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Chambru, M., Lefebvre, M., & Poupardin, E. (dirs.). (2025). La communication des sciences : Vulgariser, politiser, médiatiser. Presses Universitaires de Grenoble (PUG).

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La communication des sciences - Vulgariser, politiser, médiatiser - (EAN13 : 9782706156526) | PUG : livres papiers et numériques en ligne

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La communication des sciences - Vulgariser, politiser, médiatiser - (EAN13 : 9782706156526)

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Turcati, L., Millour, A., Debailly, R., Fort, K., Steinhausser, A., Biets, C. and Dozières, A. (2025) ‘Citizen Science in Practice: How (not) to Fail?’, Citizen Science: Theory and Practice, 10(1), p. 14.

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Pierre Artois, Jacques Moriau, Martin Wagener (dir.) (2025). Décloisonner les savoirs - Retours d'expériences de recherches collaboratives. Editions de l’Université de Bruxelles. coll. Sociologie et anthropologie n°23.

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Pierre Artois, Jacques Moriau, Martin Wagener - La recherche collaborative prend aujourd’hui de plus en plus d’importance. Cet ouvrage explore ses richesses et ses défis, où chercheurs académiques et acteurs de terrain coconstruisent le savoir.

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Nanchen, B., Bovigny-Sandoz, S., Bussy, G., Fragnière, E., Mizeret, J., Weissbrodt, R. et Rullac, S. (dir. (2024).Innovation Booster Technologie Et handicap : Un Dispositif, Des Personnes Engagées et des Projets Pour Une innovation Sociale Par la science.Éditions Sociographe.

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PhD holders at the boundaries and knowledge brokering. Garcia-Morante, M.; Castello, M.; and Sala-Bubaré, A. Studies in Continuing Education, 0(0): 1–19. 2024. Publisher: Routledge _eprint: https://doi.org/10.1080/0158037X.2024.2358007

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PhD holders at the boundaries and knowledge brokering

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Over the past decade, there has been an increase in the number of PhDs pursuing careers at the boundaries between academic and non-academic sectors, particularly with multiple transitions and dual…

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Anderson, A.M., Brading, L., Swaithes, L. et al. Building trust and inclusion with under-served groups: a public involvement project employing a knowledge mobilisation approach. Res Involv Engagem 10, 122 (2024). https://doi.org/10.1186/s40900-024-00647-2

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Building trust and inclusion with under-served groups: a public involvement project employing a knowledge mobilisation approach - Research Involvement and Engagement

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Background Certain groups are commonly under-served by health research due to exclusionary models of research design/delivery. Working in partnership with under-served groups is key to improving inclusion. This project aimed to explore the use of a knowledge mobilisation approach to start building partnerships with under-served groups based on trust and mutual understanding. Methods This co-produced public involvement project employed a knowledge mobilisation approach. The project team involved public contributors from four community organisations and staff from two Universities. A series of ‘community conversations’ were co-produced. These involved open discussions with local people in community settings. The conversations provide an informal space to engage in a multi-directional dialogue about health research and incorporated approaches such as prompt questions, live illustrations, and themed boards. The findings were reviewed collectively. Dissemination/feedback activities and lessons learned for future engagement with community organisations and under-served groups were also co-produced. Results Over 100 people attended the community conversations. Attendees varied widely in their sociodemographic characteristics (e.g., socioeconomic status and ethnicity) and brought diverse lived experiences (e.g., experiences of homelessness and disability). A strong appetite for change and desire to mobilise public knowledge were evident. Attendees reported wide-ranging barriers to inclusion in health research and suggested ways to address them. Three inter-related take-home messages were identified: ensure relevance, appreciation, and trust; prioritise language and accessibility needs; and maximise flexibility in all research-related activities. Feedback about the community conversations and dissemination activities was largely positive, with all parties planning to continue the partnership building. The lessons learned provide practical suggestions for promoting inclusion in research and highlight the importance of addressing research teams’ training/support needs. Conclusions Knowledge mobilisation was a valuable approach for facilitating multi-directional dialogues and relationship building between local communities and university teams. This approach enabled co-creation of new knowledge related to inclusion and partnership working in health research. The project has provided a firm foundation to build upon. However, creating sustainable, inclusive public partnerships is likely to require systemic changes, such as weighting of fundings schemes to projects that prioritise inclusion of under-served groups throughout the research cycle.

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Orland-Barak, L., Craig, C. J., & Hill-Jackson, V. (2024). What Matters For Mentors As Knowledge Mobilizers: Are They Easy Riders? Journal of Teacher Education, 76(1), 5-11. https://doi.org/10.1177/00224871241286349 (Original work published 2025)

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What Matters For Mentors As Knowledge Mobilizers: Are They Easy Riders? - Lily Orland-Barak, Cheryl J. Craig, Valerie Hill-Jackson, 2025

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Two bikers chart out their journey from LA to New Orleans. However, when they met a man who acts as a cross-cultural bridge, it changes their lives forever . . .

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Gervais, M.-J., Chagnon, F. & Houlfort, N. (2016). Proposition d’un cadre conceptuel illustrant trois dimensions des relations entre chercheurs et partenaires de la pratique. Nouvelles pratiques sociales, 28(2), 280–294. https://doi.org/10.7202/1041192ar

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Khouiyi, A. H., Guillemette, F. & St-Pierre, M.-J. (2022). La mobilisation des connaissances issues de la recherche dans l’accompagnement du développement professionnel. Enjeux et société, 9(2), 150–172.

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Gaborit, Emilie ; Terral, Philippe ; Génolini, Jean-Paul (2021). Étudier de près les modes de coordination pour construire un partenariat visant à réduire les inégalités épistémiques London, England: SAGE Publications Global health promotion, 2021-03, Vol.28 (1_suppl), p.39-46.

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Baré, Jean-François; Albaladejo, Christophe

Versailles (2009) La mise à l'épreuve : le transfert des connaissances scientifiques en questions. Ed. Quae.

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La « transférabilité » des connaissances scientifiques devient une question de société lorsque la science est appelée à participer à des décisions stratégiques. C’est le cas pour les problèmes environnementaux, mais plus largement dans toutes les situations où la décision dépend, au moins partiellement, de l’interprétation d’une connaissance scientifique. À travers les contributions d’anthropologues, ergonomes, agronomes, écologues, géographes, archéologues, mathématiciens et épistémologues, cet ouvrage pointe les difficultés inhérentes au « transfert » des connaissances entre disciplines scientifiques et entre scientifiques et autres acteurs sociaux.Un ouvrage destiné aux chercheurs, enseignants et étudiants s’intéressant aux rapports étroits entre science et action, mais aussi aux décideurs collaborant avec des scientifiques.

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Pratiques sociales novatrices et mobilisation des connaissances : des concepts aux applications concrètes

Veillette, Suzanne ; Perron, Michel ; Thivierge, Josée ; Arbour, Nadine ; Cook, Mathieu; Veillette, Suzanne

Groupe de recherche et d'intervention régionales (GRIR) 2010

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Une introduction à la Recommandation de l’UNESCO sur une science ouverte (2022)

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Académie suisse des sciences

Citizen Science in Switzerland: Taking Stock and Ways into the Future (2024)

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Dagenais, C., & Robert, E. (Éds.). (2012). Le transfert des connaissances dans le domaine social. Presses de l’Université de Montréal.

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Voici un livre complet, axé sur la théorie et la pratique, qui intéressera les chercheurs et les utilisateurs des connaissances. Il arrive à point : le transfert des connaissances est un enjeu organisationnel appelé à connaître une importance cruciale au cours des prochaines années.

Nathalie Houlfort Professeure agrégée Cotitulaire de la Chaire d'études sur l'application des connaissances dans le domaine des jeunes et des familles en difficulté - UQÀM

Le transfert et l'utilisation des connaissances dans le domaine social restent encore un territoire trop peu exploré. Voilà que ce livre en offre une première topographie qui montre de façon convaincante comment on peut accélérer la production et la mise à profit de nouvelles connaissances.

Céline Mercier Département de médecine sociale et préventive Université de Montréal

Ont collaboré à cet ouvrage : Johanne Archambault, Nathalie Awad, Jeanne Bazinet, Pierre-Olivier Bédard, Diane Berthelette, Fabien Besner, Mélodie Briand-Lamarche, François Chagnon, Léna d'Ostie-Racine, Christian Dagenais, Gilles Dupuis, Jacques Fortin, Mathieu-Joël Gervais, Julie Lane, Luc Lapointe, Marie-Claire Laurendeau, Marie Malo, Sandra Nutley, Mathieu Ouimet, Renée Pinard, Renée Proulx, Émilie Robert, Stéphanie Siron et Karine Souffez.

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le transfert des connaissances dans le domaine social

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Transfert des connaissances dans le domaine social (Le)

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Voici un livre complet, axé sur la théorie et la pratique, qui intéressera les chercheurs et les utilisateurs des connaissances. Il arrive à point : le transfert des connaissances est un enjeu organisationnel appelé à connaître une importance cruciale au cours des prochaines années.

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Desmarais, L., & Lortie, M. (2011). La dynamique du transfert des connaissances. Perspectives centrées sur l’usager. Les Presses de l’Université Laval.

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Ce livre est le fruit d'une réflexion de chercheurs d'horizons multiples sur les pratiques de transfert des connaissances en santé et sécurité du travail. Chercheurs et intervenants partagent souvent une large expérience du transfert qui se construit à partir d'allers-retours continus, le plus souvent informels. Le but de cet ouvrage était de regrouper un corpus de cette vaste expérience, acquise au fil des ans, et de partager les questionnements que celle-ci suscite auprès des intéressés. Chacun des textes présentés dans cet ouvrage démontre l'enjeu que représente l'investissement dans ce capital organisationnel intangible et essentiel qui a trait au transfert des connaissances en santé et sécurité au travail. L'organisation doit capitaliser sur ses expériences dépositaires d'une richesse humaine qui se construit au fil du temps. La nature même de cette construction du savoir est essentiellement dynamique et continue. L'évolution de produit au gré des situations de travail, en permettant aux apprentissages du passé d'être utiles pour construire l'avenir. D'où l'intérêt de la perspective, adoptée dans ce recueil de textes, centrée sur l'usager. Ce dernier est au cœur même de la dynamique du transfert de connaissances et il est partie prenante de la création, de la diffusion et de l'application de celles-ci.
Depuis 2006, le regroupement stratégique en transfert de connaissances du Réseau de recherche en santé et sécurité du travail Québec (RRSSTQ) organise divers symposiums sur le transfert de connaissances (TC), partage avec la communauté pratique et scientifique une veille stratégique à travers son site web et ses écrits sur le thème du transfert appliqué à la santé et la sécurité du travail .

# data[].attributes.attachment_link.title
La dynamique du transfert des connaissances. Perspectives centrées sur l'usager

# data[].attributes.attachment_link.description
Ce livre est le fruit d'une réflexion de chercheurs d'horizons multiples sur les pratiques de transfert des connaissances en santé et sécurité du travail. Chercheurs et intervenants partagent souvent une large expérience du transfert qui se construit à partir d'allers-retours continus, le plus souvent informels.

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LOMAS, J. (1993), Diffusion, Dissemination, and Implementation: Who Should Do What?. Annals of the New York Academy of Sciences, 703: 226-237.

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Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011 Dec;104(12):510-20.

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Newman, K., DeForge, R., Van Eerd, D., Mok, Y. W., & Cornelissen, E. (2020). A mixed methods examination of knowledge brokers and their use of theoretical frameworks and evaluative practices. Health Research Policy and Systems, 18(1), 34.

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Abstract

Background

Knowledge brokering is a knowledge translation approach that includes making connections between researchers and decision-makers to facilitate the latter's use of evidence in health promotion and the provision of healthcare. Despite knowledge brokering being well-established in Canada, many knowledge gaps exist, including understanding what theoretical frameworks have been developed and which evaluative practices knowledge brokers (KBs) use.

Methods

This study used a mixed methods design to examine how KBs in Canada (1) use frameworks, models and theories in their practice and (2) how they evaluate knowledge brokering interventions. We gathered interview and survey data from KB practitioners to better understand their perspectives on effective practices. Our analysis focused on understanding the theoretical frameworks used by KBs.

Results

This study demonstrates that KBs in Canada tend not to rely on theories or models that are specific to knowledge brokering. Rather, study participants/respondents draw on (sometimes multiple) theories and models that are fundamental to the broader field of knowledge translation - in particular, the Knowledge to Action model and the Promoting Action Research in Health Sciences framework. In evaluating the impact of their own knowledge brokering practice, participants/respondents use a wide variety of mechanisms. Evaluation was often seen as less important than supporting knowledge users and/or paying clients in accessing and utilising evidence.

Conclusions

Knowledge brokering as a form of knowledge translation continues to expand, but the impact on its targeted knowledge users has yet to be clearly established. The quality of engagement between KBs and their clients might increase - the knowledge brokering can be more impactful - if KBs made efforts to describe, understand and evaluate their activities using theories or models specific to KB.

Peer Review reports

Background

Under Canada's health Act, the health sector is administered and operated on a non-profit basis by the public authority. The public health sector in Canada has been moving toward evidence-informed decision-making for many years [ 1]. However, 'knowledge brokering' roles tend not to be formalised or routine, making research on the effectiveness of KB activities difficult to ascertain. Knowledge brokering is a relatively new approach to knowledge translation in which knowledge brokers (KBs) make connections between researchers and decision-makers to facilitate the latter's use of evidence in health promotion and the provision of healthcare. KBs focus on information communication, are typically familiar with the field in which they practice and have a high level of credibility in accessing and interpreting research [ 1, 2, 3, 4, 5]. KBs' responsibilities include finding relevant policy and practice research, synthesising it, organising seminars or meetings, supporting linkages between researchers and decision-makers, and building networks [ 1, 2, 3, 6].

Literature about knowledge brokering in healthcare tends to focus on KBs' roles. They are seen as linking researchers and knowledge users by developing mutual understandings of goals and cultures [ 1, 3, 7, 8, 9]. Other roles for KBs include knowledge management and building capacity to develop knowledge users' understanding and skills and to access and apply knowledge [ 10]. These roles are consistent with Van Eerd et al.'s [ 11] finding that knowledge brokering involves accessing, adapting and disseminating knowledge as well as linking and networking. Despite existing research on KBs' roles, there is neither a standard job description nor a list of acceptable qualifications for KBs. One of the reasons for this is the flexible and responsive nature of the role and its contextual influence; moreover, the variety of personal attributes among KBs, combined with the nuanced contextual factors of any given organisation utilising KB assets makes a standardised KB role difficult to define [ 10].

In a scoping review of the KB literature, Van Eerd et al. found that although KB approaches differ based on stakeholders' desired outcomes, they do have practices in common [ 11]. These include disseminating knowledge, linking/networking, adapting/translating knowledge, acquiring knowledge and enhancing capacity. Activities such as assessing and synthesising knowledge were mentioned less often, and evaluation varied from evaluations of KB roles, end-user research use or awareness, to assessments of knowledge-use processes and practice change [ 11]. Similarly, Bornbaum et al. [ 10] reported on the variability of knowledge brokering practice and the lack of strong evidence for effectiveness; to date, evidence of impact has been mainly anecdotal or theoretical. The lack of evidence for the impact of knowledge brokering may arise because many KB practitioners do not claim responsibility for their achievements, focusing instead on facilitating knowledge acquisition and/or knowledge utilisation processes with and for their teams [ 10]. To understand KBs' effectiveness and to conserve precious healthcare resources, it is important that KBs measure the impact of their interventions and cultivate a culture of evaluation or quality improvement [ 10, 12].

In examining which theoretical frameworks underpinned the studies in their scoping review (research that preceded this current study), Van Eerd et al. [ 11] found the Linkage and Exchange model [ 3] to be the most common, while other studies used models such as the Promoting Action on Research Implementation in Health Services (PARIHS) framework [ 17, 18], the Canadian Health Services Research Foundation model [ 3], the Knowledge to Action (KTA) model [ 19], or Rogers theory of Diffusion of Innovations [ 20]. Almost half of the knowledge brokering approaches examined in their scoping review were guided by multiple frameworks. Similarly, Glegg and Hoens [ 9] note that the PARIHS framework, KTA model, and Diffusion of Innovations can be used to understand knowledge brokering and its impact.

There are several possible reasons for the use of multiple theories in knowledge brokering research. Kislov et al. [ 21] found that KBs most often work in interorganisational networks, university-industry collaborations or collaborative research partnerships, and therefore have intermediary and peripheral/boundary positions. Tensions for KBs working in these positions manifest in requirements for different types of knowledge and different types of knowledge brokering. In such situations, where knowledge is transferred to users without being mobilised in routine practice, KBs need to identify and meet clients' needs to better support evidence-based decision-making at the organisational and policy levels [ 21]. Similarly, Norton et al. [ 22] suggest that drawing on multiple theoretical frameworks can inform the function and roles of KBs, what kinds of evidence might be required, and what mechanisms of knowledge synthesis might be deployed.

Methodology

Study design

The study was approved by Ryerson University's Research Ethics Board. All data were collected and securely stored in accordance with the Tri-Council Policy Statement and Ethics Board requirements.

The study followed the Convergence Model of mixed-methods design, which features two sets of data - one qualitative and one quantitative - that can be integrated (converged) during analysis to validate, confirm or disconfirm findings [ 25]. First, we interviewed knowledge brokering practitioners about KB practices and analysed the interview data. Then, we developed a survey questionnaire exploring the same topics as the qualitative phase (e.g. use of frameworks or models; evaluative practices). Key to the design of the study was to ensure that both the qualitative and quantitative methods addressed the same concepts; hence, the generation of survey response items was informed by the findings from the qualitative data. Accordingly, so that survey participants would not be responding to items that were generated from the interview phase, the two data collection procedures were conducted sequentially and the questionnaire was administered to a separate, mutually exclusive sample - as indicated in the Letter of Information, no one who participated in an interview was asked to complete the survey. We compared the two resulting datasets to examine how KBs draw on frameworks and theory and how they approach evaluative practices. Having two datasets enabled us to examine the data by confirming similar and dissimilar findings.

Study setting, recruitment of participants and sampling

As this study focused on understanding the practices of Canadian KBs, its recruitment strategy focused on KBs practicing in the Canadian healthcare landscape. Selected based on an inclusive list of job titles, contact information of potentially eligible participants was collected from public websites. Potential participants were also sought through knowledge brokering networks and organisations, including the Seniors Health Knowledge Network, Gestalt Collective, Alzheimer's Society, Physical Therapy Knowledge Broker, British Columbia Rehabilitation Sciences Research Network, Canadian Institutes for Health Research, Michael Smith Foundation, Nova Scotia Health Research Foundation, Social Sciences and Humanities Research Council, Canadian Association for Health Services and Policy Research, Canadian Foundation for Healthcare Improvement, and Strategy for Patient-Oriented Research Support units across Canada.

Once the list of potential interviewees was developed, invitations were emailed to eligible participants. A second invitation was emailed to all who did not respond to the first. Constrained somewhat by limited resources, we aimed to recruit six to eight interview participants who represented a variety of KB practitioners, that is, experienced and new, academic and applied, and from different health systems. Similarly, in the quantitative phase, potential survey respondents were recruited by email using snowball sampling, in which participants in the quantitative phase were asked to recommend professional colleagues. We also recruited respondents through the aforementioned list of Canadian health service organisations and associations that develop and/or employ KBs. The survey was initially distributed to 20 organisations and 23 key knowledge brokering stakeholders. Each email to an organisation or stakeholder included a Letter of Information and, for the quantitative phase, a link to the online survey. Organisations and stakeholders were asked to distribute the email invitation to KBs. Data were collected between November 2014 and October 2015. Only participants whose job title potentially identified them as having a professional KB role in the healthcare field, and who were 18 years of age or older and fluent in English were invited to participate in the interviews or survey.

The interviews

To guide the design of the qualitative phase, we adopted a constructionist, grounded theory approach [ 26]. Underpinning this approach is a philosophy that multiple realities exist with respect to social phenomena (i.e. in this case, the processes that are inherent to knowledge brokering) and that researchers come to understand these multiple realities through inquiry and interpretation; that is to say, analysis is informed equally by the data collected and the experience and viewpoint of the analysts. In the qualitative phase, the authors identified as trainees so that we could critically compare interviewees' insights to our own lived experiences with knowledge brokering. These varied from involvement in hospital quality improvement initiatives to nursing education, to organisational design research. Our aim in the qualitative phase was to distil insights that add to our existing knowledge, and that could be mixed with the data from the subsequent quantitative phase; this reflects a belief that mixed methods research offers complementary datasets wherein strengths from the qualitative research (e.g. rich detail of lived experience) are complemented by strengths from the quantitative research (e.g. potential generalisability) such that the research benefits from more insight than either approach could have created on its own.

Given the geographical diversity of the interview participants as well as the project's limited resources, interview data were collected by telephone. Consent was obtained from each participant prior to any audio recording being initiated. The research assistant (i.e. a graduate student with basic training in qualitative inquiry) asked all interview questions included in the interview guide (Additional file 1: Appendix A). All interviews were conducted by the same interviewer. Designed to address the research objectives, the interview questions solicited interviewees' perceptions of how knowledge brokering is defined and enacted. Questions were designed to solicit descriptions of what KBs are, what they do, their use of guiding theory/models, what enables or challenges this use, and opinions and experiences on how KBs could evaluate the success and/or impact of knowledge brokering. Interviews were transcribed verbatim. No additions or revisions were made to the interview guide during the course of data collection.

Analysis of the qualitative data was led by a project team member (RD) with extensive experience in conducting qualitative research and was supported by the lead author (KN). Concurrent with data collection, data were analysed using constant comparison, in which the emergent coding scheme is modified to reflect both newly coded data and existing relevant constructs [ 26]. By the time the last two transcripts were analysed, evidence of thematic saturation was emerging. The interview dataset lent itself to thematic content analysis because the interviewer followed the interview guide closely in each interview, thus enabling us to extract 'strips' of data (e.g. all the data related to the question on defining knowledge brokering; all the data related to the question on using theories/models, etc.). NVivo (Version 9) was used to create 'nodes' delineating each strip of data. Line-by-line coding of each strip of data then followed, wherein annotations featured key words or phrases describing the selected portion of an interviewee's response. Exemplar quotes that offered clear, compelling illustrations of each code were also highlighted. Analysis of each transcript was discussed by RD and KN to identify common insights and to resolve any analytic discrepancies. After coding each transcript, the analysts reviewed the codes assigned, collapsed and renamed the codes to reduce overlap and to enhance clarity, then composed a brief memo summarising that participant's perceptions of knowledge brokering. Finally, these memos were compared across transcripts and integrated into a single set of findings that convey both the similarities and differences among the participants' views [ 25].

The survey

The survey, in English, consisted of an online, anonymous questionnaire. In accordance with Tri-Council Policy Statement and Ryerson University's Research Ethics Board requirements, consent to participate in the study was obtained in the first survey question. Designed to provide data to supplement the interview data, questionnaire items were based on the results of a previously conducted scoping review [ 11] that examined reported approaches, stakeholders and contexts (and outcomes) that KBs use (and achieve) to support healthy aging. After we piloted the survey with five KBs and modified the questionnaire based on their feedback, the final version contained 18 items (10 multiple choice/checkbox questions and 8 open-ended questions). Some of the questions were, "In what type of organisation do you work?" and "How long have you been at this organisation as a Knowledge Broker?" - see Additional file 1: Appendix B. Descriptive statistics were calculated using Excel, and content analysis of the short answers to open-ended questions was completed.

Comparison of datasets and interpreting data

Comparison of the qualitative and quantitative datasets began after initial analysis of the survey and qualitative data. This was done by bringing together the strengths and non-overlapping weaknesses of quantitative methods with those of qualitative methods. Specifically, in comparing the quantitative and qualitative datasets, we sought to distil quantitatively derived insights that could supplement - or what Creswell calls 'embellish' - the qualitative findings by way of getting an indication of how different approaches to theory and to evaluative practices are distributed among KBs. Such analysis enabled us to increase the trustworthiness of our qualitatively derived conclusions [ 25] and is well suited to this study's purpose (to examine theoretical and evaluative practices of KBs) in that the analytic aim is to understand knowledge brokering practices by obtaining different but complementary data on the topic.

Results

This section begins with a description of the study's participants and respondents. Following that, the findings are arranged in two parts, corresponding to the research objectives: examining KBs' perspectives regarding (1) the use of models and theories to inform knowledge brokering practices, and (2) KBs' evaluative practices. Each part draws on both qualitative and quantitative data.

Description of interview participants and survey respondents

Two mutually exclusive groups of KBs were recruited for this study - one for the interviews and one for the survey. The survey and interview parts of the study were carried out sequentially, wherein the interviews and initial qualitative analysis preceded the quantitative data collection and analysis.

Interview participants

A total of eight eligible individuals consented to participate in the qualitative phase from the healthcare sectors in the Canadian provinces of Ontario, British Columbia and Nova Scotia. Interviews lasted between 45 and 75 minutes. To preserve the participants' anonymity in a field where many knowledge brokers know each other, their characteristics are not reported.

Survey respondents

A total of 109 respondents consented to participate. Data from completed questionnaires were excluded from the analysis if participants were not Canadian, did not give consent, or if 50% or more of survey items were not answered. Ultimately, after an analysis of missing data, which was inconclusive, data from 56 respondents (47% of those who responded) were retained for analysis. Respondents self-identified as KBs as all 56 respondents provided an answer to how long they had been a KB and 95% indicated that they were informed by a knowledge brokering approach.

As indicated in Table 1, 63% (35 of 56) of the respondents were from Ontario. Most were early in their careers; indeed, 75% (42 of 56 respondents) indicated they had been in their role for 5 years or fewer. Although there was modest representation from community agencies, governments and not-for-profit organisations working in the healthcare sector, most respondents worked in hospital, educational and research settings.

Table 1 Participant characteristics

As shown in Table 1, over a third of respondents reported a job title explicitly related to a knowledge brokering role (e.g. knowledge exchange, management, mobilisation or translation). Another large group of respondents were senior managers or had roles within the research and policy realms of the healthcare sector. Although the stakeholders with whom respondents interacted varied, interactions with researchers, policy-makers and healthcare-sector stakeholders were the most common.

Use of theories and models to guide knowledge brokering

In an effort to investigate knowledge brokering beyond the focus of existing literature on skills and roles, we examined how KBs' practices draw on and are informed by theories and models of knowledge translation. Our interpretation of the qualitative data analysis highlighted KBs' varied application of current knowledge translation models and theories of practice. Some participants clearly arrange their work according to a particular framework. Others more fluidly approach each project without a preselected framework or model in mind and instead rely on knowledge users or paying clients for direction on the need for an organising framework or model.

To determine whether a particular model is suitable for a specific context and is effective in meeting knowledge users' needs, participants indicated that it is important to thoroughly understand the population with which one works and to select a model that meets the specific needs of the audience. To that end, participants consistently described how they were able to integrate the PARIHS framework and the KTA framework into their interactions in a way that provided conceptual clarity to the project or initiative. For instance, in the case of KTA, the intuitive feeling of progress - from knowledge to action - gives KBs and their clients a process by which they can break down their knowledge brokering initiatives:

Interview participants also referenced the PARIHS framework, noting that it is considered adaptable and supports the inclusion and examination of different sources of evidence. This framework highlights the importance in knowledge brokering of thoroughly understanding context. Participants also spoke of the PARIHS framework's simplicity and concreteness:

Participants who selected the PARIHS framework to guide their practice reported that they chose it because it is considered effective in building capacity to access and apply research knowledge. Other participants described a hybrid of models as most useful for their practice:

" I think we've sort of created a hybrid model of our own. I use process and determinant frameworks to guide my approach with clinicians. Specifically, using the KTA framework to build a plan of for evidence-informed practice, and PARIHS and/or [the Theoretical Domains Framework] to build specific strategies to successfully implement evidence." (Knowledge Broker A)

This explicit hybridisation may reflect what many KBs implicitly rely on to drive knowledge brokering, that is, well-known and arguably fundamental knowledge translation frameworks. Moreover, as indicated by the following quote, participants emphasise doing things rather than framing their work with academic models:

Findings from the survey support the claim that knowledge brokering practices tend to be informed by 'an approach', and model selection varies depending on context and situation (Fig. 1). As with interview participants, survey respondents reported using the KTA and PARIHS frameworks most frequently.

Survey respondents' use of a framework/model to inform knowledge brokering practices

Comparison of the qualitative and quantitative findings shows that not only are KBs in this study familiar with the fundamentals of knowledge translation theory, they either implicitly or explicitly draw on process models (e.g. KTA) or determinant frameworks (e.g. PARIHS) to guide their knowledge brokering. Moreover, these findings seem to indicate that KBs in the study do not rely on only one model or framework; rather, they consider the contexts in which their KB work takes place and draw on models and frameworks that suit those contexts as well as their knowledge users' needs.

Evaluative practices

Interview participants reported a range of evaluative practices, ranging from none at all to passive evaluations, to 'wait and see' approaches, wherein changes to policy and/or practice were taken as indicators of supposedly successful knowledge brokering. While not necessarily representative of typical knowledge brokering 'success', the following quotes effectively illustrate that in some cases, changes in government policy are taken as indications of effective knowledge brokering:

Indeed, it may take quite some time for the benefits of knowledge brokering to manifest, if at all:

" What we will know in a couple of years is, you know, will we see the rates going down? We are able to evaluate - and we have those qualitative measures in place, and [if] there hasn't been a big uptake of what we have been recommending, then we will be able to assess that that didn't work." (Knowledge Broker E)

Such findings can be interpreted as a means by which KBs operationalise the impact of their work. With more of a focus on the evaluation of how knowledge brokering services were provided, other KBs who regard their practices as what they call " customer service units " take client satisfaction as the best indicator of success:

" When something hasn't gone right, we hear about it. We are a customer service unit, so we hear about it if our service isn't appreciated. So that [feedback] is coming from our faculty members who are involved in our service, as well as our community partners who are involved in our service." (Knowledge Broker C)

" Well it's easy for us, because the only way we're keeping score is that we keep getting clients. We have a fruitful business, and have [been] for four or five years now. And yeah, I'm kind of joking, but I do think that [repeat business] is an indicator of successful approaches." (Knowledge Broker H)

Others take a return to the status quo as an indication that knowledge brokering had little impact:

These qualitative data suggest that KBs' evaluative practices vary significantly, from tracking health outcome and policy changes, to those that are somewhat informal and unstructured. The survey data confirmed this finding. As shown in Fig. 2, 23% of respondents indicated that they 'Never' or 'Rarely' evaluate the impact of their knowledge brokering practices; a similar portion (23%) 'Sometimes' do, whereas only 50% responded that they 'Usually' or 'Always' evaluate their practices.

Survey respondents' tendency to evaluate impact of knowledge brokering

For respondents who do assess the impact of their knowledge brokering practices, the specific metrics or indicators they use are shown in Fig. 3. Notably, the most common indicators of success are producing knowledge products that are used, as measured by, for example, the number of website visits and file downloads.

Knowledge brokering metrics and indicators of success

When asked in the survey to describe what outcomes are most important for assessing knowledge brokering success, most respondents chose research evidence being used in decision-making. Less frequently chosen indicators of success were newly created partnerships characterised by two-way knowledge exchange, and evidence of changes in policy or practice. Although respondents' recognition that outcomes are important in knowledge brokering is perhaps not surprising, there appears to be a lack of formal, structured knowledge brokering evaluation. More common are informal assessments that assume that if partnerships between knowledge users and KBs were created, research evidence will be used in decision-making; ultimately, the partners (i.e. KBs and knowledge users) wait to see if changes in practice or policy emerge.

Discussion

In contrast to these informal evaluative practices, formal evaluations should aim to, first, assess knowledge brokering impact in terms of practice and/or policy change and, second, determine how and to what extent particular knowledge brokering activities helped achieve those outcomes. The literature on evaluative practices, especially programme evaluation, has proliferated in the past decade [ 27, 28, 29], and includes widely accepted guidance on developing project-appropriate logic models, outcomes and outcome indicators. Dobbins et al. [ 30] recently found that a knowledge translation intervention delivered by KBs resulted in improvements in evidence-informed decision-making knowledge, skills and behaviours, suggesting that, if KB researchers develop concrete, actionable indicators and ways to measure them - informed by theories, models or frameworks and keeping in mind a wide range of stakeholder perspectives - perhaps a culture of evaluation can grow within knowledge brokering. A culture of evaluation may further define knowledge brokering roles and qualifications, which may be of use to organisations as they create knowledge brokering positions and related job descriptions.

This study's findings about the use of theory or models to guide knowledge brokering are consistent with what Van Eerd et al. [ 11] identified in their scoping review - there appears to be much variability, which may reflect KBs' efforts to find theories or models that match knowledge users' context and needs. Both our qualitative and quantitative findings point to two frequently endorsed frameworks: the KTA model [ 19], which Nilsen et al. categorise as a process model [ 13], and the PARIHS framework [ 17, 18], seen by Nilsen et al. as a determinant framework. KBs' familiarity with KTA and PARIHS may reflect their familiarity with the fundamentals of knowledge translation. As a process model, KTA is deemed useful in describing to clients the steps of acquiring, tailoring and applying research evidence [ 19]. Similarly, PARIHS, with its emphasis on understanding how successful implementation is determined by facilitation strategies, robustness of evidence and by the context in which change is being introduced, provides KBs with three concrete, intuitive realms in which to focus brokering [ 17, 18]. The absence in our findings of models or theories specific to knowledge brokering can perhaps be understood as a reflection of knowledge brokering being one knowledge translation strategy. It appears that, among our study's samples, KBs' aim in knowledge brokering is to reach knowledge translation goals; hence, they may rely on knowledge translation frameworks (such as KTA or PARIHS) rather than knowledge brokering theories.

Nilsen et al.'s [ 13] three approaches to the use of theory among knowledge practitioners might be useful to KBs. These are describing the process of translating research into practice, understanding or explaining what influences implementation, and evaluating it. Were KBs able to clearly identify into which of the three approaches their clients' needs fit by describing, understanding or evaluating implementation, then perhaps KBs could more readily and accurately hone in on the model, theory or framework that best matches their knowledge users' evidence needs. If the end users that KBs are serving do not explicitly ask for an evaluation of impact, it may be that the extent of KBs' theorization is limited to describing and understanding the intervention and the evaluative aspects of popular frameworks like the KTA and PARISH are under utilized. Inconsistent and, in some cases, non-existent evaluative practices in knowledge brokering remain a concern, especially in light of others' assertions that knowledge brokering has not robustly demonstrated its effectiveness as a knowledge translation strategy that builds capacity to access and apply research knowledge [ 10].

Our study has several limitations as well as strengths. Given the dearth of literature about KBs' use of theories, models and frameworks, we had hoped that the qualitative phase of our study would yield data-rich insights into how KBs use theory. Instead, our findings describe which theories are used, and in which circumstances. Future research could delve further into KBs' use of theory, especially with respect to which KB-practice decisions are informed by it, and how explicitly used theories interact with the theories implicit in KBs' tacit knowledge bases, and how one's theoretical orientation impacts the way(s) in which knowledge brokering work is evaluated. Another limitation of our study is the small sample of interview and survey participants. Although we observed theoretical saturation in the eight interview transcripts, a larger sample may have yielded more diverse views. Conversely, our achievement of theoretical saturation suggests that the qualitative phase addressed core concepts in answering our research questions. Indeed, our focus on KBs' use of theory and their evaluative practices may have contributed to this saturation. We also cannot rule out selection bias given the small sample size and recruitment methods. Other strengths of the study include its mixed-method design, which compared qualitative and quantitative findings on the same topics to create a more comprehensive, in-depth understanding of the phenomenon being examined and to enhance the findings' credibility. Furthermore, we believe, as authors and analysts, that by giving credence to our own lived experiences with knowledge brokering, we were able to further enhance the credibility of the findings; for example, our own familiarity with the PARIHS and KTA frameworks facilitated a deeper understanding and appreciation of our participants' responses than could have been achieved by a researcher from outside of the field. Similarly, our experiences with projects that have been robustly evaluated as well as with projects that lack a strong evaluation resonated strongly with the data provided by the participants; our critical analysis and discussion of the findings was strengthened by such resonance.

Conclusions

Our study has several implications for knowledge brokers that build on Nilsen et al.'s [ 13] assertion that it is useful to take a three-pronged approach to the use of theory in knowledge brokering. First, we encourage KBs to integrate evaluative practices into their work, so that the outcomes that result from their engagement are assessed using appropriate, accessible outcome measures. Second, to understand whether and how knowledge brokering is effective, the evaluation plans of knowledge brokering projects might include objectives, activities, outputs and outcomes specific to knowledge brokering.

As a form of knowledge translation, knowledge brokering continues to expand, but it has yet to clearly establish what impact it has on its targeted knowledge users with respect to their capacity to access and apply research evidence. Engagement between KBs and their clients might improve if KBs made efforts to engage their knowledge users in discussions that explicitly describe the processes being considered to translate research into practice, which may in turn help KBs and knowledge users alike better understand what factors influence the implementation of these processes, and how to best develop an appropriate, robust evaluation plan. Such knowledge brokering practices would reflect an understanding that the needs of knowledge users and clients are not exclusive of the need to incorporate theoretical and evaluative activities; balancing practical and theoretical/evaluative imperatives is a goal to which knowledge brokering practitioners might aspire.

Availability of data and materials

The datasets analysed during the study are available from the corresponding author on reasonable request.

Abbreviations

KBs:

Knowledge brokers

KTA:

Knowledge to Action model

PARIHS:

Promoting Action on Research Implementation in Health Services framework

References

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Acknowledgements

The authors acknowledge and thank the study participants and respondents for their time and contributions. The authors also acknowledge and thank Dr Robin Urquhart, Dalhousie University, for her thoughtful contributions to the early discussions on the study's conceptualisation. The authors also thank the Faculty of Community Services, Ryerson University for Writing Week editorial support.

Funding

This study was funded by a Ryerson Health Research Funds grant and by the Faculty of Community Services, Ryerson University.

Author information

Authors and Affiliations

Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada

Kristine Newman & Yan Wei Mok

World Health Innovation Network, Odette School of Business, University of Windsor, Windsor, Canada

Ryan DeForge

Institute for Work & Health, Toronto, Canada

Dwayne Van Eerd

Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada

Evelyn Cornelissen

Contributions

KN, RD, DVE and EC conceptualised the study. The literature was reviewed by KN and RD. Data were collected by KN and YWM. Data analysis was conducted by KN, RD and YWM. The manuscript was drafted by KN and RD. All authors contributed to the final manuscript, and they read and approved it prior to submission.

Authors' information

The primary author, Dr. Kristine Newman, may be contacted at Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada, M5B 2K3, or by telephone at 01-416-979-5000 × 4160.

Corresponding author

Correspondence to Ryan DeForge.

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Ethics approval and consent to participate

This study was approved by the Ryerson University Research Ethics Board, No. 2014-250-2.

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This study has obtained consent to publish from the participant to report data.

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The authors declare that they have no competing interests.

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Newman, K., DeForge, R., Van Eerd, D. et al. A mixed methods examination of knowledge brokers and their use of theoretical frameworks and evaluative practices. Health Res Policy Sys 18, 34 (2020). https://doi.org/10.1186/s12961-020-0545-8
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Keywords

Healthcare

Implementation and dissemination

Knowledge broker

Knowledge translation

Mixed methods

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A mixed methods examination of knowledge brokers and their use of theoretical frameworks and evaluative practices - Health Research Policy and Systems

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Background Knowledge brokering is a knowledge translation approach that includes making connections between researchers and decision-makers to facilitate the latter's use of evidence in health promotion and the provision of healthcare. Despite knowledge brokering being well-established in Canada, many knowledge gaps exist, including understanding what theoretical frameworks have been developed and which evaluative practices knowledge brokers (KBs) use.

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Abstract

Background

Although healthcare is delivered in inherently multilevel contexts, implementation science has no widely endorsed methodological standards defining the characteristics of rigorous, multilevel implementation research. We identify and describe eight characteristics of high-quality, multilevel implementation research to encourage discussion, spur debate, and guide decision-making around study design and methodological issues.

Recommendations

Implementation researchers who conduct rigorous multilevel implementation research demonstrate the following eight characteristics. First, they map and operationalize the specific multilevel context for defined populations and settings. Second, they define and state the level of each construct under study. Third, they describe how constructs relate to each other within and across levels. Fourth, they specify the temporal scope of each phenomenon at each relevant level. Fifth, they align measurement choices and construction of analytic variables with the levels of theories selected (and hypotheses generated, if applicable). Sixth, they use a sampling strategy consistent with the selected theories or research objectives and sufficiently large and variable to examine relationships at requisite levels. Seventh, they align analytic approaches with the chosen theories (and hypotheses, if applicable), ensuring that they account for measurement dependencies and nested data structures. Eighth, they ensure inferences are made at the appropriate level. To guide implementation researchers and encourage debate, we present the rationale for each characteristic, actionable recommendations for operationalizing the characteristics in implementation research, a range of examples, and references to make the characteristics more usable. Our recommendations apply to all types of multilevel implementation study designs and approaches, including randomized trials, quantitative and qualitative observational studies, and mixed methods.

Conclusion

These eight characteristics provide benchmarks for evaluating the quality and replicability of multilevel implementation research and promote a common language and reference points. This, in turn, facilitates knowledge generation across diverse multilevel settings and ensures that implementation research is consistent with (and appropriately leverages) what has already been learned in allied multilevel sciences. When a shared and integrated description of what constitutes rigor is defined and broadly communicated, implementation science is better positioned to innovate both methodologically and theoretically.

Peer Review reports

Contributions to the literature

Awareness of what constitutes rigorous multilevel implementation research is essential for theory generation and refinement across the diverse contexts in which implementation research is conducted.

The methodological standards explained and recommended here are critical for planning, evaluating, and replicating multilevel implementation research.

This manuscript articulates eight characteristics of rigorous, high-quality multilevel implementation research and provides prompts, topic-specific references, and implementation examples to help readers incorporate these ideas into their studies.

Background

Rigorous implementation science requires transparent acknowledgment and skillful incorporation of the context within which implementation occurs. For implementation researchers, this requirement means addressing the inherently multilevel contexts within which healthcare is delivered. Patients who access healthcare are typically nested within one or more individual providers who deliver care (we use the term "providers" inclusively to encompass clinicians, practitioners, and others involved in health service delivery). Individual providers often work in one or more teams, clinics, or other subunits of organizations. Organizations, in turn, are typically embedded within one or more broader communities, networks, and systems. If the goal of implementation science is to improve patient and public health through "the study of methods to promote the systematic uptake of research findings and evidence-based practices (EBPs) into routine healthcare delivery" [ 1], we believe the field's methods must rigorously address this complex, multilevel reality.

When are multilevel methods necessary in implementation science?

Given the multilevel nature of healthcare and public health service delivery, we propose that implementation researchers should always start with the default assumption that their research design will need to address multilevel context and related methodological issues, moving away from this assumption only after confirming that all the methodological decisions made place the study design completely in "single-level" research territory. A design is "single level" when all phenomena and theoretical constructs of interest occur at the same level within the implementation context, all observations and measurements occur at that level, and there is neither theoretically nor empirically important nesting of research participants or dependence of observations (as might be caused, for example, by longitudinal measurement of providers working in the same unit). Although single-level conditions could be met in implementation studies, we propose it is extremely rare. We believe the burden is on implementation scientists (as developers, consumers, and evaluators of research) to ensure multilevel methodological issues are properly addressed in every implementation study.

Challenges of multilevel research

Conducting methodologically rigorous multilevel studies is challenging. Such studies are often more complicated to design and execute than single-level studies [ 2]. Two (of many potential) examples of this complexity are difficulties associated with measuring implementation strategy and health intervention effects on outcomes at different levels and estimating their interaction effects across different levels [ 3]. As a result, conducting multilevel research tends to require a specific research skillset and a transdisciplinary approach [ 2, 4]. Here, we use Choi and Pak's definition (p. 359): "Transdisciplinarity integrates the natural, social and health sciences in a humanities context, and in so doing transcends each of their traditional boundaries"[ 5].

The multilevel research literature is highly specialized and dispersed across different disciplinary journals, which hinders a researcher's ability to access and synthesize existing guidance, especially for those who do not have multilevel research training [ 6]. This training includes firm grounding in foundational multilevel literature (e.g., Kozlowski & Klein's seminal book [ 7]) and the focused study of key theories (e.g., psychological theories that explain multilevel organizational behavior), constructs (e.g., emergence, "shared unit" constructs), and methodological approaches (e.g., quantitative multilevel modeling).

Acknowledging and accounting for the multilevel structure in implementation contexts can also be laborious, resource intensive, and costly [ 2, 3, 8]. Practical challenges include getting appropriate expertise on the research team, recruiting and enrolling a large number of organizations or service systems (each of which has different gatekeepers with varying priorities/concerns), completing informed consent procedures with multiple levels of interconnected participants, and managing varying concerns about protecting participant confidentiality (e.g., collecting data that could identify participants but are considered standard demographic information such as employee age and number of years at the organization) [ 8]. Obstacles can arise when university ethics committees are unfamiliar with multilevel designs and have to make judgment calls about what constitutes coercion (e.g., staff feeling pressure to participate by their organizational leaders), how to operationalize informed consent in multilevel contexts, and who owns and houses the data [ 8].

We recognize that currently, the supply for multilevel expertise in implementation science is low, and the demand is high, especially given the field's relatively untapped relationships with partners who have this expertise (e.g., faculty in business schools). As such, at this time, it is not reasonable to expect every implementation research team to include a multilevel research expert who has all of the aforementioned training. Therefore, we write this paper with the hope that it is a first step in exposing the implementation research community to key multilevel research topics and resources such that we can begin to build capacity for conducting and elevate the quality of existing, multilevel research across the field as a whole.

Current literature

Researchers from several different disciplines have offered guidelines addressing multilevel research topics. Focusing on quantitative studies, González-Romá and Hernández [ 9] compiled an excellent list of multilevel topics, corresponding recommendations, and references. Topics include when and why multilevel methods are used, developing multilevel hypotheses, deciding between different quantitative analytic approaches (e.g., conventional multilevel modeling or multilevel structural equation modeling), and fitting a multilevel model [ 9]. As is evident in their table, each topic (1) covers content from its own separate set of references, (2) makes unique assumptions about the background knowledge readers need in order to follow the recommendations presented, and (3) is often field specific (e.g., management), a concern raised by Mathieu and Chen [ 4]. González-Romá and Hernández's [ 9] table also highlights a dominant approach in the current set of multilevel research recommendations, that is, recommendations focused on quantitative multilevel modeling and specific topics therein [ 6, 10, 11, 12]. Other existing literature includes broad reflections on the state of multilevel research in the context of a specific field (i.e., absent detailed design guidance) [ 8] and discussions related to the design and evaluation of multilevel interventions (a subtopic within the multilevel research field) [ 13].

The predicament of the implementation scientist interested in conducting multilevel research

Our eight characteristics draw from a realist ontological perspective, which holds that "entities exist independently of being perceived and independently of our theories about them" [ 14], as well as the multiple epistemological positions reflected within our authorship group and applied to projects depending on the research aims (e.g., post-positivism, social constructionism). We provide practical recommendations that are broadly applicable to all types of implementation research methodologies (i.e., quantitative, qualitative, and mixed methods). These recommendations are also relevant to any implementation research aim (e.g., implementing research-supported interventions, complex multilevel clinical practices, public health interventions, or policies) or study design (e.g., trials, observational studies) conducted at any level (or levels) of implementation contexts.

