The process of knowledge translation begs us not only to ask the important questions, but also the questions that really matter. In health practice, knowledge translation first appeared as ‘bench to bedside’ or ‘campus to clinic’ (Greenhalgh & Wieringa, 2011), it was also found that “managers and policy makers fail to draw consistently on robust evidence when designing services or allocating resources” (Greenhalgh & Wieringa, 502). The decision and motivations to turn evidence into evidence based policy is contextually based, the facts are always value laden and their application is also affected by the situation. Greenhalgh & Wieringa (2011) highlight a notion that is well documented process, despite good evidence, policy makers are not always inclined to carry out the recommendations. As Lewis (2007) states evidence base medicine and evidence based decision-making have yet to be revolutionary, he acknowledges that evidence should be more influential but this has yet to be a reality.
You would be hard to pressed to find an individual that does not have an opinion on food, we need it, we love it, and it is connected to our most basic human experience. In the words of Wendell Berry, “to be interested in food but not in food production is clearly absurd.” Food is connected to our well-being on so many levels. The state of food production is being challenged by the integration of genetically modified or genetically modified organisms (GMO), the implications of GMO products is not well understood.
Last week the Canadian Seed Trade Association (CSTA) failed to support a resolution about the regulation of GMO alfalfa at its semi-annual meeting. The CSTA is responsible for “representing 128 corporate members engaged in all aspects of seed research, production and marketing, both domestically and internationally” (Canadian Seed Trade Association, 2013). The resolution, brought to the floor wanted to support regulation of growing GMO alfalfa in dedicated areas of the province of Manitoba, whilst other areas could stay GMO free. GMO soy and corn has contaminated the Canadian markets, right of entry to European and Japanese markets have already become inaccessible for fear that we cannot guarantee the purity of that seed (CBC, 2013). Lack of access might not be the only concern, “a growing body of research connects these foods with health concerns and environmental damage” (David Suzuki Foundation, 2013). The fact is that we don’t know the impacts of GMO products, and more importantly the spread of these GMO plants is out of control in most developed countries (Sustainable Pulse, 2013).
Evidence is showing that we cannot control the growing and harvesting of GMO crops, secondly we are not sure of the long-term effects that GMOs will have on our health or the health of our planet. As Jane Barrett, negotiator for SATAWU, recently said “A farmer’s job is to take care of the soil, the plants will do the rest”. We are responsible for the actions that we take; stewardship of the planet is a serious responsibility.
The disconnect in this example is between the lack of action towards regulating something that is possibly harmful to human health, as exemplified by Michie et al. (2005), “[t]he implementation of evidence based practice (EBP) depends on human behaviour” (32). This behaviour is influenced by so many triggers, such as social or economic, and what needs to be highlighted is that regardless of evidence the actions that we take are based in complex systems influenced by so many differing stimuli.
In the field of knowledge translation where we are able to name many practical examples where good evidence is not being applied, in my opinion we need to start asking the more contextual questions, all the theory, frameworks or models are not going to solve our problems. If dissemination is the problem, let us be creative and proactive in developing knowledge translation that is effective in the context that we are trying to consider. When the important questions are asked, it is imperative that we all act with the intention of sharing that knowledge, and that we act in conjunction with the evidence not in despite of it.
Barrett, J. (November 2, 2013). SATAWU Presentation, ITF Youth Climate Change Africa regional meeting, Johanesburg, South Africa.
Canadian Seed Trade Association. (2013). Home. Retrieved from: cdnseed.org
CBC. (2013). Farmers protest introduction of GM alfalfa. Retrieved from: http://www.cbc.ca/news/business/farmers-protest-introduction-of-gm-alfalfa-1.1363280
David Suzuki Foundation. (2013). Understanding GMO. Retrieved from: http://www.davidsuzuki.org/what-you-can-do/queen-of-green/faqs/food/understanding-gmo/
Greenhalgh, T., & Wieringa, S. (2011). Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review. Journal of Social Medicine, 104, 501-509. Doi: 10.1258/jrsm.2011.110285
Lewis, S. (2007). Toward a general theory of indifference to research-based evidence. Journal of Health Services Research and Policy, 2 (1), 1-7.
Michie, S., et al. (2005). Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality Safety Health Care, 4, 23-33. doi: 10.1136/qshc.2004.011155
Sustainable Pulse. (2013). Spread of GM Crops Out of Control in Many Countries – New Report Retrieved from: http://sustainablepulse.com/2013/11/12/spread-of-gm-crops-out-of-control-in-many-countries-breaking-news/#.UorXP8Skqn8
For knowledge translation professionals, knowledge may be the business, but not all the wares are alike. We must make a distinction between explicit and tacit knowledge (TK). The former refers to formal knowledge such as data published in peer-reviewed studies and evidence-based practice guidelines. The latter is informal: unwritten practices or ‘tricks of the trade’ generally acquired through lived experience. It also encompasses less conscious knowledge such as intuition or ‘going with one’s gut’ (Welsh & Lyons, 2001). Yale anthropologist James Scott (1998) makes a strong case for the importance of TK, arguing that it central to the functioning of modern day corporations and states. In its absence, productivity falls and these entities cease to function efficiently. This is well illustrated by work-to-rule strikes: in performing only those responsibilities formally detailed in their job descriptions, employees can reduce an organization’s productivity, which is dependent on informal practices (Scott, 1998, p. 310).
