Is a Rose by any Other Name, Still a Rose? Why Knowledge Translation and Implementation Science are not Synonymous
The language we use for concepts is important because common understanding shapes our world. By avoiding confusion in nomenclature, we better understand the world around us, and as researchers or practitioners, we deepen our knowledge base and move it forward. Shared language helps us communicate more effectively and is critical to collaboration and co-creation, which in turn are critical to science (Thomas & McDonagh, 2013).
I have been teaching knowledge translation (KT) and implementation science for almost 15 years. In that time, I have arrived at a comfortable clarity about the meaning of the term knowledge translation. Here it is.
Knowledge Translation Defined
Simply put, knowledge translation is the practice of communicating research evidence using processes and strategies that ensure the evidence can be accessed and understood in a manner that can benefit a range of knowledge users, both within and beyond academia, as appropriate. Knowledge translation is best conceptualized as an umbrella term that encompasses several subspecialties that are not exclusive to health research, including: dissemination; practice, behaviour, or policy change; knowledge management; and commercialization and technology transfer. The term translation(al) science is more rarely used today but refers to the translation of basic science to clinical application; one part of the translation continuum.
When we seek to change practice, behaviour, or policy, we enter the subspecialty of implementation science, defined as “the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services and care” (Eccles & Mittman, 2006). Note that the emphasis on the purpose or KT goal is “to promote the systematic uptake”. This presumes the research evidence we are sharing has instrumental use and is ethically ready for application and scale up. Implementation science does not capture the entire spectrum of knowledge translation goals and activities, and hence, the terms are related but not synonymous.
Up until very recently, the empirical health literature has used the term “KT strategy” in specific reference to strategies directed at practice change, giving rise to the confounding of the two terms (e.g., Scott et al., 2012). The same is evident in models of practice change (e.g., Graham et al., 2006). The possibility that we might engage in knowledge translation for purposes other that practice change was lost in translation. The more recent upsurge of implementation science literature has created greater clarity, however, with references to implementation strategies (see Powell et al., 2012; Powell et al., 2015) and implementation models and frameworks (see Nilsen, 2015).
Whether you prefer the term knowledge translation or knowledge mobilization does not matter as both terms encompass the processes and strategies involved in achieving KT goals. Using the term knowledge translation synonymously with implementation science implies that practice, behaviour, or policy change is the only goal for sharing research evidence. This is simply not the case, if only for the simple reason that a great deal of KT activity in practice and science is firmly rooted in achieving awareness building and informing, and very little research is ready for instrumental use (Amara, Ouimet, & Landry, 2004). Instrumental use involves applying research results in specific, direct ways. Conceptual use involves using research results for general enlightenment; results influence actions but more indirectly and less specifically than in instrumental use. Symbolic use involves using research results to legitimate and sustain predetermined positions (Beyer, 1997).
Components of an Effective KT Approach
Effective knowledge translation begins with understanding the evidence and the meaning and benefit that others may derive from it (main message; what is being communicated). Effective knowledge translation also requires attention to the language used to communicate the evidence (plain language), knowledge user preferences regarding the format in which it is shared (e.g., oral, written, visual; how the message is communicated), and the channel through which it is delivered (e.g., radio, journal, social media, in person, newsletter; how the message physically gets transferred). Lastly, we must consider the strategy(ies) needed to achieve the KT goal (e.g., webinar, reminder, patent, opinion leader), and evaluate whether the KT goal was achieved (indicator or metric).
Begin with a KT Goal
The strategies we use to convey the ‘main messages’ of research findings are related to the purpose of the communication. Like any communication, knowledge translation always has at least one purpose or knowledge translation goal. Our everyday communications have a purpose; to inform, declare, emote, inspire, instruct, etc. When we share knowledge emerging from research (evidence-informed knowledge), we share it with a purpose that is tied to context.
The context surrounding the knowledge translation communication involves what we reasonably know from the evidence, being mindful of its’ potential use (conceptual, symbolic, instrumental), that it is shared ethically, and with awareness of how the knowledge user may access, understand, and benefit from it.