Again, recognizing that not every implementation researcher is, or can easily access, a multilevel research expert, we write this paper with these three goals in mind. First, to ease the reader's burden of digesting a large body of specialized and divergent existing literature, we offer a cohesive set of research characteristics presented in a sequence that aligns with developing a research project (from research question formulation to evaluation). Second, to ease the burden of learning a new disciplinary language and reference points, we translate ideas from existing literature using constructs and practice examples familiar to an implementation research audience. Third, to be more inclusive of qualitative and mixed methods, we expand our focus beyond quantitative multilevel modeling. In sum, we echo Molina-Azorin and colleagues [ 2], with the intent of addressing the needs of the diverse implementation research community:

Our approach will be to see the 'forest' rather than some particular 'trees.' We examine the big picture, indicating the main elements of multilevel research. An exhaustive analysis of all the elements of multilevel research goes beyond the purpose of this methodological insight, but we provide key references in the literature that could be used...[with the hope that]...multilevel research brings us closer to the reality of [implementation] practice. pg. 2

Road map for this paper

Our list of eight characteristics can be used to inform new research or enhance existing studies. We also hope that journal editors, peer reviewers, and funders will use this information when assessing the quality of multilevel implementation research. Each characteristic below is a continuation of the following sentence stem: "To conduct rigorous, high-quality multilevel implementation research..." In the text, we provide the rationale for each characteristic's inclusion and recommendations for its operationalization when designing or evaluating research. The Additional Files 1- 8 accompanying each characteristic illustrate how readers can apply it practically and concretely. Additional file documents feature prompts, practical considerations, checklists, visual aids, curated references, additional implementation research examples, notes about applicable glossary terms, and detailed guidance for navigating particular issues (e.g., creating a multilevel sampling plan). For readers interested in a holistic view of how our characteristics apply to a single study, we offer Additional File 9, which demonstrates the application of the characteristics in a mixed-methods, hybrid type III effectiveness-implementation trial called ASPIRE (for Adolescent and child Suicide Prevention in Routine clinical Encounters) [ 15]. The ASPIRE trial offers a unified, if imperfect, example of the characteristics because it incorporates (a) multiple levels of sampling with nested observations, (b) variables (i.e., antecedents, mediators, and outcomes) that occur at different levels, (c) constructs which represent shared unit characteristics which are measured through aggregation of individual responses, (d) randomization at the cluster level, and (e) both quantitative and qualitative analyses. Table 1 summarizes each characteristic and associated recommendations for implementation researchers; we envision it could be used as a simple planning tool or evaluative checklist. We also hope Table 1 encourages readers to use our eight characteristics as a whole, avoiding the problems associated with best practice misuse (e.g., cherry-picking specific sections to justify singular decisions while ignoring the others) [ 16].

Table 1 Summary of multilevel study characteristics and recommendations for implementation researchers

1. Map and operationalize the specific multilevel context for defined populations and settings

Rationale

Implementation﻿ studies are designed to make inferences about specific populations, which may consist of individuals, groups, organizations, or other systems that occur at specific levels in implementation contexts. Researchers should directly acknowledge these levels and their potential influence(s) on focal populations. Not doing so can lead to blind spots when conducting analyses and interpreting findings, and limit the generalizability of results. For example, a trial of an implementation strategy that identifies and equips clinical champions while focusing exclusively on clinic-level variables may ignore critical intra-clinic factors that may explain strategy effectiveness, such as variation in team-level leadership and characteristics of client/patient populations served [ 17].

Our recommendation for implementation researchers

Create and include a list or map of contextual levels most salient to the research question(s) and population(s) under study. This map should justify the inclusion and exclusion of specific levels within the research design based on the research question and theory about how focal antecedents, processes, or outcomes relate to each other. Table 2 presents an example of levels that may (or may not) be included in an implementation study depending on the context and aligned with the Consolidated Framework for Implementation Research (CFIR) and the Exploration, Preparation, Implementation, Sustainment (EPIS) framework [ 18, 19, 20, 21]﻿. Depending on the research questions, specific implementation studies may use only one or a few levels from this table (or some modification and expansion thereof). For more information on how to map the contextual levels within an implementation study, see Additional File 1.

Table 2 Conceptual model of levels in implementation research illustrated in CFIR and EPIS frameworks

2. Define and state the level of each construct under study

Rationale

After mapping the study's multilevel context and associated populations, the next step is to define each construct and identify its level within the design. Clear construct definition is crucial because it provides the basis for the accurate construction of measures (Characteristic 5) and treatment of analytic variables (Characteristic 7) and supports appropriate interpretation of results (Characteristic 8) [ 7]. Constructs may include implementation determinants [ 22, 23], implementation strategies [ 10, 24], variables that are part of a mediation chain [ 25], variables that modify the effects of other antecedents (i.e., moderator, effect modifier), or implementation or clinical effectiveness outcomes [ 26].

Our recommendation for implementation researchers

For each construct under study, define (1) its substantive meaning (i.e., what is it?) and (2) the level at which it resides and its associated population unit (e.g., does it occur at the level of patient, provider, team, clinic, organization?) [ 27]. For each variable, provide an explanation or "mini theory" that clarifies why the construct is assigned to its specific level and population unit [ 7]. For example, a study of hospitals might invoke the concept of organizational culture (defined following Schein as "a pattern of shared basic assumptions learned by a group as it solved its problems of external adaptation and internal integration, which has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems" ([ 28] p. 18]), assign it to the level of hospitals (i.e., culture is a characteristic of hospitals), and use organizational culture theory to explain how culture emerges at the hospital level. This definition and theory would guide measurement and analytic decisions. For more information on how to do this, see Additional File 2.

3. Describe how constructs relate to each other within and across levels

Rationale

After defining each construct in terms of its meaning, level, and associated unit, investigators must clarify how study constructs relate to each other within and across levels. This step is essential to planning analyses.

Our recommendation for implementation researchers

Research plans should include a figure or narrative that describes the study's theoretical model, including the level of each construct and the hypothesized relationships between constructs. We also suggest that researchers specify each construct's causal ordering in the study theoretical model (e.g., is it an antecedent, mediator, moderator, consequent, primary, or secondary endpoint) [ 27]. Figure 1 provides an example. Drawing on theory and prior research, researchers should provide a rationale for the proposed relationships within the model.

Example multilevel theoretical model.

Note: In this example, the study tests the relationships between three constructs which occur at different levels of the implementation context. The researchers hypothesize that variation in implementation climate across organizations will explain variation in provider competence to implement a focal intervention with fidelity which in turn will explain variation in the extent to which patients experience fidelity to the focal intervention during the course of treatment

When hypothesized relationships cross levels, researchers should identify and describe the processes through which antecedents at higher levels influence consequents at lower levels (i.e., top-down processes) or how antecedents at lower levels shape consequents at higher levels (i.e., bottom-up processes). The description should include theoretical justification for each cross-level effect to be examined in the study. For example, if an investigator hypothesizes that increased clinic implementation climate, defined as employees' shared perceptions of the extent to which their clinic expects, supports, and rewards the use of a specific intervention with high fidelity [ 29], will increase provider self-efficacy to deliver an intervention with high fidelity, this cross-level relationship implies an increase in the clinic means of provider self-efficacy, and the research plan should describe how and why that would occur. Alternatively, an investigator might hypothesize that high levels of implementation climate [ 29] will decrease the dispersion or variability of provider attitudes around their clinic means (i.e., the climate will increase the level of agreement among providers within a clinic). Since both of these variables (i.e., implementation climate and the magnitude of variability in attitudes) represent characteristics of the clinic, they occur at the same level, and the research plan should state how this same-level process would occur. For more information on how to do this, see Additional File 3.

4. Specify the temporal scope of each phenomenon at each relevant level

Rationale

Rigorous multilevel implementation research requires thoughtful consideration of temporality (i.e., the sequence of events that unfold over calendar time) and pace of change (i.e., tempo or speed of change) as well as how these might differ across levels and align within a research design. People, organizations, and other systems change over time; however, the sequence or pace of change at one level may differ from that at another level [ 7]. For instance, an organization's culture may be slow to change compared to specific aspects of policies or staffing. Additionally, organizations may change more quickly or slowly under different conditions. Externally imposed system reforms (e.g., funding shifts or policy changes) or crises (e.g., pandemics or natural disasters) may trigger more rapid change than internally planned changes. For instance, COVID-19 mitigation and other social distancing measures triggered a rapid shift from in-person service delivery to telehealth or other virtual platforms. Please see Additional File 4 for another example of this issue.

Our recommendation for implementation researchers

We recommend that researchers provide a detailed explanation of the expected temporal dynamics within their study at each level, using visual aids as needed, which includes the following: (1) when investigators expect to observe change in each outcome at each relevant level (e.g., of system- or organization-level implementation strategies), (2) how frequently and when constructs will be measured to capture these changes, (3) how changes in outcomes at different levels align with each other in the research design, and (4) the theoretical rationale for these choices. Research plans should draw on relevant theory and report the expected direction, shape, frequency, and/or tempo of anticipated change in focal constructs, at each level and across levels, with decisions about measurement frequency and timing linked to these theoretical expectations. Measurement intervals and durations may differ at each level depending on the expected temporal dynamics and emergent issues. For more information on how to do this, see Additional File 4.

5. Align measurement choices and construction of analytic variables with the levels of theories selected (and hypotheses generated, if applicable)

Rationale

The operationalization and measurement of variables must align with theory so that inferences about selected constructs accurately reflect target levels and populations. Put simply, measurement must align with the level of theory. By level of theory, we mean the level at which the construct has been defined (i.e., in Characteristic 2). An example of measurement-theory misalignment is using individually varying scores to measure a theoretically shared organizational characteristic such as organizational climate. Ensuring measurement-theory alignment requires investigators to understand the theoretical assumptions embedded within each of the study's constructs (e.g., organizational climate assumptions) and provide evidence that the measurements taken conform to those theoretical assumptions [ 7].

Our recommendation for implementation researchers

Align the levels of theory and measurement. Such alignment is often most difficult for unit-level constructs; however, the organizational research literature offers a useful typology of categories of variables (global, shared, and configural) to aid investigators in this task [ 7]. G lobal constructs are those that originate at the unit level and represent objective, easily observable characteristics of the unit. Examples of global constructs include the type of hospital ward or unit (e.g., pediatric, intensive care) and the number of patients seen by the unit in a year. S hared constructs originate at the individual level but are shared across unit members [ 7]. An example of a shared construct is clinic implementation climate [ 29]. Note that even though clinic implementation climate originates at the provider level (i.e., in individual provider perceptions), it is conceptualized as a characteristic of the unit because it is a shared, contextual feature of the work environment. C onfigural constructs originate at the individual level and represent a pattern of individual characteristics within the unit [ 7]. Examples of configural constructs include variation in years of clinical experience on a team or diversity of professional roles within the team, or the optimal performance by a single member of the team. This typology directly informs the selection of appropriate measurement approaches and guides the type of validity evidence investigators should provide to demonstrate alignment between theories and measures. For example, investigators may need to provide evidence of within-clinic agreement on clinician perceptions of implementation climate in order to support the validity of the clinic implementation climate construct within their study [ 30]. For more information on how to align the levels of theory and measurement, see Additional File 5.

6. Use a sampling strategy consistent with the selected theories or research objectives and sufficiently large and variable to examine relationships at requisite levels

Rationale

In multilevel studies, there are different sample sizes and sampling plans at each level of the design. For example, in a study of community health workers embedded within primary care clinics, the inferences drawn will be shaped by the samples of clinics and by the sample of workers within each clinic. As with all samples, investigators must attend to the number of participants necessary to generate appropriate statistical or theoretical inferences, the distribution of participants' characteristics (to ensure adequate variability), and their representativeness of a target population. However, this logic applies separately to each level's specific sample(s).

Special attention is often needed to ensure that the number and representativeness of participants within each higher-level unit are adequate to address the research questions and are aligned with the theoretical or conceptual model. For example, how representative of a clinic are participants' responses if only two of ten workers complete study surveys? What is the minimum number of participants needed per clinic? What are the implications of variation across clinics in their within-clinic response rates?

Our recommendation for implementation researchers

Given the considerations above, multilevel implementation studies should be designed to ensure there is (1) a large enough sample at each level to test hypotheses or make theoretical inferences rigorously, (2) adequate variability within the sample at each level to achieve these objectives, and (3) representativeness of the achieved sample at each level (for quantitative). To help readers of research reports assess these study characteristics, we recommend that quantitative multilevel implementation studies report the following: (1) the distribution and range of within-unit sample sizes, including a measure of central tendency (median/mean), dispersion (standard deviation), and minimum and maximum values (e.g., median, minimum, and maximum number of providers and/or patients per clinic); (2) the distribution and range of within-unit response rates (e.g., calculate the survey response rate within each clinic and report the mean, standard deviation, minimum, and maximum response rates); (3) a statistical comparison of the characteristics of unit members who responded versus nonresponders; and (4) the theoretical or empirical rationale for exclusion of units (e.g., on the basis of response rates or number of participants).

In qualitative studies, the goal is typically not to obtain a representative sample but to purposefully select cases or participants that meet preselected criteria that address the study's research questions. Nonetheless, it is critical to ensure that investigators sample at all specified levels for analytic purposes, striving for sufficient sample sizes of the population units at each pertinent level and attending to consistencies, contradictions, and interconnections across levels. For example, in a study examining an organizational implementation strategy, investigators will likely be interested not just in what executives say about change processes related to an innovation's uptake but also in triangulated data from first-level leaders (i.e., those who supervise providers) and direct service providers. Sampling at the different levels enables a more nuanced perspective on the interplay between levels and how they might influence each other. For more information on designing and justifying a quantitative or qualitative multilevel sampling plan, see Additional File 6.

7. Align analytic approaches with the chosen theories (and hypotheses, if applicable), ensuring that they account for measurement dependencies and nested data structures

Rationale

Although there is no single best way to analyze data from multilevel implementation studies, investigators must ensure that analytic choices (1) account for the dependencies that arise in hierarchically sampled observations and (2) align with the study's level(s) of theory and hypotheses or research aims [ 9]. This applies equally to quantitative, qualitative, and mixed-methods designs. Traditional quantitative data analytic approaches, such as ordinary least squares regression and t-tests, assume observations are independently sampled and thus uncorrelated. Statistical inferences are biased when this assumption is violated, as often occurs in multilevel designs where observations at a lower level (e.g., patient outcome scores) are nested within higher-level units (e.g., providers).

In qualitative studies, researchers can query the extent to which there is agreement or disagreement within levels (e.g., perceptions of leadership among a clinical team) and across levels (e.g., perceptions of leadership that vary between leader peer reports and subordinate reports of that leader) [ 31, 32]. Qualitative research can also help elucidate the kinds of complex nested relationships present within an implementation context [ 33] and can, therefore, provide valuable insight into what is most important to address related to levels of nesting. Qualitative research centered on process and the real-world interplay occurring across levels is especially useful for describing and contextualizing these dependencies while shedding light on how they likely operate to influence outcomes [ 34]. In ﻿addition, in the process of conducting qualitative research, we might identify new samples we may have not considered previously with participants who might have fresh insights into multilevel phenomena we are seeking to analyze.

Our recommendation for implementation researchers

We recommend investigators directly acknowledge nesting and dependencies (i.e., correlated observations) within the proposed study design, articulate what analytic method has been selected to account for those features (or analytically demonstrate that the dependencies are not substantial enough to be a concern), and provide a rationale for the choice of analysis approach with reference to specific characteristics of the data and strengths of the selected model. For example, a quantitative study that measures fidelity to an intervention at the session level may need to account for the nesting of sessions within patients, nesting of patients within providers, and nesting of providers within clinics, depending on the specific sampling design and focus of the investigation. An analytic approach would be selected that addresses this nesting and a rationale provided for its use in this study.

For quantitative studies, we recommend that investigators ensure that variables enter statistical models at the level warranted and scrutinize choices related to centering, standardization, and calculation of effect sizes to confirm they reflect the study's multilevel design [ 24, 35]. For randomized trials, the variable representing randomization to condition (i.e., exposure) should enter the statistical model at the level at which randomization occurs [ 36]; this often has significant implications for statistical power and sample size, particularly when the emphasis is on testing hypothesized mediators of implementation strategies' effects [ 10].

The use of qualitative methods, such as participant observation, interviews, focus groups, and periodic reflections, is crucial to contextualizing and interpreting quantitative findings regarding dependencies and nesting while also offering in-depth insight into the range of anticipated and unanticipated factors emerging in real time that shape implementation processes and outcomes [ 37, 38, 39, 40]. A variety of qualitative analytic techniques can be brought to bear in multilevel implementation research, including deductive techniques applying theoretical model constructs to support existing conceptualizations to test and validate theory and inductive techniques to generate new concepts, explanations, or theories from study data. Regardless of the approach taken, the key assessment criteria for analysis and interpretation of qualitative data center on ensuring a solid grasp of background issues and theory and a firm grounding in the data collected. Procedures that enhance the rigor and credibility of qualitative findings include investigating rival explanations pertinent to the phenomena of interest, accounting for disconfirming evidence and irregularities, and undertaking triangulation (within and across methods) [ 41, 42, 43]. The more data sources, the better. Triangulation practices typically entail summarizing analyses of all data sources and conducting side-by-side comparisons designed to corroborate and expand upon findings to create a complete or holistic picture of implementation processes and outcomes at the specified levels of interest [ 42].

Whatever analytic strategies are used to address multilevel designs in implementation research, we recommend investigators be transparent and thorough in reporting details of the analytic approach. We offer this general rule: as analytical complexity and decision points in an analysis increase, so should the level of description of the methods either in text or in a supplemental file. We also suggest investigators consider developing and sharing crosswalks that specify research questions and justify the use of data collection tools and their accompanying analytic techniques, defining their multilevel purpose and (anticipated) contributions, including "explicit connections" or "intentional redundancies" among quantitative and qualitative approaches [ 33]. Finally, we recommend that investigators make analytic tools (e.g., qualitative interview guides, statistical code) accessible to end users of multilevel research reports. For more information on how to create qualitative, quantitative, and mixed-methods multilevel analysis plans, see Additional File 7.

8. Ensure inferences are made at the appropriate level

Rationale

When analyses are complete, investigators must ensure inferences are made at the appropriate level(s). Most researchers who discuss this issue [ 7, 44, 45, 46] focus on two primary fallacies regarding inferences from multilevel research: the atomistic fallacy and the ecological fallacy. The atomistic fallacy occurs when investigators analyze the association between variables at the individual level and then inappropriately make inferences about a higher level of analysis, such as groups or organizations [ 46]. Because the association between two variables at the individual level may differ from the association between the same or analogous variables at the group level, it is inappropriate to infer group-level relationships based on individual-level analyses [ 46]. For an implementation research example, see Additional File 8.

The ecological fallacy occurs when investigators conduct studies at a higher level of analysis (e.g., group, organization, or country) and inappropriately make inferences about lower-level units (e.g., individuals) [ 7]. Investigators should not use inferences based on data at the group level to substantiate relationships at lower levels of analysis for the same reason described for the atomistic fallacy. More specifically, the association between two variables at the group level may differ from the association between the same or analogous variables at the individual level. For an implementation research example, see Additional File 8. As Chan [ 45] highlighted, both fallacies are ultimately conceptual fallacies about interpreting results.

Our recommendation for implementation researchers

Given these considerations, we recommend investigators carefully craft and check language within research reports and presentations to ensure atomistic and ecological fallacies are not present. Precise language is needed to describe the level of the constructs when discussing results. For instance, a conclusion like "higher readiness for change was associated higher fidelity" is vague about the level, as opposed to "higher unit-level readiness for change was associated with higher provider-level fidelity." We suggest investigators increase their awareness of these fallacies and build in processes to check their assumptions when interpreting results from multilevel studies. We also recommend following Chan's guidance to conduct multilevel analyses that appropriately account for variance within and between levels so that "analysis and interpretations can be aligned to avoid the conceptual problem of making inferences at the wrong level" ([ 45] p. 405).

Conclusion

Implementation research is inherently multilevel. Building strong multilevel theories that explain the reality of implementation requires rigorous studies. Although the degree to which investigators account for this reality in their work may vary, as may the specific levels assessed in a particular study, we can meaningfully advance implementation science by articulating and enacting achievable standards of rigor for what constitutes high-quality multilevel research. We believe that shared standards of rigor can improve the quality, transparency, generalizability, and replicability of multilevel implementation research. In this paper, we took the first step in establishing and communicating such standards by distilling and translating key concepts from other fields (emphasizing the organizational sciences) for an implementation science audience.

Table 1 concisely summarizes our eight characteristics and associated recommendations for implementation researchers. Our eight characteristics are structured to guide the early conceptualization and grant-writing process. They are also intended to support investigators as they move through decision-making at each research phase - from research question formulation, variable selection and measurement, analysis, and the interpretation of findings. We hope these characteristics promote a common language and provide an initial template for planning for and evaluating the quality of multilevel implementation research. We also hope that acknowledging these characteristics will push the field forward in building testable multilevel theories that capture the complexities, and addresses the needs of implementation research.

These theories can be examined and tested using a range of designs and approaches. However, the complexity inherent in implementation research calls for other innovative approaches to understanding complex multilevel contexts. Systems science approaches (e.g., social network analysis, agent-based modeling, and systems dynamics) that account for nonlinearities, interdependencies, and cross-level phenomena have strong potential for expanding and testing multilevel theories [ 47]. However, even with these types of approaches, it is important to be clear about the ways in which within-level and across-level phenomena operate and interact. Our future work will delve into specific technical considerations and offer more detailed guidance for conducting multilevel research using traditional quantitative, qualitative, and mixed-methods approaches.

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Acknowledgements

The authors wish to acknowledge members of the University of Pennsylvania NIMH ALACRITY Center (P50MH113840) whose thoughtful insights, conversations, and feedback on ideas in this manuscript helped sharpen our thinking. We also wish to acknowledge the support of Drs. Kristin Linn, Steven Marcus, and Dylan Small for their work designing the ASPIRE trial.

Funding

Dr. Lengnick-Hall is funded by NIMH P50MH113662. Dr. Williams is funded by R01MH119127 and R21MH126076. The ASPIRE trial (Beidas, PI) is funded by R01 MH123491. Dr. Beidas is also funded by P50CA244690, R33HL161752, U01HL159880, and R01NR019753. Dr. Aarons is funded by R01DA049891, P50MH126231, U01CA275118, and G11TW011841. Dr. Willging is funded by R01 NR021019 and R01HD083399. Additionally, Drs. Lengnick-Hall and Bunger are alumni, Drs. Aarons and Beidas are core faculty, and Dr. Williams is an expert faculty, with the NIMH Implementation Research Institute (IRI) at the George Warren Brown School of Social Work, Washington University, in St. Louis through an award from NIMH (R25 MH080916-08). The funding bodies played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Author information

Author notes

Rebecca Lengnick-Hall and Nathaniel J. Williams contributed equally to this work.

Authors and Affiliations

The Brown School, Washington University in St. Louis, St. Louis, MO, USA

Rebecca Lengnick-Hall

School of Social Work, Boise State University, Boise, ID, USA

Nathaniel J. Williams

Department of Psychology, University of Central Florida, Orlando, FL, USA

Mark G. Ehrhart

Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, NM, USA

Cathleen E. Willging

College of Social Work, The Ohio State University, Columbus, OH, USA

Alicia C. Bunger

Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

Rinad S. Beidas

Department of Psychiatry, UC San Diego ACTRI Dissemination and Implementation Science Center, University of California-San Diego, La Jolla, San Diego, CA, USA

Gregory A. Aarons

Contributions

RLH and NJW led the conceptual development and structure of the manuscript. All authors contributed to initial drafts of the recommendations and participated in decisions about what information to prioritize and how to tailor the information with implementation research examples. MGE provided detailed support on the references included, and RSB provided the details of the ASPIRE trial example. RLH and NJW co-drafted the manuscript, and MGE, CEW, ACB, RSB, and GAA reviewed and edited manuscript sections. All authors reviewed and revised several iterations of the manuscript and approved the final version.

Corresponding author

Correspondence to Rebecca Lengnick-Hall.

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Ethics approval and consent to participate

Ethics approval and consent are not applicable for the current manuscript because no human subject data were collected or utilized.

Consent for publication

Not applicable.

Competing interests

GAA is a co-editor in chief on the editorial board, and RSB is an associate editor of Implementation Science and Implementation Science Communications. ACB and CEW are members of the editorial board of Implementation Science. All decisions on this paper were made by another editor. RSB is principal at Implementation Science & Practice, LLC. She receives royalties from Oxford University Press and consulting fees from United Behavioral Health and OptumLabs and serves on the advisory boards for Optum Behavioral Health, AIM Youth Mental Health Foundation, and the Klingenstein Third Generation Foundation outside of the submitted work. All other authors declare that they have no competing interests.

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Supplementary Information

Glossary

Characteristic #1

Map and operationalize the specific multilevel context for defined populations and settings.

Contextual levels

Context refers to the totality of space, time, and matter around a healthcare encounter. The combination of these terms indicates context has a hierarchical structure comprised of levels (using the definition of level provided below).

Level

A position within a hierarchical, nested structure. In implementation science, healthcare is delivered to patients, by providers, within organizations, and within larger systems. Each population in this chain (patients, providers, organizations, larger systems) is nested within another population. That is, multiple patients are cared for by a single provider, multiple providers work in a single organization, and multiple systems occur within a sociopolitical context such as a nation. Therefore, each population represents a level within the implementation context. By definition, levels are associated with specific populations.

Unit

A formal group of more than one person. Examples include teams, departments, divisions, wards, or clinics. A unit can also be conceptualized as an organization or system.

Characteristic #2

Define and state the level of each construct under study.

Analytic variable

The actual, observed value used to represent a construct within a quantitative or qualitative analysis.

Focal level

The level of the implementation context that is the center of attention for a particular research question. The focal level often refers to a location in the nested, contextual hierarchy at which a key variable of interest resides and/or is expected to affect.

Unit-level construct/property/characteristic

For the purposes of our paper, a unit-level construct/property/characteristic describes a feature, quality, or state of a unit. It may be observable or latent. A unit-level construct/property/characteristic can be further categorized as global, shared, or configural (see Characteristic 5 below). Examples for implementation research include clinic implementation climate, department safety climate, team demographic composition (e.g., in terms of workforce diversity), agency size, and site proximity to a university. See definitions for level and unit in Characteristic 1.

Characteristic #3

Describe how constructs relate to each other within and across levels.

Bottom-up processes

A sequence or series of events, or actions taken, in a specific order toward a specific outcome, which begin at a lower level and terminate at a higher level. An example is increased motivation among individual clinicians within a team to use a screening tool may lead to increased leader advocacy for funding for use of the tool (in response to the groundswell of support from clinicians), which may lead to increased funding available for the tool and greater reach of the tool to more patients within the organization.

Top-down processes

A sequence or series of events, or actions taken, in a specific order toward a specific outcome, which begin at a higher level and terminate at a lower level. An example is focused organizational implementation climate increasing individual clinicians' self-efficacy to deliver an intervention with fidelity resulting in patients experiencing high fidelity to the intervention during service interactions.

Characteristic #5

Align measurement choices and construction of analytic variables with the levels of theories selected (and hypotheses generated, if applicable).

Aggregated

The process of combining responses from individuals to the unit level through some operation (often by taking the mean). For example, clinicians' individual perceptions of their clinic's climate could be aggregated by taking the mean of their responses to represent their shared experience (i.e., the unit climate).

Compilation variable

An operationalization or measurement of a unit-level construct that is derived from observations obtained from individual within a unit and represents the configuration or pattern of the individual responses or observations.

Compositional variable

An operationalization or measurement of a unit-level construct that is derived from observations obtained from multiple individuals within the unit who are believed to be affected by the construct and whose perceptions or experiences are believed to converge and coalesce around a shared experience. For example, organizational implementation climate is often measured by collecting individual perception ratings from providers within a unit, and the average of these scores is taken to represent the shared perception, i.e., focused climate, of the unit. Implementation researchers should provide evidence to support the validity of compositional variables when they are used. For example, an assessment of inter-rater agreement should be employed to show that providers within each unit agreed with each other on their perceptions of focused climate. This confirms that the climate perceptions were shared, and that the compositional variable of climate, which enters models at the unit-level, is indeed a shared characteristic of the unit.

Configural construct/configural unit property

A characteristic of a unit that represents the pattern, variability, or configuration of individuals' characteristics or contributions within the unit. Examples include the level of diversity in a team's years of experience or the network density of relationships among organization members. These properties emerge at the individual level but are not assumed to coalesce or converge among unit members; instead, individuals make distinct contributions to the pattern or configuration in the unit which combine in complex, nonlinear processes to generate the unit-level property. In defining configural properties, investigators should explain the processes by which unique individual contributions combine to form the unit-level characteristic. Operationalized measures of configural constructs are sometimes called compilation variables (see more above).

Global construct/global unit property

A characteristic of a unit that is material, descriptive, typically easily observable, and originates at the level of the unit. Group size or unit function is examples. Global characteristics do not have their basis in individuals' (or lower-level units') characteristics (or interactions), and thus, there is no possibility of within-unit variation.

Referent

The Oxford English dictionary defines referent as "the thing that a word or phrase denotes or stands for." In the context of multilevel implementation research, we use this term to refer to the person or unit to which a measure applies. For example, if someone is being asked to rate "leadership" within their unit, the items should have a referent which indicates which leader they are being asked to rate. If someone is asked to rate climate within their work environment, the item should have a referent of which unit's climate they are rating. For example, are they rating their immediate team, their whole clinic, or their whole organization?

Shared construct/shared unit property

A characteristic of a unit that is common to unit members based on the convergence or coalescence of individuals' experiences, perceptions, attitudes, values, cognitions, affect, or behavior. Shared unit characteristics originate at the individual level and emerge as a unit characteristic as a function of attraction, selection, attrition, socialization, social interaction, shared sense-making, group adaption, leadership, and other psychological processes. Organizational culture and EBP implementation climate are examples. When implementation researchers incorporate shared unit characteristics into their studies, it is especially important that they specify the processes believed to generate high levels of within-group agreement and consistency across individuals as well as provide evidence that the characteristic in question is truly shared across individuals; demonstration of within-group agreement or convergence helps support the construct validity of shared unit-level constructs. Operationalized measures of shared constructs are sometimes called compositional variables (see more above).

Unit-level construct/property/characteristic

See definition in Characteristic 2 above.

Validity evidence

Very simply, "validity evidence" represents data and analyses brought to bear to show that a variable represents what it is supposed to represent. Messick (1989) defined validity as "an integrated evaluative judgment of the degree to which empirical evidence and theoretical rationales support the adequacy and appropriateness of inferences and actions based on test scores and other modes of assessment" (p. 13). The Standards for Educational and Psychological Testing of the American Educational Research Association, American Psychological Association, and National Council on Measurement in Education (1999) calls for investigators to generate evidence of the validity of inferences generated from measures. For a given set of items which comprise a measure, traditional types of validity evidence relate to content coverage, response processes, internal structure, and relations to other variables. In multilevel studies, it is important to provide validity evidence for compositional variables such as implementation climate, to show that they represent a shared characteristic of a unit.

Characteristic #6

Use a sampling strategy consistent with the selected theories or research objectives and sufficiently large and variable to examine relationships at requisite levels. Sampling plan - We use the definition of sampling plan offered by the US National Institute of Standards and Technology in its Engineering and Statistics Handbook: "a sampling plan is a detailed outline of which measurements will be taken at what times, on which material, in what manner, and by whom...Sampling plans should be designed in such a way that the resulting data will contain a representative sample of the parameters of interest and allow for all questions, as stated in the goals, to be answered."

Characteristic #8

Ensure inferences are made at the appropriate level.

Atomistic fallacy

When investigators analyze the association between variables at the individual level and then inappropriately make inferences about a higher level of analysis, such as groups or organizations.

Ecological fallacy

When investigators conduct studies at a higher level of analysis (e.g., group, organization, or country) and inappropriately make inferences about lower levels units (e.g., individuals).

Level of analysis

The level within the implementation context of which research data are representative. For example, measures of team size represent the team level of analysis, and measures of individual provider self-efficacy represent the individual provider level of analysis.

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Lengnick-Hall, R., Williams, N.J., Ehrhart, M.G. et al. Eight characteristics of rigorous multilevel implementation research: a step-by-step guide. Implementation Sci 18, 52 (2023). https://doi.org/10.1186/s13012-023-01302-2
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DOI: https://doi.org/10.1186/s13012-023-01302-2

Keywords

# data[].attributes.attachment_link.title
Eight characteristics of rigorous multilevel implementation research: a step-by-step guide - Implementation Science

# data[].attributes.attachment_link.description
Background Although healthcare is delivered in inherently multilevel contexts, implementation science has no widely endorsed methodological standards defining the characteristics of rigorous, multilevel implementation research. We identify and describe eight characteristics of high-quality, multilevel implementation research to encourage discussion, spur debate, and guide decision-making around study design and methodological issues.

# data[].attributes.body
Ziam, S., Lanoue, S., McSween-Cadieux, E., Hong, Q. N., Lane, J., Prigent, O., … Fleury, F. C. (2023). Validation of a framework for evaluating knowledge mobilization strategies: A Delphi method approach. European Conference on Knowledge Management, 24(2), 1510‑1515.

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Authors

Saliha Ziam Université Téluq

Sèverine Lanoue Université de Sherbrooke, Sherbrooke, Canada

Esther McSween-Cadieux Université de Sherbrooke, Sherbrooke, Canada.

Quan Nha Hong Université de Montréal, Canada

Julie Lane Université de Sherbrooke, Sherbrooke, Canada

Ollivier Prigent Université de Sherbrooke, Sherbrooke, Canada.

Christian Dagenais Université de Montréal, Canada

Valery Ridde Université Paris Cité

Emmanuelle Jean Public health intelligence and knowledge translation division

Mathieu-Joël Gervais Université du Québec à Montréal, UQAM

France Charles Fleury Interregional Consortium of Knowledge in Health and Social Services

DOI:
https://doi.org/10.34190/eckm.24.2.1642

Keywords:
knowledge moblization; knowledge translation;, Framework, validation, Delphi Method

Abstract

Background: A growing number of knowledge-oriented organizations, such as granting agencies, governments, public organizations, universities, and health authorities, are investing considerable resources to increase the use of research knowledge to improve professional practice, decision making, and public policy. The proliferation of research on knowledge mobilization (KMb) over the past two decades has deepened our understanding of the dynamics of this process and of the factors that can impede its deployment, such as knowledge users' capabilities (their beliefs, capacity to absorb knowledge, etc.), contextual conditions (resources, leadership, facilitating factors, etc.), and the availability of effective mobilization strategies (frequency, implementation, fit with context). However, yet, few good-quality studies have evaluated the impacts of KMb, such that we still know too little about the effectiveness of the different strategies and the contextual conditions in which they may be effective. This is problematic, in that their development cannot be fully grounded in empirical evidence. In fact, their evaluation is complicated by the virtual absence of evaluation tools and validated indicators that would allow organizations to assess the impacts of their KMb strategies. Moreover, the difficulty that these organizations experience in relation to evaluation (due to lack of expertise and resources) is a concern that has been raised many times. Aims: This study will address this expressed need to improve organizations' capacity to conduct KMb evaluation studies. Using a collaborative co-construction approach with key actors in KMb, our aim is to design and validate an integrative and operational framework for the evaluation of KMb strategies in the social domain. Design/approach: a first step in this project, we conducted a scoping review of frameworks and theories commonly used to evaluate KMb strategies. 71 articles were selected from this scoping review. Our analyses of these articles, we identified four potentially relevant dimensions for planning and evaluation: the context, implementation process, effects, and impacts of these strategies. Using the Delphi approach, a consultation has been undertaken to enrich and validate the dimensions of this framework developed after a scoping review. Results: This paper presents the results of the Delphi consultation with an international panel of experts working in the field of knowledge mobilization. This evaluation exercise should lead to a validation of the framework components and potential indicators to be considered when evaluating knowledge mobilization strategies.

Author Biographies

# data[].attributes.attachment_link.title
Validation of a framework for evaluating knowledge mobilization strategies: A Delphi method approach.

# data[].attributes.attachment_link.description
Saliha Ziam Université Téluq Sèverine Lanoue Université de Sherbrooke, Sherbrooke, Canada Esther McSween-Cadieux Université de Sherbrooke, Sherbrooke, Canada. Quan Nha Hong Université de Montréal, Canada Julie Lane Université de Sherbrooke, Sherbrooke, Canada Ollivier Prigent Université de Sherbrooke, Sherbrooke, Canada.

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Lalancette, M., & Luckerhoff, J., (2023) Initiation au travail intellectuel et à la recherche. Pratique réflexive de recherche scientifique. Presses de l'Université du Québec.

Ce livre contient un chapitre sur la MdC. Il a été produit en collaboration avec deux professeurs de l'Université du Québec à Trois-Rivières. Cet ouvrage sera le livre de référence utilisé dans tous les cours qui traitent de la dimension méthodologique de la recherche et plus largement du travail intellectuel.

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Résumé

Ce livre initie au travail intellectuel et à la recherche en adoptant une pratique réflexive qui se déploie en trois phases : penser, faire et communiquer la recherche. Il couvre l'ensemble des thématiques clés de la recherche scientifique, dont la problématisation et les concepts, les spécificités des approches qualitatives, quantitatives et mixtes, la netnographie, l'entrevue, l'observation, ainsi que les enjeux liés à la recherche tels que l'éthique et la gestion des données.

Mettant à contribution plus de 40 chercheurs et chercheuses, l'ouvrage offre une approche novatrice afin d'appréhender les phénomènes humains, sociaux, historiques et politiques. Les chapitres présentent une structure commune - explications, exemples, exercices - facilitant l'apprentissage et l'utilisation du livre en classe.

Initiation au travail intellectuel et à la recherche : pratique réflexive de recherche scientifique vise à apporter les connaissances méthodologiques permettant aux communautés étudiantes de réussir leurs parcours au baccalauréat, à la maîtrise ou au doctorat.

Table des matières

Voir toute la table des matières

2023, 536 pages, D5891, ISBN 978-2-7605-5891-5

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Initiation au travail intellectuel et à la recherche

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Ce livre initie au travail intellectuel et à la recherche en adoptant une pratique réflexive qui se déploie en trois phases : penser, faire et communiquer la recherche. Il couvre l'ensemble des thématiques clés de la recherche scientifique, dont la pr...

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Shwed A, Hoekstra F, Bhati D, Athanasopoulos P, Chernesky J, Martin Ginis K, McBride CB, Mortenson WB, Sibley KM, Sweet SN; SCI Guiding Principles Panel; Gainforth HL. IKT Guiding Principles: demonstration of diffusion and dissemination in partnership. Res Involv Engagem. 2023 Jul 12;9(1):53.

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Khouiyi, A. H., Guillemette, F. & St-Pierre, M.-J. (2022). La mobilisation des connaissances issues de la recherche dans l’accompagnement du développement professionnel. Enjeux et société, 9(2), 150–172.

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Gaetz, S. (2014). Knowledge Mobilization as Design: The Case of the Canadian Homelessness Research Network.
Scholarly and Research Communication, 5(3), art. 0301163.

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UNESCO
Imaginer le futur de la mobilisation des connaissances
Perspectives des Chaires de recherche UNESCO

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Académie suisses des sciences
Améliorations de  la communication scientifique et du dialogue entre le public et la science en Suisse Recommandations du groupe d’expert·e·s « Communicating Sciences and Arts in Times of Digital Media » (2021)

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Le travail de veille de l'Equipe RENARD porte sur la recherche en transfert de connaissances et recense principalement des publications scientifiques telles des articles de revues académiques et des monographies. Lorsque possible, elle recueille également la littérature grise telle que des rapports de recherche, des actes de conférences, des mémoires de maîtrise et des thèses doctorales.

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Notre veille sur la recherche en transfert de connaissances recense principalement des publications scientifiques telles des articles de revues académiques et des monographies. Lorsque possible, elle recueille également la littérature grise telle que des rapports de recherche, des actes de conférences, des mémoires de maîtrise et des thèses doctorales.

Les prochaines sections du site présentent les articles parus au cours des 6 derniers mois.

Pour consulter les archives de notre bibliothèque virtuelle, veuillez communiquer avec nous.

Pour rester à l'affût des actualités en TC, rejoignez-nous via vos médias sociaux préférés parmi et .

La veille couvre plusieurs domaines de recherche :

Santé publique : domaine se rapportant aux différents aspects de la santé d'une population. Thèmes principaux : surveillance continue de l'état de santé de la population; promotion de la santé; prévention des maladies et des problèmes sociaux; protection de la santé; règlementation, législation et politiques publiques de santé; recherche et innovation; développement et maintien des compétences des personnes travaillant en santé publique (thèmes tirés du Programme national de santé publique, Gouvernement du Québec).

Santé et services sociaux : domaine portant sur la santé des individus et basé sur un principe de proximité intervenant-patient (par rapport au domaine de la santé publique). Il concerne les soins de santé, autant physique que mentale.

Développement international : domaine concernant la recherche ayant une portée internationale et non locale sur les sujets suivants : santé; éducation; sécurité alimentaire (agriculture); organisation sociale et communautaire; développement économique communautaire; droits de la personne; démocratie (thèmes tirés du Programme québécois de développement international (PQDI), Gouvernement du Québec).

: domaine relatif au monde scolaire (primaire, secondaire, post-secondaire, formation continue). Il concerne la recherche portant sur les activités de transmission des connaissances théoriques et pratiques, de même que sur les théories et pratiques éducationnelles.

Science politique, économie et gestion : domaine concernant la recherche sur les mécanismes gouvernementaux, l'analyse politique ou les activités de planification, de direction et de contrôle d'une entreprise ou d'une organisation. Thèmes principaux : gestion d'organisation ou d'entreprise; culture d'organisation ou d'entreprise; fonctionnement d'organisation ou d'entreprise.

Sciences sociales : domaine retenu quand le texte précise qu'il porte spécifiquement sur les sciences sociales sans autre précision (terme plus général que les domaines mentionnés précédemment mais plus spécifique que le domaine des généralités).

Généralités : domaine retenu lorsque le document traite de domaines de recherche variés ou non-spécifiques (autres que ceux énumérés précédemment).

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Veille | Équipe RENARD Recherche sur le transfert de connaissances

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Notre veille sur la recherche en transfert de connaissances recense principalement des publications scientifiques telles des articles de revues académiques et des monographies. Lorsque possible, elle recueille également la littérature grise telle que des rapports de recherche, des actes de conférences, des mémoires de maîtrise et des thèses doctorales.

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La revue TUC est la première revue francophone avec comité de pairs qui s’intéresse exclusivement à la recherche sur le transfert et l'utilisation des connaissances dans le domaine social.

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La revue TUC est la première revue francophone avec comité de pairs qui s'intéresse exclusivement à la recherche sur le transfert et l'utilisation des connaissances dans le domaine social.

Vol. 7 No 1 (2023): Volume 7 - Numéro 1
Voir tous les numéros

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Revue francophone de recherche sur le transfert et l'utilisation des connaissances

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La revue TUC est la première revue francophone avec comité de pairs qui s'intéresse exclusivement à la recherche sur le transfert et l'utilisation des connaissances dans le domaine social. Vol. 7 No 1 (2023): Volume 7 - Numéro 1 Voir tous les numéros

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Vieira, A. C. G., Gastaldo, D., Harrison, D., Vieira, A. C. G., Gastaldo, D., & Harrison, D. (2020). How to translate scientific knowledge into practice? Concepts, models and application. Revista Brasileira de Enfermagem, 73(5).

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How to translate scientific knowledge into practice? Concepts, models and application

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ABSTRACT Objectives: to present the concept of Knowledge Translation and Exchange as it has been…

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Turin, T. C., Lasker, M. A. A., Rahman, N., Rumana, N., & Chowdhury, N. (2022). ‘Engagement and involvement matrix’ : A co-creation blueprint for inclusive community engaged research and knowledge mobilisation. Evidence-Based Nursing.

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‘Engagement and involvement matrix’: a co-creation blueprint for inclusive community engaged research and knowledge mobilisation

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Engaging and involving knowledge users in community-based research has become widely acknowledged among researchers as a vital part of the research process. Knowledge users include those individuals, groups or organisations with a personal stake in the research being undertaken. The Canadian Institu…

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Trottier, L.-H., & Champagne, F. (2006). L’utilisation des connaissances scientifiques : Au cœur des relations de coopération entre les acteurs. R06-05, 39 pages-39 pages.

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Trocmé, N., Esposito, T., Laurendeau, C., Thomson, W. & Milne, L. (2009). La mobilisation des connaissances en protection de l’enfance. Criminologie, 42(1), 33–59.

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Résumé

La protection de l'enfance est l'un des secteurs de services qui se développent le plus rapidement au Canada. Cependant, nous en savons étonnamment peu sur l'efficacité des services offerts aux enfants maltraités et négligés. Cet article examine de nouveaux modèles de mobilisation des connaissances conçus pour soutenir l'utilisation plus systématique de la recherche dans les services sociaux. Nous commençons par discuter des limites des modèles traditionnels de diffusion des connaissances. Ensuite, nous considérons certaines des recherches qui ont été faites sur les obstacles et les facteurs facilitant l'utilisation de la recherche en santé, en éducation et dans les services sociaux. Enfin, nous présentons un modèle de mobilisation des connaissances qui est mis à l'essai et évalué dans un organisme de protection de l'enfance au Québec, décrivons les processus locaux utilisés pour affiner les six indicateurs de résultats (récurrence de la maltraitance, retards scolaires, taux de placement, déplacements d'une ressource à une autre, durée des soins et participation d'un tribunal) et concluons en présentant un exemple d'un des indicateurs retenus.

Mots-clés:

Bien-être des enfants,

mobilisation des connaissances,

gestion fondée sur des données probantes,

indicateurs de résultats

Abstract

Child protection is one of the fastest growing services sectors in Canada, yet we know surprisingly little about the effectiveness of services for abused and neglected children. This article examines emerging knowledge mobilization models designed to support the more systematic use of research in social services. We start by discussing the limits of traditional knowledge dissemination models. We then consider some of the research that has been done on the barriers and facilitators of research utilization in health, education and social services. Finally, we present a knowledge mobilization model that is being pilot tested and evaluated in a child welfare agency in Quebec and describe the local processes used to refine six outcome indicators (recurrence of maltreatment ; school delay ; placement rate ; moves in care ; time in care ; and court involvement) and conclude by presenting an example of one of the selected indicators.

Keywords:

Child welfare,

knowledge mobilization,

evidence-based management,

outcome indicators

Resumen

La protección de la infancia es uno de los sectores de servicios de más rápido desarrollo en Canadá. Sin embargo, es sorprendente lo poco que sabemos sobre la eficacia de los servicios que se ofrecen a los menores víctimas de maltrato o de negligencia. Este artículo examina nuevos modelos de movilización de conocimientos concebidos para apoyar un uso más sistemático de la investigación en los servicios sociales. Discutimos, primero, los límites de los modelos tradicionales de la difusión de conocimientos. A continuación, consideramos algunas investigaciones sobre los obstáculos y estímulos al uso de la investigación en los ámbitos de la salud, la educación y los servicios sociales. Finalmente, presentamos un modelo de movilización de conocimientos en etapa de práctica piloto y evaluación en una agencia de protección de la infancia en Quebec ; describimos los procesos locales utilizados para afinar seis indicadores de resultados (recurrencia del maltrato, retrasos escolares, tasa de colocación, desplazamiento de un recurso a otro, duración de cuidados y participación de un tribunal) y concluimos presentando un ejemplo de uno de los indicadores seleccionados.

Palabras clave:

Bienestar infantil,

movilización de conocimientos,

gestión basada en la evidencia,

indicadores de resultados

Introduction

En 1976, à la suite d'une recension exhaustive des écrits sur l'efficacité des politiques et des services de protection de l'enfance, Sheila Kamerman et Alfred Kahn ont conclu que la plupart des décisions en matière de politiques et de pratiques restent fondées principalement sur des jugements de valeur et sur des suppositions. Trente ans plus tard, malgré les appels répétés à une évaluation plus systématique des pratiques (Magura et Moses, 1986 ; Pecora et al., 1992 ; National Research Council, 1993 ; Gelles, 2001), il s'avère que les services destinés aux enfants maltraités et à leurs familles reposent encore, souvent, sur une perception des besoins qui ne tient pas compte de données objectives portant sur l'efficacité des services. Une recension récente de toutes les études canadiennes publiées entre 1995 et 2005 qui ont mesuré l'impact des services de protection de l'enfance n'a permis d'identifier que dix essais cliniques qui comportaient des groupes de comparaison, dont quatre où le devis prévoyait une répartition aléatoire des sujets (Flynn et Bouchard, 2005).

Pourtant, les services de protection de l'enfance représentent au Canada l'un des secteurs de services sociaux dont la croissance est la plus rapide. Le nombre d'enquêtes menées par les bureaux de protection de l'enfance a doublé au cours des cinq dernières années. La situation de plus de 200 000 enfants pour lesquels il y a des allégations de mauvais traitements est évaluée annuellement (Trocmé et al., 2005). De 3 à 4 milliards de dollars sont dépensés au Canada chaque année pour des services directs de protection de l'enfance et la somme des coûts annuels indirects est estimée à plus de 15 milliards de dollars (Bowlus et al., 2003).

Pourquoi, au Canada, en savons-nous si peu sur les services offerts aux enfants les plus vulnérables et comment pouvons-nous justifier que diverses mesures soient ordonnées par le tribunal alors que leur efficacité ne bénéficie que d'un appui empirique limité ? Bien que la décision de mener plus de recherches évaluatives fasse manifestement partie de la solution (au Canada moins d'un million de dollars par année est dépensé pour évaluer un système de services qui engendre des coûts de plusieurs milliards de dollars), l'expérience de secteurs d'activités qui ont investi abondamment dans la recherche montre bien l'importance cruciale de développer des programmes de recherche qui se situent dans une stratégie plus large de mobilisation de connaissances (Huberman, 1994 ; Davis et Howden-Chapman, 1996 ; Dash et al., 2003 ; Lomas, 2003). De ce point de vue, le défi n'est pas de mener plus de recherches en tant que tel, mais bien de créer une culture organisationnelle à l'intérieur de laquelle la question de l'efficacité des interventions devient un élément central de la prise de décisions.

