Failing to translate research knowledge into action in health care contributes to health inequities and wastes costly and time-consuming research1-3
. The gap between what is known and what is done leads not only to the under-use of effective treatments, but also to the incorrect use of treatments and the over-use of unhelpful or unproven treatments, all of which lead to negative outcomes for patients. The realisation that failing to use research findings in health care has a negative impact on patient care has led to an increased emphasis on transferring knowledge into action. This process is commonly referred to as ‘knowledge transfer’ or ‘knowledge translation’, and is broadly understood to encompass the exchange, synthesis and application of research results and other evidence between academic and practice settings2
There have been a number of high-profile reports which have stressed the importance of knowledge transfer, particularly within health care. For instance, the World Health Organization1
has called for a closer working relationship between the producers and users of research to ensure that research is used to improve health whilst Lord Darzi’s report on England’s National Health Service4
has emphasized the importance of doing more to encourage the uptake of medical research and evidence-based technologies.
Although there is widespread agreement about the importance of transferring knowledge into action the research and practice landscapes are less well developed. The systematic use and evaluation of knowledge transfer methods such as targeted dissemination, involving users in the research process, developing networks between researchers and users and the use of knowledge brokers are rarely reported in the literature and a recent review identified only eighteen studies which described the implementation of a specific knowledge transfer mechanism5
. As a result, the evidence for knowledge transfer interventions is sparse and largely based on anecdote and descriptions of the processes involved in knowledge transfer interventions are vague.
Instead of focusing on the evaluation of knowledge transfer interventions, literature to date has tended to focus on theories, models or frameworks of the knowledge transfer process. Recent reviews have identified as many as 63 different theories or models of knowledge transfer across fields as diverse as health care, social care and management5, 6
. Whilst clearly articulated models or frameworks could form the basis for describing knowledge transfer processes in more detail and evaluating interventions more robustly, the sheer quantity and diversity of the literature makes it difficult for researchers and managers to choose which model to use7
. In addition, many of the models remain largely unrefined and untested meaning that their suitability as tools for designing and evaluating interventions is unknown. The exception to this is Graham et al’s ‘knowledge to action’ framework which has been tested as a model for planning and evaluating knowledge transfer strategies7
. However, the model was developed from a review of planned action theories and to date has not been refined or developed following its use in practice. Its adequacy as an explanation of the knowledge transfer process is also largely unknown.
Studies in other related areas such as research utilization and behaviour change have also failed to adequately explain the processes involved in transferring research and other evidence between academic and practice settings. Instead of focusing on broad explanations of the journey from knowledge to action, research has tended to assume that it is driven by a relatively narrow range of determinants. These include characteristics of the knowledge such as rigour and credibility, characteristics of the organisation such as size and innovativeness and characteristics of the intervention such as timing and intensity8
. Many of these have been drawn from previous models or frameworks of knowledge transfer and diffusion, such as Rogers’ theory of the diffusion of innovations9
. However, these studies have shown that no single approach is effective in all circumstances, suggesting that the rate at which knowledge is translated into action cannot be directly attributed to any one factor.
One of the major difficulties with deterministic approaches to knowledge transfer is that they presume that both the knowledge itself and the contexts in which it is implemented are uniform and tend not to acknowledge the complexity of the process. Alternative views see the spread of knowledge as a social activity which involves the activities of many communities, is influenced and molded by the belief systems and analytical or creative instincts of potential users, and encompasses the reinvention, proliferation and reimplementation of ideas, the fluid engagement of multiple entrepreneurs and an expanding and contracting network of stakeholders who converge and diverge9, 10
In order to advance the theory and practice of translating knowledge into action, future research will need to address the issues outlined above. This includes moving away from narrow descriptions of knowledge transfer towards a broader sociological explanation of the process, testing the adequacy of alternative models of knowledge transfer, and refining and testing tools for designing and evaluating interventions.
We are currently conducting research which aims to meet these criteria. Our study is based on the realist approach to evaluation and synthesis11
and involves articulating the key components which are presumed to be involved in the knowledge transfer process, testing these against evidence from case studies and producing a revised framework which can be used to plan and evaluate knowledge transfer interventions. This paper documents the first phase of our research. Our purpose is to describe the development of a conceptual framework which articulates the broad areas which seem crucial to the process of translating knowledge into action and to present it as a resource for future empirical work on knowledge transfer.