.

Knowledge Translation Capacity of Arts-informed Dissemination: A Narrative Study

Background: Arts-informed dissemination is an expanding approach to enhancing knowledge translation in the health sciences. Problematic is the minimal evaluation studies and the rare reporting of the influencing factors of knowledge translation. “The 7,024th Patient” is a research-derived art installation created to disseminate findings about patients’ experiences of heart surgery and the importance of humanistic patient-centred care approaches. The current study’s purpose was to explore how arts-informed dissemination (i.e., “The 7,024th Patient”) influenced healthcare practitioners’ delivery of care.Methods: An arts-informed narrative study was guided by the Promoting Action on Research Implementation in Health Services framework. The sample included a multi-disciplinary group of 19 individuals who worked with patients undergoing and recovering from heart surgery. Two interviews were conducted with each participant at the time of viewing the installation and 6 months later. A narrative analysis was conducted using Pictorial Narrative Mapping techniques.Results: Study findings indicated that the arts as a form of evidence provide an experiential and aesthetic encounter, which stimulated reflective practice. Participants’ accounts reflected cognitive and behavioral modifications related to empathy, holistic approaches and relational care. However, the complexities associated with the interpretive process and the influencing knowledge translation elements indicated a need to dialogue about the translation process, including deconstructing the evidence within the context of one’s own practice.Conclusions: Art is not just works of beauty or eccentric paintings. There is an imaginative and aesthetic capacity that can be cultivated with diligence, creativity, and rigour in the world of healthcare research and knowledge translation. Next steps require the examination of the knowledge translation capacity of different art forms with a range of populations and disciplines. Additionally, this study suggests the need to explore arts-informed dissemination that draws upon a more dialogical intervention in which knowledge users are involved in the interpretive processes of knowledge translation.

Knowledge Dissemination of Intimate Partner Violence Intervention Studies Measured Using Alternative Metrics: Results From a Scoping Review.

Alternative metrics measure the number of online mentions that an academic paper receives, including mentions in social media and online news outlets. It is important to monitor and measure dispersion of intimate partner violence (IPV) victim intervention research so that we can improve our knowledge translation and exchange (KTE) processes improving utilization of study findings. The objective of this study is to describe the dissemination of published IPV victim intervention studies and to explore which study characteristics are associated with a greater number of alternative metric mentions and conventional citations. As part of a larger scoping review, we conducted a literature search to identify IPV intervention studies. Outcomes included znumber of alternative metric mentions and conventional citations. Fifty-nine studies were included in this study. The median number of alternative metric mentions was six, and the median number of conventional citations was two. Forty-one percent of the studies (24/59) had no alternative metric mentions, and 27% (16/59) had no conventional citations. Longer time since publication was significantly associated with a greater number of mentions and citations, as were systematic reviews and randomized controlled trial designs. The majority of IPV studies receive little to no online attention or citations in academic journals, indicating a need for the field to focus on implementing strong knowledge dissemination plans. The papers receiving the most alternative metric mentions and conventional citations were also the more rigorous study designs, indicating a need to focus on study quality. We recommend using alternative metrics in conjunction with conventional metrics to evaluate the full dissemination of IPV research.

Prevention and control of noncommunicable diseases through evidence-based public health: implementing the NCD 2020 action plan.

The control of noncommunicable diseases (NCDs) was addressed by the declaration of the 66th United Nations (UN) General Assembly followed by the World Health Organization's (WHO) NCD 2020 action plan. There is a clear need to better apply evidence in public health settings to tackle both behaviour-related factors and the underlying social and economic conditions. This article describes concepts of evidence-based public health (EBPH) and outlines a set of actions that are essential for successful global NCD prevention. The authors describe the importance of knowledge translation with the goal of increasing the effectiveness of public health services, relying on both quantitative and qualitative evidence. In particular, the role of capacity building is highlighted because it is fundamental to progress in controlling NCDs. Important challenges for capacity building include the need to bridge diverse disciplines, build the evidence base across countries and the lack of formal training in public health sciences. As brief case examples, several successful capacity-building efforts are highlighted to address challenges and further evidence-based decision making. The need for a more comprehensive public health approach, addressing social, environmental and cultural conditions, has led to government-wide and society-wide strategies that are now on the agenda due to efforts such as the WHO's NCD 2020 action plan and Health 2020: the European Policy for Health and Wellbeing. These efforts need research to generate evidence in new areas (e.g. equity and sustainability), training to build public health capacity and a continuous process of improvement and knowledge generation and translation.

Unpacking knowledge translation in participatory research: a micro-level study.

