“Integrated knowledge translation” for globally oriented public health practitioners and scientists: Framing together a sustainable transfrontier knowledge translation vision

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Table 1 A note about terminology

Artifact-mediated KT–KS practices involve the application and the sharing of knowledge through an artifact (such as a research paper, clinical practice guidelines) or around an artifact.^Citation3 In the former case, the artifact (published literature) serves as the knowledge object that can be shared/used through a knowledge database (Medline or Cochrane), or the knowledge can be exchanged through a communication channel (eg, e-mail, Facebook) between stakeholders having a common interest.^Citation3 In the latter case, the artifact serves as the focal point for a critical discussion between interested stakeholders. In both cases, the artifact serves as the stimulus for KT–KS. The artifact is linked to explicit, concrete knowledge.

Experience-mediated KT–KS practices involve the articulation and application of clinical, operational, and psychosocial experiences, insights about a particular topic.^Citation3 Health care stakeholders, originating from different backgrounds, engage, collaborate, and share their intrinsic knowledge and extrinsic work experience to address specific issues through a communication medium (eg, Webinar or e-mails exchanges). The types of knowledge involved here: (i) have the relatively limited accessibility of implicit knowledge, and (ii) fall in the categories of contextual and procedural knowledge.

Resource-mediated KT–KS practices involve the identification of knowledge resources as a by-product of actual KT-KS activities between health care stakeholders.^Citation3 In this case, the associated knowledge resources (eg, domain experts, contact persons, knowledge brokers, websites, discussion forums, knowledge artifacts, etc) are identified, registered, and shared as potential sources of knowledge for a specific health care issue. The types of knowledge involved here are pragmatic knowledge and social knowledge.

Knowledge-sharing: “In the knowledge management parlance, KS can be regarded as a systematically planned and managed activity involving a group of like-minded individuals engaged in sharing their knowledge resources, insights, and experiences for a defined objective”. ^Citation3 Heath care KS can be characterized “as the explicitation and dissemination of context-sensitive healthcare knowledge by and for health care [decision-makers] through a collaborative communication medium (…) Health care knowledge-sharing is practiced for a variety of reasons, including clinical decision-making, patient education vis-à-vis patient empowerment programs, practitioner’s education and experience enhancement, translation of knowledge to practices and vice versa, health care policy-making, clinical protocol and guideline formulation, public health and community support for patients, capturing care-giver perspectives and feedback about practices and outcomes, and disseminating clinical research findings” (p. 69). ^Citation3 The aim of heath care KS practices can be characterized as: To provide efficient and focused access to evidence-based knowledge “resources” (eg, contact persons, websites, domain experts, discussion forums, knowledge artifacts, etc), either by guiding the user to the knowledge “artifacts” (a research paper, a practice guideline, a document) or by providing peer recommendations to help to find the relevant knowledge artifacts. To share the “unpublished” intrinsic experiential know-how, insights, judgements, and problem-solving strategies of decision-makers to complement evidence-based knowledge. To establish a culture for collaboration between like-minded decision-makers in order to stimulate collaborative learning, atypical problem-solving, practice evaluation, critical appraise of evidence, practices and outcomes, leveraging peer experiences and knowledge.^Citation3,Citation4

In Canada, the term “KS” is mainly used by health care managers and administrators

Knowledge translation: The terms “KT” and “KT research” are not synonymous. KT is a human enterprise that can be studied to understand and improve knowledge translation approaches whereas KT research is the scientific study of the determinants, processes and outcomes of knowledge translation.^Citation50 KT is a dynamic and iterative process that includes synthesis, dissemination, exchange, and ethically sound application of knowledge to improve the population health, provide more effective health services and products, and strengthen the health care system.^Citation76 “Planning”: The initial stage of the KT process, occurring before the doing and evaluation stages. Planning methods and tools are used in the early stages when thinking about how to frame, approach, or organize KT activities.^Citation82 “Doing”: The intermediate stage of the KT process that occurs after the planning stage and before the evaluation stage. Doing resources are methods and tools for the active phase of implementation and are used to facilitate or perform knowledge translation activities.^Citation82 “Evaluation”: Systematic efforts, using quantitative and/or qualitative approaches, to assess the effectiveness and impact of ongoing or completed KT activities in relation of their objectives.^Citation82

In Canada, the term “KT” is mainly used by health scientists, clinicians, and public health practitioners

Knowledge translation research: KT research is the scientific study of the determinants, processes, and outcomes of KT. The goal of KT research (KT science) is to develop a generalizable empirical and theoretical basis to optimize KT activities.^Citation50 KT research is a new field in health research which is inherently interdisciplinary. A wide range of disciplines need to be engaged (clinical sciences, health services research, health information technology, communications, behavioral and organizational theories, design and engineering, etc) as well as a broad range of forms of enquiry are needed.

