The Importance of Synthesis and Integrated Knowledge ... · research and knowledge translation • Supports more than 13,600 researchers and trainees • CIHR takes a solutions-based

The Importance of Synthesis and Integrated Knowledge Translation

Adrian MotaManager, Knowledge Translation Initiatives

February 2012

Presented at Nurturing Matters Conference February 22 & 23, 2012 Brampton, Ontario Canada

Overview of CIHR

• CIHR is the Government of Canada’s funding agency for health research and knowledge translation

• Supports more than 13,600 researchers and trainees

• CIHR takes a solutions-based and multidisciplinary approach to the health challenges facing Canadians

• Committed to facilitating the move of research results into actionand working collaboratively with partners


Knowledge Translation is part of our mandate

Knowledge translation at CIHR: Definition

Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound

application of knowledge to improve the health of Canadians, provide more effective health services and products and

strengthen the health care system.

This process takes place within a complex system of interactionsbetween researchers and knowledge users that 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.


KT definition components

� The contextualization and integration of research findings of

individual research studies within the larger body of knowledge on

the topic

� Synthesis is a family of methodologies for determining what is

known in a given area or field and what the knowledge gaps are

� Involves identifying the appropriate audience for the research

findings, and tailoring the message and medium to the audience

� Refers to the interaction between the knowledge user and the

researcher resulting in mutual learning

� Encompasses the concept of collaborative or participatory,

action-oriented research where researchers and knowledge users

work together as partners to conduct research to solve knowledge

users’ problems

� The iterative process by which knowledge is actually considered,

put into practice or used to improve health and the health system

� KT activities must be consistent with ethical principles and norms,

social values as well as legal and other regulatory frameworks

Ethically-sound application of knowledge

Knowledge synthesis

Dissemination

Knowledge exchange

Why is Synthesis important?

• Synthesis is used to emphasize the importance of understanding how the results from a single research study mesh with the larger body of knowledge/research on the topic.

• It is only by conducting synthesis of the global literature that the effectiveness of most interventions/practices can be truly determined.

• the need to ensure that research findings are based on the best available science and that there is sufficient evidence to confirm that the findings should be taken up. Promoting the use of research findings prematurely can risk causing more harm than benefit

• Knowledge synthesis is one important way to ensure that the knowledge to be transferred is both valid and reliable.


Why is KT important?

• Consistent evidence of failure to translate research findings into clinical practice

• 30-45% patients do not get treatments of proven effectiveness

• 20–25% patients get care that is not needed or potentially harmful (McGlynn et al, 2003; Grol R, 2001; Schuster, McGlynn, Brook 1998)

• Cancer outcomes could be improved by 30% with optimum application of what is currently known (CSCC 2001;Ford et al 1990)


Two broad types of KT at CIHR

� The researcher develops and implements a plan

for making knowledge users aware of the

knowledge generated through a research project

� Research approaches that engage potential

knowledge users as partners in the research

process

� Requires a collaborative or participatory

approach to research that is action oriented and

is solutions and impact focused

� For example, the knowledge user partner helps

to define the research question and is involved

in interpreting and applying the findings

End-of-grant KT

Integrated KT


Integrated KT

• Integrated KT:

• Is a way of doing research (i.e., an approach, not a method)

• Is collaborative, participatory, action-oriented research; co-production of knowledge

• Involves engaging and integrating knowledge users into the research process

• Knowledge users can be:

• Policy makers, decision makers, researchers, the public, industry, clinicians, the media

• Investigators from different disciplines, teams, countriesPresented at Nurturing Matters Conference

February 22 & 23, 2012 Brampton, Ontario Canada

Integrated KT

• As a minimum requirement for conducting integrated KT, knowledge users and researchers must work together to:� Shape the research questions� Interpret study findings and craft messaging around them� Move the research results into practice

• … In addition, knowledge users and researchers can work together to:� Decide on the methodology� Help with data collection and tools development� Conduct widespread dissemination and application


Why integrated KT?

Through partnerships, the research is strengthened:• research can be more solutions-based because there is a knowledge-

user involved in developing the research question

• research can have more impact because the end-user is engaged and interested, ready for results and willing to move those results into practice because they are of direct relevance to their day-to-day lives

• by participating in the research process, end-users may have greater confidence in the results and in the researchers

• integrated knowledge translation involving K users, where they are consulted, informed and engaged from beginning to end, has the potential to improve treatment and health outcomes


What is integrated KT?

