Climate change and dying babies: Where to start?
Adaptation of knowledge to a local context. If only it was that easy. This is a key element of the knowledge-to-action (KTA) process (Graham, et al, 2006). It involves “[t]he process individuals or groups go through as they make decisions about the value, usefulness, and appropriateness of particular knowledge to their setting and circumstances” as well as the formal (or not) tailoring of knowledge to a particular situation (Graham, et al, 2006, p. 20). In theory this seems appropriate, but what gets lost when knowledge is adapted? What if individuals or groups decide that ‘good’ evidence is neither useful nor valuable to them? And what if the ‘local’ context is ‘global’, such as in the case of climate change?
A lot of scientific evidence, or knowledge, is created “in isolation from its projected users…[and] often fits uncomfortably in the settings and populations in which it is intended to be applied” (Glasgow, et al, 2012, p. 646). How do we move from this ‘uncomfortable fit’ that is resulting in a lag in improvements in population health to a more impactful use of knowledge? More research! Or at least more of the right kind or research. Glasgow et al (2012) describe the need for the kind of research that informs this key step in the KTA process – implementation and impact research. Research, they say, that focuses on external validity, context and stakeholder relevance. In other words, research that facilitates the adaptation of knowledge to local contexts. The BetterBirth Project in which researchers took an evidence-based intervention, kangaroo-care, known to save babies lives and evaluated it’s implementation in a particular context in a practical setting (Gawande, 2013) is a good example of this.
Reflecting on KTA in this way makes me eager to discover other existing kangaroo-care-type lifesaving interventions that need only be adapted to a local context. Is that where we, new (global) population health researchers, should be focussing our attention? So far in my short (!) career in global health I have grappled often with these questions. Research or practice or both? Knowledge creation or action? And which element of KTA is the most important in terms of actually improving population health? Does one have to choose? I am left with (and leaving you with) more questions than I had before delving into this week’s material. I think Hanlon, et al’s proposition for the future public health (2011), may be able to help with some of the answers and definitely deserves a second read at least.
Glasgow, RE., et al. (2012). Evidence integration triangle for aligning science with policy and practice. American Journal of Preventive Medicine, 42(6), 646-654.
Graham, ID et al. (2011). Lost in knowledge translation: time for a map?. The Journal of Continuing ducation in the Health Profession, 26(1), 13-24.
Gwande, Atul. Slow ideas: why innvations don’t always catch on. New Yorker, July 29, 2013.
Hanlon, P., et al. (2011). Learning our way into the future public health: a proposition. Journal of Public Health, 33(3), 335-342.