Integrated knowledge translation or T2 research: The terms “T2 research” and “integrated KT” are synonymous. The former is mainly used in the USA,^Citation54 whereas the latter is preferred in Canada.^Citation53,Citation36^–^Citation38 Integrated KT or T2 research requires a partnership between the T2 researchers (academic partners) and the practitioners/decision-makers/policymakers/caregivers. The development of this partnership is the hallmark of integrated KT or T2 research.

In Canada, the term “integrated KT” is more and more often used by health scientists and public health practitioners

Mode II of knowledge production: Mode II refers to the contextualization of research when research programs combine a social and a scientific relevance. Mode II is based on the assumption that science can no longer be confined to the university; science penetrates the society, while in many ways society influences science. ^Citation56,Citation68,Citation69 Mode II contrasts with Mode I of knowledge production whose substance was science confined within disciplinary boundaries. A Mode II perspective argues for co-operation by researchers for resolving critical problems in a changing global context. The production of new knowledge is valuable but insufficient: the emphasis is on the usefulness of this knowledge. ^Citation56,Citation68,Citation69 The two characteristics of the Mode II are: (1) its explicit valuation of research, and (2) intense relationships between researchers and other social actors. In Canada, recent policies by various health research funders are closely aligned with Mode II, and many funding programs foster the development of partnerships in research (“integrated KT” or “T2 research”).

Public health: An organized activity of society to promote, protect, improve, and when necessary, restore the health of individuals, specified groups, or the entire population. It is a combination of sciences, skills, and values that function through collective societal activities and involve programs, services, and institutions aimed at protecting and improving the health of all people. The term “public health” can describe a concept, a social institution, a set of scientific and professional disciplines and technologies, and a form of practice. It is a way of thinking, a set of disciplines, an institution of society, and a manner of practice. It has an increasing number and variety of specialized domains and demands of its practitioners an increasing array of skills and expertise.^Citation82

Public health practitioner: The term “public health practitioner” includes frontline workers, researchers, professionals, managers, decision-makers and policy-makers.

Figure 1 Integrated knowledge translation in a changing global context.

Table 2 The similarities and differences between KT, KT research, and integrated KT

Knowledge translation	Knowledge translation research	Integrated knowledge translation or “T2 research”
KT is about: – Making users aware of knowledge and facilitating their use of it to improve health and health care systems; – Closing the gap between what we know and what we do (reducing the know-do gap); – Moving knowledge into action. KT is a dynamic process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of population, provide more effective health services and products and strengthen the health care system.^Citation53 This process takes place within a complex system of interactions between researchers and knowledge users which may vary in intensity, complexity, and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.^Citation53	= A relatively new field in health research which is interdisciplinary (it requires a wide range of expertise in: medicine, communications, behavioral and organizational change theories, methods of clinical research, etc). KT research (KT science) is about studying the determinants of knowledge use and effective methods of promoting the uptake of knowledge. The KT research field encompasses nine areas of interest:^Citation50 Knowledge synthesis; Research into the evolution of and critical discourse around research evidence; Research into knowledge retrieval, evaluation, and knowledge management infrastructure; Identification of knowledge to action gaps; Development of methods to assess barriers and facilitators to KT; Development of the methods for optimizing KT strategies; Evaluations of the effectiveness and efficiency of KT strategies; Development of KT theory; Development of KT research methods. Four key challenges:^Citation50 Terminological and conceptual challenges (different terms – research translation, research transfer, research into practice, translational research, knowledge exchange, utilization, knowledge mobilization, etc – are used to express the same concept; the same term is used to express different concepts; many concepts are poorly described and defined); Theoretical challenge (“too many theories, not enough theory”: profusion of KT theories that are poorly conceptualized and operationalized); Evaluation challenge; Challenge of sustained funding for KT research.	= A collaborative way of doing research: participatory, action-oriented, community based research, co-production of knowledge, “T2 research.” Involves engaging and integrating knowledge users into the entire research process study. Knowledge users can be: policy- and decision-makers from the community to the federal level, researchers, the public, industry, clinicians, the media, investigators from different disciplines, teams, countries. Is all integrated KT participatory research? No. Is all participatory research integrated KT? Yes. “T2 research” is in contrast of “T1 research” or conventional research (nicknamed “helicopter research”) which focuses on the transfer of knowledge from the laboratory to clinical trials and the establishment of scientific evidence of a given practice’s effectiveness. Integrated KT Principles: – All partners are experts with various experiences; – Power differentials among partners are acknowledged and sensitively addressed; – All stakeholders discuss potential benefits and harm of research; – Process is capacity building for everyone Benefits of “Integrated KT”: – Creates capacity among various stakeholders (communities and community members, patients, organizations, practitioners, policymakers, etc) to address current and future issues. – Enhances empowerment among groups who have historically been subjects of research, or merely passive consumers of its outcomes.

Abbreviation: KT, knowledge translation.

Figure 2 Integrated knowledge translation conceptual framework.

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