Le présent article examine des modèles émergents de mobilisation des connaissances conçus spécifiquement pour soutenir une utilisation plus systématique de la recherche dans les services sociaux et le développement d'initiatives de recherche suscitées par la pratique et les politiques (" practice and policy-driven demands for research ") et qui portent sur l'efficacité des programmes d'intervention et de prévention. Nous commencerons par examiner les limites des modèles traditionnels de diffusion des connaissances à travers le prisme de notre propre expérience de diffusion. Nous considérerons ensuite certaines recherches qui ont été menées sur les facteurs facilitant et les obstacles à l'utilisation de la recherche dans les domaines de la santé, de l'éducation et des services sociaux. Enfin, nous présenterons un modèle de mobilisation des connaissances qui est mis à l'essai et évalué dans un organisme de protection de l'enfance au Québec.

Les limites de la diffusion traditionnelle

Malgré un nombre sans cesse croissant de références aux notions de " politiques basées sur des données probantes " ou " pratiques basées sur des données probantes ", le défi qui consiste à transposer les données empiriques en politiques et en pratiques exige des stratégies multiples et à long terme qui vont bien plus loin que la diffusion traditionnelle des connaissances. Synthétiser des données probantes grâce à des recensions systématiques, puis les rendre compréhensibles aux décideurs politiques et aux intervenants ne garantit en rien que ces données seront bel et bien utilisées. On se préoccupe de plus en plus du fait que les stratégies de diffusion traditionnelles n'ont qu'une influence limitée sur les politiques et sur les pratiques (Bate et Robert, 2002 ; Waddell et al., 2005).

Notre expérience de la diffusion et de la mobilisation des connaissances au Centre d'excellence pour la protection et le bien-être des enfants (CEPB) illustre plusieurs de ces défis. Au cours des cinq dernières années, le CEPB a développé avec succès un réseau actif de plus de 500 chercheurs, décideurs politiques et dispensateurs de services canadiens. Nous avons concentré nos activités de diffusion à deux niveaux. Le site Web du CEPB reçoit de 8 000 à 10 000 visites par mois et les téléchargements les plus populaires sont des fiches de renseignements de deux pages qui résument les conclusions d'études canadiennes sur la protection de l'enfance ( www.cecw-cepb.ca). Sur certaines questions prioritaires, nous avons également tenu des conférences annuelles traitant à la fois de la recherche et des politiques (par exemple, les approches spécifiques et centrées sur la réconciliation avec les communautés autochtones). Elles ont eu un effet vérifié sur les politiques provinciales et fédérales (ex. : le développement de modèles d'approches différentielles en Alberta, en Ontario et au Québec ; voir Trocmé et al., 2003 ; Loxely et al., 2005).

Bien que ces stratégies aient contribué à renforcer le réseau du CEPB et qu'elles aient augmenté de manière générale l'accès aux travaux de recherche sélectionnés, il a été plus difficile d'observer leur impact sur les pratiques individuelles, sur les services ou sur les politiques des organismes de protection de l'enfance (Conseils et Vérification Canada, 2005 ; voir Agence de la Santé Publique du Canada, 2009). Par ailleurs, aux paliers provincial et fédéral, le CEPB est de plus en plus souvent invité à développer des mécanismes de consultation plus souples qu'un éventuel colloque annuel, qui porte sur des thèmes fixes et qui s'insère dans un cycle (allant de la planification à la présentation des rapports) pour lequel il faut compter de 18 à 24 mois. Une des limites fondamentales de ce type de modèle de diffusion tient au fait qu'en protection de l'enfance, l'ensemble des données probantes disponibles est trop mince pour qu'on puisse répondre adéquatement aux nombreuses questions qui se posent présentement en matière de politiques et de services. Un processus itératif de production, de diffusion et d'utilisation des connaissances paraît alors nécessaire pour soutenir le développement d'un ensemble de données probantes, solides et pertinentes qui permette d'appuyer les décisions sur les politiques et les pratiques en protection de l'enfance.

Mobilisation des connaissances

La mobilisation des connaissances va au-delà d'un modèle de diffusion unidirectionnel dans la mesure où elle désigne un effort pour intégrer la production et l'utilisation des connaissances à la structure fondamentale des organismes (Clark et Kelly, 2005). Jonathan Lomas (2003), directeur de la Fondation canadienne de la recherche sur les services de santé (FCRSS), soutient que, dans les services de santé, les meilleurs exemples d'études ayant une véritable incidence sur la pratique proviennent d'organismes qui ont investi considérablement dans la recherche et l'ont intégrée à tous les niveaux de leur structure organisationnelle, créant ainsi une " culture organisationnelle " qui valorise des données probantes (Lomas, 2003).

Pour parler de diffusion des connaissances, un certain nombre de termes ont été mis de l'avant dans les écrits scientifiques : mobilisation des connaissances, échange de connaissances, transfert des connaissances ou application des connaissances[1]. La notion de diffusion fait référence habituellement au processus de partage des résultats de la recherche, que ce soit au moyen de congrès, de publications scientifiques ou grâce à des conférences et à des publications moins spécialisées et destinées aux professionnels ou au grand public. La notion de transfert des connaissances renvoie plus précisément à la dernière partie de la définition présentée ci-dessus. Elle désigne, par exemple, le processus de diffusion des conclusions des recherches en des termes clairs qui peuvent être compris par des non-spécialistes. Quant aux expressions " application des connaissances ", " échange de connaissances " et " mobilisation des connaissances ", elles sont utilisées pour désigner un ensemble d'activités plus interactives qui couvrent le cycle complet de la recherche : de la production à la diffusion et puis à l'utilisation des données. Le succès de l'application, de la mobilisation et de l'échange est généralement évalué à l'aune de l'influence qu'auront ces connaissances sur les utilisateurs ultimes (par exemple les médecins, les travailleurs sociaux, les professeurs, les décideurs politiques). La FCRSS définit l'échange de connaissances comme :

[...] un effort coopératif des chercheurs et des décideurs visant à résoudre des problèmes grâce à des activités de transfert et d'échange. Un bon échange de connaissances implique des interactions entre chercheurs et décideurs et amène chaque partie à développer ses connaissances dans le cadre de la planification, de la production, de la diffusion et de l'application de la recherche (nouvelle ou existante) à la prise de décision.
FCRSS, s. d.

Pour les besoins de cet article, nous utiliserons l'expression " mobilisation des connaissances " dans le même sens que celui que la FCRSS attribue à " échange des connaissances ".

Les éléments essentiels à une mobilisation efficace des connaissances

Bien qu'on ne fasse que commencer à accorder un certain intérêt à la mobilisation des connaissances dans les services sociaux, de nombreuses études se sont déjà penchées sur cette question dans les services de santé. Il en ressort que les initiatives réussies de mobilisation des connaissances partagent quelques éléments communs, soit : a) la capacité à produire des informations pertinentes, en temps opportun, grâce à des partenariats bien intégrés entre les chercheurs, les décideurs politiques et les dispensateurs de services ; et b) le développement de la capacité, dans les organismes responsables de l'élaboration des politiques et de la dispensation des services, d'intégrer les informations issues de la recherche et de favoriser une culture qui soutienne la prise de décisions fondées sur des données probantes (Harvey et al., 2002 ; Hemsley-Brown et Sharp, 2003 ; Hemsley-Brown, 2004 ; Rycroft-Malone, 2004). Les deux prochaines sections du présent article présentent les conclusions de ces études, d'abord par rapport à la production des connaissances et, ensuite, par rapport à l'utilisation des connaissances. Le tableau 1 présente de manière synthétique les concepts importants.

Tableau 1
Les notions importantes en mobilisation des connaissances

-> Voir la liste des tableaux

Les partenariats de production des connaissances

La plupart des initiatives de mobilisation des connaissances ont évolué au gré de leurs efforts pour augmenter l'influence de la recherche, tout d'abord en se concentrant davantage sur la diffusion des connaissances et, plus récemment, en créant des partenariats de recherche conçus pour mieux intégrer la recherche aux besoins des décideurs politiques et des dispensateurs de services (Gollop et al., 2006).

Denis et Lomas (tel qu'ils sont cités dans Gollop et al., 2006) décrivent la recherche en collaboration comme " un programme de recherche qui évolue en fonction des découvertes cumulatives " que partagent les chercheurs et les décideurs. Ils soutiennent que la collaboration va bien au-delà du fait de conclure des accords sur des projets de recherche dans le but d'atteindre certains objectifs déterminés d'avance. D'après leur expérience, une collaboration pleine et entière inclut les conditions suivantes : a) l'investissement de temps, ou de toute autre ressource exigée par la recherche en collaboration, est considéré utile aussi bien par les chercheurs que les praticiens ; b) la confiance s'installe à partir d'interactions informelles, qui sont essentielles au succès de la recherche en collaboration ; c) pour qu'une recherche en collaboration puisse réussir, un autre élément se combine aux deux premiers, soit la conviction que l'engagement des individus est plus important que les processus mis en place ; et d) la recherche en collaboration est, pour les chercheurs et les praticiens, une aventure à deux (" mutual journey ") dont la destination n'est pas toujours claire. Ce processus intensif de collaboration est perçu comme une condition nécessaire pour faire progresser la recherche, pour que les décideurs fassent confiance à ses travaux et qu'ils les utilisent vraiment (Lomas, 2000 ; Bate et Robert, 2002).

Bâtir la confiance entre les chercheurs et les décideurs

Les partenariats de recherche réussis se construisent sur la confiance qui peut s'installer entre les chercheurs, les décideurs et les praticiens (FCRSS, s.d. ; Hemsley-Brown, 2004). Dans de bonnes conditions, tous les groupes qui s'engagent bénéficieront de la possibilité " d'apprendre de la culture de fonctionnement de chacun et d'établir des relations personnelles " (FCRSS, s.d.). Il a été constaté que le développement de réseaux de communication entre les chercheurs, décideurs et praticiens, et que l'engagement des deux derniers groupes dans le processus de recherche, améliorent l'utilisation qui sera faite des résultats (Hemsley-Brown, 2004). La confiance s'établit et grandit avec le temps, sur la base de l'expérience positive vécue par les partenaires. Les " interactions structurées et non structurées ", " formelles et informelles " sont toutes importantes pour qui veut établir un climat de confiance, évaluer les progrès réalisés et planifier les étapes suivantes (FCRSS, s. d.).

La relation entre les chercheurs, les décideurs et les responsables de l'élaboration des politiques est un des facteurs déterminants pour promouvoir l'utilisation de la recherche dans les organismes. Des communications régulières (par exemple, en personne, par courriel ou par téléphone), des échanges formels et informels, le respect et la confiance mutuels et un dialogue ouvert sont des qualités essentielles à un partenariat efficace. Les chercheurs, les décideurs et les responsables de l'élaboration des politiques ont généralement des trajectoires de carrière et des compétences différentes. Le fait qu'ils fassent partie de cultures professionnelles différentes, qui se rejoignent rarement sans un effort concerté, met en évidence les difficultés à établir une relation de collaboration enrichie de compréhension mutuelle et d'objectifs communs (Dash et al., 2003). Pour toutes ces raisons, des efforts doivent être consentis de manière soutenue pour réunir régulièrement les groupes concernés et pour déterminer clairement les objectifs et les buts communs, les processus et les ressources nécessaires. Les parties doivent aussi construire un langage commun basé sur une compréhension mutuelle, étant donné qu'elles ont souvent des vocabulaires professionnels fort différents dans leurs secteurs respectifs (Dash et al., 2003).

Pertinence et temps opportuns

Les études qui ont examiné, au Royaume-Uni, l'utilisation des résultats de recherche en santé arrivent à la conclusion que l'utilisation effective d'une recherche est déterminée par la mesure selon laquelle les connaissances qu'elle produit sont perçues comme pertinentes, notamment pour le programme d'un organisme important (Hemsley-Brown et Sharp, 2003). La probabilité que les données probantes soient utilisées est moindre si elles ne sont pas perçues comme pertinentes pour traiter les problèmes auxquels les décideurs doivent faire face et si elles ne sont pas facilement disponibles en temps opportun (Hemsley-Brown, 2004). Pour franchir cette barrière, il est donc crucial de proposer : des sujets qui sont d'intérêt pour les décideurs ; une présentation claire des implications politiques et pratiques des conclusions de la recherche ; ainsi qu'une évaluation réaliste de ces conclusions (Hemsley-Brown, 2004 ; FCRSS, s.d.). La pertinence et l'utilisation de la recherche dépendent en partie de la mesure selon laquelle les responsables de l'élaboration des politiques et les dispensateurs de services participent à la préparation du programme de recherche.

L'importance des connaissances spécifiques au contexte

Dans ses efforts pour en arriver à ce que la mobilisation des connaissances dépasse le simple stade de la diffusion, le National Health Service Scotland (NHSS) a récemment exploré l'intérêt d'utiliser des méthodes de recherche-action pour permettre des liens plus étroits entre la production et l'utilisation de la recherche. En s'inspirant du travail sur la mobilisation des connaissances effectué par la Fondation canadienne de la recherche sur les services de santé, le National Health Service Scotland a réalisé une série d'études de cas portant sur les possibilités de mobilisation des connaissances au moyen de la recherche-action (Sharp, 2005). Ses résultats montrent que, parmi les principaux éléments qui contribuent au développement de partenariats efficaces entre les chercheurs, les dispensateurs de service et les responsables de l'élaboration des politiques, figurent : a) une plus grande importance accordée aux projets de recherche spécifiques au contexte local ; b) une intégration des connaissances tacites ; et c) le développement de la capacité d'utiliser les données de la recherche grâce au courtage des connaissances (Sharp, 2005 ; voir aussi Argyris et al., 1985).

Les deux premiers éléments soulignent l'importance d'élargir le concept de production des connaissances au-delà des paradigmes universitaires traditionnels. Tandis que les chercheurs universitaires se concentrent habituellement sur les possibilités de généraliser les connaissances au-delà des cas spécifiques, les responsables de l'élaboration des politiques et les dispensateurs de services ont tendance à accorder plus d'importance à la connaissance locale, car ils sont préoccupés par le fait que le matériel publié dans les revues internationales pourrait ne pas s'appliquer aux contextes dans lesquels ils évoluent. Par ailleurs, en général, les responsables de l'élaboration des politiques et les dispensateurs de services s'intéressent à une gamme plus vaste de données que ne le font les chercheurs. Rycroft-Malone et al. (2004) mentionnent que quatre types de données sont utilisés par les praticiens des services de santé : la recherche, l'expérience clinique, l'expérience du patient et les informations relatives au contexte local. Évidemment, les données d'une recherche ont plus de chances d'être utilisées quand elles sont soutenues par des données des trois autres sources. Cela dit, quand les différentes sources de données en arrivent à des conclusions opposées, les décideurs considèrent la crédibilité relative de chacune des sources, et en particulier la force des devis méthodologiques sous-jacentes aux données provenant de la recherche.

En service social et en criminologie, étant donné que le manque de données probantes pose des défis importants, il est particulièrement important d'aller au-delà des paradigmes traditionnels de la recherche (Mullen et al., 2005). Dans plusieurs champs de pratiques où les études contrôlées sont rares et les études de réitération (" replication studies ") pratiquement inexistantes, peu de questions se prêtent à la méta-analyse ou même à des recensions systématiques sérieuses (Dufour et Chamberland, 2003 ; Flynn et Bouchard, 2005). Mullen et al. (2005) soutiennent que dans de telles situations, on peut néanmoins opter pour une " position fondée sur des données probantes " a) en procédant avec toute la prudence rendue nécessaire par le manque de données concluantes et, b) en abordant les brèches de la recherche par une démarche " à petits pas " qui s'appuie sur la meilleure analyse possible des données déjà disponibles. Bien qu'on puisse se pencher sur la question de l'efficacité de l'intervention en menant des études contrôlées bien conçues, une approche fondée sur des données probantes en est aussi une qui fait la meilleure utilisation des données disponibles (Davis et Howden-Chapman, 1996). En disant cela, il n'est pas question de se contenter de normes insuffisantes, mais plutôt d'être explicite quant à la robustesse des données qui sont utilisées.

En résumé, l'utilisation des données probantes pour guider la prise de décision en matière de politiques et de pratiques dépend de la mesure selon laquelle la recherche est perçue par les décideurs comme pertinente et crédible. Cette pertinence et cette crédibilité, dépendent à leur tour de la mesure selon laquelle les données de recherche proviennent d'un partenariat entre les chercheurs et les décideurs. Les partenariats efficaces exigent que les chercheurs soient disposés a) à laisser les dispensateurs de services et les décideurs politiques participer et façonner le programme de recherche, et b) à utiliser une gamme plus vaste de sources de données.

Soutenir l'utilisation des connaissances

Si produire en temps opportun des données pertinentes et spécifiques au contexte local est une condition nécessaire à la mobilisation des connaissances, le renforcement des capacités d'utiliser ces données et la création d'une culture organisationnelle qui les mette en valeur constituent des facteurs tout aussi importants. En effet, comme nous l'avons fait remarquer auparavant, l'étude sur l'utilisation de la recherche menée par le NHSS a conclu que le développement de la capacité d'utiliser la recherche est un facteur-clé pour qu'il y ait éventuellement une absorption (" uptake ") des données probantes (Sharp, 2005).

Selon la recension que Hemsley-Brown (2004) a fait des études sur les obstacles et les facteurs facilitant l'utilisation de la recherche, la capacité d'évaluer d'un oeil critique les articles de recherche et le fait d'être à l'aise avec leur terminologie comptent parmi les obstacles les fréquemment mentionnés. Selon une étude comparant les habitudes de lecture de vingt professionnels du milieu de l'éducation, du génie, du droit et de la médecine, les premiers sont ceux qui consultent le moins les écrits savants (Latham, 1993, tel que cité dans Hemsley-Brown, 2004). Les éducateurs ont expliqué qu'ils n'avaient pas le temps de lire la recherche et que lorsqu'ils essayaient, ils la trouvaient trop technique et peu pertinente.

L'infrastructure de la recherche et l'accès à un soutien méthodologique jouent un rôle important pour faciliter la transposition des données de recherche en pratiques innovantes (Rycroft-Malone et al., 2004). Dans les organismes qui dispensent des services et qui élaborent les politiques, la capacité de traiter, d'interpréter et de s'approprier la recherche doit être abordée dès l'étape de la planification des projets, et non pas seulement à celle de la diffusion (Rycroft-Malone et al., 2004). Les ressources allouées doivent être clairement définies, constamment régulées (" monitored "), ciblées et elles doivent correspondre aux priorités de l'organisation. La formation du personnel dans le développement des compétences pour repérer, comprendre, évaluer d'une manière critique, adapter et appliquer la recherche est d'une importance vitale pour augmenter la probabilité qu'un organisme mette en application des données probantes.

Kitson et al. (1998) soutiennent que, dans les organismes de services de santé, la présence de facteurs facilitant la recherche est un élément central dans toute stratégie visant à ce que la recherche soit utilisée de manière efficace. Ils proposent un cadre de mise en application de la recherche dans lequel une implantation réussie dépend à la fois des données, du contexte et des stratégies de facilitation. Dans leur modèle, la facilitation va au-delà des simples rôles de diffusion de la recherche et de mise en application, elle fait référence à un processus intensif ayant une fonction habilitante (" enabling ") (Harvey et al., 2002). Bien qu'un nombre croissant d'études soulignent l'importance des facteurs facilitants pour soutenir la mise en application et l'intégration des recherches, il faudrait qu'un plus grand nombre d'études se penchent sur les caractéristiques qui rendent ces facteurs facilitants plus appropriés et efficaces dans certains contextes spécifiques (Harvey et al., 2002).

En plus des questions de capacité, l'étude de Rycroft-Malone et al. (2004) et celle de Harvey et al. (2002) soulignent l'importance cruciale du leadership dans la création d'une culture organisationnelle où les données scientifiques sont valorisées. Dans un sondage sur l'utilisation de la recherche, effectué auprès de 1 989 infirmières et administrateurs de soins infirmiers, Funk (1995, tel qu'il est cité dans Helmsley-Brown, 2004) a trouvé que le facteur facilitant le plus fréquemment mentionné était " une administration qui soutient mieux et encourage davantage l'utilisation de la recherche ". Bref, les praticiens s'inspireront de la recherche dans la mesure où les gestionnaires l'utilisent eux-mêmes et qu'ils la valorisent (Hemsley-Brown, 2004).

Pour réussir à ce que des données probantes soient mises en application dans la pratique, il est primordial que la recherche soit intégrée au coeur du fonctionnement de l'organisme et qu'elle n'en constitue pas une activité à part (Gollop et al., 2006). Dans cette perspective, la recherche intégrative est " caractérisée par un programme de recherche établi selon les besoins de l'organisation, la recherche étant menée en toute collaboration aussi bien par les gestionnaires, les cliniciens que les chercheurs, et ses résultats étant directement transposés dans la pratique grâce à des structures et des systèmes de gestion intégrée " (Lomas, 2003, tel qu'il est cité dans Gollop et al., 2006 : 259). La recherche intégrative montre bien l'importance de créer une équipe de recherche dans un organisme dispensateur de services et de développer un programme pertinent qui soit déterminé par cet organisme, dès le début, dans le but de mobiliser avec efficacité les connaissances au fil du temps (Gollop et al., 2006). Enfin, les organismes doivent,

premièrement, valoriser la recherche dans le but de maintenir une culture de pratique fondée sur des données probantes ; deuxièmement, augmenter la " masse critique " de conscientisation à la recherche au sein du personnel ; et, enfin, apprendre à considérer l'utilisation des données comme faisant partie du processus plus large de production des connaissances.
Hemsley-Brown, 2004 : 539

En résumé, la mobilisation des connaissances exige que les organismes qui ont la capacité d'utiliser la recherche consacrent du temps et des ressources pour soutenir l'accès à la recherche et qu'ils démontrent cet engagement en l'intégrant au coeur de leurs structures de gestion. Dans ce contexte, les partenariats entre les chercheurs, les dispensateurs de services et les responsables de l'élaboration des politiques doivent aller au-delà des projets de recherche partagés. Ils doivent tendre vers l'établissement de mécanismes qui permettent aux universités et à leurs centres de recherche affiliés a) de rendre leurs compétences et leurs ressources disponibles aux organismes de dispensation de services au fur et à mesure que ceux-ci adoptent, pour la première fois, un mode de gestion fondée sur des données probantes, et b) de fournir une infrastructure et une culture organisationnelle qui pourront soutenir la pratique fondée sur des données probantes.

Le projet de gestion fondée sur des données probantes (EBM[2]) de Batshaw-McGill

Un projet de gestion fondée sur des données probantes (EBM) a été conçu et développé conjointement par le Centre de recherche sur l'enfance et la famille (CRCF) de l'Université McGill et les Centres de la jeunesse et de la famille Batshaw (Batshaw Youth and Family Centres, BYFC), à la suite d'une demande des BYFC qui désiraient accroître leur capacité à mieux utiliser la recherche afin de pouvoir suivre l'impact de leurs services et de soutenir le développement de services plus efficaces. Le projet EBM a reçu une subvention de trois ans du Conseil de recherches en sciences humaines (CRSH), grâce au programme Impact du savoir dans la société conçu pour soutenir " les initiatives stratégiques de mobilisation des connaissances fondées sur la recherche universitaire qui permettent aux organismes non universitaires d'acquérir l'expertise de recherche la plus utile pour leurs besoins particuliers en sciences sociales et en sciences humaines " (CRSH - Description du programme de transformation, s.d.). Les autres partenaires sont le CEPB, l'Institut de recherche pour le développement social des jeunes, l'Association des centres jeunesse du Québec, l'Université de Toronto, l'Université de Calgary et l'Alberta Ministry of Children Services.

L'initiative a été mise en place afin de développer et d'évaluer un modèle de mobilisation des connaissances en protection de l'enfance qui sache placer la question des données probantes au premier plan des décisions de gestion et de dispensation des services. L'objectif général est de soutenir le développement d'un modèle de gestion fondée sur les données probantes. Le terme " gestion " fondée sur des données probantes a été préféré à celui de " pratique " fondée sur des données probantes parce que le type de décisions et de données qui sont ciblées à cette étape concernent des questions assez larges de politiques et de dispensation de services et non pas des décisions cliniques qui seraient spécifiques à tel ou tel client.

En s'inspirant des modèles existants, notamment de l'expérience de recherche-action du NHSS (Sharp, 2005), du modèle " données probantes-contexte-stratégies de facilitation " (Evidence-Context-Facilitation de Kitson et al., 1998 ; Rycroft Malone et al., 2006) ou du travail accompli par la FCRSS (Lomas, 2003), l'initiative ici proposée est basée sur une hypothèse voulant que, pour créer une solide culture de recherche " fondée sur les organismes " (" agency-based "), a) la mobilisation des connaissances doit être suscitée par des questions auxquelles les décideurs font face dans leurs activités de tous les jours (c'est‑à-dire pertinentes) ; b) les réponses à ces questions doivent être fournies en temps opportun (en quelques semaines ou quelques mois, mais pas en quelques années) ; c) les réponses données doivent correspondre aux questions posées (c'est-à-dire être précises) ; d) et elles doivent utiliser dans la mesure du possible les informations et l'expertise locales pour éviter autant que possible les procédures de collecte de données additionnelles qui exigent beaucoup de temps et de ressources. En d'autres termes, la boucle d'implantation de la recherche doit être opportune, pertinente, précise et locale.

Le projet concentre ses efforts sur la création d'un programme de mobilisation des connaissances au sein d'un organisme de protection de l'enfance spécifique : les BYFC. Concentrer les efforts sur un seul organisme paraît nécessaire lorsqu'on veut s'assurer que le modèle de mobilisation des connaissances est pleinement mis en application dans toute la structure de gestion de l'organisation et qu'il ne se développe pas comme un projet satellite (Lomas, 2003 ; Sharp, 2005). L'objectif général de cette première étape consiste à créer dans les BYFC une culture de gestion dans laquelle la question des données probantes est à l'avant-plan de toutes les décisions. Les gestionnaires sont ciblés, plutôt que les intervenants de première ligne, puisque les études qui évaluent l'efficacité d'initiatives de mobilisation des connaissances dans les secteurs de la santé et de l'éducation montrent qu'un changement de culture organisationnelle allant vers l'intégration des données probantes est tributaire de la mesure selon laquelle les gestionnaires valorisent et utilisent la recherche (Hemsley-Brown et Sharp, 2003).

Le processus de mobilisation des connaissances s'est mis en place afin d'aider les BYFC à faire un meilleur usage de trois types de données : a) les systèmes d'information sur les services et sur la clientèle ; b) l'expertise clinique ; et c) la recherche déjà existante et les pratiques émergentes.

Suivre les indicateurs de résultats en termes de clientèle et de services

Dans les BYFC, le suivi des informations relatives à la clientèle et aux services s'effectue grâce à un système informatisé d'informations sur les clients, soit le Système clientèle jeunesse, qui fait partie de la Plateforme intégration jeunesse (PIJ) utilisée dans toute la province de Québec. PIJ est un des systèmes d'information sur les services à l'enfance et à la jeunesse les plus complets en Amérique du Nord, mais jusqu'à maintenant, il n'a pas été exploité à sa pleine capacité (voir http://www.cecw-cepb.ca/DocsEng/PIBE20E.pdf). PIJ est utilisé principalement par les travailleurs sociaux de l'organisme lorsqu'ils veulent suivre sur une base individuelle tel ou tel client. Les gestionnaires n'ont pas encore exploité toutes les caractéristiques de cet outil de gestion, se contentant de l'utiliser pour générer des statistiques mensuelles ou annuelles sur le volume et sur le traitement des cas.

Les indicateurs à l'étude ont été choisis et opérationnalisés au cours d'un processus de consultation intensive, d'une durée de 18 mois, auprès d'un groupe de référence réunissant des gestionnaires et des cliniciens seniors choisis parmi tous les services concernés par le Système clientèle jeunesse. Partant d'indicateurs précédemment créés dans le cadre des travaux sur la Matrice nationale des indicateurs d'impacts (Trocmé et al., 2000), nous avons rencontré le groupe de référence toutes les six semaines pour réexaminer les indicateurs émergents. Des décisions ont dû être prises quant à un certain nombre de problèmes complexes, notamment : a) l'échéancier prévu pour suivre les indicateurs (par exemple, la récurrence des mauvais traitements devrait-elle être suivie 12, 24 ou 36 mois après la fin des services ?) ; b) la définition des incidents critiques reliés aux services (par exemple, comment faire la distinction entre les visites planifiées du travailleur social à la maison et les réunifications familiales ratées ?) ; et c) les types de services à inclure dans un indicateur (par exemple, tous les services rendus depuis la première rencontre ou seulement ceux qui ont été rendus après que l'évaluation du cas a été complétée).

Pour quelques indicateurs, plus d'une douzaine de définitions opérationnelles différentes ont été formulées puis comparées et diverses méthodes graphiques et tabulaires de présentation des données ont été comparées. Les membres du groupe de référence ont dû apprendre à construire des définitions cohérentes pour les différents indicateurs qu'il fallait calculer, dans les taux, comme numérateurs et dénominateurs, et aussi comprendre les différences entre les méthodes transversales, rétrospectives et prospectives permettant le suivi des cas. La figure 1 offre un exemple du résultat des décisions qui ont dû être prises. Tel qu'il est illustré dans cette figure, nous avons fini par créer trois cohortes différentes pour suivre les cas : a) une " cohorte de services " pour laquelle sont suivis tous les événements survenus au cours des 36 mois suivant la référence et ce, pour tous les cas adressés pendant une année budgétaire ; b) une " cohorte de récurrence " où tous les cas fermés sont suivis durant une année budgétaire ; et c) une cohorte de placement où les cas sont suivis jusqu'à 36 mois depuis leur placement initial. Les critères d'inclusion et d'exclusion dans chacune de ces cohortes ont été établis d'une façon conséquente.

Figure 1
Cohortes constituées pour le suivi des indicateurs de résultats, EBM 2008

-> Voir la liste des figures

Jusqu'à maintenant, nous avons finalisé six indicateurs et nous travaillons à en définir trois autres. Le tableau 2 présente un exemple du type de rapport périodique que permettent d'établir ces indicateurs (N. B. : des données modifiées ont été utilisées de manière à assurer la confidentialité de données non rendues publiques[3]).

Tableau 2
Indicateurs de résultats des services de protection de l'enfance, 2002-2006*

* Données pondérées basées sur les statistiques administratives analysées dans les BYFC

-> Voir la liste des tableaux

Peu de changements ont été notés durant les quatre années budgétaires analysées jusqu'à ce jour, si ce n'est une possible augmentation du taux de placement et de la proportion d'enfants ayant plus d'une année de retard scolaire. Ces indicateurs fournissent à l'organisme un " niveau de base " par rapport auquel l'effet de nouvelles initiatives pourra éventuellement être mesuré. Il vaut la peine de signaler également que, par rapport aux attentes des gestionnaires, plusieurs indicateurs ont révélé une situation bien meilleure que prévue. Par exemple, le nombre moyen de changements de placement (moyenne de 2,0 ; 60 % des enfants placés n'ayant subi aucun changement ou un seul) était bien inférieur à celui anticipé. Les gestionnaires ont aussi été étonnés de constater que le taux de placement était aussi bas (variant de 35 à 40 %). En effet, les analyses transversales concluent souvent à une proportion plus élevée d'enfants placés, cet artéfact provenant du fait que les dossiers de cas nécessitant un placement sont généralement laissés ouverts pour une période plus longue que les dossiers de cas pour lesquels il n'y a pas de placement.

Chaque indicateur est d'abord analysé à un premier niveau en fonction du motif pour lequel l'enfant est connu de l'organisme et de l'âge de l'enfant. Ces analyses sont présentées sous forme de tableaux accompagnés de graphiques en barres ou histogrammes facilitant l'interprétation des données. La figure 2 en donne une illustration en utilisant la répartition des taux de récurrence selon l'âge. Cette répartition selon l'âge a pu attirer l'attention de l'organisme sur le fait que la récurrence constitue un problème surtout avec la population adolescente. L'histogramme permet un rappel supplémentaire et important, à savoir que même si le taux de récurrence chez les enfants âgés de 6 à 10 ans est à moitié moins élevé que celui des adolescents, il y a presque autant d'enfants de 6 à 10 ans que d'adolescents de 14 à 18 ans qui présentent des problèmes récurrents. Cette première série d'analyses en tableaux croisés a permis d'attirer l'attention sur des sous-groupes spécifiques d'enfants qui sont à risque plus élevé que prévu de connaître de pauvres évolutions. Par exemple, les gestionnaires ont été étonnés de constater des taux d'interruption de placement plus élevés que prévu pour les plus jeunes enfants (0-5 ans).

Figure 2
Récurrence des placements selon l'âge pour l'année 2005-2006 (résultats pondérés fondés sur les données administratives analysées dans les BYFC)

-> Voir la liste des figures

Le plein potentiel de ces indicateurs comme outils de gestion apparaîtra avec le temps. Les données riches qui sont colligées dans PIJ sur chaque cas se prêtent bien à des modélisations multivariées, ce qui aidera les gestionnaires à mieux comprendre les facteurs associés aux mauvaises évolutions. Des comparaisons entre les organismes et entre les provinces aideront également à établir des critères et à déterminer des seuils acceptables pour les différents indicateurs.

Avoir accès à l'expertise clinique

L'expertise clinique peut facilement être négligée en tant que source de données qui permet de surveiller la qualité des programmes. Bien qu'un certain nombre de procédures de supervision et conseil clinique bien développées soient en place partout dans l'organisme, afin de fournir aux travailleurs sociaux une consultation spécifique au cas par cas, aucun mécanisme ne permet de regrouper ces informations à la grandeur de l'organisme.

Deux procédures ont été instituées, afin de combler cette lacune. La première, " les voix cliniques ", a utilisé une combinaison de groupes témoins et d'études de dossiers pour cerner et ensuite quantifier les problèmes émergents. La première ronde des " voix cliniques " a concentré ses efforts sur les problèmes identifiés par le groupe des travailleurs sociaux qui révisent tous les cas actifs. Deux groupes de discussion ont été mis sur pied pour déterminer les problèmes émergents et pour élaborer quelques questions que les réviseurs utiliseraient ensuite pour suivre la fréquence et la gravité de ces problèmes. Un questionnaire électronique d'une page a alors été conçu par l'équipe de recherche et rempli par les réviseurs pour toutes les révisions menées durant une période de trois mois (N = 348). Les résultats ont été analysés, résumés, complétés avec d'autres informations transmises par les réviseurs, puis transmis à l'équipe principale de gestion. Les étapes du retour sur ce rapport et des actions à mettre en place n'ont pas encore eu lieu. Le processus a finalement pris plus de temps que prévu (13 mois, sans inclure l'étape du retour sur le rapport), bien qu'une fois cette expérience initiale terminée, nous avons pu identifier un certain nombre de mécanismes qui devraient désormais accélérer le processus.

La deuxième méthode pour mettre à profit l'expertise clinique de l'organisme a utilisé les groupes de discussion et de consultations spécialisées. Ainsi, les " Groupes d'intégration clinique " (GIC) regroupent des cliniciens seniors partageant une expertise et des intérêts communs avec des chercheurs et des étudiants diplômés qui jouent le rôle de courtiers de connaissances. Jusqu'à maintenant, deux GIC ont été formés, le premier se concentrant sur la violence sexuelle, et le second sur la violence conjugale. Ils se rencontrent régulièrement pour discuter des problèmes cliniques, de même que pour revoir la recherche publiée récemment qui s'applique à ces problèmes. Dans un champ où les décisions politiques sont motivées la plupart du temps par la nécessité de réagir rapidement à des tragédies qui retiennent l'attention du public, l'initiative des GIC et des " voix cliniques " déplace l'attention vers une série beaucoup plus importante d'événements positifs et négatifs, qui peuvent éclairer la mise en place de nouvelles pratiques et de nouvelles politiques.

L'accès à la recherche publiée grâce aux courtiers de connaissances

Les courtiers de connaissances constituent un élément central de la stratégie EBM. Les courtiers de connaissances sont des universitaires et des étudiants diplômés qui aident les gestionnaires de l'organisme à accéder aux données de recherche pertinentes. Ils contribuent également à la formulation de questions auxquelles il est possible de répondre, puis ils rassemblent les informations nécessaires pour soutenir la prise de décisions en temps opportun. Le modèle de courtage met de l'avant une approche interactive qui adapte la recherche et les recensions de bonnes pratiques aux besoins et au calendrier des utilisateurs (Clark et Kelly, 2005).

Le format des rencontres d'information variera selon le contexte. Contrairement à ce qui se passe dans un modèle plus traditionnel de consultation, les courtiers ne produisent pas de rapports formels ; ils repèrent plutôt la recherche publiée possiblement pertinente, ils aident à l'évaluer ou ils soutiennent l'analyse des données administratives. Le modèle de courtage accélère considérablement les temps de réponse. Il permet à l'organisme de développer sa capacité à comprendre et à utiliser la recherche et minimise les coûts de consultation. Jusqu'à maintenant, huit courtiers du savoir - trois membres du personnel enseignant, quatre étudiants diplômés et un étudiant au post-doctorat - ont agi comme courtiers du savoir. Dans cinq cas, ils sont devenus membres de comités permanents, y compris de deux GIC. Ils agissent à certains moments comme adjoints de recherche et à d'autres comme experts de contenu. Dans six autres cas, ils ont fourni du soutien, pour un temps limité, par rapport à des questions spécifiques qui ont été soulevées à divers niveaux dans l'organisme.

Établir un lien avec d'autres initiatives à travers le Québec et le Canada

L'initiative EBM sert de projet pilote pour deux initiatives plus importantes : l'une à travers le Québec, en utilisant le système administratif d'informations sur les clients qui est partagé par les différentes régions, et l'autre en collaboration avec le Groupe de travail fédéral, provincial et territorial sur la matrice d'indicateurs d'impact (FPT-NOM). Dans les deux cas, l'échelle réduite du projet EBM permet des essais et des consultations qui ne pourraient être facilement menés sur le plan provincial ou national. Les indicateurs de résultats qui ont été opérationnalisés grâce au projet EBM sont utilisés pour d'abord démontrer leur faisabilité et leur éventuelle utilité sur le plan provincial et national.

Évaluation

Le projet EBM de BYFC-McGill est une initiative de mobilisation des connaissances qui se consacre à mettre à la disposition des gestionnaires des BYFC les ressources et l'expertise de la recherche universitaire, afin d'aider l'organisation à passer d'une approche fondée sur les données probantes vers une approche par laquelle elle développe et évalue ses propres programmes et politiques. L'efficacité de la stratégie proposée, c'est-à-dire : a) suivre les indicateurs de résultats des services grâce au système d'informations sur les clients de l'organisme ; b) intégrer les courtiers de connaissances aux équipes de gestion ; et c) augmenter l'accès à l'expertise clinique, sera évaluée en examinant des changements dans l'utilisation de la recherche et des données sur les résultats des clients lorsque les gestionnaires doivent prendre des décisions au sujet des politiques et des programmes. Le niveau de base en matière d'utilisation des connaissances a été évalué au début du projet grâce à une série de neuf groupes de discussion réunissant 76 gestionnaires des BYFC et aussi grâce à leurs réponses individuelles à un questionnaire portant sur l'utilisation des connaissances. L'influence du projet EBM sera évaluée au moyen de groupes de discussion de suivi, d'enquêtes, de même que par l'analyse des productions générées par le projet.

Conclusion

La rareté des recherches sur l'efficacité des interventions en protection de l'enfance peut être attribuée à un certain nombre de facteurs, allant du manque de subventions à une faible tradition de recherche en services sociaux, et à la complexité inhérente au fait de mener des études auprès de familles en crise, aux prises avec de nombreux problèmes. Plutôt que de se demander pourquoi les chercheurs n'ont pas concentré davantage leurs efforts dans ce secteur, il serait plus pertinent de savoir pourquoi les dispensateurs de services et les responsables de l'élaboration des politiques n'exigent pas plus de recherches. En effet, du point de vue de la mobilisation des connaissances, l'initiative pour développer un ensemble plus solide de données probantes en matière de protection de l'enfance doit venir des utilisateurs de la recherche plutôt que des producteurs.

La mobilisation des connaissances souligne l'importance de passer des modèles de diffusion unidirectionnels à des modèles itératifs où les chercheurs, les dispensateurs de services et les responsables de l'élaboration des politiques travaillent en partenariat ; des partenariats dans lesquels les dispensateurs de services et les responsables de l'élaboration des politiques sont activement engagés à chaque étape, y compris à celle de la formulation initiale des questions à étudier. Bien que de tels partenariats soient essentiels dans une stratégie de mobilisation de connaissances efficace, ils ne sont pas en soi l'objectif de la mobilisation des connaissances. Dans les initiatives intensives de ce genre, il y a toujours un risque que le processus - c'est-à-dire les partenariats de recherche - soit confondu avec les objectifs de la mobilisation des connaissances. En considérant la mobilisation des connaissances comme un processus itératif (c'est-à-dire une série de boucles en spirale), il y a un risque semblable de perdre de vue les objectifs de ce type d'initiatives.

Or, l'objectif de la mobilisation des connaissances consiste à utiliser la recherche pour aider les décideurs à choisir les programmes et les politiques les plus efficaces. Le succès des stratégies de mobilisation des connaissances en protection de l'enfance peut être évalué en fonction d'une utilisation accrue de la recherche par les décideurs, de la création de mécanismes d'assurance qualité et du suivi des résultats, et finalement de la création d'une demande pour plus de recherches sur les services permettant d'aider efficacement les enfants maltraités et négligés. La mobilisation de connaissances en protection de l'enfance exige un changement de culture radical qui vise à ce que les décisions soient guidées d'abord et avant tout par des données probantes sur l'efficacité des services.

* Données pondérées basées sur les statistiques administratives analysées dans les BYFC

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La mobilisation des connaissances en protection de l'enfance - Criminologie

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La protection de l'enfance est l'un des secteurs de services qui se développent le plus rapidement au Canada. Cependant, nous en savons étonnamment peu sur l'efficacité des services offerts aux enfants maltraités et négligés. Cet article examine de nouveaux modèles de mobilisation des connaissances conçus pour soutenir l'utilisation plus systématique de la recherche dans les services sociaux.

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Soguel, L., Vaucher, C., Bengough, T., Burnand, B., & Desroches, S. (2019). Knowledge Translation and Evidence-Based Practice : A Qualitative Study on Clinical Dietitians’ Perceptions and Practices in Switzerland. Journal of the Academy of Nutrition and Dietetics, 119(11), 1882‑1889.

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Knowledge Translation and Evidence-Based Practice: A Qualitative Study on Clinical Dietitians’ Perceptions and Practices in Switzerland

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Knowledge translation (KT) in health care is essential to promote quality of care and reduce the knowledge-to-practice gap. Little is known about KT a…

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Sharp, C. A., Boaden, R. J., Dixon, W. G., & Sanders, C. (2022). Does the process of developing products for knowledge mobilisation from healthcare research influence their uptake? A comparative case study. Implementation Science Communications, 3(1), 132.

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Abstract

Background

Getting knowledge from healthcare research into practice (knowledge mobilisation) remains a global challenge. One way in which researchers may attempt to do this is to develop products (such as toolkits, actionable tools, dashboards, guidance, audit tools, protocols and clinical decision aids) in addition to journal papers. Despite their increasing ubiquity, the development of such products remains under-explored in the academic literature. This study aimed to further this understanding by exploring the development of products from healthcare research and how the process of their development might influence their potential application.

Methods

This study compared the data generated from a prospective, longitudinal, comparative case study of four research projects which aimed to develop products from healthcare research. Qualitative methods included thematic analysis of data generated from semi-structured interviews (38), meeting observations (83 h) and project documents (300+). Cases were studied for an average of 11.5 months (range 8-19 months).

Results

Case comparison resulted in the identification of three main themes with the potential to affect the use of products in practice. First, aspects of the product, including the perceived need for the specific product being identified, the clarity of product aim and clarity and range of end-users. Second, aspects of development, whereby different types of stakeholder engagement appear to influence potential product application, which either needs to be 'meaningful', or delivered through the implicit understanding of users' needs by the developing team. The third, overarching theme, relates to the academic context in which products are developed, highlighting how the academic context perpetuates the development of products, which may not always be useful in practice.

Conclusions

This study showed that aspects of products from healthcare research (need/aim/end-user) and aspects of their development (stakeholder engagement/implicit understanding of end-users) influence their potential application. It explored the motivation for product development and identifies the influence of the current academic context on product development. It shows that there is a tension between ideal 'systems approaches' to knowledge mobilisation and 'linear approaches', which appear to be more pervasive in practice currently. The development of fewer, high-quality products which fulfil the needs of specified end-users might act to counter the current cynicism felt by many stakeholders in regard to products from healthcare research.

Peer Review reports

Contributions to the literature

This is a novel comparative case study which explores the development of products from healthcare research and is important because the development of products is likely to continue to increase, with associated costs for research funders, researchers and stakeholders.

The tension between the development of such products as a first generation (linear) solution to a problem perhaps better addressed by third generation (systems) approaches is highlighted.

Having a perceived need for the product, clear aims and intended users and paying attention to stakeholder engagement influence the potential of products to mobilise knowledge from healthcare research

Background

The rise in evidence-based practice in healthcare [ 1] has been accompanied by challenges not only in developing the best possible evidence, but also in ensuring that evidence is acted upon appropriately and in a timely fashion. Researchers have long been required to develop journal articles and conference proceedings in order to fulfil expectations set by higher education institutions and funders. However, such academic papers and conference proceedings have limited use in changing practice, and so attention has turned in recent years to demonstrating the 'impact' of research findings upon practice [ 2]. Researchers are now obliged to demonstrate that they have considered dissemination of research findings 'beyond publication' [ 3], with funders expecting them to show how dissemination will contribute to getting the findings into practice [ 4, 5]. How 'research-based knowledge is accessed, applied and embedded' [ 6] into practice using collaboration and engagement with stakeholders throughout the research process and beyond may be referred to as 'knowledge mobilisation'. This paper focuses on the mobilisation of research findings into practice through the development, and use, of research products.

Products from healthcare research

One example of products which aim to mobilise knowledge from healthcare research is toolkits. Using toolkits as an example of research products helps to illustrate a research gap in our understanding of product development and subsequent application, and it is reasonable to assume that similar findings would apply to other products. The development of toolkits in healthcare is rising, exemplified by increasing citations including the terms 'toolkit*' and 'health*' in major health research databases such as PubMed over the last 20 years (Fig. 1).

Rise in citations on PubMed including the terms 'toolkit*' AND 'health*' 2000-2020 [accessed 10/11/2021]

Evidence is lacking regarding both the development and use of research products such as toolkits. Previous qualitative studies have focussed solely on the views of end-users [ 12], with others simply including a description of product development by their developers (e.g. Goyder [ 16]). A scoping review of 83 'health-based' toolkits found that information regarding their development is very scarce [ 17]. Davis and colleagues' qualitative research study [ 12] contributes useful learning to the scant commentary regarding end-users' perceptions of obesity management intervention toolkits, identifying 'a paucity of research on the application of toolkits' (p. 504). Their study focussed on primary and community care clinicians' and administrators' opinions of features and use of these products, rather than considering why or how they might best be developed. A systematic review of the effectiveness of toolkits as 'knowledge translation strategies' included studies which (1) evaluated toolkit effectiveness in supporting integration of evidence into practice, (2) aimed to inform or change practice, and (3) which included a comparison group. Of the 39 studies included, eight were rated as methodologically moderate-strong, with clinical outcomes 'that could be somewhat attributed to the toolkit' ([ 8], p.1). The authors concluded that more systematic approaches to developing and evaluating toolkits were required. Some scholars have called for further research to ensure that the ongoing development of toolkits is 'both effective and a defensible investment of time and resources' ([ 17], p.128).

To summarise, little evidence is available regarding why products from healthcare research are developed, how they are developed or how their development might influence their use. This area is of importance because of the potential for research waste [ 19, 20] if research findings are not mobilised into practice and/or research products which are developed for this purpose fail to achieve their aim.

