What’s in a name? Differentiating between KT and D&I and insights into what’s missing

Recent years have seen a growth in the field most commonly referred to in Canada as “knowledge translation” (KT), with increasing importance placed on bridging the gap between evidence-based research and policy (Graham et al., 2006).  According to Graham et al. (2006), the field is rife with confusion that is a result of the use of a plethora of terms used to describe the KT process, whether as a whole or in parts.  Take, for example, two simple terms commonly used in KT lingo: knowledge translation, and dissemination and implementation (D&I).  They seem to represent the same concept, so how are they different?

Although the two terms are often used interchangeably, they describe two different concepts.  KT describes the process by which knowledge, or what is known or found out in research, becomes used by relevant groups to improve health outcomes (Graham et al., 2006).  In this case, the knowledge that is gained from scientific research is “translated” into policies that improve health and health systems.  Much understanding of KT is based on CIHR’s definition of the term “as 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” (“About knowledge translation”, 2013).

On the other hand, dissemination describes the act of spreading widely the knowledge that is gained from synthesis, while implementation refers to the use of this knowledge in every-day practice (Graham et al., 2006; Tabak et al., 2012).  In other words, knowledge translation consists of steps that include, but are certainly not limited to, D&I.

A point of thought that may bring these ideas together is to consider what’s missing from these definitions.  The focus of both seems to be bridging the gap between what is known and what is practiced.  Others have also characterized this point as critical and highlight the significance of relationships between scientists or researchers and policymakers (Graham et al., 2006).  Despite this focus being common in the public health field, most descriptions lack reference to the importance of collaboration among participant groups and between such groups and researchers and policymakers.

Another term that more accurately takes into account other collaborators is “knowledge sharing” or “knowledge exchange”, sometimes used in place of knowledge translation.  This term is often described as a back-and-forth between researchers (science) and decision-makers (policy) (Graham et al., 2006), though there is little emphasis on affected communities and other stakeholders as collaborators.  Increasingly, research in the health sector is encouraging community-based participatory research (CBPR) as a significant part of the knowledge process; that is, the need for the inclusion of the voices of affected communities, especially those characterized as “vulnerable” or “at-risk”, in knowledge synthesis and D&I (Glasgow et al., 2012; Cargo & Mercer, 2008; Lencucha et al., 2010; Kothari & Armstrong, 2011).

Although knowledge translation (inclusive of synthesis and D&I) implies a unidirectional approach, knowledge sharing accounts for a bi- or even multi-directional perspective on health issues.  The misunderstanding and misuse of terms within the knowledge translation discipline is a key issue that Graham et al. (2006) have reasonably acknowledged.  Ultimately, until a clear understanding and consensus is reached on the meaning of knowledge translation, the multitude of terms used to describe the process, and most importantly, who may be included in the translation of knowledge, turning what is known into what is practiced will remain limited in its capacity to improve the state of public health.

References

Cargo M, Mercer SL. (2008). The value and challenges of participatory research: strengthening its practice. Annual Review of Public Health, 29, 325-350.

CIHR. (2013). About knowledge translation. Retrieved from http://www.cihr-irsc.gc.ca/e/29418.html.

Glasgow RE, Green LW, Taylor MV, Strange KC. (2012). Evidence integration triangle for aligning science with policy and practice. American Journal of Preventive Medicine, 42(6), 646-654.

Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. (2006). Lost in knowledge translation: time for a map? The Journal of Continuing Education in the Health Professions, 26(1), 13-24.

Kothari A, Armstrong R. (2011). Community-based knowledge translation: unexplored opportunities. Implementation Science, 6, 59.

Lencucha R, Kothari A, Hamel N. (2010). Extending collaborations for knowledge translation: lessons from the community-based participatory research literature. Health Studies Publications, Paper 5.

Tabak RG, Khoong EC, Chambers DA, Brownson RC. (2012). Bridging research and practice: models for dissemination and implementation research. American Journal of Preventive Medicine, 43(3), 337-350.

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2 responses to “What’s in a name? Differentiating between KT and D&I and insights into what’s missing”

  1. higgi106 says :

    A more multidirectional approach as you’ve written is something to strive for, and I find it interesting that more often than not we focus on the researchers present approaches as solely responsible for the perpetuation of more unidirectional approach. From what I’ve seen, this is obviously a major reason for this occurrence but it seems to me that communities or officials that are targeted in knowledge exchanges are sometimes so accustomed to being on the receiving end due to the historic perpetuation of such an approach and the complexities of power dynamics between governments, international agencies, etc that upon the suggestion of a more collaborative approach it’s difficult to truly achieve in the face of such internalized patterns of behavior. Learning how to use their voice and value their knowledge themselves when the dominant discourse historically has told them it’s not of as much value can be a challenge in itself when working toward truly multidirectional exchanges.

    • lili891 says :

      I believe you’ve touched on a very significant point that warrants much more consideration than it is given. This challenge has been and continues to be at the vanguard of much of the KT work that is undertaken in the health field–the issue of power dynamics between groups involved in the research process. Frequently, researchers try to involve affected groups in one small part of process, namely D&I. The idea of disseminating knowledge and attempting to implement what has been found to “work” within the community seems simple enough, and to call it KT would not be entirely incorrect. So what’s the problem? As I see it, It can be much too easy to overlook the importance of involving these communities during the process of knowledge synthesis due to the traditional roles of the researcher as the scientist/expert and the subject as, well, the subject. Thinking point: What steps can we take to eliminate the traditional power dynamics in this relationship and strive for equal contribution? Is it even possible to do so?

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