Initiation is recognized as a fundamental early phase of integrated knowledge translation (IKT): qualitative interviews with researchers and research users in IKT partnerships

Developing, implementing, and monitoring tailored strategies for integrated knowledge translation in five sub-Saharan African countries

BACKGROUND

Integrated knowledge translation (IKT) through strategic, continuous engagement with decision-makers represents an approach to bridge research, policy and practice. The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA +), comprising research institutions in Ethiopia, Malawi, Rwanda, South Africa, Uganda and Germany, developed and implemented tailored IKT strategies as part of its multifaceted research on prevention and care of non-communicable diseases and road traffic injuries. The objective of this article is to describe the CEBHA + IKT approach and report on the development, implementation and monitoring of site-specific IKT strategies.

METHODS

We draw on findings derived from the mixed method IKT evaluation (conducted in 2020-2021), and undertook document analyses and a reflective survey among IKT implementers. Quantitative data were analysed descriptively and qualitative data were analysed using content analysis. The authors used the TIDieR checklist to report results in a structured manner.

RESULTS

Preliminary IKT evaluation data (33 interviews with researchers and stakeholders from policy and practice, and 31 survey responses), 49 documents, and eight responses to the reflective survey informed this article. In each of the five African CEBHA + countries, a site-specific IKT strategy guided IKT implementation, tailored to the respective national context, engagement aims, research tasks, and individuals involved. IKT implementers undertook a variety of IKT activities at varying levels of engagement that targeted a broad range of decision-makers and other stakeholders, particularly during project planning, data interpretation, and output dissemination. Throughout the project, the IKT teams continued to tailor IKT strategies informally and modified the IKT approach by responding to ad hoc engagements and involving non-governmental organisations, universities, and communities. Challenges to using systematic, formalised IKT strategies arose in particular with respect to the demand on time and resources, leading to the modification of monitoring processes.

CONCLUSION

Tailoring of the CEBHA + IKT approach led to the inclusion of some atypical IKT partners and to greater responsiveness to unexpected opportunities for decision-maker engagement. Benefits of using systematic IKT strategies included clarity on engagement aims, balancing of existing and new strategic partnerships, and an enhanced understanding of research context, including site-specific structures for evidence-informed decision-making.

The Maritime SPOR SUPPORT Unit (MSSU) Bridge Process: An Integrated Knowledge Translation Approach to Address Priority Health Issues and Increase Collaborative Research in Nova Scotia, Canada

BACKGROUND

There is evidence of the benefits of integrated knowledge translation (IKT), yet there is limited research outlining the purpose of a knowledge broker (KB) within this approach. The Maritime SPOR SUPPORT Unit (MSSU) acts as a KB to support patient-oriented research across the Maritime provinces in Canada. The "Bridge Process" was developed by the Nova Scotia (NS) site as a strategy that involves work leading up to and following the Bridge Event. The process supports research addressing priority health topics discussed at the event by stakeholder groups. The objectives of this paper were to (1) describe the outputs/outcomes of this IKT approach; and (2) examine the role of the KB.

METHODS

Quantitative data were collected from registration and evaluation surveys. Outputs are described with descriptive statistics. Qualitative data were collected through evaluation surveys and internal documents. Data related to KB tasks were categorized into three domains: (1) Knowledge Manager, (2) Linkage and Exchange Agent, and (3) Capacity Developer.

RESULTS

The Bridge Process was implemented four times. A total of 314 participants including government, health, patient/citizen, community, and research personnel attended the events. We identified 24 priority topics, with 7 led by teams receiving support to complete related projects. Participants reported improved understanding of the research gaps and policy needs and engaged with individuals they would not have otherwise. Although patients/citizens attended each Bridge Event, only 61% of participants who completed an evaluation survey indicated that they were 'actively engaged in group discussion.' The KB's role was identified in all three domains including Knowledge Manager (eg, defining questions), Linkage and Exchange Agent (eg, engaging stakeholders), and Capacity Builder (eg, research interpretation).

CONCLUSION

The MSSU facilitated an IKT approach by acting as a KB throughout the Bridge Process. This deliberative and sequential process served as an effective strategy to increase collaborative health research in the province.

A scoping review to identify and describe the characteristics of theories, models and frameworks of health research partnerships

Background

Engaging users of health research, namely knowledge users, as partners in the research process may to lead to evidence that is more relevant to the users. This may optimize the uptake of evidence in healthcare practice, resulting in improved health outcomes or more efficient healthcare systems. However, barriers to involving knowledge users in the research process exist. Theories, models and frameworks may help guide the process of involving knowledge users and address barriers to engaging with knowledge users in research; however, there is little evidence identifying or describing the theories, models and frameworks of health research partnerships.

Objectives

Identify and describe theories, models and frameworks of health research partnerships. Report on concepts of knowledge user engagement represented in identified theories, models and frameworks.