Models of knowledge mobilisation

The concept of knowledge mobilisation arose from the field known as dissemination, defined as the tailoring and targeting of messages arising from research to its intended audience [ 21]. Proponents of knowledge mobilisation emphasise the importance of long-term collaborations between researchers and research users, the influence of users upon research questions and a reciprocally enhanced understanding of research by end-users and end-users by researchers, in turn [ 13, 22]. Best and Holmes [ 23] conceptualise different perspectives on getting knowledge into action as (1) linear models, (2) relationship models and (3) systems models. This paper uses their 'three-generations' perspective to provide theoretical insight into the process of trying to mobilise knowledge from healthcare research (to which they refer as 'knowledge to action').

First generation, linear models, include 'producer-push' (e.g. traditional academic dissemination through academic papers) and 'user-pull' (e.g. knowledge 'users' commissioning a systematic review) [ 24]. Second generation, or relationship models, incorporate and build upon linear models, focussing on interactions occurring amongst knowledge users and creators [ 25, 26, 27, 28], for example, linkage and exchange, and paying attention to the knowledge that arises from outside of research [ 29]. Third generation, systems models, encompass and builds upon linear and relational approaches. Systems models view knowledge as situated and dependent on context [ 25, 30, 31]. The role of collaboration with stakeholders invested in that knowledge is held in high esteem [ 32]. Best and Holmes' theoretical approach is summarised in Table 1.

Table 1 Best and Holmes' (2010) [23] theoretical approach to knowledge mobilisation

This study aimed to fill the research gap identified in the literature, seeking to understand why and how products from healthcare research are developed, and whether aspects of the product or their development might influence their potential application. It used a prospective, longitudinal, comparative case study design to explore the development and potential use of products from healthcare research. Evaluation of the potential use of each product was based upon objective measurements (website hits) and stakeholder opinion of current and future utilisation [ 33]. By using Best and Holmes's [ 23] systems thinking model of knowledge mobilisation, a theoretically informed approach to the analysis was taken [ 34].

Methods

This study drew upon qualitative data generated from a prospective, longitudinal, comparative case study of research projects aiming to develop products from healthcare research (four cases from a large UK Russell Group University). Its reporting follows the COREQ guidelines [ 35] (Additional file 1).

Study design

This prospective, longitudinal, comparative case study aimed to understand why and how products are developed, and which aspects of the products or their development might influence their potential application. The comparative case study approach enabled the in-depth study of complex contemporaneous phenomena [ 36, 37] and the development of broader generalisations [ 38, 39, 40]. This approach has been advocated for the study of dissemination and implementation research [ 31, 41] more broadly and knowledge mobilisation more specifically [ 23, 42].

Each case study followed the development of 'products' which aimed to help mobilise research knowledge. When designing the study described in this paper, a number of applied healthcare research projects based at the study site planned to develop products for knowledge mobilisation. Four cases were identified using a purposive and pragmatic approach [ 38, 43], selected for their attributes, typicality and feasibility in being able to answer the research question and provide sufficient data from which to draw meaningful comparisons [ 44]. Of six possible cases, one was not awarded funding in time for this research, and it emerged that another was not planning to develop an output that might be regarded as a product from healthcare research, despite initial impressions. All four cases that were approached agreed to participate.

A combination of qualitative methods was employed including semi-structured interviews with stakeholders involved in each of the projects, within-project observations and document analysis. Principal investigators (PIs) were interviewed longitudinally (0, 6, 12 months). Project managers, researchers, stakeholders, funders and organisational leads were sampled purposively, aiming to capture a range of perspectives on the same process, and interviewed once.

The University of Manchester's Research Ethics Committee approved the study, reference 2017-2556-3819. Health Research Authority approval was awarded to cover interactions with National Health Service (NHS) employees (Integrated Research Application System reference 235035). Informed consent was written (interviews) or implied (observations).

Data generation

Interview participants were approached via email. Participants chose interview timing and location (majority face-to-face, remainder by telephone/video conference). Interactions were recorded digitally and transcribed verbatim. Contemporaneous reflexive notes were made. Case study topic guides ( Appendix 1) were informed by exploratory study findings and modified iteratively [ 45]. All interview participants were invited to review transcriptions, redact data and review direct quotes. Three participants chose to review the full transcripts, with two redacting a small amount of information (relating to personal relationships and not affecting the findings). Formal observations of key project meetings, stakeholder interactions and events showcasing products were participant/non-participant [ 46] according to each case's preference, with notes taken contemporaneously using a proforma.

Data analysis

The final coding framework from the exploratory study was entered into NVivo a priori ( Appendix 2). An abductive approach to the thematic analysis used 'deduction and induction to produce theoretical and empirical insights' ([ 47], p. 320), building upon themes generated from the exploratory study, and the literature. Transcripts were checked contemporaneously alongside the completion of 'contact summary forms' ([ 45], p.54) to identify and reflect upon initial themes. Due to the time burden of studying four cases simultaneously, data analysis occurred following the completion of most interviews.

Results

Participants

All four cases were based at The University and already underway in some form when the observations began in September 2017 (Fig. 2). Cases were studied for an average of 11.5 months (range 8-19 months).

Timeline of observations for each case (Where the development ± evaluation of the product were a component of the overall project, they are shown in darker colour. The formal observation period is represented by a black line. NB: for case C, engagement with the project began in June 2016 as the main researcher was part of the team prior to studying this case). *Launch of product (individual text mining tool for case C)

Data were generated from 38 semi-structured interviews with 30 participants, 83 h of observation and analysis of ~ 300 documents (Table 2). Of the 41 individuals approached for an interview, three declined. Interviews lasted a mean of 51 min (range 27-82) and were conducted from November 2017 to March 2019. PIs, researchers (R) and project managers (PM) were based at the university; most stakeholders (S), funders (F) and senior leaders (L) were based at large external organisations, providing a national perspective. Three respondents were familiar with two cases (either because of stakeholder engagement in both cases or due to awareness of the work being done in this field), allowing comparison. No one objected to meeting observations. Documents were sourced from research project files and emails shared with the lead researcher.

Three main themes were identified with the potential to affect the use of products in practice. First, aspects of the product, including the perceived need for the specific product being identified, the clarity of product aim, and clarity and range of end-users. These aspects were interdependent, with no fixed order required. Second, regarding aspects of development, different types of stakeholder engagement appear to influence potential application, which either needed to be 'meaningful' or delivered through the implicit understanding of users' needs by the developing team. A third, overarching theme relates to the academic context in which products are developed, which includes the motivations for product development, and acknowledges the tension arising from the academic context between linear and systems approaches to knowledge mobilisation. Figure 3 summarises the overarching themes.

Main themes influencing the development of products from healthcare research

Case narratives

The case narratives explore the main themes and explain the summary label framing each case. Detailed descriptions of each case and a summary of the themes are presented in Table 3. The key for the quotes is Case_Role_Interview number (PI only), i.e. A_PI_1 st.

Case A

Case A developed a product aiming to aid clinicians caring for patients with syndrome A, as the sole output of a 12-month project. A clinical academic PI recruited several organisations and associated personnel, who had implicit knowledge of the subject and requirements of end-users, to collaborate on product development and contribute to its funding. The PI was motivated to develop the product because syndrome A was a national clinical priority with an evident need for educational resources. The product was developed in collaboration with, and hosted by, a national not-for-profit professional organisation. At the point of the original application, the PI thought that the host organisation would fund it, akin to grant funding. However, in practice, the host organisation charged for product development and dissemination.

Aside from early work which helped form the key themes for the product, very little stakeholder engagement occurred outside of the core team developing the product. The main researcher was an active team member (participant observer), contributing during and outside meetings. The product was promoted over several months by the host organisation's communications team.

Case A's product was regarded as useful for researchers to promote research-derived knowledge and useful for practitioners to improve clinical practice. Ongoing use by practitioners was demonstrated in the consistent numbers of users spending several minutes per visit. Within the first 12 months, web pages were accessed 3264 times (average 272 hits/month (217-479) and 8.17 min (range 06.55-17.25) spent/visit). This, along with the positive perspective of several stakeholders and end-users interviewed: I really do like the content...there's a lot of valuable information on there (AB_S3), informed the framing of Case A's product summary label as 'is being used'.

Case B

Case B's product aimed to enable primary care practitioners to compare local versus national prescribing habits regarding drug B, as one of three aims of a 33-month project (the product was launched 9 months later than planned). The team was led by a clinically trained researcher and consisted mainly of researchers, with relatively high levels of staff turnover. The host regional department was funded nationally, with a remit to deliver two components-'data to knowledge' and 'knowledge to action'-the latter of which meant that product development was, essentially, a requirement of the grant. Although over-prescription of drug B was a national priority and 'something' was needed to address this, respondents reported that 'another' product was not necessarily regarded as the required solution: Throwing another system at them, it will certainly not go down well with all the GPs (B_F), nor that it would necessarily reach the intended end-user: The ones that need it the most may be the least interested, and the least motivated to do it (B_S4).

Formal consultation of stakeholders informed product design. Influential stakeholders with the potential to shape and champion the product were recruited, but the team found it challenging to assimilate and apply feedback from a lot of voices (B_R), with multiple opinions lead[ing] to confusion (B_R). Stakeholders felt their input was treated tokenistically, they didn't even listen to what I said (B_S1, paraphrased as the interview was not audio-recorded), resulting in disengagement. Relationships were rescued by the late arrival of a project manager who understood the complex interface between healthcare research and practice, making the future of the product appear brighter. The main researcher's role was as an observer. The product was hosted by the university with a promotional campaign, including a series of articles on national and regional platforms.

The delayed release meant that it was not possible to evaluate the product's use for the purpose of this study. Stakeholders held mixed views regarding its potential use in practice, which was reliant on overcoming hurdles including formal recruitment, data sharing and ethical approvals, and then engagement by users with the product. These considerations led to its summary label 'might be used': drawing firmer conclusions was inappropriate given the timing of its launch in relation to this study.

Case C

Case C planned to develop a product aiming to support NHS sites to collect, process and present patient experience data, as one of four aims from a 26-month project, supported by a national funding agency. A large multi-disciplinary team of researchers was led by an academic with healthcare professional experience. The PI was motivated to develop the product in order to contribute useful learning to future services. Of the eight projects funded under a single call, four planned to develop similar products.

A clear need for a product was difficult to establish, and potential end-users comprised a diffuse group of professionals. The nature of the research and its findings were not regarded as easily amenable to a 'plug and play approach'; a single coherent, accessible and publicly available product was not delivered: The limitation is that we've certainly not got a big all singing all dancing [product] that is just tomorrow going to drop into another trust and work (C_PI_2 nd). Mutually respectful collaboration was carried forward from previous projects and built upon during this study, with patient and public involvement (PPI) group members and NHS stakeholders working jointly to co-design and implement bespoke tools in four NHS sites. Research team members and volunteers supported the use of the products in practice. Stakeholders had myriad needs at local sites: as the project progressed, it really became apparent the core differences between the sites and the different needs (C_R1), which appeared difficult to distil into a product applicable more generally. The main researcher was embedded within the research team before formal observation for this study began and then acted as a participant observer.

Case C co-designed a number of bespoke tools at each NHS site. Where products were used in practice, their summary label is 'used locally'. A cohesive, publically available product was not developed, and at the point of analysis, one tool was available for use beyond the original research. The tool was published on a website but data regarding hits and downloads were not available.

Case D

Case D developed a product aiming to encourage the use of evidence, as one of four workstreams from a 24-month project, funded by a national charity. The research team was led by an academic. The product was delivered to fulfil a proposal made in the funding application. The aim of the product was quite conceptual which, along with contested definitions of end-users, made specifications difficult to define.

Stakeholders were recruited from a pool of interested academics and senior managers. Formal consultation included interviews and an end-of-study workshop. The product was altered materially in response to these consultation exercises, which stakeholders welcomed. The main researcher's role was as an observer, and they were consulted formally as part of the stakeholder engagement. An external agency was employed to design the product. The team had hoped that the funder would host the product, but it became clear after discussion that their standard policy was not to host work from the projects that they fund, so it was hosted by the university.

Positive feedback from potential end-users focussed on the really neat appearance and presence of a checklist, incorporated in response to stakeholder consultation which makes it real (D_S2). Some team members and external stakeholders who were interviewed reported mixed views of the final product I just can't see how it dovetails in with the current information streams, for clinicians particularly (AD_S1). There was a lack of certainty about who end-users might be, and whether and how they might use it in practice. Numbers (see Table 3) accessing the product were closely aligned with limited early communications activity, with drop-off over time. This gradual reduction in access, along with muted reception from stakeholders interviewed for this research, informed the decision to frame the product's summary label as 'appears not to be used'. Table 4 details the main themes and supporting data in greater depth.

Cross case analysis

Aspects of the product influencing use

This study identified three key aspects of products from healthcare research which may be important in enhancing their use in practice: perceived need, clear aim(s) and clarity of intended end-users. The first aspect is a perceived need for the product, reinforcing previous findings that toolkits are more likely to be used in the presence of a perceived and pre-existing need [ 18]. For example, whilst there was a perceived need for interventions in the areas addressed by cases A and B, case B's product was not regarded as being necessarily the right solution to the specific problem being addressed, potentially hindering its application in practice. It was observed that having clearly defined and instrumental aims for the products was related to a relatively increased application of the products in practice, compared to those with less clarity. Case comparison also appeared to demonstrate a relationship between having a clearly defined and narrow intended end-user group, and product use. For case D, for example, contested terminology used to describe end-users made stakeholder engagement problematic, as stakeholders focussed on the terminology rather than discussing the product itself. The importance of understanding the context for research products, and ensuring that they are timely, relevant and accessible has been acknowledged previously [ 25]. This research adds to those elements, highlighting the importance of a perceived need, clear aim and clarity of end-user, and building upon previous research which focussed on the importance of defining the target audience [ 12].

These key aspects of perceived need, aim and end-user appear to be interconnected, with the presence of all three appearing to be necessary (although they may not be sufficient) for the product to have the potential to be used in practice. When all three aspects were present, teams appeared better equipped to work effectively on developing the product. Where these aspects were unclear (for example case D, with less clearly defined aims and intended users), considerable time and effort were spent either trying to define them or discussing what the product might look like.

Aspects of development influencing use

Participants from all four cases perceived that engagement with end-users and other key stakeholders might influence product application, in line with much of the literature on knowledge mobilisation [ 51, 52, 53, 54, 55, 56]. Case comparison offers interesting insights into the potential influence of stakeholder engagement upon the use of products from healthcare research.

Despite case B's selection of high-profile stakeholders with the potential to champion the finished product, relationships with stakeholders were jeopardised by delays and a lack of communication and strategy [ 57, 58]. Our study provides rich comparative data to illustrate the importance of engaging stakeholders early in the research process and maintaining communication with those who might act as potential research champions, highlighted previously in relation to engaging policymakers [ 25].

Of all the cases, C had the most engagement with stakeholders. That it did not develop a cohesive product for wider use beyond the original research raised a question about whether engaging such a range of stakeholders and in such depth within each local site, somehow stifled this teams' intentions to step back and develop something more generic. This question has been raised by other scholars [ 59]. Despite case D consulting thoroughly with stakeholders, its product appeared not to be widely used at the point of analysis, suggesting that stakeholder engagement during product development may not be sufficient to guarantee use in practice.

Case A offers an interesting counterpoint to the argument that wide stakeholder engagement is necessary to ensure a product is used in practice. Its product was the most widely used, despite relatively low levels of engagement with stakeholders outside the core project team, suggesting that stakeholder engagement may not be necessary for success (although more engagement might have enhanced its use even further). Despite high levels of emphasis in the knowledge mobilisation literature on stakeholder engagement, we are yet to see conclusive evidence that it necessarily results in findings being taken up widely [ 59, 60]. The phenomenon observed here might be explained as follows. Although the development of products is, by definition, a linear approach (by virtue of the information being packaged into a resource by knowledge 'creators' for use in practice), this was mitigated by case A taking a systems approach to developing the product [ 23]. The role of the clinical academic, complemented by an implicit understanding not only of the subject matter but, arguably more importantly, the needs of end-users and the complex system within which they operated, with a strong network and links to high-profile organisations, enabled the development of a product which overcame the limitations that come with developing something so bound to the linear approach. Those cases taking a more linear or relational approach to product development (B and D), appeared less successful.

Discussion

Academic context

One of the challenges resulting from the development of products within the academic context is that they are driven by the desire of, and need for, researchers to (be seen to) mobilise knowledge from their research findings, rather than necessarily due to a clear requirement for the product articulated by a well-defined group of end-users. In all four cases studied here, this meant that the three aspects of the product influencing development ( need, aim, end-user) were approached in a non-linear fashion, and in no particular order. The development of products outside the academic context might reasonably start with defining the end-user, establishing their needs, and aligning the aims of the product with those needs, which this research suggests might lead to enhanced application in practice.

Existing literature has identified that the upward trajectory of the development of products from healthcare research is likely to continue [ 7, 11, 12, 13] and this research contributes to explaining why this is the case. For case B, an explicit part of the funding requirement was to turn 'knowledge to action', so some kind of interactive product was regarded as a necessity. For case D in particular and case C to a lesser extent, products were proposed in the bids due to a perception by researchers that doing so would enhance their chance of winning the award. In contrast, the motivation for development of case A's product was that its development was actively sought as the only output from that specific project, which aligns with the demonstrable need for the product and its successful application in practice.

An overarching theme identified from this research is that the academic context creates a tension between linear and systems approaches to knowledge mobilisation. Despite (some) academics' understanding of knowledge mobilisation principles, including the benefits of taking a third-generation, systems approach, this study highlights that the academic context forces the development of products which are more aligned with a first generation, or linear model [ 23]. Where a systems approach to product development was taken (case A, a relative deviant in this study), this tension was mitigated. This research provides rich evidence for the observation that, within the constraints of the current academic context, practising knowledge mobilisation principles is much harder than preaching them both for researchers [ 57] and healthcare research funding agencies [ 5]. Parallels of the influence of the academic context upon knowledge mobilisation in practice may be drawn with the mismatch between institutional and policy-driven expectations of PPI, and what researchers are able to enact in practice [ 61].

Implications for future product development

The development of fewer, high-quality products which fulfil the needs of end-users might act to counter the current cynicism felt by many stakeholders in regard to products from healthcare research [ 18]. Asking why a particular product should be developed, whether there is a need for it, what is expected of it, who its intended users are, how it should be planned and resourced, who should be involved in that process (and how), how to encourage its use and how to sustain it, might lead end-products closer to fulfilling their presumed aim of mobilising research in ways that best support practice. When considering these questions, it should be possible to conclude that a product is not needed, and to stop the development process where appropriate, thereby avoiding the development and launch of products that are not needed and/or will not achieve their aims.

Teams developing such products should pay attention to understanding end-users and their needs. Where such understanding is lacking within the research team, the importance of meaningful engagement with stakeholders rises. Both researchers and funders might benefit from a heightened awareness that stakeholder engagement requires careful planning and resourcing (in time, effort, and money) and that assigning responsibility for nurturing relationships with stakeholders and collating and assimilating their perspectives are important to optimise their potential to contribute to and champion research products now and in the future. Funders might wish to assess the proportion of grants awarded which propose the development of products, alongside costs committed to such work. They might then try to determine the impact of products which are developed, and the proportion of projects absorbing funds without developing them, in order to understand whether the (public) money they commit to these endeavours is well spent. An alternative model is one where either external agencies or research groups with the specific skills required to develop research products are employed at the project end, once it is clear which findings might generate the greatest impact.

The urge to comply with requests from colleagues to develop a 'how to' guide to product development was resisted initially; if nothing else this research has shown that a 'toolkit for product development' is unlikely to solve many of the issues it has highlighted. However, the potential for such a resource to guide the development of research products is acknowledged, with three important caveats. Firstly, a 'how to' guide alone oversimplifies the conditions necessary to secure 'success' of a product. Secondly, paying attention to relationships and taking a systems approach to product development is likely to improve its potential application. Thirdly, following these recommendations is unlikely to ameliorate the institutional constraints of project-based funding and university reward systems, both of which currently appear to create a challenging context for product development. Table 5 presents some practical questions which were developed following this research. These questions might be asked before and during product development. They are yet to be validated or evaluated; their testing and refinement might offer a pragmatic contribution towards product development in future.

Strengths and limitations

This research includes multi-stakeholder perspectives (researchers, funders, directors, product users) on product development, adding to the few existing studies using a comparative case study approach [ 38, 39] to explore knowledge mobilisation from healthcare research. Its prospective and longitudinal nature documents significant proportions of the research cycle. Member checking and the triangulation of data from multiple sources bolstered credibility [ 49].

The framing of each product studied with a 'summary label' regarding its use aided case comparison and enabled the use of theory. These labels were not regarded as definitive and were assigned under the understanding that their status may change over time.

That all cases were located in the same institution affects the potential transferability of the findings and is a limitation. The study included stakeholders from a wider network than the main institution, and we therefore believe that the findings are likely to be broadly applicable to products developed in similar institutions (i.e. Russell group universities within the UK, and potentially beyond) because contextual factors (e.g. funding and incentive structures; the relationship between healthcare research and practice), are fairly ubiquitous internationally. Studying a broader range of cases across a range of institutions might generate even more transferable findings. Studying similar cases using a more ethnographic approach and for longer might provide further insights into the effect of work aiming to evaluate and sustain products from healthcare research.

Relationships arising between all four authors and study participants were a potential limitation. Performing reflexivity [ 62, 63] was an important part of the research process, in particular for the main researcher, who acted as (participant) observer in all four cases, with the potential for relationships to influence the data and its analysis [ 38, 46]. Care was taken to be transparent when perceived conflicts arose. Reflexivity was practised through written reflexive notes and peer-debriefing sessions. The constructivist approach also mitigated this concern, in which the roles of all actors in generating data and conducting analysis are acknowledged.

Conclusions

This study aimed to understand why and how products from healthcare research are developed and whether aspects of the products or their development might influence their potential application. The study identified three main themes in regard to the development of products from healthcare research. First, aspects of the product which might influence their use in practice, including a perceived need for the product, a clear aim and clear end-user. Second, aspects of development influence potential application, including stakeholder engagement. Third is the influence of the academic context on product development. The academic context forces the ongoing development of products from healthcare research and in doing so adheres to a linear view of knowledge mobilisation, which appears to be in tension with more relational and systems approaches to knowledge mobilisation. Only where a systems approach to product development itself is employed, do products developed to mobilise knowledge from healthcare research appear to overcome this tension.

By presenting findings based on rich qualitative data generated from a longitudinal, prospective, comparative case study of the development of products from healthcare research, including a wide range of research participants, and using existing theory to illuminate those findings, this study contributes to and expands our understanding of the development of products from healthcare research. The study is important because whilst the impact agenda is pursued and the incentive structures within higher education persist in their current state, the development of such products (currently of variable relevance to their intended end-users) is likely to continue.

Availability of data and materials

The datasets generated and analysed during the current study are not publicly available due to restrictions of ethical approvals obtained for this study

Abbreviations

F:

Funder

L:

Senior leader

NHS:

National Health Service

PI:

Principal investigator

PM:

Project manager

R:

Researcher

S:

Stakeholder

References

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Acknowledgements

The authors would like to thank all the participants in this study for their contributions.

Funding

This study was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Author information

Authors and Affiliations

The Centre for Epidemiology Versus Arthritis, The University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PG, UK

Charlotte A. Sharp & William G. Dixon

The Centre for Primary Care and Health Services Research + NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, The Williamson Building, Manchester, M13 9PT, UK

Charlotte A. Sharp & Caroline Sanders

Salford Royal NHS Foundation Trust, Northern Care Alliance, Salford, UK

Charlotte A. Sharp & William G. Dixon

Alliance Manchester Business School, Booth Street West, Manchester, M15 6PB, UK

Ruth J. Boaden

Contributions

CAS designed the study; collected, analysed and interpreted the data (as part of a PhD thesis); and wrote the manuscript. RB, WGD and CS supervised the design and execution of the study. All authors contributed to the writing and reviewing of the manuscript. The authors read and approved the final manuscript.

Authors' information

CAS conducted this research as part of a PhD in Business and Management. She works clinically as a rheumatology specialty trainee and conducted the research during time out of specialty training.

Corresponding author

Correspondence to Charlotte A. Sharp.

Ethics declarations

Ethics approval and consent to participate

The University of Manchester's Research Ethics Committee approved the study, reference 2017-2556-3819. Health Research Authority approval was awarded to cover interactions with National Health Service (NHS) employees (Integrated Research Application System reference 235035). Informed consent was written (interviews) or implied (observations).

Consent for publication

All interview participants provided written informed consent for anonymous quotations to be published.

Competing interests

All four authors had some connection with one or more of the case studies in the study reported here. This is detailed within the methods and mitigated using reflexivity.

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Supplementary Information

Appendices

Appendix 1

Example topic guide for first PI interview

Process

* Talk me through the planned process of product development

* How will you disseminate it?

* How will you sustain it?

* Product aim

* Why have you chosen to develop this product?

* What do you hope the product will do?

* What problem are you trying to address?

* What practice are you trying to improve?

* What is the need for this product?

* What would be different if this knowledge were translated successfully?

Stakeholders

* Who do you think the stakeholders are?

* How have you identified them?

* How do you view the role of stakeholders, and what do you expect from them?

(a) In the project overall?

(b) In developing the product?

(c) How do you plan to engage with them?/What will their role be?

* Is there a different approach for different types of stakeholders?

* At what point did/will they become involved in the project?

* At what point did they become involved in the design of the product?

* What kind of interaction do you have with them?

* Does working with stakeholders create any difficulties for either side?

* What do you think they expect from you?

* What are the benefits to them of being involved in the project?

* What do you think co-design/participatory research means?

Impact

* What do you hope people will do as a result?

* What is your definition of success?

* How will you know whether they have done it?

* Are you going to measure this?

* How are you going to measure it?

* Who else do you think it would be useful to discuss this with?

Appendix 2

Broad theme

Narrow theme

Difficult to access NHS

Use in practice or not...

Pressures

No reward for

Excuse for missing deadlines

Team dispersal

Delays

Organisational priority influences

Lack overall strategy

Funder influencing outputs

Cost

Design costs

Raise profile

Different views from different stakeholders

Ill-defined

Centre of the overall project?

Lack user spec

Initial ambition significantly reduced

Necessary

Predetermined (e.g. did not arise from research)

Assumed

Arose from previous work

Would not use it

Feeling of being observed

Scoping

Good to get views even if the product is unfinished

Arose from previous work

Clear work packages

Learning for researchers

Burdensome

Bolt on

Hard to develop if spec unclear

What could be done differently

Further phases

No reward for doing so

No strategy

Staff turnover

Dynamics

Role within other workstreams

Used appropriately

End user within the development team

Opinions important

Engagement suboptimal (tokenistic vs resources)

Not wide enough

Focus groups hard to arrange

Not clear who they are

Do not know what to do with their input

Organisational priority influences

Lack overall strategy

Funder influencing outputs

Cost

Design costs

Google analytics only

No strategy

Not being measured

Thoughts on how to

Anxiety/fear

Modes

Networking

Learning from experts

Strength influences success

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Sharp, C.A., Boaden, R.J., Dixon, W.G. et al. Does the process of developing products for knowledge mobilisation from healthcare research influence their uptake? A comparative case study. Implement Sci Commun 3, 132 (2022). https://doi.org/10.1186/s43058-022-00360-9
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DOI: https://doi.org/10.1186/s43058-022-00360-9

Keywords

Knowledge mobilisation

Applied healthcare research

Implementation

Qualitative

Products

Dissemination

Toolkits

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Does the process of developing products for knowledge mobilisation from healthcare research influence their uptake? A comparative case study - Implementation Science Communications

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Background Getting knowledge from healthcare research into practice (knowledge mobilisation) remains a global challenge. One way in which researchers may attempt to do this is to develop products (such as toolkits, actionable tools, dashboards, guidance, audit tools, protocols and clinical decision aids) in addition to journal papers.

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Seferdjeli, L., & Stroumza, K. (2011). Partenariat de recherche en Hautes écoles spécialisées Santé Travail social de Suisse occidentale. SociologieS.

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1Depuis une vingtaine d'années, sous l'impulsion d'un modèle nord-américain déjà bien implanté, les pays européens ont initié des réformes majeures ayant pour objectif un rapprochement de la recherche publique avec le monde économique et social (Duval & Heilbron, 2006). En Europe, une institution a joué un rôle de tout premier plan dans la promotion et le développement de ce nouveau modèle, l'Organisation de coopération et de développement économiques (OCDE). La parution en 1996 d'un rapport intitulé L'économie fondée sur le savoir (OCDE, 1996) pose les principaux jalons des réformes politiques économiques et sociales qui doivent permettre de préserver la croissance. Ces dernières vont être reprises par l'ensemble des pays membres avec la promotion, notamment du concept d'" économie du savoir " qui acquiert sa légitimité et devient le fondement des " politiques de l'innovation ".

1 Rapport sur la refondation du paysage suisse des Hautes écoles, Secrétariat d'État à la science et (...)

2En Suisse, les nouvelles orientations en matière de politique scientifique donnent lieu en 1996 à une réforme du " Paysage des hautes écoles " 1 par la création des Hautes écoles spécialisées (HES) portant au niveau universitaire l'enseignement professionnel supérieur ainsi doté d'un mandat de prestations élargi incluant la formation continue, les prestations de services, la recherche appliquée et le développement (Ra&D). Ce geste politique fait des Hautes écoles spécialisées une sorte de laboratoire de la mise en œuvre des nouvelles orientations gouvernementales en matière de politique de la recherche et de l'innovation, dans la mesure où la nouvelle institution intègre formellement et explicitement dans sa structure les objectifs inscrits dans une économie du savoir visant prioritairement l'innovation technologique et le transfert des connaissances au service de l'économie et de la société.

3Pour renforcer le dispositif et soutenir le développement de compétences en recherche " orientée vers la pratique " dans les HES cantonales, un mandat est confié aux deux principales institutions fédérales de financement de la recherche publique : la Commission pour la technologie et l'innovation (CTI) et le Fonds national suisse (FNS). Un instrument spécifiquement destiné au financement de la recherche en HES Santé, Travail social, Musique et Art est mis en place : l'Action DO-REsearch. La condition de financement de ces recherches est l'implication d'un partenaire de terrain dont l'engagement se concrétise par une participation d'environ 30 % du financement demandé.

4Dès lors, dans le contexte des HES, le partenariat de recherche n'est pas une modalité que les chercheurs choisissent et explorent librement en fonction de visées scientifiques spécifiques. Il sort du champ épistémologique et méthodologique pour devenir un instrument politico-administratif qui fait désormais partie de la structure même du système scientifique des hautes écoles, une sorte de passage obligé de toute activité de recherche en HES. C'est ainsi l'ensemble des travaux réalisés depuis 1999 par les institutions de formation Santé et Travail social de la HES qui sont des recherches en partenariat. Cette configuration se présente comme une opportunité vis-à-vis de notre projet qui prend pour objet d'étude la construction des partenariats. Elle permet de suspendre le jugement quant à la catégorisation a priori des recherches et la définition de critères de délimitation. Elle nous permet d'examiner un grand nombre de recherches caractérisées par une diversité d'objets et de méthodes. Si cette diversité est visible dans les comptes-rendus, les ouvrages et autres publications, il n'en va pas de même, en revanche, des modalités de relations avec les terrains et de leurs modes de construction. Ce sont précisément ces derniers que notre travail s'attache à mettre en visibilité. Inscrite dans une approche pragmatique qui situe la genèse des savoirs dans la pratique, la recherche sur laquelle s'appuie cette contribution prend pour objet la construction des partenariats de recherche sous l'angle d'une pratique ordinaire qui ne dissocie pas activité de recherche et construction du partenariat. En s'appuyant sur les narrations des agents, elle ne définit a priori ni le rôle des agents qui s'y engagent ni la nature de leur activité mais cherche à rendre visible le mouvement d'ajustement constant des partenaires, ainsi que la diversité des ressources mises en œuvre pour ce faire.

5Bien que son usage date du xviii ème siècle en France dans le contexte du jeu, du sport ou de la finance (Gonnin-Bolo & Zay, 1995), l'émergence d'un terme de partenariat récurrent dans les discours, au niveau politique notamment, est récente tant dans les dictionnaires que dans les discours. Il apparaît dans les dictionnaires courants à la fin des années 1980, sous la définition suivante : " Système associant des partenaires sociaux ou économiques " (Mérini, 1999). Le terme partenaire lui-même n'est guère plus ancien, il fait son apparition dans les années 1960, d'abord dans les champs de l'économique, du politique et de la gestion, puis progressivement dans ceux du social, de l'éducation et de la santé (Landry & Mazalon, 1997).

6Le partenariat de recherche a cependant derrière lui une longue tradition, qui lui donne sa place au sein des activités habituelles du champ des sciences sociales et renvoie aux mêmes questions qui se sont développées dans les démarches de recherche action, recherche intervention, recherche participative, etc. Dans ce domaine, un grand nombre de travaux sont regroupés dans les courants de la sociologie de l'intervention, de la sociologie clinique, de la psychologie sociale d'intervention, qui tous conservent cependant un a priori disciplinaire qui s'intéresse d'abord à la construction des objets d'études et à leur délimitation à l'intérieur des cadres théoriques habituels de la discipline. Actuellement, cet ensemble de pratiques, dont certaines ont presque disparu, peut se regrouper au sein des principaux courants suivants : l'intervention psychosociologique, la recherche-action, la démarche clinique (Felder, 2007). Au sein de ces modalités de recherche déjà bien établies, la question de la relation au terrain est centrale et traverse l'ensemble des discours. Les réponses apportées sont nuancées et formalisées par une importante production en matière de recherches qui alimente le débat. Ces diverses méthodes de recherche sont fréquemment et traditionnellement regroupées au sein d'une même famille élargie, la recherche appliquée. Elles présentent des caractéristiques communes et adoptent les mêmes présupposés suivants (Brabant, 2006) : i) la finalité de la démarche est double : production de connaissance et changement social ; ii) l'interaction entre les praticiens et le chercheur est au premier plan, les partenaires étant considérés comme des participants ; iii) la démarche est initiée par l'identification d'un problème sous-jacent à la demande ; iv) la position de l'intervenant est celle d'un observateur-participant en même temps que celle d'un analyste-critique ; v) elle se caractérise par la dialectique entre implication et distanciation ; vi) les dimensions éthique et politique sont revendiquées.

7Une orientation majeure réunit ces diverses démarches, elle retiendra particulièrement notre attention : il s'agit de leur positionnement vis-à-vis des disciplines traditionnelles dont elles sont issues. Lorsque l'on consulte en effet les principaux ouvrages de référence dans ce domaine (par exemple : Dubost, 1987 ; Herreros, 2002 ; Barbier R., 1996 ; de Gaulejac & Roy, 1993 ; Lévy, 1997 ; Felder, 2007), on est frappé par la récurrence d'un discours qui argumente et qui tente de justifier la valeur de la démarche proposée vis-à-vis de la discipline académique d'origine et des canons classiques de validité scientifique. Ce plaidoyer, le plus souvent, fait fond sur une logique de positionnement social qui met en position basse toutes les démarches d'intervention. Comme le dit Gilles Herreros :

" Tout se passe comme si [...] les auteurs du corpus classique de la sociologie d'intervention tentaient, pour marquer "leur conformité" sociologique, de brandir leur attachement à quelque "totem" disciplinaire : la science, le respect de la neutralité, la méfiance à l'égard de toute forme d'engagement, le souci de la prise de distance objectivante [...] le rappel de la dissociation entre connaissance et action " (c'est nous qui soulignons) (Herreros, 2002, p. 19).

8La thèse que nous soutenons est la persistance d'un paradigme qui surdétermine les prises de positions et met en opposition la science et la société ou, comme le dit Gilles Herreros ci-dessus, la connaissance et l'action, ou encore, plus proche du sens commun, la théorie et la pratique. Ainsi Jean Dubost, sans équivoque, produit une synthèse des diverses démarches d'intervention qui résume parfaitement ce point de vue :

" Si l'on reconnaît que les problèmes de connaissance, les problèmes d'action et les problèmes d'existence relèvent de logiques distinctes, en partie antagonistes [...], on peut identifier au sein du groupe des pratiques que nous avons définies, trois types "idéaux" d'intervention " (Dubost, 1987, p. 182).

9Le tableau qu'il propose place sur un pôle les " Logiques de connaissance " et sur l'autre pôle les " Logiques d'action et d'existence ", ce qui lui permet ensuite de formuler les trois types " idéaux " sur un continuum : les " Recherches et Études sans action ", les " Recherche-Action " et les " Actions sans recherche ", à l'intérieur desquelles prennent place diverses démarches allant de l'expérimentation de laboratoire, sur un pôle, à l'intervention-consultation sur l'autre pôle.

10L'épistémologie classique nous a habitués à concevoir la science et la recherche à partir des caractéristiques suivantes : la science est sûre, objective, froide, sans lien avec la politique et la société, sans autre histoire que la rectification des erreurs, limitée aux faits, sans avis sur les valeurs et transmise et enseignée par diffusion (Latour, 1995). Cette conception qui réfère à " la science faite ", décrit l'un des pôles de l'opposition paradigmatique entre monde scientifique et monde social, ce dernier présentant toutes les caractéristiques inverses de celles mentionnées relativement au monde de la science : subjectivité, affectivité, contingence, normativité, expérience, efficacité, etc. Il ne s'agit pas là de considérations d'ordre épistémique seulement. Comme on le sait, les deux termes de l'opposition sont hiérarchisés et fondent les modes sociaux d'organisation du travail et de la production. Ils président à la distribution des positions dans l'espace social, la référence et la proximité avec le théorique occupant une position dominante. Si l'on a de bonnes raisons d'objecter que la critique de ce paradigme a déjà fait l'objet de maints développements dans divers courants des sciences humaines et sociales, il n'en reste pas moins que celui-ci continue de surinvestir de manière souvent inconsciente les positions, les analyses et les opinions aussi bien dans le sens commun que dans les discours savants. C'est notamment le cas, pour ce qui nous intéresse, dans les débats théoriques que nous avons examinés plus haut concernant les pratiques de recherche ou d'intervention qui thématisent un type de relation au terrain en rupture avec la recherche académique. Ils ignorent, en amont et en aval de la science faite, les phénomènes qui ne se laissent saisir que lorsque l'on porte attention à la pratique, la pratique en tant qu'elle est autre chose que la simple actualisation de schèmes, principes ou normes logés dans les esprits.

11En demeurant dans ce paradigme, en effet, se trouve escamoté, en amont de la science faite, le processus de construction des savoirs et notamment tout ce que ces derniers doivent au travail de réduction des phénomènes, à la décontextualisation que les chercheurs leur font subir pour qu'ils acquièrent une portée d'une certaine généralité. Des savoirs qui, une fois objectivés, codifiés, stabilisés dans des énoncés, deviennent de l'information et sont censés être disponibles pour l'application. Le partenariat, dans ce contexte, ne peut être que " la juxtaposition d'un système de production de connaissances et d'un système d'utilisation de ces connaissances" (Gélinas & Pilon, 1994, p. 79). La logique de la diffusion ou du transfert renforce, en effet, la confusion entre information et connaissance dans la mesure où elle masque, en aval, le travail de compréhension qu'implique, pour les acteurs, la transformation de savoirs théoriques en " savoirs détenus ", incorporés, disponibles dans l'action (Barbier J.-M., 1996). Cette incorporation se réalise elle-même au travers d'un long travail de modification ou de fabrication de l'environnement, un travail d'inscription de ces savoirs dans des agencements et des objets qui, en définitive, assurent leur disponibilité et leur stabilité dans un milieu de travail (Callon, 1999).

12Autrement dit, si les partenaires de terrain sont considérés a priori comme des agents passifs, consommateurs de connaissances produites par d'autres, alors un pan entier des phénomènes spécifiques à l'œuvre dans le processus de changement que présuppose inévitablement la notion de partenariat de recherche est rendu par là-même invisible. C'est pourquoi prendre au sérieux la recherche comme " science en train de se faire " (Latour, 1995), c'est-à-dire comme une pratique sociale au même titre que celle des partenaires de terrain, oblige à questionner ce paradigme. Dans ce mouvement, il apparaît que le chercheur n'est, ni plus ni moins que les praticiens observés, un professionnel socialement situé, engagé dans une activité (de production scientifique), qui nécessite savoir-faire et " ficelles du métier " (Becker, 2002). L'activité de recherche présente des caractéristiques tout à fait semblables à n'importe quelle autre activité laborieuse ; " on pense de façon exactement aussi incorporée, tacite, matérielle, locale, discutée, tâtonnante, collective dans le bureau air conditionné que dans l'atelier surchauffé " dit Bruno Latour à ce sujet (1996, p. 138). Pour le dire autrement, en reprenant le schéma présenté plus haut, il n'y a pas plus de " recherches et études sans action " qu'il n'y a d'" actions sans recherche " si l'on porte attention aux processus dans lesquels sont impliqués une diversité d'agents au prise avec des environnements mouvants dans lesquels ils agissent pour les transformer et qui les transforment en retour.

13Ce changement de posture modifie le rapport entre connaissance et action que nous avons présenté plus haut :

" La connaissance doit être appréhendée comme une activité qui s'exprime directement et exclusivement dans et pour l'action ; ou, plus simplement, comme l'exercice de cette faculté propre à l'espèce humaine qui permet aux individus de se relier au monde qui les environne et de s'y situer correctement pour y agir en commun. [...] Lorsque la connaissance est envisagée comme activité, elle nomme autre chose que les multiples formes de savoir encyclopédique, théorique ou technique que les individus apprennent à maîtriser " (Ogien, 2010, p. 2).

2 Une citation de Gilbert Ryle reprise par Janette Friedrich (2010) aide à comprendre cette idée " Le (...)

14Cette conception dynamique fait une place majeure au savoir-faire ou savoir tacite des agents, professionnels ou chercheurs. Un savoir-faire non pas sous la forme d'une description, d'un compte-rendu ou d'un discours, qui serait tenu après coup et à distance de la situation, mais un " savoir en fonctionnement " (Friedrich, 2010) 2, un savoir directement déployé dans le cours de l'action et dont l'individu n'a pas nécessairement conscience. Cela nous conduit à pointer du doigt au moins deux types de savoirs dont on peut s'attendre à ce qu'ils participent à la constitution et au maintien des partenariats de recherche : un savoir propositionnel que les agents, chercheurs et praticiens explicitent lorsque l'occasion se présente ou leur en est donnée, et un savoir non-propositionnel (savoir-faire ou savoir tacite) qui se déploie à l'insu des agents, le plus souvent, mais qui est nécessairement convoqué dans l'agir en commun.

15La rencontre entre chercheurs et praticiens est d'abord une rencontre entre des activités hétérogènes. L'ajustement de chacun au cours d'action implique d'incessantes opérations d'anticipation (comment va réagir mon interlocuteur ?), d'objectivation (de quoi s'agit-il ?), de conceptualisation (sous quel type saisir le cas ?) et d'inférence (que puis-je en déduire ?) qui sont indexées à une situation dans laquelle chacun puise des instructions pour s'orienter et mener à bien l'activité. Dans cette perspective, les savoirs sont le produit d'une activité d'enquête, elle-même prise dans une dynamique sociale où les phénomènes de communication et d'énonciation marquent la dépendance de ces savoirs à l'égard du contexte. C'est dans l'enquête pour résoudre une situation problématique que sont déterminées et stabilisées des conduites viables dans des conditions concrètes, l'enquête consistant à imaginer ou à prendre en considération des possibilités et à les tester, et cela jusqu'à ce qu'une forme de résultat stable, assurant un équilibre, soit atteinte.

16Le savoir ainsi conçu pose le problème de l'évaluation des recherches en partenariat. Si les comptes rendus issus de la recherche font l'objet des habituels rapports scientifiques à l'intention des instances de subventionnement ainsi que d'une valorisation écrite ou orale dont l'évaluation par les pairs ne fait pas problème, le savoir-faire acquis dans le cours des rencontres et des activités communes demeure, par sa nature, irrémédiablement diffus. Nous allons voir que si le Fonds national suisse n'intègre pas explicitement cette conception des savoirs tacites dans son dispositif de soutien et d'évaluation, il y est néanmoins sensible.

17Si le Fonds national suisse annonce mettre un terme à son programme DORE en 2011, l'activité de ce dernier depuis 1999 a généré la production d'une masse critique de recherches justifiant la publication de trois rapports successifs. Nous nous sommes intéressées à la manière selon laquelle le FNS intègre la question de l'application dans son évaluation de l'activité DORE. Plus précisément, on prêtera attention aux arguments énoncés sous l'angle de la validation des démarches de recherche appliquée.

18Dans le Rapport des sous-commissions Santé et Travail social pour la reconnaissance des diplômes HES, le principal point soulevé à propos de la recherche appliquée et du développement concerne, en effet, la validation de ces démarches : " La Commission de reconnaissance pense qu'on devra insister sur le principe de la double validation de la démarche et des résultats, d'un point de vue académique (les exigences de validité académiques) et d'un point de vue professionnel (les exigences d'efficacité professionnelle)" (Commission de reconnaissance des diplômes HES cantonaux, 2005, p. 28). Mais la notion de double validation demeure floue et les indicateurs qui permettraient son opérationnalisation ne sont pas définis. En réalité, le seul indicateur d'une forme de validation par les terrains professionnels relève du cofinancement des projets, quelle que soit par ailleurs la nature de ce cofinancement. Le rapport d'activités 2004-2006 signale que " 272 ponts ont pu être construits entre la recherche et la pratique " ( op. cit. p. 21) et, qu'en moyenne, trois partenaires sont impliqués dans chaque projet. Sur le plan financier, la contribution des partenaires se monte à 37 % du financement des projets ( op. cit. p. 22). Il apparaît cependant que la participation financière des terrains n'est pas tant une validation en aval de la recherche qu'une intention de collaboration, en amont de cette dernière.

19Le bilan globalement positif fait par le FNS de l'Action DORE durant la période 1999-2001 s'appuie, de fait, également sur des échanges menés avec les partenaires de terrain. Le constat suivant est relevé :

" D'abord, il semble que de nombreux milieux professionnels peuvent [...] développer une culture de promotion de la recherche comme dimension déterminante de leurs activités. Les retombées de la recherche se situent au niveau d'une amélioration de la pertinence, de la qualité et de l'efficience des pratiques, et dans la maîtrise de celles-ci par les professionnels. Il en résulte souvent aussi, une satisfaction accrue au sein de l'exercice professionnel et donc une plus grande motivation " (Action DORE 2004-2006, p.32, c'est nous qui soulignons).

20Pour formuler son constat, en effet, le FNS s'est appuyé sur des échanges avec les partenaires et c'est leur satisfaction déclarée qui constitue l'indice autorisant un bilan positif. Le rapport précise encore : " La valorisation des connaissances produites par les recherches DORE ne saurait donc se limiter à des bénéfices directement mesurables en termes financiers " ( op. cit. p. 32).

21L'examen de quelques-uns des constats de l'Action DORE permet de mettre en évidence certains des enjeux relatifs à l'étude de la construction des partenariats de recherche en Santé et Travail social. On voit ainsi que, dans le cadre de la recherche appliquée en HES, la problématique des partenariats de recherche prend une allure spécifique dont les lignes sont dessinées par les quelques données objectives récoltées par DORE dans son dernier rapport (financement, partenaires de terrains, distribution par HES des requêtes déposées, etc.). Les données objectives sur lesquelles s'appuie DORE sont quantitatives comme le sont d'habitude les indicateurs qui visent à mesurer l'impact de la recherche dans l'économie. Cet exercice, déjà réalisé en 2005 dans les domaines de l'ingénierie et de la gestion (Impactera, 2006), trouve ses limites lorsqu'il est mis en œuvre dans les domaines de la santé et du travail social. Les commentateurs, dès lors, apparaissent démunis et leurs commentaires ont une allure un peu spéculative, fondés comme ils le sont sur la seule " satisfaction des partenaires ". Difficile d'évaluer le transfert même de connaissances, difficile d'évaluer et de prendre en compte ce qui se passe dans le processus de partenariat à l'aide d'indicateurs quantitatifs.

22Pour avancer dans la prise en compte du processus même de partenariat et de ce qui s'y passe, nous avons mené 16 entretiens avec les différents intervenants de six partenariats dans le champ de la santé et du travail social. De l'analyse de ces entretiens (analyse de contenu et énonciative : Stroumza, 2007 ; Seferdjeli, 2007), nous retenons quatre résultats sur la nature de l'activité partenariale et la conception même du savoir qui sous-tend les modèles de la recherche appliquée.

