Nation-wide knowledge translation to promote research on seniors' independence
Carol L. McWilliam, MScN, EdD, University of Western Ontario
Gloria Gutman, PhD, Simon Fraser University
Margaret Penning, PhD, University of Victoria
Rev. Bruce Mutch, Canadian Pensioners Concerned
Louise Plouffe, PhD, Health Canada
Miriam Stewart, PhD, University of Alberta
Robyn Tamblyn, McGill University
The end of multiple Canadian programs of research on seniors' independence sparked a nation-wide knowledge translation (KT) project to engage stakeholders in widespread uptake and application of the research. Bringing policy makers, program planners, service providers, educators, seniors' advocacy groups, and researchers together, the project focused on knowledge spread, exchange, choice, and action. While knowledge spread and exchange activities were highly successful, a focus on consensus-building actually reduced attention to the comprehensive knowledge available for uptake. However, as the exercise progressed, valuable relationships and networks for collective action emerged, achieving a previously unacknowledged goal of building social capital.
In 1998, 14 Canadian programs of research on seniors' independence came to a close. Both the Health Canada funders and the researchers wanted to see the results used to promote the health and independence of aging Canadians. Health Canada funded a three-year KT project to engage numerous stakeholders—policy makers, program planners, service providers, educators, seniors' advocacy groups, and researchers—in activities that fostered widespread experiential learning and application of the research and to evaluate related knowledge spread, exchange, choice and uptake.
The idea was to create a "community of knowing"1 using a social interaction model of KT that exposes researchers and the potential research users to each other's worlds and needs. This model treats the users as active individuals who interpret research evidence in light of what they already know.1,2 Researchers, policy and program planners, health services decision makers and professionals, senior consumers and advocacy groups, educators, and the public would work together, as both the agents and architects of evidence-based change. We wanted to spread knowledge across Canada; get people from all the stakeholder groups to exchange knowledge about the evidence, issues, priorities and potential actions; get them to choose what key evidence they would apply; and get them to act to improve health policy, services, and care. In accordance with other estimates of people's inclination to take up knowledge, we hoped to see 15% more people reporting an awareness of and action on the research evidence, and a 15% increase in their self-reported levels of knowledge and action.3,4
The KT initiative
The Health Canada funders and the researchers first constructed a list of opinion leaders for each of the stakeholder groups, from which they then appointed a National Consensus Committee (NCC) to lead the process. Members included 20 high-profile Canadians representing federal and provincial health, social service, seniors, and economic policy personnel; service planners; health and social service providers and their professional associations; seniors advocacy groups, senior consumers, and public representatives; and academics from centres on aging and the diversity of health and social service fields.
The committee developed a KT plan and involved other opinion leaders and their constituencies. The Canadian Association on Gerontology (CAG), comprising 800 members representing all stakeholder groups, facilitated connections and activities. The NCC then identified knowledge experts in four key research areas and contracted teams of researchers to review the relevant research evidence.5 From these academic research syntheses, sub-committees identified key, actionable messages for each theme. These messages were posted on an interactive website, shared at symposia at three annual scientific and educational meetings of the CAG, and highlighted in lay print materials and theme-based policy fact sheets. The network of opinion leaders used their connections and influence to disseminate these materials and to engage others in knowledge spread.
Knowledge exchange and choice were facilitated through the interactive website, symposia at annual CAG meetings, and numerous discussions staged by participating organizations. Participants in both face-to-face meetings and users of the website were asked to rate given priorities for policy developments and service and practice refinements in each theme area, and the questionnaires were constantly reviewed and updated to reflect their feedback.
These activities enabled participants to integrate their knowledge, values, and priorities with the research evidence, and to work towards consensus on priorities and potential action. Four theme-related consensus panels comprised of policy, programming, provider, academic, and senior consumer experts then synthesized the selected messages and priorities, prepared recommendations for action, shared their reports and served, along with the lead committee, as moderators, discussants and champions of change at theme-related symposia. Subsequently, a single large consensus-building symposium brought the four thematic panels and a broader audience together with the intent of optimizing social interaction and support for knowledge choice and uptake.