Methods

We conducted a scoping review. Database (MEDLINE, Embase, CINAHL, PCORI) and ancestry and snowball searches were utilized. Included articles were written in English, published between January 2005 and June 2021, specific to health, a research partnership, and referred to a theory, model or framework. No critical appraisal was conducted. We developed a coding framework to extract details related to the publication (e.g. country, year) and theory, model or framework (e.g. intended users, theoretical underpinning, methodology, methods of development, purpose, concepts of knowledge user engagement). One reviewer conducted data extraction. Descriptive statistics and narrative synthesis were utilized to report the results.

Results

We identified 21 874 articles in screening. Thirty-nine models or frameworks were included in data analysis, but no theory. Two models or frameworks (5%) were underpinned by theory. Literature review was the method (n = 11, 28%) most frequently used to develop a model or framework. Guiding or managing a partnership was the most frequently reported purpose of the model/framework (n = 14, 36%). The most represented concept of knowledge user engagement was principles/values (n = 36, 92%).

Conclusions

The models and frameworks identified could be utilized by researchers and knowledge users to inform aspects of a health research partnership, such as guidance or implementation of a partnership. Future research evaluating the quality and applicability of the models and frameworks is necessary to help partners decide which model or framework to implement.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-022-00877-4.

Fit for purpose. Co-production of complex behavioural interventions. A practical guide and exemplar of co-producing a telehealth-delivered exercise intervention for people with stroke

Background

Careful development of interventions using principles of co-production is now recognized as an important step for clinical trial development, but practical guidance on how to do this in practice is lacking. This paper aims (1) provide practical guidance for researchers to co-produce interventions ready for clinical trial by describing the 4-stage process we followed, the challenges experienced and practical tips for researchers wanting to co-produce an intervention for a clinical trial; (2) describe, as an exemplar, the development of our intervention package.

Method

We used an Integrated Knowledge Translation (IKT) approach to co-produce a telehealth-delivered exercise program for people with stroke. The 4-stage process comprised of (1) a start-up planning phase with the co-production team. (2) Content development with knowledge user informants. (3) Design of an intervention protocol. (4) Protocol refinement.

Results and reflections

The four stages of intervention development involved an 11-member co-production team and 32 knowledge user informants. Challenges faced included balancing conflicting demands of different knowledge user informant groups, achieving shared power and collaborative decision making, and optimising knowledge user input. Components incorporated into the telehealth-delivered exercise program through working with knowledge user informants included: increased training for intervention therapists; increased options to tailor the intervention to participant’s needs and preferences; and re-naming of the program. Key practical tips include ways to minimise the power differential between researchers and consumers, and ensure adequate preparation of the co-production team.

Conclusion

Careful planning and a structured process can facilitate co-production of complex interventions ready for clinical trial.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-021-00790-2.

Integrated Knowledge Translation in Non-Communicable Disease Research in Sub-Saharan Africa: A Comparison of Systematic and Ad Hoc Stakeholder Engagement

Background

Low- and middle-income countries (LMICs) are currently experiencing an increasing prevalence of non-communicable diseases (NCDs). To address this as well as other health challenges, Integrated Knowledge Translation (IKT) approaches to build mutually beneficial relationships between researchers and decision-makers can concurrently inform research as well as enhance evidence use in policy and practice. The Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) is a research consortium which conducts research on NCDs and uses an IKT approach to facilitate the uptake of this research in five African countries: Ethiopia, Uganda, Rwanda, Malawi, and South Africa. Tailored IKT strategies were designed and implemented to plan and guide stakeholder engagement. This systematic approach contrasts with more commonly used ad hoc approaches to stakeholder engagement.

Methods

In this article, we explore the experiences of researchers engaged in the CEBHA+ IKT approach across the five African countries. Data sources included: 1) an informal document review of CEBHA+ country-specific IKT strategies, IKT team meeting minutes and activity reports, and 2) a semi-structured survey of IKT implementers to elicit country-specific experiences on actual implementation and adaptation of the IKT strategies. Results were collated and contrasted across all CEBHA+ countries with a focus on systematic versus ad hoc approaches to engagement.

Results

South Africa, Malawi and Ethiopia country teams indicated that their engagements benefited from a systematic IKT strategy. This was especially the case in the early stages of the project as it allowed focused and intentional engagement. However, ad hoc engagement was still required as new professional relationships developed, and contextual circumstances - including the SARS-CoV-2 pandemic - required responsive engagement with decision-makers and other stakeholders. In Rwanda and Uganda, continuous systematic engagement was found to bolster ownership of the research at both community and national levels.

Conclusion

Political and health climates are constantly shifting with a need to maintain flexibility in how IKT strategies are implemented. While strategic IKT can benefit from deliberate planning and stakeholder engagement, there is value in remaining flexible to respond to the needs of stakeholders and contextual circumstances. This paper highlights how IKT implementers in the five African CEBHA+ countries responded to this challenge.

Trainee-led research using an integrated knowledge translation or other research partnership approaches: a scoping reviews

BACKGROUND

There are increasing expectations for researchers and knowledge users in the health system to use a research partnership approach, such as integrated knowledge translation, to increase the relevance and use of research findings in health practice, programmes and policies. However, little is known about how health research trainees engage in research partnership approaches such as IKT. In response, the purpose of this scoping review was to map and characterize the evidence related to using an IKT or other research partnership approach from the perspective of health research trainees in thesis and/or postdoctoral work.