23Le partenariat est décrit comme un processus empreint d'incertitude, de confiance et d'engagement. Le point de départ du partenariat, ce qui est présenté comme initiateur du processus, est dans la majeure partie des entretiens un événement (un article dans la presse, une table ronde, une rencontre inopinée), mais un événement qui tire sa force d'une rencontre de trajectoires : telles personnes qui se connaissaient déjà ; un contexte politique qui met une thématique sur le devant de la scène ; un changement d'orientation au niveau professionnel, une réorganisation de l'institution. Quelque chose est d'emblée présenté comme acquis à propos de cet événement par les différents protagonistes des partenariats, mais qui reste peu spécifié, assez vague : " ça les intéressait ", " ils étaient partant ". La manière dont est décrit l'événement témoigne d'une rencontre à la fois éthique, politique et épistémique, mais la plupart du temps de façon implicite ou très allusive. Des associations sont tissées dans cette première rencontre, liant événement, milieu de travail, acteurs concernés et promesses de découvertes. Ainsi, dans la question de recherche se niche un engagement éthique et politique : chercher à comprendre l'influence des inégalités sociales sur certaines situations ou encore l'efficacité de certaines pratiques. Et cela implique de prendre au sérieux ces questions, mais également de les considérer comme étant ouvertes, à valider scientifiquement. Il y a là un engagement dans l'accomplissement d'une action en situation qui définit les acteurs concernés par les questions formulées ainsi que par la manière dont ils sont concernés et expriment ou non leur intérêt - phase que Madeleine Akrich, Michel Callon & Bruno Latour (1988) nomment " problématisation ". L'intéressement réussi des partenaires les incite à prendre une part de responsabilité dans la diffusion de la problématisation qui lie les premiers acteurs : les professionnels prennent en charge une part des négociations avec la hiérarchie qu'implique la mise en place d'un dispositif de recherche. Les liens se formalisent dans des conventions, mandats, budgets, demandes de financement impliquant les institutions, définissant des temps et des espaces pour l'activité de recherche.

24Cet engagement des acteurs implique pour eux de se colleter à un développement imprévisible des circonstances, un saut dans l'incertain, en s'exposant à des conséquences futures que l'on ne peut jamais entièrement spécifier à l'avance. Ce saut s'appuie sur des ressources : méthode scientifique, références théoriques qui permettent de poser la question de recherche ; appréhension du contexte politique qui amène à considérer la question comme importante au moment de la rencontre ; enjeux éthiques liés à l'aventure dans laquelle les partenaires du partenariat se lancent et où ils vont en partie dépendre les uns des autres. Cet engagement n'implique pas un accord, son contenu et ses ressources ne sont pas explicités dans les entretiens (seule l'est - et souvent de façon assez vague, la question de recherche), il vient de cette rencontre de trajectoires et de l'acceptation de ce saut dans l'incertain : les partenaires " font confiance au processus de travail qu'ils établissent en commun, se préoccupant de construire un devenir "qui convient" " (Béguin & Cerf, 2009, p. 10), ils ont " confiance dans le devenir-scientifique d'une telle relation " (Thiery & Cerf, 2009, p. 37).

25Le processus de partenariat se déroule ensuite en étroite dépendance avec un contexte mouvant, incertain et les protagonistes s'ajustent, pallient les différents incidents, les contingences indéterminées. Les partenaires doivent utiliser les circonstances pour réduire l'incertitude et traiter les contingences, ainsi qu'agir au bon moment en saisissant les occasions favorables. Cela amène les uns et les autres à s'engager dans des activités auxquelles aucun statut n'est attribué, ni méthodologique ni professionnel, mais qui s'impose à un moment donné et dont la nécessité n'est pas mise en question (participer à une fête, assister à une rencontre imprévue, rédiger un petit texte, prendre des photos...).

26Si le processus est guidé par le requérant principal (ou par délégation à des collectifs), par des questions épistémiques, éthiques et politiques (les ressources de cet engagement), nous sommes néanmoins loin de l'image du requérant principal comme entrepreneur, sur les épaules duquel reposerait le processus car plusieurs intervenants diversifiés interviennent (Akrich, Callon & Latour, 1988) ; de plus, et cela ressort nettement des entretiens, le requérant, comme les autres protagonistes, se soumettent aussi au processus, à sa dynamique, qui sert alors également de guide. Soumission à l'agencement qui implique notamment qu'après (parfois) une phase d'exploration, d'ajustement, de test, où le guidage est confié au corps, à un accordage sensori-affectif, sans disposer du recul, de la réflexion ou de l'anticipation réflexive, l'attention au processus est non-focale. Se retrouvent ainsi, pour décrire ce processus de partenariat, des caractéristiques de toute pratique ordinaire : les chercheurs s'installent sur le terrain, habitent et sont habités par le processus. " La continuité de l'action réclame bien plus que l'obéissance à des ordres, l'application de règles ou la négociation d'un accord. Elle repose sur notre très ordinaire familiarité avec le monde " (Ogien, 2010, p. 9).

27Les entretiens dessinent ainsi une autre conception de l'action de partenariat que celle sous-jacente au modèle de la diffusion, dont les modalités d'ajustement ne seraient que marginales et ne remettraient pas en question la linéarité du processus. Le contexte n'est pas stable et identifié au départ, les protagonistes ne sont pas passifs, l'action n'est pas la simple exécution d'un plan. Les planifications, les anticipations ne sont pas écartées de cette conception mais elles trouvent une autre place, elles servent de ressources parmi d'autres pour guider la réalisation de l'action. Pour s'ajuster aux circonstances, mener ce processus tout en s'y soumettant, interviennent en plus des ressources matérielles, humaines et théoriques : des standards de correction, des normes, à la fois celles de toute pratique ordinaire (politesse, sincérité, loyauté...) et celles propres à l'activité scientifique, et qui lui confèrent sa légitimité (rigueur, neutralité...). Cette conception de l'action ou du processus de partenariat comme excédant ses inputs et ses outputs et comme ayant donc les caractères d'un événement irréductible à ses outputs formalisés, justifie que le processus soit étudié en lui-même (et non seulement son produit). Ainsi, le partenariat n'est pas que la mobilisation ou la définition d'acteurs, d'objets, de contextes, il s'agit d'une activité guidée par le requérant et par les partenaires, mais à laquelle ils se soumettent également, une " activité événement ". Et c'est dans cette dimension événementielle que se nichent des apprentissages, des savoirs tacites.

28Du point de vue pragmatique qui est le nôtre, le partenariat de recherche est ainsi considéré dans ces entretiens comme une expérience que l'on observe, comme " une traversée " modifiant ceux qui la subissent (Ogien & Quéré, 2005). Cette traversée implique la rencontre avec des événements ou des situations qui ne se laissent pas saisir par la simple habitude, du fait du caractère inédit de la rencontre. Les interactions entre chercheurs et praticiens sont sources de découvertes sur le monde et sur soi et elles révèlent de nouvelles possibilités de compréhension et d'interprétation. Elles sont donc " productrices non seulement de vérité, que ce soit sous forme de connaissance ou de compréhension, mais aussi d'individualité (celle de l'événement ou de la situation) et d'identité (celle de celui qui fait l'expérience et est instruit par elle) " (Ogien & Quéré, 2005, p. 37).

29Les activités ajoutées en cours de processus et qui n'ont pas de statut méthodologique ni professionnel (ajout d'un entretien à la méthodologie de départ, mise en avant de collaboration pour satisfaire des instances, venir assister à des événements non prévus dans le protocole, faire de l'entrisme politique), mais dont la nécessité n'est pas mise en question, sont présentées dans les entretiens comme des éléments stratégiques, ajoutés pour rassurer, faire plaisir, montrer que l'on s'intéresse à quelqu'un. Les termes utilisés, la manière de les décrire font écho à des caractéristiques de toute pratique ordinaire. Nécessaires au processus de partenariat mais contingents par rapport à l'activité de recherche ? Cette contingence ou extériorité n'est pas de mise dans tous les entretiens, certains présentent d'emblée ces éléments comme importants pour l'activité même de recherche et dans les entretiens où ces éléments sont présentés comme contingents, la plupart sont finalement reconnus comme utiles à l'activité de recherche (ou plus rarement comme contre-productifs). Cette intrication des éléments stratégiques et épistémiques rejoint un questionnement de la littérature sur le partenariat où s'opposent deux orientations : une tendance à une désacralisation de la connaissance, la privant du caractère de transcendance et d'irréductibilité que lui confèrent les discours épistémologiques et en faisant un discours de part en part " social ", proche d'une pratique ordinaire. Il s'agit, dès lors, dans cette orientation anti-cognitiviste, de rendre compte de la connaissance, en son noyau le plus intime, en termes d'opérations, de stratégies et d'associations (Akrich, Callon & Latour, 1988 ou Latour, 2000, par exemple). Les éléments stratégiques ne sont alors pas extérieurs à l'activité scientifique mais la constituent. Une autre option consiste à récuser ce modèle de la rationalité stratégique et à maintenir une spécificité, quiddité de l'activité scientifique (Ogien, 2010 ; Stengers, 1995). Dans cette optique, le processus de partenariat n'est plus à comprendre d'une manière abstraite comme un réseau qui se laisserait décrire en termes d'opérations, de stratégies et d'associations, mais il convient de le décrire comme un attachement dont il faut étudier la spécificité, celle-ci dépendant en partie de sa soumission à la structure interne de son objet. Le processus de partenariat se soumet en ce sens à l'activité scientifique, à ses normes, à son objet et à son déroulement ; le processus peut également être décrit comme un " faitiche ", au sens qu'il fait faire quelque chose aux partenaires (Latour, 2000). Cette conception du processus de partenariat comme " faitiche " permet de conjuguer à la fois le fait que ce processus est piloté et le fait que les partenaires s'y soumettent. Cela remet en question le fait de situer l'origine de l'action dans les protagonistes même, que ce soit chez les chercheurs (modèle de la diffusion) ou chez les partenaires (conception utilitariste de la science orientée vers l'application). Le terme de " recherche fondamentale orientée vers l'application " utilisé par le Fonds national suisse traduit, nous semble-t-il, un positionnement dans ce débat théorique, un refus d'une conception utilitariste ou uniquement stratégique de la démarche scientifique.

30C'est le fait de quitter le modèle de la diffusion sans pour autant perdre l'autonomie de l'activité scientifique et la manière spécifique dont cette autonomie se joue à l'intérieur du processus de partenariat qui est ici en question. Les entretiens que nous avons menés permettent de soulever le problème mais pas d'y répondre ; pour ce faire, il faudrait inclure dans l'analyse du processus de partenariat une étude fine de l'activité scientifique (requête, articles, rapports, réunions d'équipe...).

31Contrairement à une conception des partenaires considérés comme de passifs consommateurs de connaissances produites par le processus de recherche, les entretiens montrent, conformément à la conception des savoirs tacites, qu'une partie de ces connaissances étaient déjà du côté de l'activité professionnelle.

32Selon les partenariats, et selon les connaissances dont il est question, se retrouvent ainsi, à côté d'un processus de transfert, les processus suivants : mettre en visibilité et légitimer les connaissances tacites ; faire émerger ces connaissances, les élaborer, les formaliser, construire de nouveaux savoirs. Le processus de visibilisation, de légitimation de connaissances déjà-là, s'accompagne dès lors d'un processus de reconnaissance des savoirs tacites. Le processus de partenariat en tant que pratique ordinaire, qu'il convient pour le chercheur d'habiter, permet aussi une familiarisation avec ces savoirs tacites des professionnels, ce qui en soi constitue un apprentissage du côté des chercheurs.

33Dans le champ de la santé et du travail social, le professionnel expert se doit d'être réflexif, cela fait partie intrinsèque de la définition de son activité professionnelle et de sa qualité. " Socialiser un milieu professionnel à la culture de la recherche et à l'attitude réflexive ", pour reprendre le constat d'un évaluateur (Action DORE 2000-2003, p. 4), ne se fait ainsi pas de l'extérieur, comme un apport de connaissances à la pratique professionnelle, mais bien davantage par la dynamique interne au processus de partenariat et à l'activité professionnelle. Ce qui permet d'expliquer que ces processus de partenariat, même s'ils ont formellement tous une fin (fin du financement, restitution du rapport à l'instance de financement, restitution aux professionnels, repas de clôture...) ont semé pour la plupart, quelque chose qui continue au-delà : un dispositif, des instruments de mesure ou d'évaluation, la fabrication d'une plaquette, des changements dans les pratiques. Qualité, efficacité des pratiques, satisfaction et motivation des professionnels (à la fois pour les chercheurs et pour les partenaires) sont affectés dans l'entremêlement des activités professionnelles et de recherche. Temps, rigueur, espace de pensée sont développés au sein même de l'activité professionnelle par la dynamique du processus de partenariat.

34Sur le plan de la légitimation et de la visibilisation des savoirs tacites également, la proximité est grande entre pratique professionnelle et pratique scientifique. Légitimation, visibilisation rejoignent la dimension de témoignages dont la plupart des professionnels partenaires interrogés revendiquent qu'elle fait partie intégrante de leur mission.

35Les professionnels du champ de la santé et du social interrogés estiment qu'il est de leur mission de témoigner des difficultés rencontrées par les usagers, de se faire les porte-parole auprès du monde politique de ce qu'ils nomment la réalité du terrain. La reconnaissance apportée à leurs connaissances tacites n'est ainsi pas uniquement quelque chose qui facilite la motivation et la satisfaction au travail - au sens d'une santé au travail - mais qui est nécessaire à l'accomplissement de ce qu'ils s'assignent comme mission, à la qualité de leur activité de travail (à son efficacité). La fréquentation de situations singulières éprouvantes sur le plan moral - et dont précisément la singularité empêche leur mise en visibilité - affecte conjointement chercheur et praticien. Ces expériences partagées ont parfois réorienté le dispositif de recherche par le biais d'un complément d'entretien ou de catégories supplémentaires dans un protocole.

36Si les partenaires ou plutôt leurs activités servent ainsi de témoins fiables (ou en permettent l'accès) pour l'activité scientifique, ils sont également des témoins auprès des politiques. En effet, la légitimité scientifique du processus de partenariat leur permet de rendre leurs témoignages plus fiables auprès des politiques, de gagner en légitimité et, éventuellement, en représentativité. Plutôt que de parler de mobilisations d'acteurs, les entretiens nous montrent que ce qui est mobilisé, ce qui est développé par le processus de partenariat, ce sont des activités, activité du champ de la santé et du social et activité scientifique. Activités qui produisent, de par leur développement, des connaissances et des apprentissages.

37Ce qu'il nous a importé de montrer au travers de cette contribution, c'est que dans le modèle du transfert ou de la diffusion des connaissances (ou dans tout autre modèle alternatif) se logent des conceptions de l'activité scientifique, de l'activité professionnelle, du dispositif de formation et du savoir qu'il convient d'interroger. Ces modèles répondent, souvent implicitement, aux questions suivantes : quelle autonomie et/ou quelle articulation au politique pour l'activité scientifique ? Quelle conception de l'expertise et de la réflexivité dans l'activité professionnelle ? Quelle place pour les savoirs et les savoirs tacites dans le dispositif de formation ? Ces questions sont au cœur du projet HES - ces universités des métiers - et les défis qu'elles soulèvent obligent à prendre au sérieux l'étude des processus à l'œuvre dans la recherche en partenariat.

3 Voir le travail mené par le groupe EREFIN, Groupe de travail inter-établissements sur l'évaluation (...)

38Dans un contexte où les politiques scientifique se préoccupent de plus en plus de l'impact des résultats de la recherche sur l'économie et sur la société, le développement corrélatif des procédures d'évaluation de la recherche est inévitable. Or nous l'avons vu, ne pas se limiter à une conception des savoirs comme explicites et décontextualisés, pose le problème de l'évaluation des recherches en partenariat. Il s'agit dès lors de ne plus cantonner l'évaluation de l'activité de recherche à ses seuls résultats, c'est-à-dire à la science faite et au jugement de leur originalité et de leur universalité, mais d'y intégrer une évaluation du processus, c'est-à-dire la manière dont ces recherches se mènent - la science en train de se faire - pour rendre partageable à des évaluateurs, non seulement les résultats conçus comme des savoirs produits explicites et décontextualisés mais également les savoirs tacites qui sont présents dans le processus de partenariat. Il serait possible, par exemple, de valoriser et de formaliser le temps passé à mener des activités conjointes entre chercheurs et partenaires pour inclure dans la démarche et rendre visible les phases de discussion, négociation, problématisation, observation ou restitution. Ces phases, comme nous l'avons vu, sont portées par la contingence et échappent à la maîtrise du chercheur 3. Si la recherche appliquée dans les domaines de la santé et du travail social des HES se laisse trop facilement prendre dans la logique des enjeux relatifs à l'innovation technologique - qui impose des critères d'évaluation uniformément quantitatifs et monétaires en grande partie inadaptés à la réalité des phénomènes à l'œuvre dans les processus de partenariat - elle ne pourra pas affirmer la spécificité de ses activités de recherche et préserver ses objets. Non pas tant du risque de soumission à la demande sociale, tel qu'on le conçoit habituellement, mais plutôt du risque de voir des apports majeurs du processus de partenariat pour les pratiques professionnelles, et même pour les pratiques scientifiques, disparaître sous la rationalité économique.

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Mathieu Ouimet Mélanie Rembert Grégory Léon Clémence Rousseau-Cyr Pierre-Olivier Bédart

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La force des liens entre les chercheurs universitaires et les agents de recherche ministériels augmente-t-elle la probabilité d’utilisation par les agents de l’information acquise ? | Revue francophone de recherche sur le transfert et l’utilisation des connaissances

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Interagir avec des chercheurs universitaires fait partie des différentes stratégies à la disposition des agents de recherche des ministères pour accéder, à moindre coût, aux savoirs scientifiques. Dans les faits, certains agents de recherche des ministères québécois entretiennent des relations avec…

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Newman, K., DeForge, R., Van Eerd, D., Mok, Y. W., & Cornelissen, E. (2020). A mixed methods examination of knowledge brokers and their use of theoretical frameworks and evaluative practices. Health Research Policy and Systems, 18(1), 34.

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Abstract

Background

Knowledge brokering is a knowledge translation approach that includes making connections between researchers and decision-makers to facilitate the latter's use of evidence in health promotion and the provision of healthcare. Despite knowledge brokering being well-established in Canada, many knowledge gaps exist, including understanding what theoretical frameworks have been developed and which evaluative practices knowledge brokers (KBs) use.

Methods

This study used a mixed methods design to examine how KBs in Canada (1) use frameworks, models and theories in their practice and (2) how they evaluate knowledge brokering interventions. We gathered interview and survey data from KB practitioners to better understand their perspectives on effective practices. Our analysis focused on understanding the theoretical frameworks used by KBs.

Results

This study demonstrates that KBs in Canada tend not to rely on theories or models that are specific to knowledge brokering. Rather, study participants/respondents draw on (sometimes multiple) theories and models that are fundamental to the broader field of knowledge translation - in particular, the Knowledge to Action model and the Promoting Action Research in Health Sciences framework. In evaluating the impact of their own knowledge brokering practice, participants/respondents use a wide variety of mechanisms. Evaluation was often seen as less important than supporting knowledge users and/or paying clients in accessing and utilising evidence.

Conclusions

Knowledge brokering as a form of knowledge translation continues to expand, but the impact on its targeted knowledge users has yet to be clearly established. The quality of engagement between KBs and their clients might increase - the knowledge brokering can be more impactful - if KBs made efforts to describe, understand and evaluate their activities using theories or models specific to KB.

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Background

Under Canada's health Act, the health sector is administered and operated on a non-profit basis by the public authority. The public health sector in Canada has been moving toward evidence-informed decision-making for many years [ 1]. However, 'knowledge brokering' roles tend not to be formalised or routine, making research on the effectiveness of KB activities difficult to ascertain. Knowledge brokering is a relatively new approach to knowledge translation in which knowledge brokers (KBs) make connections between researchers and decision-makers to facilitate the latter's use of evidence in health promotion and the provision of healthcare. KBs focus on information communication, are typically familiar with the field in which they practice and have a high level of credibility in accessing and interpreting research [ 1, 2, 3, 4, 5]. KBs' responsibilities include finding relevant policy and practice research, synthesising it, organising seminars or meetings, supporting linkages between researchers and decision-makers, and building networks [ 1, 2, 3, 6].

Literature about knowledge brokering in healthcare tends to focus on KBs' roles. They are seen as linking researchers and knowledge users by developing mutual understandings of goals and cultures [ 1, 3, 7, 8, 9]. Other roles for KBs include knowledge management and building capacity to develop knowledge users' understanding and skills and to access and apply knowledge [ 10]. These roles are consistent with Van Eerd et al.'s [ 11] finding that knowledge brokering involves accessing, adapting and disseminating knowledge as well as linking and networking. Despite existing research on KBs' roles, there is neither a standard job description nor a list of acceptable qualifications for KBs. One of the reasons for this is the flexible and responsive nature of the role and its contextual influence; moreover, the variety of personal attributes among KBs, combined with the nuanced contextual factors of any given organisation utilising KB assets makes a standardised KB role difficult to define [ 10].

In a scoping review of the KB literature, Van Eerd et al. found that although KB approaches differ based on stakeholders' desired outcomes, they do have practices in common [ 11]. These include disseminating knowledge, linking/networking, adapting/translating knowledge, acquiring knowledge and enhancing capacity. Activities such as assessing and synthesising knowledge were mentioned less often, and evaluation varied from evaluations of KB roles, end-user research use or awareness, to assessments of knowledge-use processes and practice change [ 11]. Similarly, Bornbaum et al. [ 10] reported on the variability of knowledge brokering practice and the lack of strong evidence for effectiveness; to date, evidence of impact has been mainly anecdotal or theoretical. The lack of evidence for the impact of knowledge brokering may arise because many KB practitioners do not claim responsibility for their achievements, focusing instead on facilitating knowledge acquisition and/or knowledge utilisation processes with and for their teams [ 10]. To understand KBs' effectiveness and to conserve precious healthcare resources, it is important that KBs measure the impact of their interventions and cultivate a culture of evaluation or quality improvement [ 10, 12].

In examining which theoretical frameworks underpinned the studies in their scoping review (research that preceded this current study), Van Eerd et al. [ 11] found the Linkage and Exchange model [ 3] to be the most common, while other studies used models such as the Promoting Action on Research Implementation in Health Services (PARIHS) framework [ 17, 18], the Canadian Health Services Research Foundation model [ 3], the Knowledge to Action (KTA) model [ 19], or Rogers theory of Diffusion of Innovations [ 20]. Almost half of the knowledge brokering approaches examined in their scoping review were guided by multiple frameworks. Similarly, Glegg and Hoens [ 9] note that the PARIHS framework, KTA model, and Diffusion of Innovations can be used to understand knowledge brokering and its impact.

There are several possible reasons for the use of multiple theories in knowledge brokering research. Kislov et al. [ 21] found that KBs most often work in interorganisational networks, university-industry collaborations or collaborative research partnerships, and therefore have intermediary and peripheral/boundary positions. Tensions for KBs working in these positions manifest in requirements for different types of knowledge and different types of knowledge brokering. In such situations, where knowledge is transferred to users without being mobilised in routine practice, KBs need to identify and meet clients' needs to better support evidence-based decision-making at the organisational and policy levels [ 21]. Similarly, Norton et al. [ 22] suggest that drawing on multiple theoretical frameworks can inform the function and roles of KBs, what kinds of evidence might be required, and what mechanisms of knowledge synthesis might be deployed.

Methodology

Study design

The study was approved by Ryerson University's Research Ethics Board. All data were collected and securely stored in accordance with the Tri-Council Policy Statement and Ethics Board requirements.

The study followed the Convergence Model of mixed-methods design, which features two sets of data - one qualitative and one quantitative - that can be integrated (converged) during analysis to validate, confirm or disconfirm findings [ 25]. First, we interviewed knowledge brokering practitioners about KB practices and analysed the interview data. Then, we developed a survey questionnaire exploring the same topics as the qualitative phase (e.g. use of frameworks or models; evaluative practices). Key to the design of the study was to ensure that both the qualitative and quantitative methods addressed the same concepts; hence, the generation of survey response items was informed by the findings from the qualitative data. Accordingly, so that survey participants would not be responding to items that were generated from the interview phase, the two data collection procedures were conducted sequentially and the questionnaire was administered to a separate, mutually exclusive sample - as indicated in the Letter of Information, no one who participated in an interview was asked to complete the survey. We compared the two resulting datasets to examine how KBs draw on frameworks and theory and how they approach evaluative practices. Having two datasets enabled us to examine the data by confirming similar and dissimilar findings.

Study setting, recruitment of participants and sampling

As this study focused on understanding the practices of Canadian KBs, its recruitment strategy focused on KBs practicing in the Canadian healthcare landscape. Selected based on an inclusive list of job titles, contact information of potentially eligible participants was collected from public websites. Potential participants were also sought through knowledge brokering networks and organisations, including the Seniors Health Knowledge Network, Gestalt Collective, Alzheimer's Society, Physical Therapy Knowledge Broker, British Columbia Rehabilitation Sciences Research Network, Canadian Institutes for Health Research, Michael Smith Foundation, Nova Scotia Health Research Foundation, Social Sciences and Humanities Research Council, Canadian Association for Health Services and Policy Research, Canadian Foundation for Healthcare Improvement, and Strategy for Patient-Oriented Research Support units across Canada.

Once the list of potential interviewees was developed, invitations were emailed to eligible participants. A second invitation was emailed to all who did not respond to the first. Constrained somewhat by limited resources, we aimed to recruit six to eight interview participants who represented a variety of KB practitioners, that is, experienced and new, academic and applied, and from different health systems. Similarly, in the quantitative phase, potential survey respondents were recruited by email using snowball sampling, in which participants in the quantitative phase were asked to recommend professional colleagues. We also recruited respondents through the aforementioned list of Canadian health service organisations and associations that develop and/or employ KBs. The survey was initially distributed to 20 organisations and 23 key knowledge brokering stakeholders. Each email to an organisation or stakeholder included a Letter of Information and, for the quantitative phase, a link to the online survey. Organisations and stakeholders were asked to distribute the email invitation to KBs. Data were collected between November 2014 and October 2015. Only participants whose job title potentially identified them as having a professional KB role in the healthcare field, and who were 18 years of age or older and fluent in English were invited to participate in the interviews or survey.

The interviews

To guide the design of the qualitative phase, we adopted a constructionist, grounded theory approach [ 26]. Underpinning this approach is a philosophy that multiple realities exist with respect to social phenomena (i.e. in this case, the processes that are inherent to knowledge brokering) and that researchers come to understand these multiple realities through inquiry and interpretation; that is to say, analysis is informed equally by the data collected and the experience and viewpoint of the analysts. In the qualitative phase, the authors identified as trainees so that we could critically compare interviewees' insights to our own lived experiences with knowledge brokering. These varied from involvement in hospital quality improvement initiatives to nursing education, to organisational design research. Our aim in the qualitative phase was to distil insights that add to our existing knowledge, and that could be mixed with the data from the subsequent quantitative phase; this reflects a belief that mixed methods research offers complementary datasets wherein strengths from the qualitative research (e.g. rich detail of lived experience) are complemented by strengths from the quantitative research (e.g. potential generalisability) such that the research benefits from more insight than either approach could have created on its own.

Given the geographical diversity of the interview participants as well as the project's limited resources, interview data were collected by telephone. Consent was obtained from each participant prior to any audio recording being initiated. The research assistant (i.e. a graduate student with basic training in qualitative inquiry) asked all interview questions included in the interview guide (Additional file 1: Appendix A). All interviews were conducted by the same interviewer. Designed to address the research objectives, the interview questions solicited interviewees' perceptions of how knowledge brokering is defined and enacted. Questions were designed to solicit descriptions of what KBs are, what they do, their use of guiding theory/models, what enables or challenges this use, and opinions and experiences on how KBs could evaluate the success and/or impact of knowledge brokering. Interviews were transcribed verbatim. No additions or revisions were made to the interview guide during the course of data collection.

Analysis of the qualitative data was led by a project team member (RD) with extensive experience in conducting qualitative research and was supported by the lead author (KN). Concurrent with data collection, data were analysed using constant comparison, in which the emergent coding scheme is modified to reflect both newly coded data and existing relevant constructs [ 26]. By the time the last two transcripts were analysed, evidence of thematic saturation was emerging. The interview dataset lent itself to thematic content analysis because the interviewer followed the interview guide closely in each interview, thus enabling us to extract 'strips' of data (e.g. all the data related to the question on defining knowledge brokering; all the data related to the question on using theories/models, etc.). NVivo (Version 9) was used to create 'nodes' delineating each strip of data. Line-by-line coding of each strip of data then followed, wherein annotations featured key words or phrases describing the selected portion of an interviewee's response. Exemplar quotes that offered clear, compelling illustrations of each code were also highlighted. Analysis of each transcript was discussed by RD and KN to identify common insights and to resolve any analytic discrepancies. After coding each transcript, the analysts reviewed the codes assigned, collapsed and renamed the codes to reduce overlap and to enhance clarity, then composed a brief memo summarising that participant's perceptions of knowledge brokering. Finally, these memos were compared across transcripts and integrated into a single set of findings that convey both the similarities and differences among the participants' views [ 25].

The survey

The survey, in English, consisted of an online, anonymous questionnaire. In accordance with Tri-Council Policy Statement and Ryerson University's Research Ethics Board requirements, consent to participate in the study was obtained in the first survey question. Designed to provide data to supplement the interview data, questionnaire items were based on the results of a previously conducted scoping review [ 11] that examined reported approaches, stakeholders and contexts (and outcomes) that KBs use (and achieve) to support healthy aging. After we piloted the survey with five KBs and modified the questionnaire based on their feedback, the final version contained 18 items (10 multiple choice/checkbox questions and 8 open-ended questions). Some of the questions were, "In what type of organisation do you work?" and "How long have you been at this organisation as a Knowledge Broker?" - see Additional file 1: Appendix B. Descriptive statistics were calculated using Excel, and content analysis of the short answers to open-ended questions was completed.

Comparison of datasets and interpreting data

Comparison of the qualitative and quantitative datasets began after initial analysis of the survey and qualitative data. This was done by bringing together the strengths and non-overlapping weaknesses of quantitative methods with those of qualitative methods. Specifically, in comparing the quantitative and qualitative datasets, we sought to distil quantitatively derived insights that could supplement - or what Creswell calls 'embellish' - the qualitative findings by way of getting an indication of how different approaches to theory and to evaluative practices are distributed among KBs. Such analysis enabled us to increase the trustworthiness of our qualitatively derived conclusions [ 25] and is well suited to this study's purpose (to examine theoretical and evaluative practices of KBs) in that the analytic aim is to understand knowledge brokering practices by obtaining different but complementary data on the topic.

Results

This section begins with a description of the study's participants and respondents. Following that, the findings are arranged in two parts, corresponding to the research objectives: examining KBs' perspectives regarding (1) the use of models and theories to inform knowledge brokering practices, and (2) KBs' evaluative practices. Each part draws on both qualitative and quantitative data.

Description of interview participants and survey respondents

Two mutually exclusive groups of KBs were recruited for this study - one for the interviews and one for the survey. The survey and interview parts of the study were carried out sequentially, wherein the interviews and initial qualitative analysis preceded the quantitative data collection and analysis.

Interview participants

A total of eight eligible individuals consented to participate in the qualitative phase from the healthcare sectors in the Canadian provinces of Ontario, British Columbia and Nova Scotia. Interviews lasted between 45 and 75 minutes. To preserve the participants' anonymity in a field where many knowledge brokers know each other, their characteristics are not reported.

Survey respondents

A total of 109 respondents consented to participate. Data from completed questionnaires were excluded from the analysis if participants were not Canadian, did not give consent, or if 50% or more of survey items were not answered. Ultimately, after an analysis of missing data, which was inconclusive, data from 56 respondents (47% of those who responded) were retained for analysis. Respondents self-identified as KBs as all 56 respondents provided an answer to how long they had been a KB and 95% indicated that they were informed by a knowledge brokering approach.

As indicated in Table 1, 63% (35 of 56) of the respondents were from Ontario. Most were early in their careers; indeed, 75% (42 of 56 respondents) indicated they had been in their role for 5 years or fewer. Although there was modest representation from community agencies, governments and not-for-profit organisations working in the healthcare sector, most respondents worked in hospital, educational and research settings.

Table 1 Participant characteristics

As shown in Table 1, over a third of respondents reported a job title explicitly related to a knowledge brokering role (e.g. knowledge exchange, management, mobilisation or translation). Another large group of respondents were senior managers or had roles within the research and policy realms of the healthcare sector. Although the stakeholders with whom respondents interacted varied, interactions with researchers, policy-makers and healthcare-sector stakeholders were the most common.

Use of theories and models to guide knowledge brokering

In an effort to investigate knowledge brokering beyond the focus of existing literature on skills and roles, we examined how KBs' practices draw on and are informed by theories and models of knowledge translation. Our interpretation of the qualitative data analysis highlighted KBs' varied application of current knowledge translation models and theories of practice. Some participants clearly arrange their work according to a particular framework. Others more fluidly approach each project without a preselected framework or model in mind and instead rely on knowledge users or paying clients for direction on the need for an organising framework or model.

To determine whether a particular model is suitable for a specific context and is effective in meeting knowledge users' needs, participants indicated that it is important to thoroughly understand the population with which one works and to select a model that meets the specific needs of the audience. To that end, participants consistently described how they were able to integrate the PARIHS framework and the KTA framework into their interactions in a way that provided conceptual clarity to the project or initiative. For instance, in the case of KTA, the intuitive feeling of progress - from knowledge to action - gives KBs and their clients a process by which they can break down their knowledge brokering initiatives:

Interview participants also referenced the PARIHS framework, noting that it is considered adaptable and supports the inclusion and examination of different sources of evidence. This framework highlights the importance in knowledge brokering of thoroughly understanding context. Participants also spoke of the PARIHS framework's simplicity and concreteness:

Participants who selected the PARIHS framework to guide their practice reported that they chose it because it is considered effective in building capacity to access and apply research knowledge. Other participants described a hybrid of models as most useful for their practice:

" I think we've sort of created a hybrid model of our own. I use process and determinant frameworks to guide my approach with clinicians. Specifically, using the KTA framework to build a plan of for evidence-informed practice, and PARIHS and/or [the Theoretical Domains Framework] to build specific strategies to successfully implement evidence." (Knowledge Broker A)

This explicit hybridisation may reflect what many KBs implicitly rely on to drive knowledge brokering, that is, well-known and arguably fundamental knowledge translation frameworks. Moreover, as indicated by the following quote, participants emphasise doing things rather than framing their work with academic models:

Findings from the survey support the claim that knowledge brokering practices tend to be informed by 'an approach', and model selection varies depending on context and situation (Fig. 1). As with interview participants, survey respondents reported using the KTA and PARIHS frameworks most frequently.

Survey respondents' use of a framework/model to inform knowledge brokering practices

Comparison of the qualitative and quantitative findings shows that not only are KBs in this study familiar with the fundamentals of knowledge translation theory, they either implicitly or explicitly draw on process models (e.g. KTA) or determinant frameworks (e.g. PARIHS) to guide their knowledge brokering. Moreover, these findings seem to indicate that KBs in the study do not rely on only one model or framework; rather, they consider the contexts in which their KB work takes place and draw on models and frameworks that suit those contexts as well as their knowledge users' needs.

Evaluative practices

Interview participants reported a range of evaluative practices, ranging from none at all to passive evaluations, to 'wait and see' approaches, wherein changes to policy and/or practice were taken as indicators of supposedly successful knowledge brokering. While not necessarily representative of typical knowledge brokering 'success', the following quotes effectively illustrate that in some cases, changes in government policy are taken as indications of effective knowledge brokering:

Indeed, it may take quite some time for the benefits of knowledge brokering to manifest, if at all:

" What we will know in a couple of years is, you know, will we see the rates going down? We are able to evaluate - and we have those qualitative measures in place, and [if] there hasn't been a big uptake of what we have been recommending, then we will be able to assess that that didn't work." (Knowledge Broker E)

Such findings can be interpreted as a means by which KBs operationalise the impact of their work. With more of a focus on the evaluation of how knowledge brokering services were provided, other KBs who regard their practices as what they call " customer service units " take client satisfaction as the best indicator of success:

" When something hasn't gone right, we hear about it. We are a customer service unit, so we hear about it if our service isn't appreciated. So that [feedback] is coming from our faculty members who are involved in our service, as well as our community partners who are involved in our service." (Knowledge Broker C)

" Well it's easy for us, because the only way we're keeping score is that we keep getting clients. We have a fruitful business, and have [been] for four or five years now. And yeah, I'm kind of joking, but I do think that [repeat business] is an indicator of successful approaches." (Knowledge Broker H)

Others take a return to the status quo as an indication that knowledge brokering had little impact:

These qualitative data suggest that KBs' evaluative practices vary significantly, from tracking health outcome and policy changes, to those that are somewhat informal and unstructured. The survey data confirmed this finding. As shown in Fig. 2, 23% of respondents indicated that they 'Never' or 'Rarely' evaluate the impact of their knowledge brokering practices; a similar portion (23%) 'Sometimes' do, whereas only 50% responded that they 'Usually' or 'Always' evaluate their practices.

Survey respondents' tendency to evaluate impact of knowledge brokering

For respondents who do assess the impact of their knowledge brokering practices, the specific metrics or indicators they use are shown in Fig. 3. Notably, the most common indicators of success are producing knowledge products that are used, as measured by, for example, the number of website visits and file downloads.

Knowledge brokering metrics and indicators of success

When asked in the survey to describe what outcomes are most important for assessing knowledge brokering success, most respondents chose research evidence being used in decision-making. Less frequently chosen indicators of success were newly created partnerships characterised by two-way knowledge exchange, and evidence of changes in policy or practice. Although respondents' recognition that outcomes are important in knowledge brokering is perhaps not surprising, there appears to be a lack of formal, structured knowledge brokering evaluation. More common are informal assessments that assume that if partnerships between knowledge users and KBs were created, research evidence will be used in decision-making; ultimately, the partners (i.e. KBs and knowledge users) wait to see if changes in practice or policy emerge.

Discussion

In contrast to these informal evaluative practices, formal evaluations should aim to, first, assess knowledge brokering impact in terms of practice and/or policy change and, second, determine how and to what extent particular knowledge brokering activities helped achieve those outcomes. The literature on evaluative practices, especially programme evaluation, has proliferated in the past decade [ 27, 28, 29], and includes widely accepted guidance on developing project-appropriate logic models, outcomes and outcome indicators. Dobbins et al. [ 30] recently found that a knowledge translation intervention delivered by KBs resulted in improvements in evidence-informed decision-making knowledge, skills and behaviours, suggesting that, if KB researchers develop concrete, actionable indicators and ways to measure them - informed by theories, models or frameworks and keeping in mind a wide range of stakeholder perspectives - perhaps a culture of evaluation can grow within knowledge brokering. A culture of evaluation may further define knowledge brokering roles and qualifications, which may be of use to organisations as they create knowledge brokering positions and related job descriptions.

This study's findings about the use of theory or models to guide knowledge brokering are consistent with what Van Eerd et al. [ 11] identified in their scoping review - there appears to be much variability, which may reflect KBs' efforts to find theories or models that match knowledge users' context and needs. Both our qualitative and quantitative findings point to two frequently endorsed frameworks: the KTA model [ 19], which Nilsen et al. categorise as a process model [ 13], and the PARIHS framework [ 17, 18], seen by Nilsen et al. as a determinant framework. KBs' familiarity with KTA and PARIHS may reflect their familiarity with the fundamentals of knowledge translation. As a process model, KTA is deemed useful in describing to clients the steps of acquiring, tailoring and applying research evidence [ 19]. Similarly, PARIHS, with its emphasis on understanding how successful implementation is determined by facilitation strategies, robustness of evidence and by the context in which change is being introduced, provides KBs with three concrete, intuitive realms in which to focus brokering [ 17, 18]. The absence in our findings of models or theories specific to knowledge brokering can perhaps be understood as a reflection of knowledge brokering being one knowledge translation strategy. It appears that, among our study's samples, KBs' aim in knowledge brokering is to reach knowledge translation goals; hence, they may rely on knowledge translation frameworks (such as KTA or PARIHS) rather than knowledge brokering theories.

Nilsen et al.'s [ 13] three approaches to the use of theory among knowledge practitioners might be useful to KBs. These are describing the process of translating research into practice, understanding or explaining what influences implementation, and evaluating it. Were KBs able to clearly identify into which of the three approaches their clients' needs fit by describing, understanding or evaluating implementation, then perhaps KBs could more readily and accurately hone in on the model, theory or framework that best matches their knowledge users' evidence needs. If the end users that KBs are serving do not explicitly ask for an evaluation of impact, it may be that the extent of KBs' theorization is limited to describing and understanding the intervention and the evaluative aspects of popular frameworks like the KTA and PARISH are under utilized. Inconsistent and, in some cases, non-existent evaluative practices in knowledge brokering remain a concern, especially in light of others' assertions that knowledge brokering has not robustly demonstrated its effectiveness as a knowledge translation strategy that builds capacity to access and apply research knowledge [ 10].

Our study has several limitations as well as strengths. Given the dearth of literature about KBs' use of theories, models and frameworks, we had hoped that the qualitative phase of our study would yield data-rich insights into how KBs use theory. Instead, our findings describe which theories are used, and in which circumstances. Future research could delve further into KBs' use of theory, especially with respect to which KB-practice decisions are informed by it, and how explicitly used theories interact with the theories implicit in KBs' tacit knowledge bases, and how one's theoretical orientation impacts the way(s) in which knowledge brokering work is evaluated. Another limitation of our study is the small sample of interview and survey participants. Although we observed theoretical saturation in the eight interview transcripts, a larger sample may have yielded more diverse views. Conversely, our achievement of theoretical saturation suggests that the qualitative phase addressed core concepts in answering our research questions. Indeed, our focus on KBs' use of theory and their evaluative practices may have contributed to this saturation. We also cannot rule out selection bias given the small sample size and recruitment methods. Other strengths of the study include its mixed-method design, which compared qualitative and quantitative findings on the same topics to create a more comprehensive, in-depth understanding of the phenomenon being examined and to enhance the findings' credibility. Furthermore, we believe, as authors and analysts, that by giving credence to our own lived experiences with knowledge brokering, we were able to further enhance the credibility of the findings; for example, our own familiarity with the PARIHS and KTA frameworks facilitated a deeper understanding and appreciation of our participants' responses than could have been achieved by a researcher from outside of the field. Similarly, our experiences with projects that have been robustly evaluated as well as with projects that lack a strong evaluation resonated strongly with the data provided by the participants; our critical analysis and discussion of the findings was strengthened by such resonance.

Conclusions

Our study has several implications for knowledge brokers that build on Nilsen et al.'s [ 13] assertion that it is useful to take a three-pronged approach to the use of theory in knowledge brokering. First, we encourage KBs to integrate evaluative practices into their work, so that the outcomes that result from their engagement are assessed using appropriate, accessible outcome measures. Second, to understand whether and how knowledge brokering is effective, the evaluation plans of knowledge brokering projects might include objectives, activities, outputs and outcomes specific to knowledge brokering.

As a form of knowledge translation, knowledge brokering continues to expand, but it has yet to clearly establish what impact it has on its targeted knowledge users with respect to their capacity to access and apply research evidence. Engagement between KBs and their clients might improve if KBs made efforts to engage their knowledge users in discussions that explicitly describe the processes being considered to translate research into practice, which may in turn help KBs and knowledge users alike better understand what factors influence the implementation of these processes, and how to best develop an appropriate, robust evaluation plan. Such knowledge brokering practices would reflect an understanding that the needs of knowledge users and clients are not exclusive of the need to incorporate theoretical and evaluative activities; balancing practical and theoretical/evaluative imperatives is a goal to which knowledge brokering practitioners might aspire.

Availability of data and materials

The datasets analysed during the study are available from the corresponding author on reasonable request.

Abbreviations

KBs:

Knowledge brokers

KTA:

Knowledge to Action model

PARIHS:

Promoting Action on Research Implementation in Health Services framework

References

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Acknowledgements

The authors acknowledge and thank the study participants and respondents for their time and contributions. The authors also acknowledge and thank Dr Robin Urquhart, Dalhousie University, for her thoughtful contributions to the early discussions on the study's conceptualisation. The authors also thank the Faculty of Community Services, Ryerson University for Writing Week editorial support.

Funding

This study was funded by a Ryerson Health Research Funds grant and by the Faculty of Community Services, Ryerson University.

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Authors and Affiliations

Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada

Kristine Newman & Yan Wei Mok

World Health Innovation Network, Odette School of Business, University of Windsor, Windsor, Canada

Ryan DeForge

Institute for Work & Health, Toronto, Canada

Dwayne Van Eerd

Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada

Evelyn Cornelissen

Contributions

KN, RD, DVE and EC conceptualised the study. The literature was reviewed by KN and RD. Data were collected by KN and YWM. Data analysis was conducted by KN, RD and YWM. The manuscript was drafted by KN and RD. All authors contributed to the final manuscript, and they read and approved it prior to submission.

Authors' information

The primary author, Dr. Kristine Newman, may be contacted at Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada, M5B 2K3, or by telephone at 01-416-979-5000 × 4160.

Corresponding author

Correspondence to Ryan DeForge.

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This study was approved by the Ryerson University Research Ethics Board, No. 2014-250-2.

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This study has obtained consent to publish from the participant to report data.

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The authors declare that they have no competing interests.

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Newman, K., DeForge, R., Van Eerd, D. et al. A mixed methods examination of knowledge brokers and their use of theoretical frameworks and evaluative practices. Health Res Policy Sys 18, 34 (2020). https://doi.org/10.1186/s12961-020-0545-8
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Keywords

Healthcare

Implementation and dissemination

Knowledge broker

Knowledge translation

Mixed methods

# data[].attributes.attachment_link.title
A mixed methods examination of knowledge brokers and their use of theoretical frameworks and evaluative practices - Health Research Policy and Systems

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Background Knowledge brokering is a knowledge translation approach that includes making connections between researchers and decision-makers to facilitate the latter's use of evidence in health promotion and the provision of healthcare. Despite knowledge brokering being well-established in Canada, many knowledge gaps exist, including understanding what theoretical frameworks have been developed and which evaluative practices knowledge brokers (KBs) use.

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Neal, J. W., Posner, S., & Brutzman, B. (2023). Understanding brokers, intermediaries, and boundary spanners : A multi-sectoral review of strategies, skills, and outcomes. Evidence & Policy, 19(1), 95‑115.

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Understanding brokers, intermediaries, and boundary spanners: a multi-sectoral review of strategies, skills, and outcomes

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Background: Brokers, intermediaries, and boundary spanners (BIBS) bridge research and policy or practice, and can elevate the role of evidence in decision making. However, there is limited integration of the literature across different sectors to understand the strategies that BIBS use, the skills needed to carry out these strategies, and the expected outcomes of these strategies.

# data[].attributes.body
Neal, J. W., Neal, Z. P., & Brutzman, B. (2021). Defining brokers, intermediaries, and boundary spanners : A systematic review. Evidence & Policy: A Journal of Research, Debate and Practice.

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Minogue, V., Morrissey, M., & Terres, A. (2022). Supporting researchers in knowledge translation and dissemination of their research to increase usability and impact. Quality of Life Research.

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References

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Acknowledgements

The authors are grateful to all members of the Knowledge Translation, Dissemination and Impact Project Working Group and implementation group who are responsible for the delivery and oversight of the project. They would also like to acknowledge the input of the Patient and Public Involvement Knowledge Translation Sub-group.

Funding

No external funding was sought for this project.

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Authors and Affiliations

Strategy and Research, HSE Research and Development, Jervis House, Jervis Street, Dublin 1, Ireland

Virginia Minogue

HSE Research and Evidence, Strategy and Research, 4th Floor, Jervis House, Jervis Street, Dublin 1, Ireland

Mary Morrissey

Strategy and Research, HSE, Jervis House, Jervis Street, Dublin 1, Ireland

Ana Terres

Contributions

VM, MM, AT contributed to the development of the research study and design. VM and MM drafted the manuscript, and all authors critically reviewed each version of the manuscript and read and approved the final version. VM and MM are the HSE leads for the knowledge translation, dissemination and impact project which is part of the HSE Action Plan for Health Research. AT is the lead for the implementation of the plan and oversees the work of the KT workstream.

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Correspondence to Virginia Minogue.

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Minogue, V., Morrissey, M. & Terres, A. Supporting researchers in knowledge translation and dissemination of their research to increase usability and impact. Qual Life Res 31, 2959-2968 (2022). https://doi.org/10.1007/s11136-022-03122-1
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Keywords

Research waste

Knowledge translation

Research impact

Stakeholder engagement

Patient and public involvement

# data[].attributes.attachment_link.title
Supporting researchers in knowledge translation and dissemination of their research to increase usability and impact - Quality of Life Research

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Purpose One of the key areas of delivery of the 'Action Plan for Health Research 2019-2029', for the Health Service Executive (HSE) in Ireland, is adding value and using data and knowledge, including health-related quality of life (HRQoL), for improved health care, service delivery and better population health and wellbeing.