Results of the KT experience
To measure knowledge spread, exchange, choice, and uptake, participants at both the CAG symposia and users of the interactive website were surveyed as they joined the exercise, immediately after activities ended, and one year later. Qualitative analysis of minutes and field notes of meetings and symposia and open-ended survey answers also added insights.
We determined that research evidence was spread through 86 activities to 2,946 initial contacts who attended the symposia or accessed the website, including 186 organizations, and through them, as reported in follow-up questionnaires, to 63,387 people, an unaccountable percentage of whom represented additional organizations. The website questionnaire series engaged 608 organizations and individuals. Several organizations and policy and planning personnel used the fact sheets and sought out the experts identified therein as resources for knowledge exchange activities. Academics and professionals used the print materials for foundational and continuing professional education.
However, the target increases in the numbers of people reporting awareness and action, and their reported levels of awareness of and action on the evidence were not met, perhaps because a high percentage of participants was aware of the research evidence at the outset of the exercise. While there was positive change, gains were small, and self-reported levels of awareness increased significantly in only one theme area. At the outset, over half of those participating in each of the four theme areas indicated that they had already chosen to use the research evidence for acting on issues or for informing previously-decided directions. Nevertheless, requests for materials and expert resources for two years after the exercise ended suggested that knowledge uptake continued. Qualitative findings revealed that the further goal of these knowledge spread activities, the consensus-building strategy, elicited frustration because of the repetitiveness of the knowledge choice activities and concern about the priorities that emerged.
Our knowledge spread and exchange activities were judged to be extremely successful and are still referenced by Health Canada policy personnel. The consensus-building process, on the other hand, actually reduced attention to the comprehensive knowledge available for uptake. In addition, participants sometimes replaced issues and priorities premised on the research evidence with unrelated concerns, taking the discussions in unanticipated and often contested directions.
As the exercise progressed, participants became less focused on knowledge uptake per se and more focused on building relationships and networks for collective action.6 Accordingly, the ultimate goal of fostering seniors' independence was achieved as a process output rather than as concrete outcomes in the form of evidence-based policies, programs, and practice change. Seniors, their advocates, and public opinion leaders ranked the opportunity to be involved and to be heard as the most valuable aspect of the exercise. Receiving information for making change and enhancing their own knowledge was less important to them.
If the goal of building social capital had been more widely acknowledged and accepted at the time, the value of this KT exercise may have been more widely appreciated. While individual participation in such activities normally declines over time, in this exercise, organizational participation was sustained, increased, and created new activity.
Conclusions and implications
There is no easy way to ascertain how knowledge is spread through outreach strategies or whether people who receive the information actually attend to it.
There is no easy way to ascertain how knowledge is spread through outreach strategies or whether people who receive the information actually attend to it. In fact, the assessment of knowledge choice and uptake in specific topic areas is somewhat artificial, as each stakeholder group can do little or nothing about issues beyond their mandate. Participants move in and out of knowledge exchange and choice activities over time, making tracking of outcomes difficult. Furthermore, the complexity and political nature of the policy process precludes confident conclusions about outcomes. New approaches for evaluating the process of KT are needed, with greater reliance on qualitative evaluation of the processes, quantitative measurement of process outputs and more longitudinal follow-up of outcomes.
Increasing action through building consensus across diverse stakeholder groups is an elusive ideal demanding close attention to what values, and whose, come into play.7 The political nature of consensus-building was a huge challenge. But political processes are an inevitable part of life and if we are committed to participatory democracy, we need to build in enough time to allow it to transpire. Sequenced activities and longer timeframes to allow stakeholder groups to build consensus between and among their respective constituencies might help.
For anyone committed to KT that fosters enlightened, empowered, and socially just effort on behalf of vulnerable groups, this KT process is worthwhile. Rather than being a top-down, authoritative model, our activities appealed to people at the grassroots of public policy and service delivery. And, who knows better than those at the front lines experiencing and enacting public policy and delivering services what is most important, how the research evidence fits with what will work and how the evidence can be used to make effective refinements. On the other hand, the approach is process-focused; all participants share responsibility and accountability for it, and its outcomes cannot be controlled. In a world where performance appraisal is premised on measurable outcomes, this approach is not likely to advance the professional careers of academics, or those of senior policy personnel, planners, and decision makers.
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