Full citation

McWilliam, C. L., Kothari, A., Ward-Griffin, C., Forbes, D., Leipert, B. & South West Community Care Access Centre Home Care. (2009). Evolving the Theory and Praxis of Knowledge Translation Through Social Interaction: A Social Phenomenological Study.Implementation Science, 4(26).

Format: Peer-reviewed article

Type: Research — Non-experimental

Experience level of reader: Fundamental

Annotation: The paper describes knowledge translation (KT) as a social process that requires attention to be paid to the ‘how to’ of KT and not just the ‘what’ of KT. The socially-mediated KT process is encapsulated in the Participatory Action KT (PAKT) model, which integrates KT content and KT context through KT facilitation, across multidisciplinary individuals, teams and organizations — and goes beyond the basic principles of science push and demand pull. The aim is to blend KT into the everyday craft of professional practice.

Setting(s) to which the reported activities/findings are relevant: Government, University

Knowledge user(s) to whom the piece of literature may be relevant: Clinicians, Policy Makers, Researchers

Knowledge user level addressed by the literature: Organization

This article uses the Commercial Devices and Services version of the NtK Model

Primary Findings

Barrier: Mutually exclusive roles for researchers as 'knowledge brokers' and participants as 'knowledge users', sometimes creates we/they relationships, rather than a more desirable collaborative relationship.
Summary of a KT intervention based upon the participatory action KT (PAKT) model.
Occurrence of finding within the model: KTA Step 1.D, KTA Step 2.D

Carriers:

  • Participatory Action Knowledge Translation (PAKT) model — Having participants choose an internal facilitator offsets the we/they relationship problem somewhat, rendering researchers more 'equal' group members.
    Summary of a KT intervention based upon the participatory action KT (PAKT) model.
    Occurrence of finding within the model: KTA Step 1.D, KTA Step 2.D
  • Removal of KT barriers is aided when KT participants interact openly and intentionally confront existing individual, team and organizational barriers; resolve conflict; and mutually construct KT strategies and facilitators.
    Summary of a KT intervention based upon the participatory action KT (PAKT) model.
    Occurrence of finding within the model: KTA Step 1.D, KTA Step 2.D
  • Throughout the KT process, participants collectively construct an organization encompassing their co-created, shared beliefs and assumptions about their organizational identity, one that increasingly espouses the principles of empowering partnering.
    Summary of a KT intervention based upon the participatory action KT (PAKT) model.
    Occurrence of finding within the model: KTA Step 1.D, KTA Step 2.D
  • KT can become a non-boundaried part of everyday work, where neither KT nor any of its components have an identifiable beginning, ending, or place in a fixed sequence. This occurs when social interaction focuses attention on the co-creation of knowledge, through the adoption of mutual engagement, shared enactment and transformative leadership — enabling existing boundaries and barriers to be jointly confronted and collaboratively removed.
    Summary of a KT intervention based upon the participatory action KT (PAKT) model.
    Occurrence of finding within the model: KTA Step 1.D, KTA Step 2.D

Method: The Participatory Action Knowledge Translation (PAKT) model can be used to specifically answer the research question: What is the nature of the process of implementing KT through social interaction? The answer to this question emphasizes the integration of the ‘how to’ with the ‘what’ of KT — specifically, by paying attention to KT content, KT context and KT facilitation. KT content is not simply acquired as fact and applied. Rather, KT content is learned, via interpretation, formation, contextualization and performance and becomes incorporated into the craft of professional practice. KT context is leveraged when all KT participants experience a level playing field for the expression of factors they each consider to impede or facilitate KT. Skilled facilitators, jointly chosen by KT participants, enhance the process of KT.
Summary of a KT intervention based upon the participatory action KT (PAKT) model.
Occurrence of finding within the model: Step 3.1, Step 2.2, Step 1.1

Tips:

  • As action group discussions unfold, participants can move more naturally between knowledge creation, transfer, uptake, and application, addressing and integrating each component into everyday work, if and as appropriate, in no particular order.
    Summary of a KT intervention based upon the participatory action KT (PAKT) model.
    Occurrence of finding within the model: KTA Step 1.C, KTA Step 2.C, KTA Step 6.D, Step 3.1, Step 1.4
  • Knowledge translators should adopt conceptualizations of knowledge, evidence, and KT as human processes fraught with all of the challenges of human subjectivity, dynamic interaction, and change within a complex context.
    Occurrence of finding within the model: KTA Step 1.A, KTA Step 1.B, KTA Step 2.A, KTA Step 2.B, Step 3.2, Step 2.2, Step 1.1

Secondary Findings

Barriers:

  • Resistance to uptake can be particularly marked where professional roles and identities are strong, social distances between disciplines are great, and research traditions, conceptions, agendas, and questions are markedly different. This finding cautions against undertaking KT within heterogeneous provider groups. (Ferlie, J.R. et al. [2005])
    Occurrence of finding within the model: KTA Step 1.C, KTA Step 2.C
  • Contextual factors, including space and time issues, organizational impediments, and structural barriers affect the management of KT. (Birdsell J.M. et al. [2002])
    Occurrence of finding within the model: KTA Step 1.C, KTA Step 2.C
  • Social and cognitive boundaries between health professions impede spread, as individual professionals tended to operate within their own disciplinary paradigms and communities of practice. (Ferlie, J.R. et al. [2005])
    Occurrence of finding within the model: KTA Step 1.C, KTA Step 2.C

Methods:

  • Promoting Action on Research Implementation in Health Services (PARiHS) — suggests three essential considerations: the evidence, the context, and facilitation. The evidence is described as encompassing research findings, clinical experience, and professional craft knowledge (that is, tacit 'how to' knowledge). The context ideally reflects sympathetic values and beliefs, openness to change, strong leadership, decentralized decision-making, role clarity, and appropriate monitoring and feedback. Facilitation by skilled external and internal personnel is recommended to enable teams and individuals undertaking KT to analyze, reflect upon, and change their own attitudes and behaviours, and particularize research findings. (Kitson, A. et al. [2008]; Rycroft-Malone, J. et al. [2002]; Rycroft-Malone, J. et al. [2004])
    Occurrence of finding within the model: KTA Step 1.D, KTA Step 2.D
  • Participatory Action Research (PAR) has been found to integrate KT with the innovation development and adoption process. Specifically, the PAR process enables participants to take an innovation and adapt it to their context, to engage in critical reflection to achieve this adaptation, and to work behind the scenes to encourage involvement and commitment. (Waterman, et al. [2007])
    Occurrence of finding within the model: KTA Step 1.A, Step 3.1, Step 3.3, Step 2.2, Step 1.3, Step 1.2