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Metz, A., Boaz, A., & Robert, G. (2019). Co-creative approaches to knowledge production : What next for bridging the research to practice gap? Evidence & Policy: A Journal of Research, Debate and Practice, 15(3), 331‑337.

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Co-creative approaches to knowledge production: what next for bridging the research to practice gap?

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Growing interest in the potential of collaborative approaches to knowledge production as innovative solutions to bridging the research-to-practice gap ( Boaz et al, 2018; Rycroft Malone et al, 2016) has been accompanied by critical considerations, both in this journal (for example Geddes et al, 2018 and Décieux, 2018) and wider public management literatures ( Osborne et al, 2016; Osborne, 2018).

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McSween-Cadieux, E., Chabot, C., Dagenais, C., Lane, J., & Dancause, L. (2023). Le transfert de connaissances chez les personnes étudiantes aux cycles supérieurs : Des perceptions et pratiques qui témoignent d’un changement de paradigme au Québec ? Revue francophone de recherche sur le transfert et l’utilisation des connaissances, 7(1), Article 1.

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Depuis plusieurs années, de plus en plus d'organismes de financement de la recherche demandent que les équipes de recherche explicitent un plan d'activités de transfert ou de mobilisation de connaissances (TC) afin que leurs recherches entraînent davantage de retombées concrètes. Toutefois, est-ce que les personnes étudiantes aux cycles supérieurs, soit la relève en recherche, sont sensibilisées à l'importance du TC et outillées pour mener de telles activités ? Nous en savons encore peu sur la place que prennent les activités de TC durant leur parcours et leurs perceptions sur le TC. Nous avons donc mené une étude pilote à l'Université de Montréal en 2019-2020 visant à mieux comprendre les perceptions des personnes étudiantes à la maitrise et au doctorat, ce qui pouvait influencer leurs pratiques de TC et ce qui pouvait être mis en œuvre pour mieux les soutenir dans cette voie. Un devis de recherche mixte convergent a été utilisé afin de collecter des données quantitatives (questionnaire en ligne, n= 138) et qualitatives (entretiens semi-structurés, n=25). La roue du changement de comportement (Michie et al., 2011) a été utilisée comme cadre théorique pour guider l'analyse et l'interprétation des données. Les résultats montrent que les personnes étudiantes aux cycles supérieurs sondées sont généralement motivées et sensibilisées à l'importance du TC. Cependant, plusieurs rapportent un manque de connaissances et de compétences, qui peut s'expliquer par le fait que le TC est généralement peu abordé durant leur parcours. De plus, le milieu universitaire est perçu comme relativement peu propice au TC. Les résultats montrent également qu'elles désirent renforcer leurs capacités en TC, mais aussi qu'elles aimeraient être mieux soutenues afin que le TC devienne une priorité collective dans le milieu universitaire. Ainsi, des actions devraient être menées à différents niveaux de l'écosystème académique.

# data[].attributes.attachment_link.title
Le transfert de connaissances chez les personnes étudiantes aux cycles supérieurs : des perceptions et pratiques qui témoignent d'un changement de paradigme au Québec ?

# data[].attributes.attachment_link.description
Depuis plusieurs années, de plus en plus d'organismes de financement de la recherche demandent que les équipes de recherche explicitent un plan d'activités de transfert ou de mobilisation de connaissances (TC) afin que leurs recherches entraînent davantage de retombées concrètes.

# data[].attributes.body
Mc Sween-Cadieux, E., Lane, J., Kadio, K., Ridde, V., & Dagenais, C. (2022). Un processus de transfert de connaissances pour favoriser l’utilisation des résultats d’évaluation. In L. Rey, J.-S. Quesnel, & V. Sauvain, L’évaluation en contexte de développement : Enjeux, approches et pratiques (p. 441‑462). Éditions JFD.

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L'évaluation en contexte de développement | Éditions JFD

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Cliquez ici pour télécharger gratuitement la version PDF du livre. Sous la direction de Lynda Rey, Jean Serge Quesnel et Vénétia Sauvain Ce manuel est destiné aux personnes souhaitant s'initier à l'évaluation de programmes, en particulier en contexte de développement et de coopération internationale.

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Mc Sween-Cadieux, E., Dagenais, C., & Ridde, V. (2018). A deliberative dialogue as a knowledge translation strategy on road traffic injuries in Burkina Faso : A mixed-method evaluation. Health Research Policy and Systems, 16(1), 113.

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Abstract

Introduction

Deliberative dialogues are increasingly being used, particularly on the African continent. They are a promising interactive knowledge translation strategy that brings together and leverages the knowledge of diverse stakeholders important to the resolution of a societal issue. Following a research project carried out in Burkina Faso on road traffic injuries, a 1-day workshop in the form of a deliberative dialogue was organised in November 2015. The workshop brought together actors involved in road safety, such as researchers, police and fire brigades, health professionals, non-governmental and civil society organisations, and representatives of government structures. The objective was to present the research results, propose recommendations to improve the situation and develop a collective action plan.

Method

To better understand the workshop's utility and effects, a mixed-method evaluation was conducted. Data were obtained from two questionnaires distributed at the end of the workshop ( n  = 37) and 14 qualitative interviews with participants 6-10 weeks after the workshop. Descriptive statistics were used to analyse the quantitative data, and a thematic analysis was conducted for the qualitative data.

Results

The data revealed several positive impacts of the workshop, such as the acquisition of new knowledge about road safety, the opportunity for participants to learn from each other, the creation of post-workshop collaborations, and individual behaviour changes. However, several challenges were encountered that constrained the potential effects of the workshop, including the limited presence of political actors, the lack of engagement among participants to develop an action plan, and the difficulty in setting up a monitoring committee following the workshop.

Conclusion

While the deliberative workshop is not the standard format for reporting research results in Burkina Faso, this model should be reproduced in different contexts. This interactive knowledge translation strategy is useful to benefit from the experiential knowledge of the various actors and to encourage their involvement in formulating recommendations.

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Background

The process of moving from research to action is complex and multifactorial. However, the use of research is important for improving health policy, interventions and decision-making, especially in low-income countries, where health indicators continue to be a concern and equity is sometimes neglected. Knowledge translation (KT) aims to produce, synthesise, disseminate and share research-based evidence (RBE) to support its application [ 1, 2]. KT can provide mechanisms by which researchers and users can interact to combine scientific knowledge with experiential knowledge [ 3]. With this approach, users can be included in developing, producing, interpreting and applying RBE [ 4]. Integrating the knowledge of all stakeholders involved in resolving a health issue is essential to producing concrete and realistic recommendations that are adapted to the local context and based on research results [ 5, 6]. However, thus far, few studies have evaluated interactive KT strategies in West Africa [ 7, 8, 9].

Deliberative or policy dialogues are increasingly being used, particularly on the African continent. These dialogues " allow research evidence to be considered together with the views, experiences and tacit knowledge of those who will be involved in, or affected by, future decisions about a high-priority issue" [ 10]. They are used to draw on the knowledge of various key stakeholders involved in addressing a societal issue, such as researchers, policy-makers, practitioners and civil society organisations (CSOs) [ 11, 12, 13, 14]. The value of this deliberative process lies in the fact that RBE is just one of the factors influencing decision-making, and that a variety of actors, not just policy-makers, can also act and contribute significantly to decision-making processes [ 10]. According to best practices [ 15], a deliberative dialogue should address a priority policy issue, look at it from different angles and examine its impact on different groups, foster discussions around various solutions to resolve the problem, and consider the feasibility of proposed solutions. To ensure the dialogue is based on the most relevant knowledge, one or more research briefs should be prepared to consolidate the main research findings and present possible solutions [ 16]. These briefs should be distributed at least 2 weeks before the event [ 10]. While a deliberative dialogue is not expected to reach a consensus on any decision [ 17], it could conclude with the stakeholders making commitments to undertake a set of concrete actions.

The case of road safety in Burkina Faso

The African continent has the highest road accident mortality rates in the world [ 18]. Moreover, according to the WHO report on road safety in the African region [ 19], official data tend to be vastly underreported and discrepancies are often observed between data sources [ 20]. Among young people aged 15-29 years, road accidents are the leading cause of death. According to WHO, the efforts being made to meet the target set by the sustainable development goals, which is to halve the number of road traffic deaths and injuries, are insufficient [ 18]. In Burkina Faso, a landlocked country in West Africa, road accidents represent a significant public health burden. According to the National Police and Gendarmerie, 1125 fatalities at the crash scene were reported in 2013 [ 19]. In the same report, WHO data estimated the mortality rate at 30 per 100,000 population [ 19]. In Ouagadougou, the country's capital, a steady increase in the number of accidents has been observed since 2005 [ 21]. However, very few studies have been performed on the subject in this region of the world, and the data available on road accidents are not always rigorous [ 22].

In 2008, the government of Burkina Faso set up the National Road Safety Council and the National Road Safety Office (ONASER), with the mission to ensure the smooth flow of road traffic, improve the road network and promote road safety. More than 20 associations working in the field of safety promotion and road safety education joined forces in 2012 (FAPSER-BF) for better coordination of community actions. Despite the creation of these structures, the development of a 2011-2020 action plan, and the implementation of several actions to improve the situation, road accidents remain a public health issue, requiring better coordination of forces and adequate funding. In addition, road safety law enforcement is weak in the country and the helmet wearing rate remains low among two-wheeled vehicle users [ 18, 19].

In 2015, a research project was conducted on road traffic injuries in Ouagadougou as the result of a collaboration between the Institut de recherche pour le développement of France, the Burkina Faso National Police, and the Centre Hospitalier Universitaire Yalgado Ouédraogo, as part of a research programme funded by the Canadian Institutes of Health Research. The purpose of the study was to test the effectiveness, acceptability and capacity of a surveillance system to assess the number of accidents and their consequences on the health of accident victims [ 21]. This study counted the accidents reported to the police for 6 months, identified the most accident-prone areas, estimated mortality, morbidity and disabilities resulting from road accidents, identified vulnerable road users and, finally, monitored the treatment of the injured. The collaborative approach of the study and the innovative monitoring system set up to collect accident data were strengths of the project [ 20]. In less than 7 months, police officers recorded 2752 crash scenes, involving 1338 injuries and 25 deaths [ 23]. During the same period, the results from the survey conducted by the hospital emergency trauma services showed that 1867 victims were admitted to the main hospital and 47 deaths were reported [ 20, 24]. More than 80% of the injured were users of two-wheeled vehicles. Furthermore, the study also showed that 26% of the injured still experienced disabilities 30 days after the accident [ 20].

A deliberative dialogue workshop on road safety

A dissemination workshop, in the form of a deliberative dialogue, was organised in November 2015. The main objectives were to report the study's results and, based on these findings, to propose recommendations to address the situation. To improve on the traditional format of research dissemination workshops [ 25], the researchers sought to create a more participatory and egalitarian dialogue by building on the diversity of knowledge, inviting a wide variety of stakeholders involved in road safety, limiting the number of scientific presentations to allow more time for group work, and encouraging the development of an action plan to implement the recommendations resulting from the RBE and deliberations. Several structures were represented, including the police, fire brigades, non-governmental organisations (NGOs) and CSOs involved in road safety, as well as research centres, the ministries of Scientific Research, Innovation, and National Education and Literacy, and ONASER. Nearly 60 people attended the opening and 45 people participated from start to finish. Additionally, three research briefs were prepared by the researchers and distributed to participants 1 week prior to the workshop. These were reviewed by KT specialists to ensure the content was clear, accessible and applicable [ 23, 24, 26, 27].

The workshop was conducted in three phases (Box 1). First, the researchers presented the main results of the study, followed by a question period. Presentations were based on the content of the briefs but provided more detail. Subsequently, the 11 recommendations arising from the study findings and presented in the briefs were discussed. The participants voted by a show of hands on each recommendation's relevance and feasibility in Burkina Faso. Voting cards in the colours of traffic lights were distributed. The green card meant the recommendation was feasible, the yellow card meant it was considered moderately feasible, and the red card meant it would be difficult to implement. In the second phase, participants were divided into three subgroups (health and health transport, law enforcement, civil society). A framework was designed to structure the discussions. Each subgroup was asked to identify recommendations upon which they could act, to adapt them or formulate new ones, and to propose actions for context-appropriate implementation. Third, in the plenary session, each group presented its recommendations and reflections on their implementation, and then participants discussed their post-workshop commitments. The workshop was facilitated by a neutral and qualified KT specialist familiar with the issue, who had not been involved in the research project.

To know the relevance, acceptability and impact of this deliberative workshop in the Burkinabè context, an evaluation was conducted. This article presents the results of the evaluation, whose objectives were to (1) assess participants' reactions to the conduct and content of the deliberative workshop and the research briefs distributed; (2) measure their intention to use the knowledge presented at the workshop; (3) measure their use of this knowledge in the months following the workshop; and (4) make suggestions for improving the follow-up and implementation of recommendations coming out of the workshop.

Methods

Conceptual framework

The conceptual model developed by Boyko et al. [ 17] guided the organisation and evaluation of the deliberative workshop. This model identifies three key elements for organising a deliberative workshop, namely a supportive environment, the presence of a variety of participants and the use of research results in deliberations (Fig. 1). The expected short-term effects of a deliberative workshop are, first, an improvement in knowledge and skills at the individual level (e.g. what is known about the issue and how it might be addressed) and then an improvement at the organisational level to better respond to the issue collectively [ 17]. Long-term objectives are to promote access to research-based knowledge, to support stakeholders and, ultimately, to develop a culture that values evidence-based decision-making [ 17].

Conceptual model of deliberative dialogue as a KT strategy adapted from Boyko et al. [ 17]

Data collection

A mixed-method evaluation design was favoured [ 28] since the use of different types of complementary data increases the validity and credibility of the results [ 29]. A convergent design was selected, wherein qualitative and quantitative data were collected and analysed independently, but the findings were compared and combined in the interpretation [ 30]. The quantitative and qualitative results were compared to identify key similarities or discrepancies. The qualitative component was nevertheless predominant, since the interview data were used to explain, clarify and refine several quantitative results. The qualitative component also collected additional data (e.g. new knowledge gained, ways to improve the workshop, etc.) that would be complex to quantify.

Quantitative component

The quantitative component assessed participants' reactions after the workshop (objective 1) and measured their intention to use the knowledge imparted (objective 2). The instruments used to meet these objectives were two questionnaires, which assessed (1) the overall evaluation of the deliberative workshop (12 questions) and (2) the intention to use the knowledge (14 questions). Participants rated the various questions on a 7-point Likert scale ranging from 'strongly disagree' (1 point) to 'strongly agree' (7 points). The questionnaires were completed at the end of the day ( n  = 37/45; 82%). The data were analysed using descriptive statistics.

Questionnaire on the overall evaluation of the workshop

The questions regarding participants' overall evaluation of the workshop focused on their achievement of personal objectives, the quality of the discussions and of the workshop organisation, and the usefulness of the knowledge transmitted. Three additional qualitative questions concerned the elements most and least appreciated by participants, as well as suggestions for improving the KT process.

Questionnaire on intention to use the knowledge

The questions on the intention to use knowledge come from a tool based on the theory of planned behaviour [ 31]. This tool was developed and partially validated by Boyko et al. [ 32] with policy-makers in Canada. This theory postulates that the intention to use research is a predictor of actual use. The questionnaire measures four constructs, namely intention to use, attitudes, subjective norms (social pressure), and perceived control over behaviour. The tool has good internal consistency (Cronbach's alpha ranges from 0.68 to 0.89) [ 32] but has not been validated in the Burkinabè context.

Qualitative component

The qualitative component was used to clarify and deepen participants' assessments following the workshop (objective 1), to identify the knowledge use reported by participants (objective 3), and to understand how to improve the follow-up and implementation of recommendations (objective 4).

Semi-structured interviews were conducted 6-10 weeks after the activity with 14 participants. Three respondents had not attended the workshop to the end, but it was still important to obtain their views on KT because of their professional status. In-depth contrast sampling was used to ensure that at least one representative from each relevant group was present in the sample for the purpose of the survey [ 33]. This diversity of actors made it possible to highlight the different points of view. The respondents consisted of representatives of international NGOs ( n = 2), a health professional ( n = 1), a police chief ( n = 1), a driving school manager ( n = 1), youth CSO leaders ( n = 2), road safety CSO leaders ( n = 2), representatives of a government structure/ministry ( n = 2), representatives of a national research centre ( n = 2), and a road infrastructure professional ( n  = 1). The interviews lasted 45 min on average and were conducted by the first author (EMC), since both co-authors (CD, VR) were involved in the organisation of the workshop.

The interview grid was based mainly on the elements identified in the conceptual model of Boyko et al. [ 17] (Fig. 1). Several themes were addressed, such as the respondents' evaluation of the researchers' presentations and the discussions, their opinion on the group composition and dynamics, the usefulness of the workshop and its potential impact, any obstacles to implementing the proposed recommendations, the monitoring committee, ideas for improving the workshop, etc. The qualitative data were analysed using the thematic analysis approach defined by Paillé and Mucchielli [ 34]. The interviews were first coded using the themes identified in the interview grid. The different themes that emerged during the meetings were also coded. In addition, the different types of research use were coded, as follows: 'conceptual use' (change in understanding, attitudes or conception of an issue), 'instrumental use' (change in behaviour, practice or decision-making), 'persuasive use' (influencing decisions, legitimising positions or actions, convincing others to take a position), and 'process-related use' (changes due to involvement in the research or evaluation process) [ 35, 36]. Once the main themes were coded, the perceptions of the various respondents were compared to obtain a complete and nuanced portrait.

Results

The results are presented in line with the evaluation objectives, namely (1) evaluation of the workshop and research briefs; (2) intention to use the knowledge; (3) types of use reported; and (4) follow-up and implementation of workshop recommendations.

Evaluation of the workshop and research briefs

All respondents acknowledged the relevance of a workshop not only to report the results of the research, but also to compare the researchers' proposals with the realities on the ground. In general, the workshop was appreciated and met the participants' expectations (Table 1), which were to acquire knowledge on road accidents, to find out the results of the study and to establish relationships with other actors in the field.

Table 1 Mean scores for items in the questionnaire on reactions (n = 37)

Research briefs

Participants rated all three research briefs positively and recognised the value of having access to these documents. Several stressed the importance of visual presentation in communicating statistical data (graphs, location maps, tables). Very few items were proposed to be modified in the research briefs. However, as the briefs were relatively short, several participants suggested making the content more explicit (e.g. providing social profiles of accident victims, presenting more detail on the causes and circumstances of accidents, developing a brief on socio-anthropological analysis). Suggestions for improvement were limited to involving the various road safety stakeholders in preparing the briefs and adding a target audience to the recommendations. Many stressed the importance of sending briefs out a few weeks before the workshop.

Group climate and dynamics

The workshop brought together a wide variety of actors involved in road safety (prevention, accident investigation, care of the injured, healthcare, rehabilitation). This diversity was appreciated, as this was the first comprehensive consultation effort. The participatory atmosphere, and the discussions and debates among the participants, were the elements most appreciated by respondents to the evaluation questionnaire. Participants also said they benefited from networking to get to know the structures active in the field. A few reported having created collaborations there that were consolidated following the workshop.

Several respondents said they understood the realities on the ground better as a result of the discussions following the researchers' presentations and during the group work. The participants' diverse experiences led them to compare ideas that could bring about changes in practices. While the workshop generated some more lively discussions between certain structures, a climate of respect and listening prevailed.

However, several respondents noted the absence of decision-makers or ministry representatives. As the workshop was held 1 week before the presidential elections, some said the timing was not ideal. Several stressed the importance of making additional efforts to ensure their presence such as by sending out invitations well in advance, given the time frames involved in ministry procedures, going to them to extend the invitation or presenting them with the key findings of the study in advance. The impact of the workshop can be limited if decision-makers are not present for the summary of recommendations.

Presentations of research results

All respondents felt the researchers' presentations were accessible. The qualitative data from the evaluation questionnaire also showed that the second most appreciated aspect was the clarity of the information provided during the presentations. However, it should be noted that several participants were involved in the research process and that they already knew the main results presented. As Table 1 shows, the average score for new knowledge transmitted was the lowest (3.74/7). Participants were particularly interested in the examples from neighbouring countries and in the images used to create road safety awareness in the presentations. The fast pace of the presentations was acceptable, but some respondents noted that too little time was allocated for discussion following each large group presentation. To balance the contribution of each group of actors, some suggested that speaking time should also be given to certain structures during the morning to present their road safety activities and raise the key issues.

Some respondents suggested that the objectives of the deliberative workshop should be clearly explained at the start of the day, including the objective of developing a collective action plan to implement the recommendations emerging from the workshop. Many had expected it to be a traditional research dissemination workshop in which participants generally leave without having any task to perform or follow-up to do.

Working in subgroups

The majority of respondents appreciated working in subgroups during the afternoon to reflect concretely on the actions to take and to share their respective concerns. Having this opportunity for direct conversations allowed several participants to change their views on certain partners.

However, several civil society actors proposed dividing participants into diverse groups to take greater advantage of the variety of actors present. It was also proposed to organise pre-workshop consultations with each group of stakeholders so that the discussions could be more in-depth and applied on the workshop day. The grid used to structure the group work was useful, mainly because it helped refocus the discussions around the feasibility of the recommendations.

Synthesis and action plan

The collective synthesis following the group work did not generate much discussion and deliberation. This result was consistent with the evaluation of the debates in the quantitative questionnaire, as this item obtained lower scores (Table 1). Additionally, the synthesis of the recommendations did not elicit the desired commitment to develop an action plan and set up a monitoring committee. A ministry representative spoke about the need to consult upper line managers before engaging in such initiatives and to respect the procedures of their parent organisation. Thus, this request for mobilisation to implement the recommendations appeared to have surprised the participants:

" The people present were shaken because the workshop had been going very well. There were reflections, which happens in one workshop out of four, in my opinion... But the request for mobilisation [that emerged] without notice, although quite logical and well presented, was not necessarily compatible with the logics, the rhythms of Burkina Faso, and with the absence of any existing rudimentary platform in road safety. " (NGO representative)

Table 2 summarises the evaluation results in relation to the key features to be respected in deliberative workshops, as proposed by the conceptual model of Boyko et al. [ 17, 37] (Fig. 1).

Table 2 Summary of the characteristics of the deliberative workshop

Intention to use the knowledge

Table 3 presents the scores obtained on the different items of the questionnaire measuring the intention to use knowledge. Generally, respondents intended to use the knowledge (6.03/7) and already envisioned an opportunity to do so (6/7). The items with the highest scores were those related to participants' attitudes (mean 6.67/7), which may support the acceptability of the study results. However, items measuring respondents' perception of their control over knowledge use scored lower (3.63/7 to 4/7), but with significant variation in scores (SD 2.17). In analysing the sociodemographic characteristics, it can be seen that many respondents with higher scores (perception of less control) were trainees, students, safety officers or driving school trainers. This is consistent with the importance of reporting to their line managers, as mentioned above. This result is also consistent with the qualitative data, as many respondents deplored the absence of senior decision-makers, ministry representatives and government authorities at the deliberations.

Table 3 Respondents' level of agreement with the intention to use knowledge (n = 37)

Types of knowledge use

The effects reported by participants after the workshop are described in Table 4 and more specific examples of different types of knowledge use are presented in the following sections. The main perceived impact of the workshop is that participants got access to evidence and gained a better understanding of the road accidents situation. Several participants also shared the main results in their network and some were motivated to organise public prevention activities, especially with young people. Moreover, many impacts reported by respondents stem more from their participation in the deliberative process and the networking. For example, the workshop allowed stakeholders to become familiar with local actors, to create partnerships, and to develop interest and motivation in KT through the organisation of subsequent workshops.

Table 4 Main effects reported by participants after the workshop

Conceptual use

The vast majority of respondents reported that the workshop provided them with new knowledge about road accidents (e.g. accident-prone zones, most affected groups, traffic light accidents, etc.). Some respondents, less involved in road safety, said the results gave them a better understanding of the magnitude of the situation. Nearly half of the respondents also mentioned having been personally made aware of the importance of wearing helmets and of their behaviour on the road. For some respondents, the study led them to reconsider their own professional practices:

" If it hadn't been for the workshop, if I hadn't been made aware of the study, I would never have considered the question [about the physical separation between the lanes for two-wheel transport and for other vehicles]. I will discuss this with the engineer, the technical design office, and the project manager. " (Road infrastructure worker)

Instrumental use

In terms of professional practices, the CSO representatives interviewed reported that they had used the information obtained at the workshop to organise and hold road safety prevention activities after the workshop. They said they wanted to integrate the study's main messages into the training offered in road safety (e.g. driving school training for a driver's license). As this respondent explained, the workshop also generated ideas for action at the local level:

" Thanks to the group discussions, we were able to unleash our creativity and generate ideas, [and to] enrich the very content of our association's objective by offering new awareness-raising activities in the neighbourhood. " (Driving school instructor)

Persuasive use

The actors directly involved in road safety, and thus already aware of the issues, used most of the knowledge strategically. First, the results of the study confirmed the relevance of the public awareness activities on road safety carried out by the CSOs. For example, in light of the results of the study, some CSO representatives said they were motivated to intensify their efforts to promote road safety, specifically among youth. To explain the relevance of acting on road safety, some also distributed the research briefs or the main results of the study within their professional environment. Others went even further, reporting that they used the results to implement new projects by citing the results in their funding applications:

Several respondents reported concrete changes in their behaviour since the workshop. For example, a few respondents stated they were raising awareness about road safety in their networks.

Process-related use

Some pointed out that involving stakeholders during the study would have encouraged direct conversations among participants during the workshop and strengthened the general acceptability of the results:

The experience of collaboration also seemed to have been positive, with a respondent explaining the intention to possibly include the information system set up by the researchers within the National Police and to continue the collaborations:

Follow-up and implementation of recommendations

Several respondents indicated that national coordination of road safety activities would be insufficient to ensure follow-up of the various activities and ensure coordination among the different stakeholders. ONASER, the representative of the Burkinabè state, was recognised by the actors as the structure that should assume this role. However, some said ONASER did not adequately perform its mandate as intermediary between the various ministries involved in road safety and the actors on the ground. Moreover, the difficulty experienced by associations in trying to obtain funding, via ONASER, to implement road safety interventions was often noted as a major obstacle to implementing the recommendations. However, respondents were optimistic that the recent creation of a Directorate-General for Road Safety within the Ministry of Security would generate a surge of road safety actions:

Creating a monitoring committee

Respondents agreed, however, on the relevance of creating a monitoring committee at their level that would, for example, convey the workshop's conclusions to the right people. While the initiative to create this monitoring committee did not materialise in the short term following the workshop, the proposal was considered useful. To prevent the scattering of efforts, it is essential to avoid any proliferation of road safety groups. The challenge is to bring together actors who are motivated to contribute to this committee and have the resources to influence change. With each person caught up in their own professional commitments, it is difficult to find people who would be dedicated to monitoring. Respondents commented on the mission that this committee could have and on its leadership. In terms of the committee's composition, it was considered important that all stakeholders be represented to maximise its impact. However, opinions differed on the committee's leadership. Some felt this committee should be coordinated by the researchers, since they started the initiative by convening the workshop. On the other hand, many believed the leadership should come from the CSOs, given that a structure was already in place (FAPSER), insofar as their capacity would be strengthened and resources provided to carry out the recommendations. Another proposal was to rely on neutral actors, such as knowledge brokers, who are not already implementing road safety projects. The committee would then be seen as a platform of partners:

Generally speaking, the mission of this committee should be to monitor and evaluate the implementation of recommendations within the various structures. Some respondents also proposed that this committee should have an advocacy mission vis-à-vis the authorities and ONASER. This committee could also take on a facilitation role, bringing together the various structures and partners by organising discussion meetings, for example. Finally, several respondents proposed that this committee could serve as a centre of expertise by providing the most recent research knowledge to stakeholders such as by offering training to CSOs.

Discussion

Road accidents are a public health issue requiring an intersectoral approach [ 18]. The deliberative dialogue workshop model used as a KT strategy in Ouagadougou responded to this need. Participants recognised the usefulness of this workshop format to take advantage of their own experiential knowledge, from numerous actors, while using the knowledge produced by the study. The main effects of the workshop were at the individual level (knowledge acquisition, development of collaborations, improved understanding of the issue, etc.), with organisational changes requiring more time and perseverance [ 17]. However, participants observed some effects at the organisational level as a result of sharing their experiences, research briefs and workshop conclusions within their respective organisations (e.g. ideas for activities to be undertaken, development of action plans in their association, etc.). The results also showed that, while participants saw the usefulness of the knowledge and recommendations and intended to apply them in their professional practice, the fact that most of them had limited decision-making power (perception of low control) reduced the effects observed a few weeks after the workshop [ 38]. During the deliberations, the majority of participants first wanted to submit a report to the various ministries involved listing the recommendations developed. This proposal is understandable in the political and policy context of a country like Burkina Faso, where decision-making systems are often centralised and where international organisations and donors influence the agenda-setting for certain public health issues [ 39, 40]. This undoubtedly discourages local actors from taking initiative and exercising leadership, which are often determining factors in KT approaches [ 41]. More collective efforts will be needed to observe longer-term effects at the system level (road accident issues on the government agenda, appropriate funding mechanism for prevention activities, etc.) [ 13].

Despite the limited effects reported and the obstacles to implementing the monitoring committee, this deliberative workshop experience in Burkina Faso showed that stakeholders appreciated this process more than the traditional research dissemination workshop that had been held a few years earlier [ 25]. In fact, the efforts made to adapt the researchers' language (i.e., to avoid scientific jargon) and limit their speaking time, to produce clear, concise and action-oriented research briefs [ 27], and to base the workshop on multiple interactions and the collective development of recommendations, were strengths of the approach. Thus, the majority of participants interviewed said that they would like to see a repeat of the consultation framework offered by the workshop, as this would encourage the exchange of ideas and lead to improved practices. The climate of trust fostered by the collaborative research project [ 42] was conducive to interaction and discussion. Participatory or embedded research is often cited as a promising approach for producing locally relevant evidence, thereby fostering better KT to improve health systems [ 43].

The evaluation results uncovered what may have negatively influenced the outcome of this KT approach. With reference to some of the key characteristics identified in Boyko et al.'s [ 17] conceptual model (Fig. 1) to foster an appropriate environment for deliberative workshops, the following reflections are aimed at better understanding how the workshop's effects could be improved in the Burkina Faso context.

Timeliness of the policy issue

According to Yehia and El-Jardali [ 44], a deliberative process is appropriate when the issue is important and in the public interest, when there is research or knowledge available on how to resolve it, and when there is openness to change in the system. In the case of road safety in Burkina Faso, the timing of the workshop was determined by the conclusion of the research project grant. This timing coincided with the end of a transitional government in the country and the holding of presidential elections a few days later. Thus, the question arose as to whether road accidents represented a sufficiently recognised and important public health issue to warrant the hope that it would be placed on the political agenda in the short term following the workshop [ 41, 45]. By improving visibility and monitoring, such a deliberative workshop could, in any case, contribute to the politicisation of a societal issue.

Pre-event work

In addition to distributing research briefs beforehand to workshop participants, it is sometimes proposed that a steering committee be created before the workshop is held [ 7, 46]. This committee would be representative of the various stakeholders whose involvement is key to resolving the issue; its role would include performing a stakeholder mapping analysis to identify participants to be invited to the deliberations [ 47]. In the case of Burkina Faso, the research team organised the workshop due to time constraints. However, since the research project was conducted in close collaboration with stakeholders, the researchers were familiar with their concerns and needs. To continue with the participatory approach of the research project, it would have been useful to invite certain key stakeholders to a pre-workshop consultation meeting to validate the research briefs, clarify and verify the acceptability of the workshop objectives, and use their networks of contacts to maximise the presence of important stakeholders [ 7].

Participant commitment and rules of engagement

To further engage participants, the specific workshop objectives and desired outcomes could have been communicated more clearly to participants in the invitation so they would have a clear understanding of their role in the deliberations and the utility of the process [ 48]. In order to move more towards best practices for deliberative processes, the same amount of speaking time should have been offered to the different stakeholders to share their respective knowledge [ 7]. Moreover, as mentioned above, the sometimes-limited decision-making power of the actors present may have been an impediment to the impact of the workshop [ 44]. When preparation time is limited because of field constraints, it would be advisable to advance more gradually and not seek to obtain participants' commitment to implementing recommendations as early as the first workshop [ 10, 17]. However, if stakeholders were better prepared before the workshop, developing an action plan would be achievable. With regard to engagement, the likely influence of the per diem culture on policy-makers' participation in research dissemination workshops should also be noted [ 49]. Often associated with development aid projects in Africa, per diems are used to remunerate project stakeholders to motivate them to attend workshops and thereby promote implementation of the project [ 50]. However, the impact of this practice on political actors' engagement, especially in KT activities, requires further exploration.

Adequate resources and post-event work

To organise, implement, monitor and evaluate a deliberative process, especially for deliberative dialogues at the national level, significant resources must be mobilised [ 51]. In Burkina Faso, there were several gaps in terms of the resources available for monitoring. This experience underscores the importance of planning to anticipate key challenges such as ensuring leadership, funding monitoring activities and supporting participants over the long term. For example, it remains to be seen whether the fact that the workshop was a research project initiative may have influenced the follow-up, given the end of the research grant and the limited availability of the researchers in the field [ 13]. It is also important to be aware that stakeholder involvement can impose considerable human and financial resource burdens on the various CSOs involved. Similar difficulties in coordinating follow-up and implementation of recommendations were encountered at a national deliberative workshop organised in the field of health in Niger [ 52], where the obstacles observed included corruption, lack of per diems paid to the monitoring committee and absence of political will.

This KT experience in the field of road safety in Burkina Faso provides lessons to guide future initiatives of this kind. Box 2 presents the main recommendations to be considered when organising, conducting and following up on a deliberative workshop.

Limitations of the study

This evaluation presents certain limitations. The self-report questionnaires were not validated in the Burkina Faso context. Moreover, as these questionnaires were anonymous, it was not possible to match the quantitative responses with the interview data. This would have allowed the data to be triangulated for a better understanding of the quantitative item scores. The timing of the interviews may also have influenced the validity of data. Interviews should be conducted at least a few weeks or months after the workshop to give participants time to take action. In this case, the interviews may have been conducted too early, which may have limited the observation of changes. On the other hand, the passage of time can, conversely, affect participants' ability to recall more specific elements such as the content or conduct of the workshop. As such, it would have been useful to conduct several waves of interviews, but this was not possible due to time constraints. Social desirability bias may also have positively influenced the evaluation results, even though respondents were told their feedback was being sought to improve future KT initiatives. Finally, generalisation of the study is limited, as the effects could be different depending on the nature of the issue under study, the research results presented, the different actors involved in the process and the funding available.

Conclusion

This study showed that it could be useful to organise more deliberative workshops to foster the translation and application of research-based knowledge in Burkina Faso. It would also be important to understand the potential effects of such workshops when they are part of a broader KT approach. An additional element that could be interesting to study, for example, would be the impact of having an intermediary in the process, such as a knowledge broker, whose role would be to provide longer-term support. In future initiatives, it would be important to give early consideration to systemic issues that might influence KT in the context, such as politicisation of the issue, the decision-making process, and the scarcity of financial, material and human resources for public health. While this study proposes recommendations, further studies are needed to clarify best practices for organising, conducting and following up on a deliberative workshop, specifically in West Africa.

Box 1 Workshop agenda

Presentation of the study

Deliberative workshop

Box 2 Recommendations for conducting deliberative workshops in Burkina Faso

Organisation

➔ Set up a steering committee that is representative of the different stakeholders to guide and validate the organisation of the workshop

➔ Organise pre-workshop consultations with different groups of actors to stimulate reflection and familiarise them with the workshop format

➔ Ensure resources are available for monitoring and/or obtain the support of governmental/international structures for the process

Conduct

➔ Hold the workshop over 2 days to increase the discussions, foster uptake of the information transmitted, reflect more on the implementation of recommendations, and plan the follow-up

➔ Limit the researchers' presentations to give some defined speaking time to the different actors and avoid having the leadership of the process devolve to the researchers

➔ Project the recommendations formulated by the participants onto a screen to encourage discussion and systematise the deliberations

Follow-up

➔ Make conclusions available soon after the workshop to maintain active communication among the participants, and provide support to those who would like a better grasp of the knowledge

➔ Encourage leadership by impartial and available intermediaries to ensure a strong presence in the field

➔ Use mass media to disseminate the results of the study and the recommendations coming out of the workshop to give visibility to the issue

Abbreviations

CSO:

civil society organisation

KT:

knowledge translation

NGO:

non-governmental organisation

ONASER:

National Road Safety Office

RBE:

research-based evidence

References

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Acknowledgements

We would like to thank the research team for their involvement in the knowledge translation process, Emmanuel Bonnet, Aude Nikiéma, Lucie Lechat and Paul-André Somé. We would like to thank also everyone who generously gave their time to respond to our questions and Donna Riley who translated the manuscript.

Funding

This work was supported by the Canadian Institutes of Health Research which funded the program "Community research studies and interventions for health equity in Burkina Faso" [FRN-112476; and ROH-115213]. VR holds a Canadian Institutes of Health Research-funded Research Chair in Applied Public Health [CPP 137901]. EMC received a doctoral scholarship from the Fonds de recherche du Québec - Santé (FRQS).

Availability of data and materials

The datasets generated and analysed during the current study are not publicly available due to confidentiality constraints but are available from the corresponding author upon reasonable request.

Author information

Authors and Affiliations

Department of Psychology, University of Montreal, P.O. Box 6128, Centre-Ville Station, Montreal, QC, H3C 3J7, Canada

Esther Mc Sween-Cadieux & Christian Dagenais

IRD (French Institute for Research on sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France

Valéry Ridde

University of Montreal Public Health Research Institute (IRSPUM), 7101 Avenue du Parc, 3rd Floor, Montreal, QC, H3N 1X9, Canada

Valéry Ridde

Contributions

All three authors conceptualised and designed the study. EMC developed the interview questions, collected the data, transcribed interviews, and analysed and interpreted the data independently. EMC wrote the manuscript. CD and VR reviewed and commented on drafts of the manuscript, providing input and guidance. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Esther Mc Sween-Cadieux.

Ethics declarations

Ethics approval and consent to participate

Ethics certificates were obtained from the research ethics committees of the University of Montreal Hospital Research Centre (12.273) and the National Health Ethics Committee of Burkina Faso (2012-11-85). Informed consent to participate was obtained from participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Mc Sween-Cadieux, E., Dagenais, C. & Ridde, V. A deliberative dialogue as a knowledge translation strategy on road traffic injuries in Burkina Faso: a mixed-method evaluation. Health Res Policy Sys 16, 113 (2018). https://doi.org/10.1186/s12961-018-0388-8
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DOI: https://doi.org/10.1186/s12961-018-0388-8

Keywords

Deliberative workshop

Knowledge translation

Research dissemination

Research utilisation

Research use

Evaluation

Road safety

Public health

Burkina Faso

West Africa

# data[].attributes.attachment_link.title
A deliberative dialogue as a knowledge translation strategy on road traffic injuries in Burkina Faso: a mixed-method evaluation - Health Research Policy and Systems

# data[].attributes.attachment_link.description
Introduction Deliberative dialogues are increasingly being used, particularly on the African continent. They are a promising interactive knowledge translation strategy that brings together and leverages the knowledge of diverse stakeholders important to the resolution of a societal issue.

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MacKillop, E., & Downe, J. (2023). Knowledge brokering organisations : A new way of governing evidence. Evidence & Policy, 19(1), 22‑41.

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LOMAS, J. (1993), Diffusion, Dissemination, and Implementation: Who Should Do What?. Annals of the New York Academy of Sciences, 703: 226-237.

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Lavis, J. N., Robertson, D., Woodside, J. M., McLeod, C. B., & Abelson, J. (2003). How Can Research Organizations More Effectively Transfert Research Knowledge to Decision Makers? The Milbank Quarterly, 81(2), 221‑248.

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Abstract

Five questions--What should be transferred to decision makers? To whom should it be transferred? By whom? How? With what effect?--provide an organizing framework for a knowledge transfer strategy. Opportunities for improving how research organizations transfer research knowledge can be found in the differences between the answers suggested by our understanding of the research literature and those provided by research-organization directors asked to describe what they do. In Canada, these opportunities include developing actionable messages for decision makers (only 30 percent of research organizations frequently or always do this), developing knowledge-uptake skills in target audiences and knowledge-transfer skills in research organizations (only 20 to 22 percent frequently or always do this), and evaluating the impact of knowledge-transfer activities (only 8 to 12 percent frequently or always conduct an evaluation). Research funders can help research organizations take advantage of these opportunities.

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Résumé

Alors que depuis plusieurs années, de nombreux organismes recommandent de s'appuyer sur des données probantes pour mener des actions dans le domaine de la santé, l'utilisation des résultats des recherches scientifiques par les milieux de pratique semble poser problème dans le champ de la santé mentale en France. En s'appuyant sur des travaux réalisés dans le domaine du transfert de connaissances en santé et sur l'analyse d'une situation prototypique, cet article vise à questionner la place des données scientifiques dans les domaines pratiques en santé mentale en France. Une typologie des modes de transfert et d'utilisation des connaissances présente le modèle conceptuel (qui regroupe le mode " désintéressé " et le mode " éclairage "), le modèle instrumental (qui comprend le mode " expert " et le mode " résolution de problème "), le modèle " stratégique ", et le modèle " interactif ". Différents obstacles au processus de transfert recensés dans la littérature sont ensuite exposés : les problèmes associés aux questions et résultats de recherche, ceux associés à la diffusion, et ceux en lien avec la rencontre de cultures organisationnelles différentes. Une analyse d'une situation de transfert de connaissances en santé mentale en France permet ensuite de caractériser la problématique française dans ce domaine : une méconnaissance des connaissances et méthodes scientifiques, une confusion des rôles et des places entre praticiens et scientifiques, une relation entre milieu de pratique et milieu scientifique construite sur l'opposition et l'absence d'échange, un problème d'articulation des connaissances scientifiques avec les univers de pratique. Enfin, à partir des données de la littérature, quelques solutions sont présentées afin de favoriser l'émergence d'une coopération constructive entre milieux scientifiques et milieux de pratique.

Abstract

While for several years numerous organisms in the field of health recommend to base interventions on evidence, the use of scientific knowledge by practitioners seems to be problematic in the mental health field in France. Using data in the field of knowledge transfer in health and analysing a prototypic case, this article aims to question the place of scientific knowledge in practical domains in mental health in France. A typology of modes of transfer and use of knowledge introduces the conceptual model (which regroups "unselfished" mode and "enlightenment" mode), the instrumental model (which consists of "knowledge driven" mode and "problem solving" mode), the "strategical" model and the "interactive" model. Different obstacles to the process of transfer of knowledge based on a literature review are then presented: problems linked to questions and research results, those linked to diffusion and those linked with the gap of different organizational cultures. An analysis of a situation of transfer of knowledge in mental health in France characterizes French problems in this domain: An ignorance of knowledge and scientific methods, a confusion of roles and places between practitioners and scientists, a relation between practitioners and scientists based on opposition and absence of exchange, a problem of application of the scientific knowledge. Finally, some solutions are introduced to facilitate the emergence of a useful collaboration between scientists and practitioners.

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La science peut-elle être utile à la pratique ? Réflexion sur le transfert et l'utilisation des connaissances scientifiques dans le domaine de la santé mentale en France

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Alors que depuis plusieurs années, de nombreux organismes recommandent de s'appuyer sur des données probantes pour mener des actions dans le domaine de la santé, l'utilisation des résultats des recherches scientifiques par les milieux de pratique semble poser problème dans le champ de la santé mentale en France.

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Krieger, J. L., Lee, D., Vilaro, M. J., Wilson-Howard, D., Raisa, A., & Addie, Y. O. (2021). Research Translation, Dissemination, and Implementation. In The Routledge Handbook of Health Communication (3rd éd., p. 33‑46). Routledge.

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This chapter reviews theories and perspectives on the role of communication in the area of research translation, dissemination, and implementation. The chapter is divided into three sections that map out the terrain of translational communication as an area of science. The first section reviews prominent translational research models. The second section addresses how communication scholarship intersects and contributes across the translational research continuum. The third section reflects on the ways translational research contexts present new theoretical challenges for communication scholars. The chapter concludes with suggestions for future research.

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Research Translation, Dissemination, and Implementation | 4 | v3 | The

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This chapter reviews theories and perspectives on the role of communication in the area of research translation, dissemination, and implementation. The chapter is divided into three sections that map out the terrain of translational communication as an area of science. The first section reviews prominent translational research models.

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Kothari, A., & Cameron, J. (2022). A New Perspective on Emerging Knowledge Translation Practices; Comment on “Sustaining Knowledge Translation Practices : A Critical Interpretive Synthesis”. International Journal of Health Policy and Management.

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A New Perspective on Emerging Knowledge Translation Practices; Comment on "Sustaining Knowledge Translation Practices: A Critical Interpretive Synthesis"

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The critical interpretive synthesis by Borst and colleagues offered a new perspective on knowledge translation (KT) sustainability from the perspective of Science and Technology Studies. From our applied health services perspective, we found several interesting ideas to bring forward. First, the idea that KT sustainability includes the ongoing activation of networks led to several future research questions.

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Gervais, M.-J., Souffez, K., & Ziam, S. (2016). Quel impact avons-nous? Vers l’élaboration d’un cadre pour rendre visibles les retombées du transfert des connaissances. Revue francophone de recherche sur le transfert et l’utilisation des connaissances, 1(1).

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Gervais, M.-J., Marion, C., Dagenais, C., Chiocchio, F., & Houlfort, N. (2015). Dealing with the complexity of evaluating knowledge transfer strategies : Guiding principles for developing valid instruments. Research Evaluation, rvv034.

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Gervais, M.-J., & Larrivée, M.-C. (2010). Les stratégies visant à favoriser l’utilisation des connaissances et la mesure de ses retombées : Recension de littérature (p. 21‑21). Chaire d’étude CJM-IU-UQÀM sur l’application des connaissances dans le domaine des jeunes et familles en difficulté.

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Gervais, M.-J., Gagnon, F., & Bergeron, P. (2013). Les conditions de mise à profit des connaissances par les acteurs de santé publique lors de la formulation des politiques publiques : L’apport de la littérature sur le transfert des connaissances. Chaire d’étude CJM-IU-UQÀM sur l’application des connaissances dans le domaine des jeunes et familles en difficulté.

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Gervais, M.-J. (2010). Modélisation des déterminants et des retombées de l’application des connaissances issues de la recherche psychosociale : Rapport final (p. 98‑98). Chaire d’étude CJM-IU-UQÀM sur l’application des connaissances dans le domaine des jeunes et familles en difficulté.

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Gershoff, E. T., Mistry, R., & Crosby, D. A. (Éds.). (2014). Connecting research and practice. In Societal contexts of child development : Pathways of influence and implications for practice and policy. Oxford University Press.

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Societal Contexts of Child Development: Pathways of Influence and Implications for Practice and Policy

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Abstract. In the past half century, contextual models of child development have risen to prominence, and contexts beyond the home environment have been increasi

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Gagnon, S., Mailhot, C., & Ziam, S. (2018). The role and contribution of an i...ractive knowledge transfer model. Evidence & Policy: A Journal of Research, Debate and Practice.

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Fillol, A., Sween-Cadieux, E. M., Ventelou, B., Larose, M.-P., Kamguem, U. B. N., Kadio, K., Dagenais, C., & Ridde, V. (2022). Quand le messager est plus important que le message : Étude expérimentale en Afrique francophone sur l’utilisation des connaissances. Revue francophone de recherche sur le transfert et l’utilisation des connaissances, 6(3), Article 3.

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Contexte : Les injustices épistémiques sont de plus en plus décriées dans le domaine de la santé mondiale. Cette étude vise à déterminer si la source des connaissances influence la perception de ces connaissances et la volonté de les utiliser. Méthodes : L'étude suit un devis expérimental randomisé dans lequel les participant·es ont été assigné·es au hasard à l'une des sept notes de politique conçues avec le même contenu scientifique, mais avec différentes organisations présentées comme autrices. Chaque organisation était représentative d'une autorité financière, scientifique ou morale. Pour chaque type d'autorité, deux organisations étaient proposées : l'une nord-américaine ou européenne, l'autre africaine. Résultats : Les résultats montrent que le type d'autorité et la localisation des organisations autrices ne sont pas significativement associés à la qualité perçue et à l'utilisation instrumentale déclarée. Toutefois, des interactions entre le type d'autorité et la localisation étaient significatives. Ainsi, les analyses stratifiées ont mis en évidence que pour la qualité perçue, les notes de politique signées par l'organisme bailleur (autorité financière) africain obtenaient de meilleurs scores que les notes de politique signées par l'organisme bailleur nord-américain/européen. Tant pour la qualité perçue que pour l'utilisation instrumentale déclarée, ces analyses stratifiées ont révélé que les notes de politique signées par l'université africaine (autorité scientifique) étaient associées à des scores plus faibles que les notes de politique signées par l'université nord-américaine/européenne. Interprétation : Les résultats confirment l'influence significative des sources sur la perception des connaissances en santé mondiale et rappellent l'intersectionnalité de l'influence des sources d'autorité. Cette analyse nous permet à la fois d'en apprendre davantage sur les organisations qui dominent la scène de la gouvernance mondiale en santé et de réfléchir aux implications pour les pratiques d'application des connaissances.