• We commissioned Ann Macaulay (PRAM) to create an educational module on researcher and knowledge-user collaboration

• Available on the CIHR website: http://www.cihr-irsc.gc.ca/e/39128.html#Guide

• Includes advice/discussion about how to manage research of this sort: negotiating roles and responsibilities ahead of time, dealing with IP, dealing with disagreements; guidance as to how to be mutually respectful, etc.


Basic idea behind our study

Purpose:

Explore the nature of researcher-knowledge-user partnerships in health research and address the gap in understanding the nature of these partnerships and their impact on the KT process.

Objectives:

1) Gain an in-depth understanding of partnerships

2) Explore current partnership relationships

3) Improve CIHR partnership practices and support mechanisms


The study in a nutshell

Literature search on partnerships conducted by a CIHR-CHSRF post doctoral fellow (Shannon Sibbald)

Surveys developed based on literature search and in collaboration with Shannon

Survey posted on-line and full Dillmanmethodology used to encourage researchers and knowledge-users to respond

Semi-structured interviews conducted with 50 survey respondants


Survey response rate

Population: every funded iKT grant from 2005 to September 2009 (224 grants)

Includes:

Partnerships for Health System Improvement (83)

Knowledge to Action (40)

Knowledge Synthesis (101)

Knowledge-users

• Received by 161

• Completed by 110: RR= roughly 68%

Researchers

• Received by 203

• Completed by 173: RR= roughly 85%Presented at Nurturing Matters Conference

February 22 & 23, 2012 Brampton, Ontario Canada

Impact of partnership

% responding yes Researcher Knowledge-user

In your view, did being in a partnership increase the uptake of the study results? 86.5% 81.6%

Compared to other studies you have been involved in that did not involve a knowledge-user partner, would you say that this study is (was) more likely to have an impact? 87.3% 86.2%


Did being in a partnership increase the uptake of the study results?

• success stories – from researchers:– “Given the changes in the provincial health care system, the

partnership was critical in ensuring that the project could adapt to the changing circumstances”

– “Our knowledge-users have been active in using the findings from the project in their work – they have been champions for the work”

• success stories – from knowledge-users:– “I believe our participation opened the doors to a number of

government departments being open to the research results and being willing to discuss how it may impact their policies and practices”

– “I was able to improve access to service providers”


Warning: Beware of the “KT imperative”

• The “KT imperative” is the perceived need to do everythingto encourage everyone to apply their research findings

• Results from a single research study should be contextualized within a synthesis of global research results before extra-ordinary dissemination or implementation efforts are undertaken – hence the importance of synthesis

• We need to bring common sense as well as academic rigour to bear on our decisions about the degree and intensity of KT activities warranted by a single research study – i.e., judicious KT


Key word: Appropriateness

• For all KT grants and activities the most important consideration is appropriateness.

• Each discipline, research project, and knowledge-user community is different. When there are limitations on the validity or generalizability of the results with few potential knowledge-users, a modest approach is most appropriate.

• The key to a successful grant is to ensure that there is a match between the expected research findings, the targeted knowledge-users and the KT strategies selected.


Another key word: Engagement

For all iKT activities another important consideration is engagement. By engaging in partnerships, knowledge-users and researchers can benefit from the expertise each offer to participate in research with a high potential for impact and to move high quality, locally adapted evidence into practice.


Benefits of Synthesis Registration for CIHR/Funders

• Avoids duplication ($ and effort)– prevents funding what is already being done or has been done

• Facilitates trialists’ grant writing- SR requirement for RCT applications

• Facilitates peer reviewers’ work

• Contributes to impact by providing mechanism to identify potential publication bias

• Promotes KT- facilitates finding syntheses by knowledge users

– Makes it easy to find most up to date version of synthesis


Need to Push the Envelope

• Initially registration of SR protocols: effects of interventions; wider determinants of health

• Expand to include all forms of synthesis (including ones not focused on effects)

– CIHR also funds: realist reviews, narrative synthesis, meta-analysis, meta-ethnography, etc (focus on systematic, transparent, reproducible methods)

– All our syntheses are peer reviewed and deemed excellent in order to be funded (avoid methodological imperialism)

– Let potential users of the synthesis determine their quality


For More Information

Website: About Knowledge Translation

http://www.cihr-irsc.gc.ca/e/29418.html

Thank you

E-mail: [email protected]


Documents

The Importance of Synthesis and Integrated Knowledge ... · research and knowledge translation • Supports more than 13,600 researchers and trainees • CIHR takes a solutions-based