METHODS

We conducted this scoping review following the Joanna Briggs Institute methodology and Arksey and O'Malley's framework. We searched the following databases in June 2020: MEDLINE, Embase, CINAHL and PsycINFO. We also searched sources of unpublished studies and grey literature. We reported our findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

RESULTS

We included 74 records that described trainees' experiences using an IKT or other research partnership approach to health research. The majority of studies involved collaboration with knowledge users in the research question development, recruitment and data collection stages of the research process. Intersecting barriers to IKT or other research partnerships at the individual, interpersonal and organizational levels were reported, including lack of skills in partnership research, competing priorities and trainees' "outsider" status. We also identified studies that evaluated their IKT approach and reported impacts on partnership formation, such as valuing different perspectives, and enhanced relevance of research.

CONCLUSION

Our review provides insights for trainees interested in IKT or other research partnership approaches and offers guidance on how to apply an IKT approach to their research. The review findings can serve as a basis for future reviews and primary research focused on IKT principles, strategies and evaluation. The findings can also inform IKT training efforts such as guideline development and academic programme development.

Using an integrated knowledge translation or other research partnership approach in trainee-led research: a scoping review protocol

INTRODUCTION

Collaborative research approaches, such as co-production, co-design, engaged scholarship and integrated knowledge translation (IKT), aim to bridge the evidence to practice and policy gap. There are multiple benefits of collaborative research approaches, but studies report many challenges with establishing and maintaining research partnerships. Researchers often do not have the opportunity to learn how to build collaborative relationships, and most graduate students do not receive formal training in research partnerships. We are unlikely to make meaningful progress in strengthening graduate and postgraduate training on working collaboratively with the health system until we have a better understanding of how students are currently engaging in research partnership approaches. In response, this scoping review aims to map and characterise the evidence related to using an IKT or other research partnership approach from the perspective of health research trainees.

METHODS AND ANALYSIS

We will employ methods described by the Joanna Briggs Institute and Arksey and O'Malley's framework for conducting scoping reviews. The reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews checklist. We will include both published and unpublished grey literature and search the following databases: MEDLINE, Embase, CINAHL, PsycINFO, ProQuest Dissertations & Theses Global databases, Google Scholar and websites from professional bodies and other organisations. Two reviewers will independently screen the articles and extract data using a standardised data collection form. We will narratively describe quantitative data and conduct a thematic analysis of qualitative data. We will map the IKT and other research partnership activities onto the Knowledge to Action cycle and IAP2 Levels of Engagement Framework.

ETHICS AND DISSEMINATION

No ethical approval is required for this study. We will share the results in a peer-reviewed, open access publication, conference presentation and stakeholder communications.

We have the program, what now? Development of an implementation plan to bridge the research-practice gap prevalent in exercise oncology

Background

Exercise has emerged as a promising therapy for people with cancer. Novel programs have been developed to translate research into practice; however, implementation barriers have limited their success in part because successful translation of exercise oncology research into practice requires context-specific implementation plans. The aim of this study was to employ the implementation mapping protocol to develop an implementation plan to support programming of a co-located exercise clinic and cancer treatment center.

Methods

The Implementation Mapping protocol, which consists of five specific iterative tasks, was used. A stakeholder advisory group advised throughout the process.

Results

A comprehensive needs assessment was used to identify the organization’s general manager as the program adopter; oncologists, center leaders, and various administrative staff as program implementers; and the operations manager as the program maintainer. Twenty performance objectives were identified. The theoretical domains framework was used to identify likely determinants of change, which informed the selection of eight individual implementation strategies across the individual and organizational levels. Finally, an evaluation plan was developed which will be used to measure the success of the implementation plan in the project’s next phase.

Conclusion

The Implementation Mapping protocol provided a roadmap to guide development of a comprehensive implementation plan that considered all ecological domains, was informed by theory, and demonstrated an extensive understanding of the implementation context. Strong research-practitioner partnerships and effective stakeholder engagement were critical to development of the plan.

Engaging patients and stakeholders in preresearch: findings from the Pipeline to Proposal Awards Initiative

Aim: The Patient-Centered Outcomes Research Institute Pipeline to Proposal (P2P) Awards Initiative funded 177 awardees to engage patients and stakeholder partners in preresearch. Based on P2P, we described engagement strategies; outcomes; facilitators; and challenges to inform research funders and stakeholders participating in preresearch. Materials & methods: We used a qualitative approach based on content analysis of program data and interviews with P2P awardees and partners. Results: Awardees developed partnership infrastructure by recruiting patients and stakeholders, establishing clear roles, and providing training. Building trust was key to engaging patients and stakeholders in preresearch. Awardees reported partners were more likely to engage in PCOR in the future. Conclusion: P2P awardees increased capacity of patient and stakeholder partnerships to conduct PCOR.