Cet article est republié en français avec l'autorisation de la maison d'édition Springer.

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Quand le messager est plus important que le message : étude expérimentale en Afrique francophone sur l'utilisation des connaissances

# data[].attributes.attachment_link.description
Contexte : Les injustices épistémiques sont de plus en plus décriées dans le domaine de la santé mondiale. Cette étude vise à déterminer si la source des connaissances influence la perception de ces connaissances et la volonté de les utiliser.

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Esmail, R., Hanson, H. M., Holroyd-Leduc, J., Brown, S., Strifler, L., Straus, S. E., Niven, D. J., & Clement, F. M. (2020). A scoping review of full-spectrum knowledge translation theories, models, and frameworks. Implementation Science, 15(1), 11.

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Rosmin Esmail 1,2,3,4,

Heather M Hanson 1,2,

Jayna Holroyd-Leduc 1,2,3,4,5,

Sage Brown 1,6,

Lisa Strifler 7,8,

Sharon E Straus 7,9,

Daniel J. Niven 1,2,3,10 &

...

Fiona M. Clement 1,3,6

Show authors
Implementation Science 15, Article number: 11 (2020) Cite this article

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Abstract

Background

Application of knowledge translation (KT) theories, models, and frameworks (TMFs) is one method for successfully incorporating evidence into clinical care. However, there are multiple KT TMFs and little guidance on which to select. This study sought to identify and describe available full-spectrum KT TMFs to subsequently guide users.

Methods

A scoping review was completed. Articles were identified through searches within electronic databases, previous reviews, grey literature, and consultation with KT experts. Search terms included combinations of KT terms and theory-related terms. Included citations had to describe full-spectrum KT TMFs that had been applied or tested. Titles/abstracts and full-text articles were screened independently by two investigators. Each KT TMF was described by its characteristics including name, context, key components, how it was used, primary target audience, levels of use, and study outcomes. Each KT TMF was also categorized into theoretical approaches as process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks. Within each category, KT TMFs were compared and contrasted to identify similarities and unique characteristics.

Results

Electronic searches yielded 7160 citations. Additional citations were identified from previous reviews ( n = 41) and bibliographies of included full-text articles ( n = 6). Thirty-six citations describing 36 full-spectrum were identified. In 24 KT TMFs, the primary target audience was multi-level including patients/public, professionals, organizational, and financial/regulatory. The majority of the KT TMFs were used within public health, followed by research (organizational, translation, health), or in multiple contexts. Twenty-six could be used at the individual, organization, or policy levels, five at the individual/organization levels, three at the individual level only, and two at the organizational/policy level. Categorization of the KT TMFs resulted in 18 process models, eight classic theories, three determinant frameworks, three evaluation frameworks, and four that fit more than one category. There were no KT TMFs that fit the implementation theory category. Within each category, similarities and unique characteristics emerged through comparison.

Conclusions

A systematic compilation of existing full-spectrum KT TMFs, categorization into different approaches, and comparison has been provided in a user-friendly way. This list provides options for users to select from when designing KT projects and interventions.

Trial registration

A protocol outlining the methodology of this scoping review was developed and registered with PROSPERO ( CRD42018088564).

Peer Review reports

Contributions to the literature

There has been a proliferation of knowledge translation (KT) theories, models, and frameworks (TMFs) creating confusion for users on which to select.

This scoping review provides a compendium and comparison of full-spectrum KT TMFs defined as those that have been used in the literature by study authors to inform their KT work and guide all four phases of knowledge translation from planning/design, implementation, evaluation, and sustainability/scalability.

The review findings contribute to the field by providing a concise reference source for those undertaking a KT project or designing a KT intervention to assist with KT TMF selection.

Background

Many of KT theories, models, and frameworks, collectively referred to as "TMFs" hereafter, exist. Although four reviews have been conducted in this area to date, none of these reviews provide a comprehensive list of TMFs that include all four KT phases (planning/design, implementation, evaluation, and sustainability) [ 9, 10, 11, 12]. A non-systematic review used a snowball sampling method to develop a list of 61 dissemination and implementation research TMFs [ 12]. A second review, which included literature from 1990 to 2014, found 41 different frameworks and models from 98 papers with a focus on research translation frameworks [ 11]. Further, a scoping review of published and grey literature between 2009 and 2013 identified 51 classification schemes (23 taxonomies, 15 frameworks, eight intervention lists, three models, and two other approaches) on KT interventions that could be used to integrate evidence into practice [ 10]. The most recently published scoping review was limited to TMFs used in cancer and chronic disease management and prevention, identifying 159 articles that met the inclusion criteria of the review [ 9]. Each of these studies used different research methodologies (two were narrative reviews and two were scoping reviews), literature search strategies, dates in their searches, and different inclusion/exclusion criteria. Moreover, the overlap of the KT TMFs captured in all four of these reviews was low with different TMFs included in each synthesis piece. In addition, Wensing and Grol note that the development in the fields of KT and IS has been hindered by the proliferation of TMFs for implementation, transfer, and improvement without testing, refinement, and integration [ 6]. It is likely that users would use, test, and or refine existing TMFs if there was a concise resource to add in their selection of a TMF. Thus, a compendium of full-spectrum KT TMFs is required. This study employs scoping review methodology to identify, describe, and compare the available full-spectrum KT TMFs.

Methods

A protocol outlining the methodology of this scoping review was developed using the Arksey and O'Malley methods and registered with PROSPERO (CRD42018088564) [ 13]. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed [ 14].

Search strategy

Study selection

Titles and abstracts were screened independently by two investigators (RE, SB). The inclusion criteria were:

1.
English language articles.

2.
Described a KT TMF as defined by Nilsen [ 17]. The definitions are as follows: A theory is defined as "a set of analytical principles or statements designed to structure our observation, understanding and explanation of the world." A model is "a deliberate simplification of a phenomenon or a specific aspect of a phenomenon." Lastly, a framework is described as "structure, overview, outline, system or plan consisting of various descriptive categories" [ 17]. As an entity, we considered "TMF" together as the unit when reviewing them as full spectrum.

3.
Full spectrum. Specifically, a full-spectrum KT TMF is one that has been used in the literature by study authors to inform their KT work and guide all four KT phases: (i) planning/design (identifies a knowledge gap, engages stakeholders, develops an intervention), (ii) implementation, (iii) evaluation, and (iv) sustainability/scalability [ 9].

4.
Used at any level within a system (clinical, organizational, policy).

5.
Applied prospectively rather than retrospectively. A TMF that was applied only retrospectively to determine fit after project completion or for refinement was not considered. Only TMFs that were applied prospectively to support a project during its lifespan were considered.

6.
Was not included in the scoping review by Strifler et al. [ 9].

7.
Published journal articles, books, book chapters, reports, conference abstracts, and study protocols where study results (preliminary or full) had been published. Abstracts, letters, editorials, opinion articles, dissertations, and reviews were excluded.

Prior to full screening, reviewers completed a calibration exercise on 10% of retrieved articles, and inter-rater reliability was calculated for title and abstract screening using the kappa ( κ) statistic. A moderate level of agreement (0.41 to 0.60) was considered acceptable due to the variability of this topic in the literature [ 18]. Titles and abstracts identified by either reviewer were included in the full-text review. Full-text articles were retrieved and reviewed in duplicate by the same two investigators (RE, SB). Reasons for exclusion of title/abstracts and full-text articles were documented using Microsoft Excel. Again, a κ statistic was calculated to measure agreement. Any disagreements were resolved through consensus by RE and SB. When consensus could not be reached, a third reviewer (FC and/or HH) assessed the article for eligibility.

Data extraction items and process

Data were extracted in duplicate by two investigators independently (RE and SB). Any disagreements were resolved through consensus by RE and SB through discussion. Data elements included study characteristics (author, year, geographic region, funding source), aims of study, developmental approach, KT TMF characteristics (name, terms used to describe it-theory/model/framework), context, key components of the KT TMF, description of how it was used, primary target audience or user, levels of use, and study outcomes. As the focus of this review was identification of all full-spectrum KT TMFs, quality appraisal was not conducted nor does a tool to assess quality exist.

Data analysis and synthesis

Data were summarized based on study characteristics and KT TMF characteristics. The KT TMFs were then categorized by two researchers (RE and JHL) according to the five categories of theoretical approaches described by Nilsen [ 17]. The categories include process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks (Table 1). Any disagreements were resolved through consensus by RE and JHL through discussion.

Table 1 Theoretical approach categories as described by Nilsen P [17]

The KT TMFs within each category were described based on their primary target audience or user, context, how it has been used, and levels of use (individual, organization, or policy). Further, each KT TMF was compared and contrasted within each category with respect to its similarities and unique characteristics.

Results

Search results

The updated database search from January 2016 to February10, 2018, yielded 9286 articles. When duplicates were removed, 7160 unique citations were assessed ( κ = 0.482), and 50 full-text articles were identified for further review ( κ = 0.458) with a moderate level of agreement. After full-text review, 42 citations were excluded: 38 did not describe a KT TMF, two were duplicates, one had not been tested or used, and one KT TMF was not full-spectrum. Therefore, eight full-spectrum KT TMFs were identified [ 44, 45, 46, 47, 48, 49, 50, 51]. Of the 47 references, 41 from the Milat et al. review and six articles from the hand search of the reference lists of the eight articles identified from the database search, five met the criteria for inclusion [ 52, 53, 54, 55, 56]. Eighteen were already cited in Strifler et al.'s scoping review or through the electronic database search, 18 were not full-spectrum, and six did not describe a KT TMF. The final data set included 36 full-spectrum KT TMFs (Fig. 1). Of note, there were 19 KT TMFs identified in the search that were not included in the final data set as they did not meet the criteria of full-spectrum. In particular, all 19 KT TMFs did not have the sustainability/scalability phase and two of these KT TMFs also did not have the evaluation phase (Additional file 1: Table S1).

PRISMA flowchart summarizing study review and inclusion

Description and categorization of TMFs

Knowledge translation theories, models, and frameworks by level of use

Table 2 List of full-spectrum theories, models, and frameworks by theoretical approaches categories (n = 36)

Categorization of full-spectrum knowledge translation theories, models, and frameworks ( n = 36)

Process models

The 18 process TMFs in this category were group further based on their specific focus or similar characteristics.

TMFs that build on existing TMFs

Twelve TMFs incorporated components of or built on existing TMFs. For instance, six TMFs have been used for quality improvement purposes and five incorporate the Plan-Do-Study-Act (PDSA) cycle [ 23, 25, 26, 27, 45, 49]. Another four TMFs incorporated or provided variations on the KTA framework [ 5]. The Knowledge-to-Action (KTA) framework was incorporated into the CAN-IMPLEMENT [ 22], the community-based knowledge translation model [ 56], the National Center on Health, Physical Activity and Disability Knowledge, Adaptation, Translation and Scale-up Framework (NCHPAD N-KTAS) [ 50], and the Translational Model of the Black Dog Institute [ 51]. In addition, the CollaboraKTion Framework [ 46] which focusses on population health incorporated the co-KT framework [ 47], making it a more iterative rather than linear process as depicted by the co-KT framework.

TMFs that use stages to describe the KT process

Meta-framework or network TMFs

Lastly, there were two TMFs that were distinct from the others in this category. The Quality Implementation Framework was a meta-framework of the synthesis of 25 implementation frameworks [ 28]. The Western Australia Health Policy Development and Implementation Cycle is a network model that incorporated the concept of a community of practice approach to build relationships between stakeholders. Both of these TMFs did not incorporate or build on other TMFs and did not consist of stages to drive process change.

Therefore, users seeking full-spectrum KT process models to provide a step by step "how to" approach to translation of knowledge into practice may wish to determine their focus and select the process KT TMF accordingly. In this category, there may be more updated versions of KT TMFs or variations of KT TMFs to contemplate and select from.

Classic theories

The eight theories within this category can be described as formal theories described as theories that are structured and technical and provide formal accounts of concepts [ 57]. Further differentiation between these theories is dependent on their purpose and level of change. For example, if the focus of the change is happening at the organizational or community levels, the Diffusion of Innovations Theory (DIT), the Interorganizational Relations Theory (IOR), or the Social Ecology Model (SE) for Health Promotion would be applicable [ 31, 33, 37]. If theories are required for individual health behaviour, the Transtheoretical Model (TTM) of Behaviour Change and Precaution Adoption Process Model (PAPM) would fit this purpose [ 35, 39]. If theories are being sought on the interpersonal environment that affect an individual's health behaviour, the Social Cognitive Theory (SCT), Self-Regulation (SR) Theory, and Social Learning Theory (SCT) would be suitable [ 32, 34, 36].

The TTM and PAPM are stage theories and similar to the KT TMFs described in the process category that also specifically use stages to describe the change process [ 24, 48, 55]. The PAPM differs from TTM in the number of stages and its conceptualization [ 58]. It also considers the stage in which people may be unaware of a risk and includes a stage where people decide not to act. It does not consider commencement of risky behaviour as with TTM [ 35]. A notable characteristic of the TTM is that it provides ten processes of change, which can be used at each stage [ 39]. The TTM has been criticized as not having evidence of effectiveness as demonstrated by reviews [ 57, 58].

Four theories (SR, SLT, SCT, SE) are focussed on behaviour change and the environment which is key to understanding the context in which change is occurring. SR is focused on self-regulation or taking a response or behaviour and replacing it with a less common, but more desired response [ 34]. It considers the environment like the SE model and IOR in shaping behaviour [ 33, 37]. Its second dimension of self as it relates to others is similar to SLT and SCT [ 32, 36]. SLT is about learning and meaning. SCT is based on SLT and bridges the gap between learning and behaviour [ 36]. SCT also adds the notion of self-efficacy and self-regulation like SR [ 32].

Determinant frameworks

Three full-spectrum KT TMFs were found in this category [ 29, 40, 54] (Additional file 4: Table S4). All three had multi-level target audiences.

All three frameworks provide determinants that could influence change and implementation. The Social Marketing Framework uses the principles, techniques, and tools of marketing [ 29]. It overlaps with CIFR on the identification of target audience, internal factors (degree of readiness), external factors (self-efficacy), and perceived risk. As with CIFR, it also integrates both qualitative and quantitative research methods. In addition, the Social Marketing Framework considers price in terms of incentives and disincentives, whereas CIFR considers costs in terms of the intervention. However, the Social Marketing Framework also has distinguishing features such as how the five Ps are inter-related and additional determinants such as audience segmentation, competition, and exchange [ 29].

The Knowledge Integration Process illustrates a cycle of five overlapping phases from problem identification and discovery to population health outcomes [ 54]. Each phase consists of determinants to consider, but it does not go into detail on the determinants. Similar to CIFR and the Social Marketing Framework, the Knowledge Integration Process considers stakeholder engagement.

Lastly, CFIR is meta-theoretical framework based on existing theories and empirical studies. It provides tools and a guide that can be used alongside the framework. CIFR can be used to assess barriers and facilitators for behaviour change. However, one drawback is that it does not depict interrelationships between these determinants [ 40].

Therefore, users seeking full-spectrum KT determinant frameworks to identify barriers and facilitators that may influence implementation outcomes have three distinct frameworks to choose from. Moreover, there are other non-full-spectrum KT determinant frameworks that may be useful to consider in addition to these three [ 59].

Evaluation frameworks

Three full-spectrum KT TMFs fit this category [ 41, 42, 53] (Additional file 4: Table S4). Two had multi-level [ 42, 53] and one had individual or organizational levels [ 41] as their primary target audience.

All three TMFs can be used to evaluate interventions and the extent to which the interventions are applied in practice. Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) focusses on five elements and is the only full-spectrum evaluation framework that is solely quantitative in nature [ 41]. This framework is unique as it allows for the assessment of intervention impact over time and for comparison of interventions. However, RE-AIM assumes that the five elements are equal, which may not be the case. In addition, the time interval for assessing implementation (6 months to a year) and maintenance (two or more years), respectively, is arbitrary [ 41].

The Conceptual Framework for Planning and Improving Evidence-based Practices is focussed on planning and improving best practices. Its public health impact component is adapted from RE-AIM. In contrast to RE-AIM, it provides a series of questions for the five elements. However, not all the questions are comprehensive and some may not be able to be used for all practices [ 53]. Further, it does not provide practical guidance on what to do with the information obtained.

Similar to the Conceptual Framework, PRECEDE-PROCEED also focusses on the adaptation of best practices. It provides a generic framework and logic model to assess the linkage between activities and long-term impacts [ 42]. In contrast to the Conceptual Framework, this framework describes phases to assist with generating information for subsequent decisions rather than posing questions that need to be addressed. Of the three evaluation frameworks, it is the only one that provides linkage between evaluation being part of implementation, monitoring, and continuous quality improvement.

Therefore, users seeking full-spectrum KT evaluation frameworks to evaluate interventions may need to consider these factors when selecting from these three frameworks.

KT theories, models, and frameworks that fit more than one theoretical approach category

Four KT TMFs fit more than one theoretical approach category [ 38, 43, 44, 52] (Additional file 5: Table S5). Two had multi-level [ 43, 44], one had organizational level [ 38], and one had community [ 52] as their primary target audience.

The Community Connection Model is not based on specific behavioural theories rather the author's reflection on the development and implementation of a chronic disease program. However, it does provide a broad overview of the components that necessitate change to occur similar to other theories. Its four components can also be considered determinants for change to occur. Moreover, one component is the alignment of policy to facilitate building partnerships, which is similar to the Social Marketing Framework that considers other providers and community organizations as a determinant of change.

In relation to the classic theories, the Community to Community Mentoring Model (CCM) is based on elements from DIT and the SCT TMFs including innovation characteristics, peer modeling to influence behaviour, and self-efficacy. CCM also incorporates community-based participatory research (CBPR) principles. It overlaps with the Community Connection Model through the partnership component. Moreover, it also provides three additional components of context, community-based participatory research principles, and innovation elements that are also similar to the determinants within CIFR.

The Evidence-driven Community Health Improvement Process (EDCHIP) builds on CHIP and incorporates the search and organization of scientific literature and RE-AIM, respectively. EDCHIP is similar to the KTA process TMF [ 5] through the synthesis of scientific knowledge (the funnel) and specific implementation steps (the action cycle). Further, it replicates RE-AIM [ 41] within its analysis and implementation cycle. It is novel in that it incorporates elements from two distinct full-text KT TMFs from the process and evaluation categories and integrates them for a more comprehensive TMF.

Thus, these four cross-cutting KT TMFs offer yet other options and may be suitable for users seeking more than one theoretical approach in a KT TMF.

Discussion

Key findings

Three key findings emerged from this scoping review: an up-to-date compilation of full-spectrum KT TMFs using scoping review methodology; categorization of these KT TMFs based on five categories of approaches; a detailed description of each KT TMF; and comparison within each category to assist with their selection for a KT project or intervention.

This scoping review identified 36 full-spectrum KT TMFs. The use of full-spectrum KT TMFs to anchor a KT project is considered an important and foundational starting point. Rather than the development of yet another KT TMF, users are encouraged to select from this current list and then share their experiences on application (Additional files 2, 3, 4, and 5). This approach will help to further develop and improve the theoretical foundation that KT science is built on.

The lack of a full-spectrum KT TMF within the implementation theory category may reflect that these KT TMFs are used in implementation science to understand and explain aspects of implementation. Thus, they may not cover all four phases of KT, but instead focus on the planning/design and implementation phases. An example is the COM-B (Capability, Opportunity, Motivation and Behaviour) [ 60]. This framework posits that the presence of COM can influence behaviour which in turn influences COM. It has been used to explain why and how implementation occurs.

Comparison of the KT TMFs within each category highlighted similarities and unique characteristics. Within the process category, two thirds of the KT TMFs incorporated other TMFs or provided variations of previous TMFs. Six of these TMFs had a focus toward quality improvement. The classic theory category presented TMFs that were foundational, such as the DIT. The theories within this category concentrated on the level of change at the organizational, community, or behavioural change related to self. Both determinant and evaluation framework categories had three TMFs each. The determinant category offered a meta-theoretical framework, with two simpler determinant frameworks. The evaluation category offered three very distinct TMFs, with one quantitative in nature. The final category afforded TMFs that could fit more than one category. As such, they would be useful for users seeking more than one theoretical approach.

This list of 36 full-spectrum KT TMFs and their categorization provides a starting point for any KT project or intervention. By providing a detailed description and comparison of TMFs within each category, users can scan the available TMF options and determine which may be best suited to their KT approach. For example, a user searching for a process KT TMF to apply within multiple target audiences at the policy level could select from three potential process TMFs, (KTA, Collaborative Model for Achieving Breakthrough Improvement, PDSA cycle) [ 5, 23, 27]. Moreover, if users are looking for a KT TMF that has both a process and evaluation approach, they could select the EDCHIP model [ 52]. Therefore, users have a concise list of KT TMFs to select from based on approach, purpose, context, and the level of use [ 61].

Birken et al. has suggested a more complex process for selecting a KT TMF that involves 19 criteria [ 62]. However, not dissimilar to how the KT TMFs were described in this review, the criteria ranked most important were empirical support, application to a specific setting or population, explanatory power or testability, description of a change process, and analytical level (macro-policy level, meso-health care organization level, and micro-clinical level). Furthermore, the authors have developed the T-CAST: an implementation theory comparison and selection tool with 16 specific criteria, organized within four categories, applicability, usability, testability, and acceptability. Users of the T-CAST tool will find it helpful for deciding whether a specific TMF is relevant for their project or for deciding which of several TMFs is most relevant for their project. As such, the T-CAST aids in the selection of TMFs from among a candidate list [ 63]. Thus, this scoping review provides a list for users to review the range of candidate full-spectrum TMFs available and subsequently apply the T-CAST tool to compare and select a KT TMF.

Therefore, this scoping review can be used as a resource and starting point from which users can select a full-spectrum KT TMF. The T-CAST tool or a usability scale could then be applied by users to compare among these KT TMFs to assist with potential fit of the KT TMF or TMFs used in combination for their project.

Strengths

This scoping review followed a rigorous protocol, building on a previous high-quality scoping review [ 9] in a unique manner that enabled the capture of full-spectrum KT TMFs. Moreover, whereas the previous scoping review [ 9] focussed on cancer and chronic disease, this scoping review modified the search strategy to identify KT TMFs regardless of context and provided details and comparison of each KT TMF. The comprehensive nature of the search included a search of the grey literature, examination of review articles published after the scoping review, and a review of the final list by KT experts, which helped minimize the risk of missing a relevant full-spectrum KT TMF. To our knowledge, it is the only scoping review that provides a compendium and comprehensive description of full-spectrum KT TMFs. The scoping review also compares each KT TMF within categories to allow users to better understand and assist with their selection.

Limitations

Articles published in languages other than English were not incorporated into the search strategy due to lack of resources. So, the review may be subject to language bias. In addition, there may have been misclassification of TMFs during the search. However, the BeHEMOth search strategy utilizes different terms for theory, model, and framework to minimize the risk of misclassification. Kappa agreement between the reviewers was moderate and could be attributed to the lack of clarity in the literature of how a KT TMF is defined.

Nilsen's definitions of a theory, model, and framework were used, but there are other definitions that could have been used to define these terms [ 66]. Moreover, often these three terms are used inter-changeably in the literature and cause further confusion. These terms are not synonyms and there is a need for future research to provide guidance on how to determine which approach to use, i.e. a theory, model or framework based on the research study and context prior to the actual selection of the TMF.

Providing a compendium of full-spectrum TMFs only may miss several commonly used TMFs such as those cited by Birken et al. [ 62]. In this study, CIFR, RE-AIM, and DIT have been cited as the top three most commonly used TMFs, and they also were classified as full-spectrum in this scoping review. However, other commonly used TMFs such as Promoting Action on Research Implementation in Health Services (PARIHS) Framework [ 67] and Normalization Process Theory [ 68] did not make the full-spectrum list. PARIHS and Normalization Process Theory were cited by Strifler et al.'s scoping review. However, they were not classified as full-spectrum. PARIHS did not have the planning/design and sustainability/scalability phases and the Normalization Process Theory was missing the implementation and sustainability phases [ 9]. Nonetheless, there is added value in presenting KT TMFs that are full-spectrum as they meet the criteria for all four KT phases considered important for users when implementing KT projects or interventions. In addition, users may want to explore the use of both full-spectrum KT TMFs and other commonly used KT TMFs. Combining KT TMFs for implementation has been shown to be beneficial given the context and complex nature of implementation science itself [ 69].

Conclusions

This scoping review provides a summary of the full-spectrum KT TMFs that could be used as a foundation for clinicians, researchers, and policy makers, undertaking KT projects within the health care context. The application of an existing KT TMF is recommended for all applied KT projects and interventions [ 9]. It is only by further understanding, utilizing, and evaluating these KT TMFs that the field of KT science can advance and ultimately improve the implementation of evidence into practice.

Availability of data and materials

Abbreviations

AHRQ:

Agency for Healthcare Research and Quality

BeHEMOth:

Behaviour of interest; Health context; Exclusions; Models or Theories

CADTH:

Canadian Agency for Drugs and Technologies in Health

CBPR:

Community-based participatory research

CDC-OPS:

Center for Disease Control and Prevention's Obesity Prevention Strategy

CCM:

Community to community mentoring model

CFIR:

Consolidated Framework for Implementation Research

CHIP:

Community Health Improvement Process

CIHR:

Canadian Institutes of Health Research

COM-B:

Capability, Opportunity, Motivation and Behaviour

DIT:

Diffusion of Innovations Theory

EBI:

Evidence-based interventions

EDCHIP:

Evidence-Driven Community Health Improvement Process

HCIM:

Healthcare Improvement Collaborative Model

IOR:

Interorganizational Relations Theory

KT:

Knowledge translation

KTA:

Knowledge-to-Action

NCCMT:

National Collaborating Center for Methods and Tools

NCHPAD N-KTAS:

National Center on Health, Physical Activity and Disability Knowledge, Adaptation, Translation and Scale-up Framework

PAPM:

Precaution Adoption Process Model

PARIHS:

Promoting Action on Research Implementation in Health Services

PEFL:

Policy effectiveness feasibility loop

PDSA:

Plan-Do-Study-Act

PRECEDE-PROCEED:

Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development

PRISMA-ScR:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews

RE-AIM:

Reach, Effectiveness, Adoption, Implementation, and Maintenance

SE:

Social Ecology Model of Health

SCT:

Social Cognitive Theory

SLT:

Social Learning Theory

SR:

Self-Regulation Theory

TMF:

Theory, model, and framework

TTM:

Transtheoretical Model

T-CAST:

Implementation theory comparison and selection tool

SONAR:

Social Networking App/Action for Resilience

SUS:

System Usability Scale

USA:

United States of America

VHA:

Veterans Health Administration

WA:

Western Australia

References

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Funding

Rosmin Esmail is funded through an Alberta Innovates Graduate Studentship. The funding body did not participate in the design of the study and collection, analysis, and interpretation of data or writing of the manuscript.

Author information

Authors and Affiliations

Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D14A Teaching and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada

Rosmin Esmail, Heather M Hanson, Jayna Holroyd-Leduc, Sage Brown, Daniel J. Niven & Fiona M. Clement

Alberta Health Services, Calgary, Alberta, Canada

Rosmin Esmail, Heather M Hanson, Jayna Holroyd-Leduc & Daniel J. Niven

O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada

Rosmin Esmail, Jayna Holroyd-Leduc, Daniel J. Niven & Fiona M. Clement

Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada

Rosmin Esmail & Jayna Holroyd-Leduc

Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada

Jayna Holroyd-Leduc

Health Technology Assessment Unit, University of Calgary, Calgary, Alberta, Canada

Sage Brown & Fiona M. Clement

Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada

Lisa Strifler & Sharon E Straus

Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

Lisa Strifler

Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Sharon E Straus

Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

Daniel J. Niven

Contributions

RE, HH, and FMC conceived the idea for the manuscript. RE conducted the literature search. RE and SB conducted study selection and data extraction. RE and JHL conducted the theoretical categorization. RE conducted the data analysis and synthesis. RE, FMC, HH, JLH, and DJN were involved in drafting of the manuscript. FMC, HH, SB, LS, SS, DJN, and JHL were involved in revising the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fiona M. Clement.

Ethics declarations

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Not applicable

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Not applicable

Competing interests

The authors declare that they have no competing interests.

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Supplementary information

Appendices

Appendix A

Ovid MEDLINE Search Strategy Adapted from Strifler et al 2018

Database: Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) <1946 to Present>

--------------------------------------------------------------------------------

Database: Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) <1946 to Present>

--------------------------------------------------------------------------------

1 (knowledge adj2 (application or broke$ or creation or diffus$ or disseminat$ or exchang$ or implement$ or management or mobili$ or translat$ or transfer$ or uptak$ or utili$)).tw.

2 (evidence$ adj2 (exchang$ or translat$ or transfer$ or diffus$ or disseminat$ or exchang$ or implement$ or management or mobil$ or uptak$ or utili$)).tw.

3 (KT adj2 (application or broke$ or diffus$ or disseminat$ or decision$ or exchang$ or implement$ or intervent$ or mobili$ or plan$ or policy or policies or strateg$ or translat$ or transfer$ or uptak$ or utili$)).tw.

4 (research$ adj2 (diffus$ or disseminat$ or exchang$ or transfer$ or translation$ or application or implement$ or mobil$ or transfer$ or uptak$ or utili$)).tw.

5 ("research findings into action" or "research to action" or "research into action" or "evidence to action" or "evidence to practice" or "evidence into practice").tw.

6 Translational Medical Research/

7 Diffusion of Innovation/or (diffusion adj2 innovation).tw.

8 (("systematic review$" or "knowledge synthes$") adj5 ("decision mak$" or "policy mak$" or "policy decision?" or "health polic$")).tw.

9 (("systematic review$" or "knowledge synthes$") adj2 (application or implement$ or utili?ation or utilize? or utilise? or utili?ing)).tw.

10 research utili?ation.tw.

11 ((evidence base$ or evidence inform$) adj2 (decision$ or plan$ or policy or policies or practice or action$)).tw.

12 or/1-11

13 (model* or theor* or concept* or framework*).tw.

14 12 and 13

15 limit 14 to english

16 limit 15 to yr = 2016-current

Appendix B

Grey literature websites

In addition to websites listed in the CADTH grey matter approach, the following websites were searched:

KT Canada Clearinghouse ( http://ktclearinghouse.ca/tools/uncategorized)

Implementation Central ( http://www.implementationcentral.com/index.html)

Alberta Innovates Health solutions https://spor.albertainnovates.ca/the-alberta-spor-support-unit/knowledge-translation-platform/

Consolidated Framework for Implementation Research (CFIR) ( http://cfirguide.org/)

National Collaborating Center for Methods and Tools (NCCMT) ( http://www.nccmt.ca/resources/registry)

Cochrane Community ( http://community.cochrane.org/review-production/knowledge-translation/framework-and-implementation-plan)

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Esmail, R., Hanson, H., Holroyd-Leduc, J. et al. A scoping review of full-spectrum knowledge translation theories, models, and frameworks. Implementation Sci 15, 11 (2020). https://doi.org/10.1186/s13012-020-0964-5
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DOI: https://doi.org/10.1186/s13012-020-0964-5

Keywords

Knowledge translation

Implementation

Models

Theories

Frameworks

Diffusion

Dissemination

Research utilization

# data[].attributes.attachment_link.title
A scoping review of full-spectrum knowledge translation theories, models, and frameworks - Implementation Science

# data[].attributes.attachment_link.description
Background Application of knowledge translation (KT) theories, models, and frameworks (TMFs) is one method for successfully incorporating evidence into clinical care. However, there are multiple KT TMFs and little guidance on which to select. This study sought to identify and describe available full-spectrum KT TMFs to subsequently guide users.

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Ellis, K. (2014). Knowledge Translation and the Governance of Health Research in Canada : A Critical Discourse Analysis [Ph.D., University of Western Ontario].

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Abstract

Knowledge translation (KT) is a dominant discourse in the governance of health research in Canada. I critically examine the KT discourse of the Canadian Institutes of Health Research (CIHR), Canada's major health research funder. Informed by a governmentality perspective, I explore how the KT discourse operates to shape the directions of health research and the activities of health researchers using critical discourse analysis with a sample of publicly available CIHR documents.

This KT discourse is constructed through three rationales: a "gap" between knowledge creation and its application; financial and health care accountabilities for public investment in health research; and, the expectation of economic prosperity and an international competitive edge for Canada. Through these rationales, the use of health research becomes problematized and KT is constructed as an unquestioned solution.

KT is constructed to function in ways consistent with the three rationales in shaping health research and researchers in particular directions. Ideal health research is"innovative", "world-class", and demonstrates an economic return on taxpayers' investment. Health researchers are constructed as the workforce in a transformed "research enterprise", expected to meet knowledge "users'" needs. CIHR is constructed as theGovernment of Canada's "health research investment agency", a national manager of health research and researchers and international authority in KT.

KT operates as a technology of governance, with potential effects in prioritizing particular health research agendas and privileging particular kinds of researcher orientations within the context of neoliberal rationalities of government. The rationales are considered in relation to evidence-based medicine and new public management to critically reflect on the contemporary governance of health research and researchers in Canada.

Recommended Citation

Ellis, Kathleen S., "Knowledge Translation and the Governance of Health Research in Canada: A Critical Discourse Analysis" (2014). Electronic Thesis and Dissertation Repository. 2198.
https://ir.lib.uwo.ca/etd/2198

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canadian institutes of health research (cihr)

# data[].attributes.attachment_link.title
Knowledge Translation and the Governance of Health Research in Canada: A Critical Discourse Analysis

# data[].attributes.attachment_link.description
Knowledge translation (KT) is a dominant discourse in the governance of health research in Canada. I critically examine the KT discourse of the Canadian Institutes of Health Research (CIHR), Canada's major health research funder.

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Elissalde, J., & Renaud, L. (2010). Les démarches de circulation des connaissances : Mobilisation et valorisation des connaissances (L. Renaud, Éd.; p. 408‑429). Presses de l’Université de Québec.

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Ce livre est le fruit d'une réflexion de chercheurs d'horizons multiples sur les pratiques de transfert des connaissances en santé et sécurité du travail. Chercheurs et intervenants partagent souvent une large expérience du transfert qui se construit à partir d'allers-retours continus, le plus souvent informels. Le but de cet ouvrage était de regrouper un corpus de cette vaste expérience, acquise au fil des ans, et de partager les questionnements que celle-ci suscite auprès des intéressés. Chacun des textes présentés dans cet ouvrage démontre l'enjeu que représente l'investissement dans ce capital organisationnel intangible et essentiel qui a trait au transfert des connaissances en santé et sécurité au travail. L'organisation doit capitaliser sur ses expériences dépositaires d'une richesse humaine qui se construit au fil du temps. La nature même de cette construction du savoir est essentiellement dynamique et continue. L'évolution de produit au gré des situations de travail, en permettant aux apprentissages du passé d'être utiles pour construire l'avenir. D'où l'intérêt de la perspective, adoptée dans ce recueil de textes, centrée sur l'usager. Ce dernier est au cœur même de la dynamique du transfert de connaissances et il est partie prenante de la création, de la diffusion et de l'application de celles-ci.
Depuis 2006, le regroupement stratégique en transfert de connaissances du Réseau de recherche en santé et sécurité du travail Québec (RRSSTQ) organise divers symposiums sur le transfert de connaissances (TC), partage avec la communauté pratique et scientifique une veille stratégique à travers son site web et ses écrits sur le thème du transfert appliqué à la santé et la sécurité du travail .

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La dynamique du transfert des connaissances. Perspectives centrées sur l'usager

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Ce livre est le fruit d'une réflexion de chercheurs d'horizons multiples sur les pratiques de transfert des connaissances en santé et sécurité du travail. Chercheurs et intervenants partagent souvent une large expérience du transfert qui se construit à partir d'allers-retours continus, le plus souvent informels.

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Dari, T. H. (2017). Development and Validation of Community-Based Participatory Research (CBPR) Competencies : A Delphi Study [Ph.D.].

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Development and Validation of Community-Based Participatory Research (CBPR) Competencies: A Delphi Study

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Explore millions of resources from scholarly journals, books, newspapers, videos and more, on the ProQuest Platform.

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Dagenais, C., & Robert, E. (Éds.). (2012). Le transfert des connaissances dans le domaine social. Presses de l’Université de Montréal.

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Voici un livre complet, axé sur la théorie et la pratique, qui intéressera les chercheurs et les utilisateurs des connaissances. Il arrive à point : le transfert des connaissances est un enjeu organisationnel appelé à connaître une importance cruciale au cours des prochaines années.

Nathalie Houlfort Professeure agrégée Cotitulaire de la Chaire d'études sur l'application des connaissances dans le domaine des jeunes et des familles en difficulté - UQÀM

Le transfert et l'utilisation des connaissances dans le domaine social restent encore un territoire trop peu exploré. Voilà que ce livre en offre une première topographie qui montre de façon convaincante comment on peut accélérer la production et la mise à profit de nouvelles connaissances.

Céline Mercier Département de médecine sociale et préventive Université de Montréal

Ont collaboré à cet ouvrage : Johanne Archambault, Nathalie Awad, Jeanne Bazinet, Pierre-Olivier Bédard, Diane Berthelette, Fabien Besner, Mélodie Briand-Lamarche, François Chagnon, Léna d'Ostie-Racine, Christian Dagenais, Gilles Dupuis, Jacques Fortin, Mathieu-Joël Gervais, Julie Lane, Luc Lapointe, Marie-Claire Laurendeau, Marie Malo, Sandra Nutley, Mathieu Ouimet, Renée Pinard, Renée Proulx, Émilie Robert, Stéphanie Siron et Karine Souffez.

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Transfert des connaissances dans le domaine social (Le)

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Voici un livre complet, axé sur la théorie et la pratique, qui intéressera les chercheurs et les utilisateurs des connaissances. Il arrive à point : le transfert des connaissances est un enjeu organisationnel appelé à connaître une importance cruciale au cours des prochaines années.

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Dagenais, C. (2021). Le point de vue des décisionnaires du Burkina Faso sur l’utilisation de la recherche au ministère de la Santé. In Vers une couverture sanitaire universelle en 2030 ? Réformes en Afrique subsaharienne (Éditions science et bien commun). Québec : Éditions science et bien commun.

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Christian Dagenais

Introduction

Depuis l'émergence du mouvement de la médecine fondée sur des preuves dans les années 1990, la tendance à fonder les pratiques et la prise de décision sur des données probantes a connu un essor remarquable (Bowen & Graham, 2013; Kitson et al., 2013). Néanmoins, malgré tous les efforts consentis, l'écart persiste entre les connaissances scientifiques disponibles et leur utilisation (Kothari et al., 2014; Leijen-Zeelenberg et al., 2014; Lysenko et al., 2014; Nutley, 2011). Les écrits scientifiques sur le transfert de connaissances (TC) présentent encore peu de données probantes sur les processus qui mènent à l'utilisation des connaissances scientifiques dans un contexte donné et sur leur efficacité (Breckon et al., 2016; Cherney e t al., 2013; Cooper, 2014; Dagenais et al., 2013; Langer et al., 2016).

En février 2017, le ministre de la Santé Nicolas Méda, lui-même médecin et chercheur, envisageait de créer une unité destinée à favoriser l'utilisation de la recherche pour la prise de décision au sein de son Ministère. Il m'a alors mandaté pour en accompagner la mise en œuvre. Le 27 septembre 2017 (Burkina Faso, 2017), le gouvernement a entériné par décret la réorganisation du Ministère proposée par le ministre et la création d'une Unité de Gestion et de Transfert des Connaissances (UGTC) directement rattachée à son cabinet. Cette unité vise à développer une meilleure prise en compte des données de recherche dans la prise de décision et la gestion du système de santé à tous les niveaux. Elle a pour mission d'éclairer, par des données probantes et dans un environnement complexe, la prise de toutes les décisions publiques en matière de santé.

Ce chapitre présente les résultats d'une étude menée à la suite de plusieurs années de recherche au Burkina Faso. Tout au long de ces années, les équipes avec qui j'ai travaillé ont déployé des efforts considérables pour favoriser l'utilisation de nos résultats en mettant notamment en place des activités de courtage de connaissances (Dagenais et al., 2015, 2016; D'Ostie-Racine et al., 2016). Ces efforts ont souvent produit des impacts positifs aux niveaux local et régional, mais on a peu de traces d'une utilisation des résultats au niveau central (Dagenais et al., 2013; McSween-Cadieux et al., 2017; Ridde & Dagenais, 2018), car il a toujours été difficile d'impliquer des haut-e-s dirigeant-e-s dans nos activités de restitution et à obtenir quelques minutes d'entretiens avec eux ou elles. On commence à peine à identifier les conditions d'utilisation de la recherche par les décisionnaires politiques, mais on sait que leurs attitudes et opinions face à la recherche constituent un des principaux déterminants (Nabyonga-Orem et al., 2015; Oliver et al., 2014; Rütten & Gelius, 2014; South & Cattan, 2014).

Avant la mise en place de l'UGTC, il est apparu important d'étudier l'attitude face à la recherche au sein des hautes instances du ministère de la Santé du Burkina Faso. J'ai mené une série d'entretiens individuels en mai 2017 auprès de 14 décisionnaires du cabinet du ministre. Ces entretiens, d'une durée moyenne d'environ 45 minutes, ont été enregistrés sur support numérique avec l'accord explicite des participant-e-s à qui l'on a garanti l'anonymat. L'entretien visait à recueillir leur point de vue sur l'utilisation de la recherche pour la prise de décision. Les principaux thèmes abordés lors de ces rencontres portaient sur : 1) la perception de l'attitude générale face à la recherche; 2) les obstacles; 3) et les éléments qui pourraient favoriser une plus grande utilisation de la recherche au sein du Ministère. J'ai également demandé aux personnes interrogées de 4) fournir des exemples concrets de résultats de recherche qui avaient été utilisés dans leur direction et 5) d'explorer des moyens d'améliorer la participation des décisionnaires aux activités de transfert des connaissances issues de la recherche. Les entretiens ont été partiellement retranscrits le jour même où ils ont été réalisés et une analyse thématique de contenu (Patton 2002) a été appliquée à l'ensemble du matériel recueilli.

Une attitude mitigée face à la recherche

Si plusieurs affirment qu'il y a, d'une manière générale, une bonne acceptation de la recherche et qu'elle est nécessaire à la planification, d'autres personnes la considèrent comme le parent pauvre du système. D'une part, l'utilisation de la recherche est encouragée et certain-e-s affirment même qu'elle fait partie des priorités de tous les cadres du ministère de la Santé. On cite pour preuve le fait que trois centres de recherche sont sous la tutelle du Ministère.

D'autre part, c'est pourtant une majorité des personnes interrogées qui considèrent que la recherche influence très faiblement les décisions, sauf peut-être en ce qui concerne certaines directions telles que la direction générale de la santé, et la direction des études et statistiques sectorielles. Pour les autres décisionnaires, c'est un peu l'indifférence qui domine. On rapporte que certaines personnes ont parfois même une attitude hostile face à la recherche. Pour plusieurs, la recherche est vue comme un monde à part, une " chasse gardée " qui ne constitue pas une priorité. Selon une personne interrogée, on aurait tendance à s'appuyer beaucoup plus sur les recommandations des grandes ONG et de l'OMS plutôt que sur la recherche, sauf quand il y a urgence, comme par exemple lors de la dernière flambée de dengue en 2016. Mais certaines personnes expliquent que la situation évolue, grâce entre autres aux deux derniers ministres qui avaient un profil de chercheur.

D'importants obstacles à l'utilisation de la recherche

Outre l'ouverture parfois mitigée face la recherche, les deux principaux obstacles relevés par les personnes rencontrées portent sur les difficultés d'accès aux résultats de recherche et sur le fait que des pistes d'action pour appliquer les résultats ne soient souvent pas proposées par les équipes de recherche. Puisqu'on " ne peut pas utiliser ce dont on ne connait pas l'existence ", dit l'un des répondant-e-s, la question de l'accès aux résultats de recherche est fondamentale et il doit survenir au moment opportun. Or, la majorité des personnes interrogées ont affirmé avoir des difficultés à repérer les études qui pourraient les aider à prendre des décisions. Ceci s'explique en partie, selon certaines personnes, par le fait que les scientifiques n'ont souvent pas la préoccupation de communiquer leurs résultats autrement que par des publications dans les revues avec comité de pairs : " [...] le chercheur fait ça pour ses galons; ils vont diffuser ailleurs, mais pas ici ". Même si une quantité importante d'études sont menées, il n'existe pas de répertoire qu'on pourrait consulter pour retracer celles qui seraient utiles le cas échéant. On souligne l'absence d'une stratégie claire de communication autour de la recherche. L'autre principal obstacle à l'utilisation est lié aux scientifiques et au fait que souvent, ils et elles ne formulent pas de recommandations au sujet de la mise en œuvre des résultats, ce qui réduit les chances que des changements découlent des études menées. Puisque " dans les écoles [de formation] on ne met pas l'accent sur l'utilisation ", un accompagnement est souvent nécessaire pour mettre en œuvre les changements qui pourraient découler d'une étude.

Un autre obstacle important à l'utilisation liés aux scientifiques touche leur mode de communication qui utilise trop souvent un jargon spécialisé, difficile d'accès. On souligne également la pertinence des études disponibles qui ne sont pas toujours en phase avec les réalités auxquelles fait face le Ministère : " [...] on fait des recherches utiles pour le chercheur, pas nécessairement pour le Ministère ", ainsi que les problèmes de financement non seulement de la recherche, mais aussi de l'application de ses résultats.

Plusieurs idées pour favoriser l'utilisation de la recherche

Pour contourner l'obstacle que constitue l'accès aux résultats de recherche, la plupart des personnes interrogées ont proposé des solutions. La principale concerne la coordination de la diffusion et le rôle que pourrait avoir la direction des archives et de la documentation qui, même si leur mandat précis est peu connu, pourrait mettre en place un répertoire des études disponibles. Selon certaines, cette direction devrait se charger de faire connaître les résultats : " [...] ils doivent prendre le leadership pour faire connaître les résultats. Si cette direction se donne cette prérogative, certainement elle trouvera le moyen ". Les résultats de recherche devraient être publiés sur le site du Ministère : " Il faut d'abord savoir que l'étude existe et après y accéder [...] ". Il faudrait utiliser les réseaux sociaux pour diffuser sous forme de résumés d'une page, de bulletins, les résultats les plus pertinents et organiser des restitutions ciblant spécifiquement l'équipe technique susceptible d'utiliser les résultats. Mais pour que les décisionnaires accèdent aux résultats de recherche, il faut leur parler de leurs utilités, montrer ce que la recherche peut apporter de positif. Il faut les convaincre qu'ils et elles ont intérêt à l'utiliser : " Ça prendrait un genre de lobbying de la recherche; il faut arriver à expliquer l'intérêt ou l'impact que cette étude pourrait avoir ou pourrait être utilisée ". Ceci pourrait susciter la " soif d'aller chercher l'information " et il faut développer les compétences pour aller la chercher.

Une autre partie des solutions proposées vise les scientifiques et notamment ceux et celles des centres sous la tutelle du ministère de la Santé : " Il faut rappeler aux centres qu'ils relèvent du Ministère; ils vont diffuser ailleurs, mais pas ici... Il faudrait que les centres focalisent sur des thématiques prioritaires pour le Ministère ". Plusieurs insistent sur l'importance de développer les capacités des scientifiques pour " traduire en adages très simples " et mieux communiquer leurs résultats : " [...] il faut parler de comment communiquer les résultats. Les gens, ils sont là et ils s'ennuient parce qu'ils ne comprennent pas, on ne s'adresse pas à eux ". Il faudrait aussi que les scientifiques n'attendent pas que les non scientifiques aillent vers eux et elles, qu'ils et elles soient pro-actifs et pro-actives, " ils connaissent les personnes qui peuvent utiliser ". Quelques personnes considèrent qu'il appartient aux scientifiques de démontrer en quoi la mise en œuvre peut impacter positivement les décisions. On souligne également l'avantage d'impliquer les décisionnaires dans la recherche pour faciliter l'utilisation des résultats et l'importance que les haut-e-s responsables du Ministère soient au cœur de la communication.

