CIHR Institute of Population and Public Health Canadian Population Health Initiative

A casebook of knowledge translation stories

Canadian Institutes of Health Research
160 Elgin Street, 9th Floor
Address Locator 4809A
Ottawa, ON K1A 0W9 Canada

© Her Majesty the Queen in Right of Canada (2006)
Cat. No.: Mr21-70/2006
ISBN: 0-662-69590-9

Table of contents

• Acknowledgements
• Foreword
• Aboriginal health
  • Developing a community health tool kit with Indigenous health organizations
  • The Manitoba First Nations Centre for Aboriginal Health Research: Knowledge translation with Indigenous communities
  • Understanding knowledge translation in an urban Inuit community
• Child and youth health
  • Knowledge translation in the community: The Early Child Development Mapping Project
  • Joint policy making in early childhood development
  • The Canadian Adolescents at Risk Research Network: Research for and with youth
  • Should we teach harm minimization to teenagers in school? The production and translation of controversial new knowledge in addictions
• Women's health
  • The Healthy Balance Research Program: Knowledge translation for women's unpaid caregiving
  • The Women's Health Surveillance Report: Translating research to policy
  • The Globalization, Gender and Health Project
• Occupational and workplace health
  • Knowledge translation through research-based theatre
  • The Agricultural Health and Safety Network
  • The Quebec Network for Work Rehabilitation: The challenge of knowledge translation and implementing a program in clinical practice
  • Interprovincial knowledge translation in occupational health and safety
  • Translating research knowledge to stakeholders: The case of forklift safety
• Infectious and chronic diseases
  • Ontario's Asthma Plan of Action: Bridging the gap between knowledge and practice
  • Lessons from dissemination and capacity building in the Canadian Heart Health Initiative
  • The Canadian AIDS Treatment Information Exchange

Acknowledgements

CIHR Institute of Population and Public Health (IPPH) and the Canadian Population Health Initiative (CPHI) of the Canadian Institute for Health Information would like to acknowledge the following individuals for their generous contributions of time and expertise to the inaugural IPPH/CPHI Knowledge Translation Casebook:

• The core project implementation team, including Michelle Gagnon, for overseeing and leading the project; Heidi Matkovich, for working closely with the case authors and staff to edit the Casebook; Leanne Moussa, for strategic communications advice; Lori Greco and Liz Stirling, for knowledge translation expertise and support; and Kim Gaudreau, for assisting with the case abstract review process.
   
• The Casebook review committee, including Patricia Martens, Gilles Paradis, and Jean-Yves Savoie (committee chair) from IPPH's Institute Advisory Board; Teresa Hennebery, past member of CPHI's Board; and Nadine Valk, CPHI staff member, for reviewing the case abstracts.
   
• John Frank, Scientific Director, IPPH, Erica Di Ruggiero, Associate Director, IPPH, and Elizabeth Gyorfi-Dyke, Director, CPHI, for their advice and support.

The views expressed in this report do not necessarily represent the views of the Canadian Institutes of Health Research or the Canadian Institute for Health Information.

CIHR Mandate

The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to catalyze its translation into improved health, more effective health services and products, and a strengthened Canadian health care system. Composed of 13 Institutes, CIHR provides leadership and support to close to 10,000 health researchers and trainees across Canada.

IPPH Mandate

The CIHR Institute of Population and Public Health (IPPH) will support research into the complex interactions (biological, social, cultural, environmental), which determine the health of individuals, communities, and global populations; and the application of that knowledge to improve the health of both populations and individuals, through strategic partnerships with population and public health stakeholders, and innovative research funding programs.

CPHI mandate

The Canadian Population Health Initiative (CPHI), a part of the Canadian Institute for Health Information (CIHI), was created in 1999. The mission of CPHI is twofold: to foster a better understanding of factors that affect the health of individuals and communities, and to contribute to the development of policies that reduce inequities and improve the health and well-being of Canadians.

CIHI is an independent, pan-Canadian, not-for-profit organization working to improve the health of Canadians and the health care system by providing quality health information. CIHI's mandate, as established by Canada's health ministers, is to coordinate the development and maintenance of a common approach to health information for Canada. To this end, CIHI is responsible for providing accurate and timely information that is needed to establish sound health policies, manage the Canadian health system effectively and create public awareness of factors affecting good health.

Foreword

Knowledge translation (KT) is a broad concept, encompassing all steps between the creation of new knowledge and its application to yield beneficial outcomes for society. Successful KT strategies can include linkage and exchange, communication and education, policy change and program and practice improvement initiatives.

CIHR's vision of successful KT is the exchange, synthesis, and ethically sound application of knowledge within a complex set of interactions among researchers and users-to accelerate the capture of the benefits of research for Canadians through improved health, more effective services and products and a strengthened health care system. A core element of CIHR's KT strategy is to support and recognize KT excellence; another is to act as a KT resource for Canada.