Funding bodies, policy makers, researchers and clinicians are seeking strategies to increase the translation of knowledge between research and practice. Participatory research encompasses a range of approaches for clinicians' involvement in research in the hope of increasing the relevance and usability of research. Our aim was to explore how knowledge is translated and integrated in participants' presentations and negotiations about knowledge. Twelve collaboration meetings were observed, and discussions between researchers and clinicians were recorded. The material was examined using the following analytical terms: knowledge object, knowledge form, knowledge position and knowledge tasks. We identified a recurring rhetorical pattern in translational processes that we call 'relevance testing': a strategy by which the participants attempt to create coherence and identify relevance across different contexts. The limitation of this translational strategy was a tendency to reinforce a 'two-communities' logic: re-establishing the separated worlds and rationales between clinicians and researchers. The 'translational work' that unfolds during discussions remains implicit. It may be that participants are unable to explicitly address and identify the knowledge translation processes because they lack necessary conceptual tools. Our results contribute to increased awareness about translational processes and provide a language through which barriers to translation can be addressed.

Do knowledge translation (KT) plans help to structure KT practices?

BackgroundA knowledge translation (KT) planning template is a roadmap laying out the core elements to be considered when structuring the implementation of KT activities by researchers and practitioners. Since 2010, the Institut national de santé publique du Québec (INSPQ; Québec Public Health Institute) has provided tools and guidance to in-house project teams to help them develop KT plans. This study sought to identify the dimensions included in those plans and which ones were integrated and how. The results will be of interest to funding agencies and scientific organizations that provide frameworks for KT planning.MethodsThe operationalization of KT planning dimensions was assessed in a mixed methods case study of 14 projects developed at the INSPQ between 2010 and 2013. All plans were assessed (rated) using an analytical tool developed for this study and data from interviews with the planning coordinators. The analytical tool and interview guide were based on eight core KT dimensions identified in the literature.ResultsAnalysis of the plans and interviews revealed that the dimensions best integrated into the KT plans were ‘analysis of the context (barriers and facilitators) and of users’ needs’, ‘knowledge to be translated’, ‘KT partners’, ‘KT strategies’ and, to a lesser extent, ‘overall KT approach’. The least well integrated dimensions were ‘knowledge about knowledge users’, ‘KT process evaluation’ and ‘resources’.ConclusionsWhile the planning coordinators asserted that a plan did not need to include all the dimensions to ensure its quality and success, nevertheless the dimensions that received less attention might have been better incorporated if they had been supported with more instruments related to those dimensions and sustained methodological guidance. Overall, KT planning templates appear to be an appreciated mechanism for supporting KT reflexive practices. Based on this study and our experience, we recommend using KT plans cautiously when assessing project efficacy and funding.

Learning from Somaliland? Transferability of learning from volunteering to national health service practice in the UK.

BackgroundCapacity building partnerships between healthcare institutions have the potential to benefit both partners particularly in staff development. Previous research suggests that volunteering can contribute to professional development but there is little evidence on how learning is acquired, the barriers and facilitators to learning in this context or the process of translation of learning to the home environment.ResultsVolunteers from a healthcare partnership between the UK and Somaliland reported learning in communication, interdisciplinary working, teaching, management, leadership and service development. This learning came from observing familiar practices in unfamiliar environments; alternative solutions to familiar problems; learning about Somali culture; opportunities to assume higher levels of responsibility and new professional relationships. There was variability in the extent of translation to NHS practice. Time and support available for reflection and mentoring were important facilitators of this process.ConclusionsThe professional development outcomes documented in this study came directly from the experience of volunteering. Experiential learning theory suggests that this requires a complex process of critical reflection and new knowledge generation, testing and translation for use in new contexts. This process benefits from identification of learning as an important element of volunteering and support for reflection and the translation translation of learning to UK contexts. We suggest that missed opportunities for volunteer learning will remain until the volunteering process is overtly framed as part of continuing professional development.

Published and unpublished evidence in coverage decision-making for pharmaceuticals in Europe: existing approaches and way forward

BackgroundDissemination bias occurs when only some results emerging from clinical research reach their intended audience in the knowledge translation process. Given that coverage decisions increasingly rely on evidence, it is important to explore the types of evidence considered. This paper aimed to examine the evidence base used by regulatory institutions involved in pricing and reimbursement of pharmaceuticals in a broad range of European countries, as well as their awareness of and approach towards dissemination bias.MethodsA mixed methods approach was adopted. Regulatory documents and published literature were identified in systematic searches and relevant documents were analysed. An online survey was carried out to verify and expand insights.ResultsForty-two relevant regulatory documents and 10 publications were included. The survey had a 35% response rate, yielding valid responses for 13 countries. A fragmented impression was obtained for most countries indicating a general lack of transparency regarding both processes of decision-making and approaches towards unpublished information. Dissemination bias was rarely consistently considered. Practices for the identification and inclusion of all available evidence varied considerably, as did the influence of missing evidence on decision-making. Differences were often attributable to the regulatory context and/or institutional principles.ConclusionsBest practice is difficult to generalize given the identified variations. Individual exemplary practices support the necessity for institutional exchange at international level. Increased institutional commitment to transparency of methods and processes should be advocated.Electronic supplementary materialThe online version of this article (doi:10.1186/s12961-016-0080-9) contains supplementary material, which is available to authorized users.