Enfin, on suggère la mise en place d'un cadre d'échanges pour créer une dynamique d'interaction entre scientifiques et décisionnaires: " [...] il faut que le politique voie que la recherche c'est important et que les chercheurs voient que c'est important de partager [...] pour alimenter ceux qui peuvent s'en servir ". Selon certain-e-s, les scientifiques et les décisionnaires devraient se rencontrer sur une base régulière et on pourrait profiter des mécanismes en place, tels que le conseil d'administration du secteur ministériel (CASEM) ou le cadre sectoriel de dialogue (CSD), pour inviter des scientifiques à venir présenter leurs travaux.

Relativement peu de traces de l'utilisation de la recherche rapportées par les répondant-e-s

Près de la moitié des personnes interrogées n'ont pas été en mesure de citer une étude qui avait servi à prendre une décision ou à guider des actions au sein de leur direction. Lorsque ça a été fait, le plus souvent, on évoquait des données populationnelles ou épidémiologiques ayant servi, par exemple, à identifier des districts qui performent moins bien que d'autres. Certaines personnes ont cité des politiques adoptées récemment, mais n'ont pas été en mesure de citer une seule étude qui en avait influencé la formulation.

Mais certaines personnes, même si peu nombreuses, sont très au fait des études produites au sujet de la gratuité de soins et sont en mesure de nommer les résultats qui ont été pris en compte dans la politique mise en place. Ces études ont permis de bien comprendre les avantages de la gratuité et ont guidé les actions pour améliorer la santé des mères et des enfants. L'une des personnes rencontrées a tout lu et est en mesure de citer la plupart des études à ce sujet. D'autres études récentes au sujet de la dengue ont servi à faire connaître la présence de cette maladie au Burkina et à sensibiliser la population. Mais on ne sait pas nécessairement jusqu'où se sont rendu ces informations. D'autres études sont signalées par les personnes interrogées au sujet d'un vaccin contre le paludisme, par exemple. La plupart du temps, il s'agit d'une seule étude à laquelle ils ou elles ont participé. Ou encore une étude a permis de comprendre ce qu'il fallait mettre en place (sur la rétention du personnel en région rurale par exemple), mais les ressources pour le faire n'ont pas suivi.

Favoriser l'engagement des acteurs et actrices politiques dans des activités de transfert des connaissances

En fin d'entretien, j'ai raconté aux personnes interrogées les difficultés que nos équipes ont rencontrées au cours des dernières années pour amener les décisionnaires à participer à des activités de transfert de connaissances lors d'ateliers de restitution ou de dialogues délibératifs. Malgré nos efforts répétés, la plupart du temps, le ou la décisionnaire invité-e déléguait un ou une collègue ou subalterne ou se présentait au début de l'activité et quittait aussitôt après son discours d'ouverture.

Pour les personnes interrogées, cette situation est une réalité du Ministère et c'est, selon certaines, " le mal de l'Afrique "; les dirigeants et dirigeantes sont très occupé-e-s. Ils et elles ont par conséquent tendance à déléguer ce qu'ils et elles connaissent le moins et prioriser ce qu'ils et elles connaissent. Il faut donc arriver à les sensibiliser pour qu'ils et elles puissent prioriser cette activité; aller les inviter directement, les rencontrer pour leur expliquer pourquoi ils ou elles devraient venir. La moitié des personnes interrogées suggèrent d'utiliser le poids de la hiérarchie, que les plus haut-e-s dirigeant-e-s donnent la consigne : " [...] si ça vient du ministre ou du secrétaire général (SG) ça va marcher; il faut que le grand chef passe un message clair ".

Pistes de réflexion et d'action

Un travail colossal de synthèse réalisé récemment par l'" Alliance pour des connaissances utiles " porte sur l'efficacité de différents mécanismes qui visent à augmenter l'utilisation de la recherche par les décisionnaires (Breckon et al., 2016; Langer et al., 2016). Cette synthèse reprend les résultats de 23 revues systématiques dans le domaine du TC et elle a été complétée par une revue exploratoire dans d'autres domaines des sciences sociales. C'est en fonction des six mécanismes de TC identifiés comme étant efficaces dans cette " revue des revues ", qu'une série de pistes de réflexion et d'action ont été proposées au ministre.

Accroître la sensibilisation et promouvoir une attitude positive envers la prise de décision éclairée par les données probantes;

Construire un consensus sur ce qui constitue des questions de politique publique en lien avec les données adaptées;

Communiquer sur et fournir un accès aux données probantes;

Faciliter les interactions entre décisionnaires et scientifiques;

Développer les compétences pour accéder aux données probantes et donner un sens à la preuve;

Influencer les structures et les processus décisionnels.

Le premier mécanisme regroupe les stratégies visant à sensibiliser les utilisateurs et utilisatrices à l'utilité de la recherche et à modifier leur opinion face à celle-ci. Il existe de solides données probantes sur l'efficacité de stratégies telles que le marketing social et les campagnes de sensibilisation. De telles stratégies pourraient être explorées et adoptées par l'Équipe de l'UGTC afin de développer des attitudes plus positives face à la recherche au sein du Ministère.

Le deuxième mécanisme porte sur le développement d'une compréhension commune des questions d'intérêt auxquelles la recherche devrait répondre. Les limites liées au mandat qui m'a été confié n'a pas permis d'accéder à un " plan d'action de la recherche " qui aurait pu éclairer mon équipe et moi-même au sujet de l'adéquation entre les questions de recherche explorées par les scientifiques burkinabè et les besoins d'information du Ministère. Mais selon le discours tenu par plusieurs, les études menées dans les centres de recherche sous la tutelle du Ministère ne répondraient pas toujours à ses priorités. Bien sûr, la recherche dite " libre " est nécessaire et ce ne sont pas toutes les études qui devraient faire l'objet d'un transfert. Cependant, un consensus pourrait être créé autour des questions d'intérêt pour le Ministère en mettant à profit des méthodologies démontrées efficaces telles que les groupes Delphi ou la cartographie conceptuelle (concept mapping).

Le troisième mécanisme regroupe les stratégies qui visent à améliorer l'accès et à communiquer les résultats de recherche, telles que la création de bibliothèques virtuelles permettant de repérer les informations pertinentes, des médias sociaux et d'autres médias en ligne ainsi que la transformation des résultats dans un format approprié (notes de politique, résumés de recherche, infographies, etc.). Ces stratégies sont efficaces lorsqu'elles sont utilisées au moment opportun et que la stratégie de communication emploie des moyens variés et adaptés au contexte des utilisateurs et utilisatrices (théâtre forum, bandes vidéo, ateliers délibératifs, etc.). Comme on l'a vu, au ministère de la Santé, un registre des études disponibles devra dans un premier temps être créé, travail qui a été amorcé par la Direction des archives et de la documentation. Le rôle de l'UGTC pour communiquer les résultats pertinents sera au cœur de la stratégie.

La synthèse présente peu de données probantes concernant l'efficacité des interactions entre les scientifiques et les décisionnaires pour favoriser l'utilisation de la recherche. Même si d'autres données sont nécessaires, il demeure hautement probable que ces mécanismes puissent influencer l'utilisation. Comme mentionné, plusieurs des travaux récents auxquels j'ai pris part, en Afrique de l'Ouest et plus particulièrement au Burkina Faso, ont porté sur l'évaluation de stratégies, telles que le courtage de connaissances, pour favoriser l'interaction scientifiques/utilisateurs et utilisatrices (par exemple : Dagenais, Queuille & Ridde, 2013; Dagenais et al., 2015, 2016; D'Ostie-Racine, Dagenais & Ridde, 2021; Mc Sween-Cadieux et al., 2017; 2019). Mais comme l'analyse des discours le montre bien, ces interactions devront être considérées prioritaires pour ces derniers et dernières, et le rôle de la hiérarchie, nommément du ou de la ministre et de son SG, sera nécessaire pour assurer une participation active des décisionnaires en position d'agir. Bien que d'autres études soient nécessaires pour en démontrer l'efficacité, la mise en place de l'UGTC, qui joue le rôle d'une unité de courtage de connaissances, nous apparaît des plus prometteuses. Cette initiative est susceptible de faire école dans les pays d'Afrique et ailleurs. Un projet d'évaluation d'envergure devra être prévu pour accompagner la mise en œuvre de cette unité et en mesurer l'efficacité pour favoriser l'utilisation de la recherche au Ministère.

Les mécanismes de formation et de développement de compétences des scientifiques pour communiquer à un public non-scientifique, et celles des utilisateurs et utilisatrices pour accéder aux résultats de recherche et pour les comprendre sont efficaces et nécessaires. La robustesse de ces résultats devrait inciter à développer plus de formations, mais il demeure nécessaire d'évaluer leurs effets sur l'acquisition de connaissances et le développement d'habiletés. Cependant, à elles seules, ces formations ne pourront mener à des changements pérennes si d'autres efforts ne sont pas mis en œuvre pour développer une réelle culture ouverte à la recherche au sein du Ministère.

Enfin, le potentiel de réussite de l'initiative du ministre de l'époque est solidement appuyé par la synthèse de l'Alliance (Breckon et al., 2016; Langer et al., 2016). Leurs résultats montrent en effet que le sixième mécanisme permettant de favoriser l'utilisation des données probantes par les décisionnaires politiques implique des changements au niveau des structures qui influencent les processus décisionnels. Lorsque, comme dans le cas de ce qui est prévu avec l'UGTC, ces changements sont combinés à un meilleur accès aux données probantes et à des activités de formation des utilisateurs et utilisatrices, ils sont efficaces pour soutenir la prise de décision éclairée par les données probantes.

À ma connaissance, l'UGTC est une initiative innovante unique en Afrique de l'Ouest. Quelques expériences ont été mises en œuvre dans différents pays de la région. Par exemple, des services de " réponse rapide " ont été créés par l' African Population and Health Research Center dans sept pays d'Afrique : Kenya, Rwanda, Zambie, Malawi, Sierra Leone, Burkina Faso et Libéria. Le mandat de ces équipes porte sur la production, au moment opportun, de revues rapides des données probantes. D'autres initiatives de ce type ont été intégrées dans une plateforme destinée à offrir un accès rapide à des données de recherche de qualité au sujet des systèmes de santé (Zida et al., 2018). Cependant, aucune de ces initiatives n'était directement rattachée au cabinet d'un ministre, ce qui les aurait placées en position d'autorité sur les directions du Ministère, et aucune ne disposait d'un mandat clair d'éclairer la prise de décisions en matière de santé.

Cette étude visait à connaître le point de vue des décisionnaires au sein du ministère de la Santé du Burkina Faso concernant l'utilisation de la recherche. Les résultats ont permis de formuler six pistes de réflexion et d'action à l'intention du ministre en prévision de la création de l'UGTC. Malheureusement, deux ans après que le Conseil des ministres du Burkina Faso ait autorisé la création de l'UGTC, le ministre a été remplacé par un jeu de chaise musicale politique. Au moment où il a quitté, le chef d'unité est la seule personne qui avait été nommée et aucun des cinq membres du personnel pressentis n'avait été recruté. La nouvelle ministre, une médecin radiologue, a affirmé peu après son entrée en fonction avoir l'intention de maintenir l'Unité, mais les postes n'ont jamais été comblés. Ainsi, presque quatre ans après avoir créée, aucun membre du personnel n'avait été recruté et le chef d'Unité a été muté à une autre fonction. Pourtant, il est clair que cette initiative innovante aurait permis d'éclairer, par des données probantes et dans un environnement complexe, la prise de toutes les décisions publiques en matière de santé. Il n'en demeure pas moins que les réflexions et actions présentées dans ce chapitre pourraient certainement être utiles pour guider la mise en œuvre d'autres initiatives de ce type ailleurs en Afrique, au bénéfice de la couverture universelle en santé.

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Van Leijen-Zeelenberg, J.E., van Raak, A. J., Duimel-Peeters, I.G., Kroese, M.E. et al. (2014). Barriers to implementation of a redesign of information transfer and feedback in acute care: Results from a multiple case study. BMC Health Services Research, 14(149).

Zida, A., Lavis, J. N., Sewankambo, N. K., Kouyate, B. & Ouedraogo, S. (2018). Evaluating the process and extent of institutionalization: A case study of a rapid response unit for health policy in Burkina Faso. The International Journal of Health Policy and Management, 7(1), 15-26. https://doi.org/10.15171/ijhpm.2017.39

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Vers une couverture sanitaire universelle en 2030 ?

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Christian Dagenais Introduction Depuis l'émergence du mouvement de la médecine fondée sur des preuves dans les années 1990, la tendance à fonder les pratiques et la prise de décision sur des données probantes a connu un essor remarquable (Bowen & Graham, 2013; Kitson et al., 2013).

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Courcy, I., Bureau, A., & Grenier, G. (2022). L’art visuel comme outil de pratique en mobilisation et transfert de connaissances: Revue francophone de recherche sur le transfert et l’utilisation des connaissances, 6(3), Article 3.

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Cet article présente le processus de mobilisation des connaissances intégré à une recherche menée avec un organisme communautaire en autisme. Notre démarche, ancrée dans une vision de partage des savoirs, a donné lieu à la réalisation d'une murale grand format peinte en milieu hospitalier par un collectif d'artistes, les participants et l'équipe de recherche. Nous présentons les différentes étapes de ce projet de transfert des connaissances et ses retombées à partir de la perspective des parties prenantes (participants, intervenantes, artistes, chercheure et professionnelles en mobilisation des connaissances). Trois principaux aspects ressortent comme éléments ayant contribué au succès de ce projet : le lieu de production, l'utilisation du médium visuel et l'arrimage relationnel développé au cours du processus. Les apprentissages que nous en retirons pour des applications futures sont présentés.

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L'art visuel comme outil de pratique en mobilisation et transfert de connaissances | Revue francophone de recherche sur le transfert et l'utilisation des connaissances

# data[].attributes.attachment_link.description
Cet article présente le processus de mobilisation des connaissances intégré à une recherche menée avec un organisme communautaire en autisme. Notre démarche, ancrée dans une vision de partage des savoirs, a donné lieu à la réalisation d'une murale grand format peinte en milieu hospitalier par un collectif d'artistes, les participants et l'équipe de recherche.

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Centre de collaboration nationale sur les politiques publiques et la santé. (2015). Partage de connaissances et politiques publiques – Une représentation des processus d’influence.

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Centre de collaboration nationale sur les politiques publiques et la santé

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Mieux comprendre la circulation des connaissances dans l'univers politique peut aider à améliorer les pratiques de partage de connaissances afin d'accroître leurs retombées. Dans le but d'approfondir cette compréhension, ce document présente une représentation graphique (un modèle logique) des processus par lesquels les connaissances issues de la santé publique peuvent influencer les politiques publiques. De plus, des questions sont posées au cours du texte pour amener le lecteur à réfléchir à ses pratiques de partage de connaissances, à l'univers dans lequel elles se déploient et aux facteurs sur lesquels il a une certaine capacité d'agir pour favoriser le processus.

Partage de connaissances et politiques publiques : une représentation des processus d'influence
14 pages.

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Partage de connaissances et politiques publiques : une représentation des processus d'influence

# data[].attributes.attachment_link.description
Mieux comprendre la circulation des connaissances dans l'univers politique peut aider à améliorer les pratiques de partage de connaissances afin d'accroître leurs retombées. Dans le but d'approfondir cette compréhension, ce document présente une représentation graphique (un modèle logique) des processus par lesquels les connaissances issues de la santé publique peuvent influencer les politiques publiques.

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Briand-Lamarche, M. (2017). Évaluation du développement et de la mise en œuvre d’un référentiel de compétences pour favoriser l’utilisation des connaissances issues de la recherche en éducation. (Thèse de doctorat en psychologie)

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Évaluation du développement et de la mise en oeuvre d'un référentiel de compétences pour favoriser l'utilisation des connaissances issues de la recherche en éducation

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Breckon, J., & Dodson, J. (2016). Using Evidence : What Works?

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An introduction to and discussion of the findings from the research project The Science of Using Science.

Key findings

Six underlying mechanisms for enabling the use of research were drawn from the literature, and these are explored in the discussion paper, with examples from government, the public sector and charities. Mechanisms which the research found to be effective in getting research used include:

Awareness - building awareness and positive attitudes towards evidence use.

Agree - building mutual understanding and agreement on policy-relevant questions and the kind of evidence needed to answer them.

Access and communication - providing communication of, and access to evidence.

We all have our favourite methods of knowledge exchange, but do we have rigorous evidence that these methods do actually change people's use of research (and/or motivation, capacity or opportunity) to do so?

The Science of Using Science project was set up by the Alliance for Useful Evidence and funded by the Wellcome Trust and the What Works Centre for Wellbeing. The project aimed to uncover the evidence on what works to enable decision-makers' research use.

This discussion document is based on a systematic review of 36 existing reviews and a second scoping review of research from the broader social science literature conducted by the EPPI-Centre at UCL. More than 150 possible interventions were identified but there were many cases with mixed or no evidence which illustrated the need for more research in this area.

If you'd like to delve deeper, you can also read the final project report from the research team at EPPI-Centre, available from the Alliance for Useful Evidence website.

Authors

Jonathan Breckon and Jane Dodson

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An introduction to and discussion of the findings from the research project The Science of Using Science. Six underlying mechanisms for enabling the use of research were drawn from the literature, and these are explored in the discussion paper, with examples from government, the public sector and charities.

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Bogenschneider, K. (2020). Positioning Universities as Honest Knowledge Brokers : Best Practices for Communicating Research to Policymakers. Family Relations, 69(3), 628‑643.

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Bissonnette-Maheux, V. (2014). Développement d’un blogue promouvant de saines habitudes alimentaires pour favoriser le transfert des connaissances en nutrition : Une étude qualitative [Mémoire de maîtrise, Université Laval].

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Développement d'un blogue promouvant de saines habitudes alimentaires pour favoriser le transfert des connaissances en nutrition : une étude qualitative

En cours de chargement...

Les médias sociaux comme les blogues sont de plus en plus utilisés dans la population et représentent une opportunité unique d'améliorer le transfert des connaissances en santé. L'objectif principal du projet était d'explorer les perceptions des femmes quant à l'utilisation de blogues écrits par une nutritionniste comme outil pour leur permettre d'améliorer leur alimentation. Afin de maximiser l'identification des croyances, un modèle théorique combinant la Théorie du Comportement Planifié et le Modèle de l'Acceptation de la Technologie a été utilisé. Les participantes ont été rencontrées individuellement et en groupe de quatre à six femmes. Les principaux résultats suggèrent qu'un blogue visuellement attrayant, complet, incluant des recettes et bien structuré pourrait contribuer à augmenter son utilité et sa facilité d'utilisation. Les travaux de cette maîtrise représentent la première étape vers l'élaboration d'un blogue qui sera testé pour déterminer la faisabilité d'une intervention nutritionnelle utilisant ce type d'outils de transfert de connaissances.

Social media such as blogs are increasingly being used in the population and therefore represent a unique opportunity to improve knowledge transfer in health. The main objective of this project was to explore women's perceptions about the use of healthy eating blogs written by a dietitian as a tool to improve their dietary habits. To maximize the identification of beliefs, a theoretical model combining the Theory of Planned Behavior and the Technology Acceptance Model was used. Participants were interviewed individually and in groups of four to six women. The main results showed that a blog visually appealing, comprehensive, including recipes and well-structured could help increase its relevance and use in women. The work of this master's degree thesis is the first step towards the creation of a blog that will be tested to determine the feasibility of a nutritional intervention using this type of knowledge translation tool.

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Développement d'un blogue promouvant de saines habitudes alimentaires pour favoriser le transfert des connaissances en nutrition : une étude qualitative

# data[].attributes.attachment_link.description
Les médias sociaux comme les blogues sont de plus en plus utilisés dans la population et représentent une opportunité unique d'améliorer le transfert des connaissances en santé. L'objectif principal du projet était d'explorer les perceptions des femmes quant à l'utilisation de blogues écrits par une nutritionniste comme outil pour leur permettre d'améliorer leur alimentation.

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Bammer, G. (2019). Key issues in co-creation with stakeholders when research problems are complex. Evidence & Policy: A Journal of Research, Debate and Practice, 15(3), 423‑435.

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Abstract

The extensive literature on research co-creation is mostly based on problems being treated as clearly defined and solvable. What is the impact on co-creation when problems are complex, with the following characteristics: difficult to delimit, contested definitions, multiple uncertainties and unresolvable unknowns, constraints on what can be done, and no perfect solution? Co-creation on such problems requires a research mindset that appreciates that stakeholders have an essential role in making complexity evident and that limiting stakeholder involvement also limits the ability to understand and effectively act on complex problems. The Integration and Implementation Sciences (i2S) framework is introduced as a way to systematically take into account multiple stakeholders with multiple relevant inputs. In addition, one specific tool, the research-relevant modified International Association for Public Participation (IAP2) spectrum, is described as a way of exploring stakeholder engagement. For complex problems this modified spectrum can be used to describe different ways of including stakeholders, to reflect on appropriate forms of engagement, as well as to take into account both level of researcher control and different categories of stakeholder groups. A research programme examining the feasibility of prescribing pharmaceutical heroin as a treatment for heroin dependence stimulated thinking about co-creation on complex problems and is used as a practice example to illustrate the points covered.

key messages

Understanding research co-creation must expand from defined, solvable problems to complex problems.

Stakeholders should include decision makers as well as those affected by the complex problem.

Complex problems require detailed knowledge synthesis and unknowns management to support change.

Multiple ways to engage stakeholders are needed: inform, consult, involve, collaborate, empower.

Background

A primary driver for co-creation is the expectation, by researchers, that it will increase the likelihood that their research will influence policy and practice change ( Boaz, et al, 2018; Concannon et al, 2014; Greenhalgh et al, 2016; Minkler and Wallerstein, 2008). There are two key aspects to this expectation. One is that the research findings will be more useful, because they incorporate decision-maker and other stakeholder perspectives and address their concerns. The second is that the interactions involved in the co-creative research facilitate change happening, through processes that are not well defined, resulting in decision makers becoming more open to using research findings, researchers becoming more savvy about how to support change, and other stakeholders in the research becoming more influential.

There is an extensive literature on the related topics of co-creation, co-production, co-design, stakeholder engagement and participatory research (eg Boaz et al, 2018; Bremer and Meisch, 2017; Concannon et al, 2014; Greenhalgh et al, 2016; Minkler and Wallerstein, 2008; Spears Johnson et al, 2016; Staniszewska et al, 2017). Although some (especially Greenhalgh et al, 2016) recognise non-linear chains of causation, complex interdependencies and other manifestations of complex problems, the literature is mostly based on problems being treated as 'tame', described by Rittel and Webber (1973) as those with a clear mission and solution.

What is different about co-creation when the problem under consideration is complex, or 'wicked' in Rittel and Webber's terminology? Examples of complex problems include: mitigating the effects of global climate change, reducing social and health inequalities, and combatting organised crime.

To explore this question, the first step is to transform Rittel and Webber's characterisation of 'wicked' problems from the planning context in which they conceived them to a research context. Because the term 'wicked' is not easily translatable into many other languages, the term 'complex' is preferred here.

Five key characteristics of complex problems are proposed for the research context ( Bammer et al, in preparation):

Difficult to delimit.

Complex problems are open systems problems where everything is connected to everything else, therefore there are no clear boundaries to the problem.

Contested problem definitions.

Different disciplines and stakeholders will define the problem differently and the definition will also change as the context (for example, political, economic or geographic) changes.

Multiple uncertainties plus unresolvable unknowns.

Everything cannot be known or found out about complex problems. Further, ignoring unknowns is a source of major adverse unintended consequences and nasty surprises.

There are real-world constraints on what can be done.

Policy and practice responses to complex problems - whether they are by government, business or civil society - are constrained by political, economic, historical, cultural and other circumstances.

Solutions are not true/false, but good/bad, and they are partial and temporary.

The interrelationships among the characteristics of complexity described above mean that perfect solutions are not possible. For research to proceed, compromises have to be made at all steps: boundaries have to be set to delimit the problem, a specific problem definition has to be decided, not all unknowns can be resolved, and core elements of context (from the multitude available) have to be prioritised. Imperfection is the inevitable result of these essential compromises and the compromises are necessary to be able to move forward on a complex problem. The aim is to find the best possible ways to proceed on a particular problem at a particular time and place.

Dealing with any complex problem requires understanding how these five characteristics play out for that problem, as well as how actions can best be shaped around them. In turn, this requires inputs from multiple disciplines and stakeholders. The focus here is limited to stakeholder inputs.

It is also worth noting that simple (or tame) and complex (or wicked), should be seen as endpoints on a continuum rather than as a dichotomy. Further, researchers may embrace or choose to ignore elements of complexity in their approach to a problem. For example, improving a treatment service, which is often approached as a simple problem, may have elements of complexity. Service failures may be systemic; different stakeholders may define the problem differently; some unknowns may be hidden (unknown unknowns); the history, geographical location, and/or cultural context may be significant; and the solution may involve trade-offs.

The aim of this paper is to start to lay out what complexity means for co-creation, as well as best practices for co-creative research on complex problems. A framework (the Integration and Implementation Sciences or i2S framework) is introduced that allows the elements of complexity to be systematically unpicked and dealt with. The paper then takes one tool - for thinking about how stakeholders are engaged in co-creation - which is relevant to the whole i2S framework and examines three aspects of the use of this tool when the research problem is complex.

The development of Integration and Implementation Sciences (i2S) had its origins in a seven-year research programme that I led from 1990 to 1997. This involved examining the feasibility of prescribing pharmaceutical heroin as a treatment for heroin dependence in Canberra, Australia's capital city ( Bammer, 1997). Reducing illicit drug use is a complex problem. Although the research was focused on one potential response, that is, trialling pharmaceutical heroin prescription, the feasibility research was structured to explore the benefits and risks of that response, rather than seeing it as a perfect solution.

In this programme, the research team worked closely with stakeholders affected by the problem, specifically illicit drug users, ex-users, the families of drug users, and the general public, as well as stakeholders in a position to do something about the problem, namely police, treatment and other service providers, and policy makers. The research was unusual in that there were no major funding or time constraints, meaning that we were not limited in which stakeholders we could engage or how. This gave us a unique opportunity, within one programme of research, to learn multiple lessons about stakeholder engagement and co-creation. Although the research was conducted more than 20 years ago, the lessons are still pertinent and provide a range of examples for the key points of the paper. The i2S framework has subsequently been tested against other complex problems relating to population health, the environment and national security, but none of these has provided a richer set of illustrations for co-creation in research on complex problems.

What does complexity mean for co-creation?

Different stakeholders will have different, often unique, perspectives on the five elements of complexity, that is, the problem's connections with other problems, different ways the problem can be defined, important uncertainties and unknowns, some of the real-world constraints on what can be done, and what will make a good solution. For example, in the heroin prescription feasibility research, illicit drug users made us aware of the connection between drug dependence and, for some of them, childhood sexual abuse. Some parents of illicit drug users defined the problem as lack of support by intervention services for young people who had lost their way, while others saw the problem as a failure by society to shield young people from accessing drugs. The police drew our attention to a critical unknown, namely how to prevent an influx of drug users to a city where heroin was provided on prescription. Policy makers pointed out the real-world constraint that heroin prescription would have to fit within Australia's international treaty obligations. Some of the general public thought that making heroin available on prescription was a good option, others opted for strengthened law enforcement, yet others wanted to focus on different treatment options, and others again wanted to see heroin use legalised.

As these examples illustrate, stakeholders have an essential and intimate role in making complexity evident. As a consequence, co-creation on complex problems requires a specific research mindset towards stakeholder involvement. Stakeholders help co-create an understanding of the problem, as well as charting a path forward in dealing with it. This contrasts with the way most researchers have been trained, which is that the problem, and how it will be dealt with, is defined by one or more disciplines. Further, the understanding and path forward will vary depending on the mix of stakeholders involved in the research. In the heroin prescription feasibility research we aimed to be comprehensive, and our appreciation of the problem and recommendations would have been different if we had only worked with treatment providers, or if we had confined input to a range of stakeholders committed to continuing prohibitionist policies.

How can research take into account multiple stakeholders with multiple relevant inputs? The heroin prescription feasibility research led to the development of a framework specifically designed for dealing with complex problems. Integration and Implementation Sciences (i2S; Bammer, 2013) begins by considering three core research domains:

synthesis of existing knowledge

developing an understanding of critical unknowns and figuring out what to do about them

making the research evidence available to support policy and practice change. The research evidence includes the synthesised knowledge, any new knowledge produced by reducing unknowns and the assessment of remaining unknowns.

For each domain a set of fine-grained considerations is then teased out to guide the researchers in planning or documenting the research overall (see below and Figure 1). When used for documenting the research, the questions elicit decisions made about a) the problem (for example, 'how was the problem defined and framed'), and b) the methods employed in the research (for example, 'which systems methods were used'), as well as prompting self-evaluation (question 5). These in turn help the researchers capture what they engaged with stakeholders about and the specific methods they used.

View Full Size

Figure 1:

The three domains of Integration and Implementation Sciences (i2S) highlighting key aspects of research on complex real-world problems, as well as fine-grained considerations for each domain.

Citation: Evidence & Policy 15, 3; 10.1332/174426419X15532579188099

Figure 1:

The three domains of Integration and Implementation Sciences (i2S) highlighting key aspects of research on complex real-world problems, as well as fine-grained considerations for each domain.

Citation: Evidence & Policy 15, 3; 10.1332/174426419X15532579188099

The fine-grained considerations are:

What was the aim and who was intended to benefit?

Which aspects of knowledge, unknowns and of policy or practice?

◦ Which systems methods were used to approach the problem, the unknowns and the intervention space?

◦ What possibilities were canvassed, for example: What were all the perceived relevant kinds of knowledge and unknowns? Which disciplines and stakeholders would have had something to contribute? Where in the intervention space could support have been provided?

◦ Having charted all the possibilities, which were most critical and feasible in this project?

◦ How was the problem defined and framed?

◦ How were values expressed? Were there value conflicts and how were they managed?

◦ How did the co-creative team work together? What were the desirable differences in knowledge, skills and dispositional attributes among team members and how did the project harness them? What differences had the potential to get in the way of the collaboration and how were they managed?

How was the knowledge synthesis undertaken? How were unknowns identified, understood and managed? How was research support (bringing together the knowledge synthesis and the approach to unknowns) for policy and practice change undertaken?

◦ Which methods were used for knowledge synthesis?

◦ Which research questions were addressed? How were unknowns that were not the topic of investigation managed to reduce the likelihood of adverse unintended consequences and nasty surprises?

◦ Which action options were considered and employed? Was the focus on government, business or civil society? Were policy or practice change the target?

What were the contextual factors?

◦ What was the relevant big-picture context, for example, the history of the problem, the political situation?

◦ What sort of authorisation was needed to research this problem?

◦ How did the structure and culture of the organisations involved in the research facilitate or inhibit what research was possible?

How well was each of these questions addressed? Were good choices made?

In planning or documenting research on complex problems, these questions and sub-questions can generally be asked in any order. The key issue is that all questions are addressed.

In documenting the research and the co-creation with stakeholders, the i2S framework serves an analogous purpose to the frameworks available for co-creation on more straightforward research problems, such as those developed by Brown and Vega (2008), Concannon and colleagues (2014), Mercer and colleagues (2008), and Staniszewska and colleagues (2017). There are many overlaps, but the i2S framework has a broader scope and does not deal with more administrative issues, such as stakeholder engagement on funding applications.

As well as providing a useful framework for tackling complex problems, i2S also provides a growing compilation of concepts and methods for elucidating different elements of the i2S framework. For example, there are several dialogue methods that can be used for synthesis of knowledge from researchers and stakeholders ( McDonald et al, 2009), a helpful concept for understanding values and value conflict has been developed by Schwartz (2012), and Mendizabal (2010) and Mitchell and colleagues (1997) have provided frameworks for stakeholder analysis. One of the challenges is that these concepts and methods are scattered throughout the published and grey literatures and are therefore not easily accessible. Compilations are available through the Integration and Implementation Sciences website ( http://i2s.anu.edu.au) and the Integration and Implementation Insights blog ( http://i2Insights.org).

It is beyond the scope of this paper to deal with the i2S framework in full or to compare it with other frameworks. Instead the paper focuses on one tool that is useful across the i2S framework - for thinking about how stakeholders are engaged in co-creation - and examines three aspects of the use of this tool when the research problem is complex.

What does complexity mean for how stakeholders are engaged?

Two frameworks are widely used to describe how stakeholders are engaged: Arnstein's ladder ( Arnstein, 1969) and the International Association for Public Participation (IAP2) spectrum of participation (2014). It is noteworthy that neither was developed for the research context; instead they address public participation in government decision making. Most research studies have used these frameworks to identify where in the ladder or spectrum they are operating, rather than in any more analytic way.

Rewriting the IAP2 spectrum for the research context provides a useful framework for exploring how stakeholders are engaged, including on complex problems ( Figure 2). The key aspects of the original have been maintained, notably:

View Full Size

Figure 2:

Research-relevant modified IAP2 spectrum. This spectrum for stakeholder participation in research is adapted from the International Association for Public Participation (IAP2) spectrum of public participation in decision making.

Citation: Evidence & Policy 15, 3; 10.1332/174426419X15532579188099

Figure 2:

Research-relevant modified IAP2 spectrum. This spectrum for stakeholder participation in research is adapted from the International Association for Public Participation (IAP2) spectrum of public participation in decision making.

Citation: Evidence & Policy 15, 3; 10.1332/174426419X15532579188099

the five types of engagement: inform, consult, involve, collaborate, empower

the idea that 'differing levels of participation are legitimate and depend on the goals, time frames, resources, and levels of concern' in the research to be undertaken

the 'promise' to the stakeholder group for each type of participation.

The five types of engagement in the original spectrum can be easily translated from public decision making to research. Only one modification is required to make the spectrum relevant for complex problems. In the stakeholder participation goal for 'collaboration', 'each' is replaced with 'salient' as in 'Researchers partner with stakeholders for salient aspects of the research process'. While full collaboration may be possible on a straightforward research question (with, for example, few stakeholder groups and one simple form of data collection), it is unlikely that any stakeholder groups will be able (or even want) to contribute meaningfully to each aspect of the research on a complex problem.

Three issues are particularly pertinent when the research problems are complex. These are the ability to:

involve different stakeholder groups in different ways

think deeply about which forms of stakeholder engagement are likely to be most appropriate

take into account when researchers do and do not have control and different categories of stakeholder groups.

Involving different stakeholder groups in different ways

The particular value of the research-relevant modified IAP2 spectrum when the research problem is complex is that - given that such research generally involves a large number of stakeholder groups - it makes it possible to consider that different groups (separately or together) can be involved in different ways. Further, over the course of the study or in different aspects of the study, the same stakeholder group can also be involved in different ways. Sterling and colleagues (2017, p. 166) also make this point, conceptualising 'these engagements as iterative and non-linear, with different groups of stakeholders engaging in dynamic ways through various stages of a program or activity'.

A useful illustration comes from the inclusion of illicit drug users and police in the heroin prescription feasibility research. Each group was involved in three major ways. First, both groups, as a whole, were informed about the research, using a variety of mechanisms tailored to the specific group. Second, police representatives (chosen to represent a spectrum of views about heroin prescription) collaborated in designing and interpreting a survey of police; similarly drug user representatives collaborated in a survey of their peers. Finally, representatives of each group were consulted about how the research findings would be presented to policy makers.

Thinking deeply about which forms of stakeholder engagement are likely to be most appropriate

The modified research-relevant IAP2 framework not only provides a way of describing different levels of engagement, but also provides a way of thinking deeply about which forms of engagement are likely to be most appropriate, given the different aspects of complexity the stakeholders can provide information about, including delimiting the problem, problem definition, relevant unknowns, real-world constraints, and possible ways forward. The point is to think about these in the overall context of the research and the mix of stakeholder groups involved.

For example, in the heroin prescription feasibility research, we recognised a major conflict between those who thought action was required to strengthen prohibition (and therefore opposed heroin prescription) and those who argued for drug law reform (and therefore supported heroin prescription). This reflected different values about self-direction, hedonism, conformity and benevolence ( Schwartz, 2012). We wanted to be even-handed, respecting both value systems, and that affected our collaboration with different stakeholder groups. 'Inform', 'consult' and 'involve' were all relatively unproblematic, but we had to be much more careful when we wanted to 'collaborate' with or 'empower' stakeholder groups, because these are much harder to implement in a neutral fashion.

We did engage through collaboration and empowerment when we worked with the local Aboriginal and Torres Strait Islander community, however ( Humes et al, 1993). Not only was this the most appropriate and respectful way to work with them, but they also represented both sets of values, so that maintaining neutrality was not an issue.

Take into account when researchers do and do not have control and different categories of stakeholder groups

One aspect of co-creation that is made evident by the i2S framework but rarely discussed is that while researchers have a high degree of control over the processes pertaining to knowledge synthesis, and understanding and managing unknowns, they have little control over supporting policy and practice change. Knowledge synthesis and understanding and managing unknowns are the core business of research, and it is up to researchers to cede some control to 'let in' stakeholders. On the other hand, policy and practice change is not core research business, and it is up to decision makers to cede some control to 'let in' researchers. Researchers can determine what they set out to do, but not whether any necessary interactions with decision makers are achieved or how their inputs are acted on ( Cairney and Oliver, 2017 make the same point).

It can also be helpful to specifically consider stakeholders in two categories:

those affected by the problem

those in a position to do something about the problem ( Bammer, 2013).

This is not a hard and fast distinction, but rather a useful heuristic. (As an aside, it is noteworthy that in many co-creation studies it is only stakeholders from the first category who are included ( Concannon et al, 2014), with those in the second category often poorly represented or ignored completely.)

The research-relevant modified IAP2 spectrum works for both categories of stakeholders, but there is an additional set of considerations under 'empower', especially for stakeholders in a position to do something about the problem. Researchers can seek to increase the power of decision makers to achieve change. Most commonly, this involves applying pressure from outside the policy or practice systems - through advocacy - with the aim of strengthening the influence of decision makers arguing for particular action on a problem (see also Cairney and Oliver, 2017). Researchers can do this by advocating for particular outcomes themselves or they can seek to strengthen the advocacy of stakeholder groups affected by the problem, by giving their perspectives legitimacy through including them in the research. Researchers can also take the additional step of activism, where they specifically contribute to the lobbying and other actions required to make change happen. For an example, see Chapman's description ( 2015) of activism by researchers to support the introduction and passing of legislation for plain-packing of tobacco products. There is a substantial discussion to be had about the appropriate roles of advocacy and activism by researchers and how closely they should engage with decision makers in the research process, but that is beyond the scope of this paper.

In the heroin prescription feasibility research, our starting point was to keep decision makers informed about the research, and - where they were willing - to consult, involve and/or collaborate with them. We chose a neutral stance, reviewing carefully both the potential costs and benefits of heroin prescription, and therefore eschewed advocacy and activism.

These distinctions about control and different categories of stakeholders are also useful in considering how the specific elements of the research-relevant modified IAP2 spectrum play out in practice. Combining them, as shown in Table 1, provides a useful way to tease out key questions to guide researcher engagement with stakeholders. The point here is not to be comprehensive, but to illustrate that the type of stakeholder involved, and where in the research process they are involved (understanding or action) influences the considerations that are relevant.

Research Domain

Knowledge synthesis and Understanding and managing unknowns

Supporting policy and practice change

Stakeholders affected by the problem

What experience and expertise do these stakeholders have to offer? Are their perspectives homogeneous?

How big is the stakeholder group? Does it have influence beyond sheer size?

How accessible are these stakeholders? Are they organised into one or more groups? If not, can representatives be identified? If representatives are unwilling to participate who else can help?

Do these stakeholders see the problem as requiring action? If so, how urgent is it?

Will being involved in the research give these stakeholders additional legitimacy?

Can the researchers access stakeholders who are not able to be accessed by decision makers?

Can the involvement of stakeholders affected by the problem strengthen the influence of particular decision makers? If so, how should this be handled?

Decision makers (stakeholders in a position to do something about the problem)

What experience and expertise do these stakeholders have to offer? Are their perspectives homogeneous?

Are these stakeholders at the right level to provide useful input?

Are these stakeholders constrained by confidentiality?

Is the input of these stakeholders likely to be influenced by vested interests?

Are there other sources who can counterbalance unwillingness to participate or distortions in input (for example, retired decision makers)

Will the participation of these stakeholders be seen as giving the research legitimacy?

Are we researchers working with decision makers at the right level of power and influence?

Have all the relevant sectors (that is, government, business, civil society) been adequately considered?

Has the research considered the trade-offs that are important to these stakeholders? How have these been balanced against other trade-offs?

Can the research increase the influence of particular stakeholders? If so, how should this be handled?

By and large these questions are self-explanatory, but it may be helpful to illustrate four of them with examples from the heroin prescription feasibility research. First, on the question of action and urgency from the first quadrant of Table 1, the stakeholder groups mostly agreed that illicit drug use was a problem that needed action. But there was disagreement on urgency, for example families of drug users tended to see the need for considering heroin prescription as urgent, whereas some treatment providers thought that existing treatment services should be improved first.

Second - relevant to quadrant 2 in Table 1 - although this was not the case in Australia, in some countries it would not be possible for government policy makers to be seen to liaise with 'criminals' such as illicit drug users, so that research may be the only way for these stakeholders to be heard. This also relates to the issue of accessibility and organisation in quadrant 1 of Table 1. In Australia, government acceptance and (sometimes) funding meant that illicit drug users had formed a small number of organisations, the most prominent being AIVL (Australian Injecting and Illicit Drug Users League, http://aivl.org.au/). This meant that we could access effective and legitimate representatives at least of the organisation, if not the group as a whole.

Third - relevant to quadrant 3 in Table 1 - in the heroin trial feasibility research, policy makers from the affected jurisdiction gave the research legitimacy by putting discussion of the progress and findings on the agenda of an influential national policy committee, ensuring that the committee stayed abreast of what was in train and eventually made a decision.

Finally - relevant to understanding trade-offs important for decision makers (quadrant 4 in Table 1) - early in the research, key politicians made us aware of the perspectives that would be most influential in their decision making, including those of the police commissioners and the key medical professional association, so that we were able to ensure that we included those perspectives in our research.

Conclusion

The aim of this paper has been to describe the key characteristics of complex problems and to start to unpack what these mean for good practice relevant to co-creation. It has highlighted that a different research mindset to stakeholder engagement is required, one that recognises that stakeholders help co-create an understanding of the problem, as well as charting a path forward in dealing with it. The Integration and Implementation Sciences (i2S) framework was introduced to show how multiple stakeholders with multiple relevant inputs could be systematically taken into account. One specific tool, the research-relevant modified IAP2 spectrum, was then described, focusing on its particular relevance to dealing with complex problems.

The paper has aimed to contribute a piece to the jigsaw of co-creation, complementing existing insights into, for example, stakeholder engagement on straightforward problems and detailed co-creation processes. As well as highlighting areas for further theorising and research, the overall purpose is to improve the effectiveness of co-creative research, in order to find more effective responses to the complex problems faced by society.

Funding details

Through the Theme 'Building Resources for Complex, Action-Oriented Team Science' and the 'Co-Creative Capacity' pursuit, this work was supported by the National Socio-Environmental Synthesis Center (SESYNC) under funding received from the National Science Foundation DBI-1052875.

Acknowledgements

Particular thanks to one of the anonymous reviewers for highly constructive feedback.

Conflict of interest

The author declares that there is no conflict of interest.

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Key issues in co-creation with stakeholders when research problems are complex

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The extensive literature on research co-creation is mostly based on problems being treated as clearly defined and solvable. What is the impact on co-creation when problems are complex, with the following characteristics: difficult to delimit, contested definitions, multiple uncertainties and unresolvable unknowns, constraints on what can be done, and no perfect solution?

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Albers, B., Schultes, M.-T., Brauchli, P., Naef, R., Wyl, V. von, & Clack, L. (2022). Implementation science in Switzerland : It’s time to seize the opportunity. Swiss Medical Weekly, 152(4950), Article 4950.

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Viewpoint

Vol. 152 No. 4950 (2022)

Bianca Albers

Marie-Therese Schultes

Peter Brauchli

Rahel Naef

Viktor von Wyl

Lauren Clack

Khan S, Chambers D, Neta G. Revisiting time to translation: implementation of evidence-based practices (EBPs) in cancer control. Cancer Causes Control. 2021 Mar;32(3):221-30. https://doi.org/https://doi.org/10.1007/s10552-020-01376-z DOI:https://doi.org/10.1007/s10552-020-01376-z

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How to Cite

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Albers B, Schultes M-T, Brauchli P, Naef R, von Wyl V, Clack L. Implementation science in Switzerland: It's time to seize the opportunity. Swiss Med Wkly [Internet]. 2022 Dec. 10 [cited 2023 Apr. 24];152(4950):40021. Available from: https://smw.ch/index.php/smw/article/view/3274

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# data[].attributes.attachment_link.title
Implementation science in Switzerland: It's time to seize the opportunity

# data[].attributes.attachment_link.description
Viewpoint Vol. 152 No. 4950 (2022) Bianca Albers Marie-Therese Schultes Peter Brauchli Rahel Naef Viktor von Wyl Lauren Clack Khan S, Chambers D, Neta G. Revisiting time to translation: implementation of evidence-based practices (EBPs) in cancer control. Cancer Causes Control. 2021 Mar;32(3):221-30. https://doi.org/https://doi.org/10.1007/s10552-020-01376-z DOI:https://doi.org/10.1007/s10552-020-01376-z Albers B, Shlonsky A, Mildon R.

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Abrami, P., Lysenko, L., Janosz, M., Bernard, R., & Dagenais, C. (2010). L’utilisation des connaissances issues de la recherche par les écoles. Groupe de recherche sur les environnements scolaires.

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L'utilisation des connaissances issues de la recherche pour améliorer les pratiques est considérée par plusieurs auteurs comme un facteur favorisant la réussite scolaire. Or, nos travaux révèlent qu'elles sont très peu utilisées par les enseignants et les administrateurs scolaires. Cette sous-utilisation pourrait s'expliquer par le fait que les intervenants scolaires, en grande majorité, confondent les sources de connaissances et les connaissances elles-mêmes, ne différencient pas les connaissances issues de la recherche des autres types de savoir et s'appuient d'abord et avant tout sur leur intuition pour évaluer la qualité des connaissances qu'ils adoptent dans leurs pratiques.

Le développement d'une opinion favorable aux connaissances issues de la recherche est crucial.

Ultimement, nos travaux visaient à répondre à la question suivante : comment favoriser l'utilisation des connaissances issues de la recherche par les intervenants scolaires? Grâce à des méthodes robustes et éprouvées, notre recherche apporte plusieurs éléments de réponse. Pour amener les utilisateurs potentiels à faire usage de la recherche, le développement d'une opinion favorable aux connaissances issues de la recherche est crucial. Pour ce faire, plusieurs conditions gagneraient à être réunies.

D'une part, des efforts devraient être consentis de manière à amener les écoles à valoriser les connaissances issues de la recherche. D'autre part, des stratégies efficaces devraient être adoptées afin de soutenir les acteurs dans leur utilisation des connaissances issues de la recherche (octroyer les ressources nécessaires à l'utilisation, recourir à des agents de soutien, etc.). Conjointement, le développement d'un contexte organisationnel favorable à la recherche et l'implantation de stratégies de soutien adéquates favoriseront le développement de l'expertise des acteurs à utiliser les connaissances issues de la recherche. Le développement de cette expertise apparaît capital, dans la mesure où la majorité des répondants conceptualise difficilement ce que sont les connaissances issues de la recherche.

Plus important encore, c'est grâce à une expertise suffisante que les utilisateurs potentiels modifieraient leur opinion à l'égard des connaissances issues de la recherche et, ce faisant, seraient plus enclins à les utiliser.

Chercheur principal : Christian Dagenais, Université de Montréal

Titre original : Examen des mécanismes en jeu dans la décision des intervenants scolaires d'utiliser les connaissances issues de la recherche pour changer leurs pratiques

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Utiliser les connaissances issues de la recherche dans les pratiques scolaires | Scientifique en chef

# data[].attributes.attachment_link.description
L'utilisation des connaissances issues de la recherche pour améliorer les pratiques est considérée par plusieurs auteurs comme un facteur favorisant la réussite scolaire. Or, nos travaux révèlent qu'elles sont très peu utilisées par les enseignants et les administrateurs scolaires. Cette sous-utilisation pourrait s'expliquer par le fait que les intervenants scolaires, en grande majorité, confondent les [...]