KT is also integral to the work of the Canadian Institute for Health Information (CIHI). CIHI's vision is to improve the health of Canadians and strengthen their health system by developing, integrating and disseminating timely and relevant health and health services information and by facilitating informed discussion and evidence-based decision-making.

In early 2005, the CIHR Institute of Population and Public Health (IPPH) and the Canadian Population Health Initiative, a part of CIHI, issued a joint call for KT "stories" that illustrated both successful and less-than-successful examples of the collaborative development and practical use of population and public health research evidence. We wanted to encourage and recognize KT activity and provide a vehicle for publishing and sharing lessons from KT experiences.

We also wanted to highlight the potential impact of population and public health research evidence in shaping changes in policy and practice. There is growing interest among health and other organizations, community groups, individual researchers and decision makers in sharing experiences that lead to a greater understanding of KT in action and its better practices, including, but not limited to, improved programs and policies.

We invited individuals, teams and organizations working in health and other sectors related to the advancement of population and public health to contribute to this Knowledge Translation Casebook.^* Cases were selected based on review of the abstracts submitted. The collection represents a naturally broad cross-section of experiences-ranging from the use of research-based theatre in a knowledge translation initiative with injured workers, to developing a community health tool kit in partnership with Indigenous health organizations, to a large-scale international collaboration to identify issues in globalization, gender, and health.

The cases in this Casebook are first-hand, personal stories. We asked contributors to be frank about their successes and failures and to report, from their own experiences, what worked, what didn't and the lessons they learned. This Casebook is not intended to be a replacement for insights gained from systematic reviews of the growing KT literature. But many of these stories echo common themes about conducting KT in the Canadian context.

Lessons learned

• Many cases in this Casebook tell the stories of KT with communities that have not traditionally been involved in research or decision making. These partnerships can provide new perspectives on research challenges, result in better-informed research and create interest in, and improved uptake of, research findings. However, partner roles need to be carefully defined. Formal agreements, which detail expectations and resources to be provided, can be useful, but must be supported by trusting and open relationships. Building this trust can be the biggest challenge in partnerships involving non-traditional or historically wary collaborators. Significant work is often required to establish the requisite understanding of each other's contexts, needs and expectations.
   
• Importantly, such partnerships can result in a shift to community-based leadership of initiatives to improve programs and practices. But for this to happen and, more broadly, for any KT activity to be optimally successful, there must be capacity in the community to adopt new knowledge and adapt to the changes it requires. Capacity building-to enhance efforts to uptake and use research and practice innovations-can make the difference between the success or failure of a KT initiative, and is most effective when supported at an organizational level.
   
• While the organizational climate is crucial, individuals can make a huge difference. A researcher's genuine passion for practice change can play an unquantifiable, yet vital, role in KT, particularly in communities where a demonstrable commitment is a key part of building trust. Such human factors can't always be replicated but it is important to acknowledge their contribution and to capitalize on individual strengths when creating broader KT strategies. It is also worth recognizing that participants in discussion and consensus-building groups need to be chosen with care, as they can be a key determinant of an initiative's success.
   
• KT must be tailored to the community. There are no good KT practices that can be simply and reliably applied to any situation. Good KT is appropriate to its context, and local processes of knowledge uptake and utilization must be understood to create effective KT strategies. Research knowledge risks remaining unused unless it is presented in a way that speaks to its audience, whether through neighbourhood-based maps, youth-oriented websites, or a professional theatre production. However, the old truths about KT-research results need to be timely, clearly presented and contextual-should not be forgotten either. A number of cases here serve as timely reminders.
   
• KT is most successful when there are tangible benefits for all partners. KT is rarely induced by the mere notion that research should be practically applied, and is often ineffective when change is simply mandated without accompanying incentives. KT works best when all partners in the initiative have the possibility of making concrete gains towards their own priorities, shared or otherwise.
   
• Finally, KT requires constant effort. Relationships, particularly with community partners, need to be carefully maintained. This can be a difficult task within the constraints of research funding cycles, particularly in the early stages, when existing funding models and mechanisms rarely support the constant tending that new relationships need. Without such vigilance, however, misunderstandings can arise, commitment can be doubted and research and KT activities can be seriously undermined. The most successful KT initiatives actively evolve in parallel with the needs of their user communities. Success, however, can pose its own problems, when small community-based initiatives are pressed to expand, or when the demand for KT outstrips the capacity of researchers to respond.

We hope that this Casebook becomes a valuable resource for the diversity of population and public health communities in Canada. While we intend that this will be the first of many such efforts to illustrate population and public health research-related KT in Canada, it is a pilot project, and will be evaluated for its usefulness as a source of information about KT in action. We therefore welcome your comments on content, presentation, distribution or any other aspects of this project.

John Frank
Scientific Director
Institute of Population and Public Health
Canadian Institutes of Health Research

Jennifer Zelmer
Vice-President, Research and Analysis
Canadian Institute for Health Information

^* CIHR's Institute of Health Services and Policy Research has concurrently produced a Knowledge Translation Casebook.