Unsurprisingly, TK also plays a central role in clinical and public health practice. Yoshioka-Maeda et al. (2006) found that public health nurses working in Japan relied on tacit knowledge to plan and coordinate services for clients with complex needs. In doing so, the nurses departed from traditional planning processes that begin with a community assessment, instead allowing problems to emerge from their everyday interactions with clients. Likewise, Kothari et al. (2012) point to an important role for TK in creating or adapting an intervention so that it attends to the local context. Tacit knowledge provides not only contextual information but is vital to accomplishing everyday activities when time and resources are at a premium. Practitioners will rely on past experience to make decisions about personnel (“Is this person reliable?”) and methods (Kothari et al., 2012). Gabbay and le May reported that practitioners in the UK infrequently used evidence-based practice guidelines in their daily interactions with patients, relying instead on ‘mindlines’: “collectively reinforced, internalised tacit guidelines” developed through experience (2004, pp. 1014-1015). However, these engrained habits may also be a barrier to change; it may be hard to convince practitioners to modify engrained habits (Kothari et al., 2012, p. 30).
If TK plays such an important role, how can we manage it to our benefit? Gabbay and le May’s (2004) observed that tacit knowledge exchange took place primarily through interpersonal interactions; the same story emerged from Kothari et al.’s (2012) interviews with practitioners in Ontario. We can encourage such exchanges through promoting and assisting in the development of communities of practice. For a model we might look to Ontario’s Seniors Health Research Transfer Network; there, dedicated knowledge brokers have worked to establish new connections with- and facilitate meetings between practitioners working in the field of seniors’ health (Conklin et al., 2013). We might also take a cue from work done outside of public health. NASA (2013) compiled and published a collection of interviews with individuals who had worked on the space shuttle program. Such an initiative allows individuals to benefit from TK when face-to-face contact is not possible. While these are promising practices, some TK may not be well suited to transfer, as it is often context-specific. Furthermore, there may be certain affective dimensions of TK that we cannot package; lived experience may be essential to knowing or understanding certain phenomena (e.g. managing traumatic experiences).
The lesson for researchers and practitioners is that we must reorient the way in which we evaluate evidence. As the aforementioned studies demonstrate, qualitative inquiry is much better placed to capture the nuances of TK in a given context. In research and practice many accept a specific hierarchy of evidence that privileges formal or explicit knowledge. This hierarchy places randomized, ostensibly generalizable studies (e.g. systematic reviews and meta-analyses) over case studies and those employing non-random samples. If TK plays an essential role in oiling the gears of program planning and implementation, then perhaps the hierarchy of evidence needs reconsidering. While individual case studies are at the bottom of the evidence hierarchy, such a study might provide the crucial “how” or “why” that Riley et al. (2008) find lacking in many program evaluations.
Conklin, J., Lusk, E., Harris, M., & Stolee, P. (2013). Knowledge brokers in a knowledge network: the case of Seniors Health Research Transfer Network knowledge brokers. Implementation Science, 8(1), 7.
Gabbay, J., & May, A. L. (2004). Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care. BMJ, 329(7473), 1013.
Kothari, A., Rudman, D., Dobbins, M., Rouse, M., Sibbald, S., & Edwards, N. (2012). The use of tacit and explicit knowledge in public health: a qualitative study. Implementation Science, 7(1), 20.
National Aeronautics and Space Administration. (2013). NASA JSC Space Shuttle Program Tacit Knowledge Capture Project. Retrieved from http://www.jsc.nasa.gov/history/oral_histories/ssp.htm.
Riley, B. L., MacDonald, J., Mansi, O., Kothari, A., Kurtz, D., von Tettenborn, L. I., & Edwards, N. C. (2008). Is reporting on interventions a weak link in understanding how and why they work? A preliminary exploration using community heart health exemplars. Implementation Science, 3(1), 27.
Scott, J. C. (1998). Seeing like a state: How certain schemes to improve the human condition have failed. Yale University Press.
Welsh, I., & Lyons, C. M. (2001). Evidence‐based care and the case for intuition and tacit knowledge in clinical assessment and decision making in mental health nursing practice: An empirical contribution to the debate. Journal of Psychiatric and Mental Health Nursing, 8(4), 299-305.
Yoshioka-Maeda, K., Murashima, S., & Asahara, K. (2006). Tacit knowledge of public health nurses in identifying community health problems and need for new services: a case study. International journal of nursing studies, 43(7), 819-826.
Fall 2013 about a dozen of us (united under the rubric of SFU’s HSCI 891 graduate seminar) are embarking on explorations related to KT, aka dissemination and implementation. Join in! Enjoy! Save the world!