Development of an Emergency Department Violence Intervention Program for Youth: An Integrated Knowledge Translation Approach.

Violent interpersonal injury is a common presentation to emergency departments (EDs) and is increasingly being treated as a preventable condition. Given the complexity of the issue, it is key to ensure interventions are feasible and acceptable within the communities that are affected by violence. Our team consists of ED staff, community members who work with youth affected by violence, people who were affected by violence in their youth, and researchers. We describe how an integrated knowledge translation (KT) process was used to develop an ED violence intervention program (EDVIP) for youth affected by violence. We used the Canadian Institutes of Health Research Guidelines for integrated KT (iKT) to develop an EDVIP. Specifically, we report the Knowledge to Action process which involves both knowledge creation and an action cycle. Our team determined the research question, the research approach, assessed feasibility and determined outcomes for our study. Using the iKT approach facilitated initiation of a funded trial that is now active. This paper highlights the benefit of including community experts at the beginning of and throughout the research process.

Knowledge translation lessons from an audit of Aboriginal Australians with acute coronary syndrome presenting to a regional hospital.

Objective:Translation of evidence into practice by health systems can be slow and incomplete and may disproportionately impact disadvantaged populations. Coronary heart disease is the leading cause of death among Aboriginal Australians. Timely access to effective medical care for acute coronary syndrome substantially improves survival. A quality-of-care audit conducted at a regional Western Australian hospital in 2011–2012 compared the Emergency Department management of Aboriginal and non-Aboriginal acute coronary syndrome patients. This audit is used as a case study of translating knowledge processes in order to identify the factors that support equity-oriented knowledge translation.Methods:In-depth interviews were conducted with a purposive sample of the audit team and further key stakeholders with interest/experience in knowledge translation in the context of Aboriginal health. Interviews were analysed for alignment of the knowledge translation process with the thematic steps outlined in Tugwell’s cascade for equity-oriented knowledge translation framework.Results:In preparing the audit, groundwork helped shape management support to ensure receptivity to targeting Aboriginal cardiovascular outcomes. Reporting of audit findings and resulting advocacy were undertaken by the audit team with awareness of the institutional hierarchy, appropriate timing, personal relationships and recognising the importance of tailoring messages to specific audiences. These strategies were also acknowledged as important in the key stakeholder interviews. A follow-up audit documented a general improvement in treatment guideline adherence and a reduction in treatment inequalities for Aboriginal presentations.Conclusion:As well as identifying outcomes such as practice changes, a useful evaluation increases understanding of why and how an intervention worked. Case studies such as this enrich our understanding of the complex human factors, including individual attributes, experiences and relationships and systemic factors that shape equity-oriented knowledge translation. Given the potential that improving knowledge translation has to close the gap in Aboriginal health disparities, we must choose strategies that adequately take into account the unique contingencies of context across institutions and cultures.

Collaborative research and the co-production of knowledge for practice: an illustrative case study.

BackgroundIn 2008, the National Institute for Health Research (NIHR) began funding a major 5-year pilot research programme of translational research in England, establishing nine ‘Collaborations for Leadership in Applied Health Research and Care’ (CLAHRCs). A number of evaluations were carried out to examine whether or not the various collaborations worked as intended and why. In this paper, we examine what the theory of co-production adds to understanding of processes of knowledge creation and translation we observed in one of the CLAHRCs.MethodsA case study of a successful knowledge translation project was identified from our wider realist evaluation of the mechanisms of closer collaboration at play in the CLAHRC. In the project, a computer simulation model of an emergency pathway for acute ischaemic stroke was built to explore if and how the time between the onset and treatment of the condition could be minimised by redesigning the pathway. The aim of the case study was to improve our understanding of the nature and workings of the mechanisms of closer collaboration that were associated with the more successful projects by examining the relevance of the theory of co-production. Qualitative methods of analysis were used to explore the fit between the mechanisms of closer collaboration we observed in the realist evaluation and the principles of co-production we identified from the literature.ResultsWe found a close fit between the nine mechanisms of closer collaboration at work in the project and the principles of co-production (active agents; equality of partners; reciprocity and mutuality; transformative; and facilitated). The successful style of collaborative working exemplified by the project was consistent with a strong form of co-production.ConclusionsIn our view, the theory of co-production provides useful insights into what it is about the qualities of collaborative working that inspire the requisite mechanisms for generating knowledge that is translated into practice. The theory provides a potentially useful basis for future knowledge translation programmes and projects in applied health research in a range of contexts.