Knowledge translation goals include: building awareness and interest; informing research to build the scientific knowledge base; informing decision-making; facilitating practice, behaviour or policy change; and/or facilitating commercialization or technology transfer. When we share research evidence, it is with at least one of these goals in mind.
To be successful in achieving practice, behaviour, or policy change first requires engaging in adequate sharing of evidence to inform, build awareness, shift attitudes (create buy in), and inform decision-making. Not all evidence shared for building awareness or informing is ready for application, but this does not make it less beneficial to the knowledge user.
Knowledge translation exists on a continuum; each KT goal within the continuum is tied to the strength and potential use and/or benefit of the evidence to be shared. It is entirely appropriate to share what has been learned from a single study, as we do when we publish in a peer-reviewed journal or present at a conference. Doing so ethically requires us to be mindful of the limits of what we know, how it may be interpreted, and how it may benefit knowledge users. However, when we intend for research evidence to drive practice, behaviour, or policy change, we must hold the evidence to a higher standard for strength, quality and rigour. Engaging with the purpose of changing how someone behaves requires strong evidence that has been replicated in high quality studies; systematic reviews help us to identify this evidence.
As in any scientific field, there is an evolution of understanding and advancement of concepts. The field of knowledge translation has evolved considerably, and continues to do so. Perhaps some clarity on terminology will help us all to move in unison, across the sectors and disciplines that seek to extend the impact of new knowledge.
Note: This understanding of knowledge translation terminology is available in multiple formats, including the Knowledge Translation Planning Template (Barwick, 2008, 2013) and two e-learning modules (see references).
References
Barwick, M. (2008, 2013) Knowledge Translation Planning Template. Toronto ON: The Hospital for Sick Children. Available from: http://www.melaniebarwick.com/training.php
Barwick, M. (2016). Building Scientist Capacity in Knowledge Translation: Development of the Knowledge Translation Planning Template. Technology Innovation Management Review, 6(9): 9-15
Barwick, M., Filipovic, S., McMillen, K., Metler, S., & Warmington, K. (2017) Working with the KT Planning Template. E-learning module. www.melaniebarwick.com/training.php
Barwick, M., Filipovic, S., McMillen, K., Metler, S., & Warmington, K. (2017) Introduction to knowledge translation. E-learning module. www.melaniebarwick.com/training.php
Eccles, M. P., and Mittman, B. S. (2006). Welcome to implementation science. Implementation Science, 1(1), doi: 10.1186/1748-5908-1-1.
Graham I, Logan J, Harrison M, Straus S, Tetroe J, Caswell W, Robinson N. (2006). Lost in knowledge translation: time for a map? Journal of Continuing Education in the Health Professions, 26, 13-24. 10.1002/chp.47.
Nilsen, P. (2015). Making sense of implantation theories, models, and frameworks. Implementation Science, Apr 21;10:53. doi: 10.1186/s13012-015-0242-0.
Powell, B. J., McMillen, J. C., Proctor, E. K., Carpenter, C. R., Griffey, R. T., Bunger, A. C., … York, J. L. (2012). A compilation of strategies for implementing clinical innovations in health and mental health. Medical Care Research and Review, 69(2), 123-157. DOI: 10.1177/1077558711430690
Powell, B. J., Waltz, T. J., Chinman, M.J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., Proctor, E.K., Kirchner, J.E. (2015). A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science,Feb 12;10:21. doi: 10.1186/s13012-015-0209-1.
Scott, S.D., Albrecht, L., O’Leary, K., Ball, G.D., Hartling, L,, Hofmeyer, A., Jones, C.A., Klassen, T.P., Kovacs Burns, K., Newton, A.S., Thompson, D., Dryden, D.M. (2012). Systematic review of knowledge translation strategies in the allied health professions. Implementation Science, Jul 25;7:70. doi: 10.1186/1748-5908-7-70.
Thomas, J., and McDonagh, D. (2013). Shared language: Towards more effective communication. Australasian Medical Journal, 6(1):46–54.
[1] “A rose by any other name would smell as sweet” is a popular reference to William Shakespeare’s play Romeo and Juliet, in which Juliet seems to argue that it does not matter that Romeo is from her family’s rival house of Montague, that is, that he is named “Montague”.
NOTE: This blog post appears on the KNAER Blog as an invited submission.