Today I’m presenting a brief description and evaluation of the Knowledge Translation literature. My presentation will encompass not only Knowledge Translation literature but also my specific employment role in the process of collecting, organizing and synthesizing the literature. I use the term “Mental Muddle” in the title of my presentation to describe my own confusion at times with the array of different terminology, ideas, research studies and almost everything else in the Universe of knowledge studies that falls into the category of Knowledge Translation, Utilization, Transfer, or Diffusion. Although I will be unable to clarify completely the fuzziness of Knowledge Translation, by the end of this presentation you will understand just how clearly-fuzzy it all is.
My Presentation is divided into two major sections. 1) a simple, and instructive description of my everyday Praxis, that is, the continual process of work and learning….and my work affecting my learning, and thus leading to different understandings of different knowledge based resources. 2) I will later discuss a way in which to organize understand the different knowledge resources using the Knowledge System concept, as introduced to me in 2003 by Dr. Harley Dickinson. This will involve a brief assessment of knowledge resources using both Wittgenstein’s concept of Family Resemblances and Holzner and Marx’s 1979 publication on the knowledge System.
In the spring of 2003, I worked…patiently and diligently….. in my role as a Faculty Librarian at Brandon University’s Technical Division, in Brandon Manitoba. However, an interesting opportunity came in the summer of 2003 to be engaged in research work at the University of Saskatchewan in the Sociology Department. I joined Dr. Dickinson’s KUPI research team (Knowledge Utilization and Policy Implementation whose Principle investigator was Carole Estabrooks): I was to fulfill the role of a Research Librarian and Associate, to not only retrieve and organize resources, but to contribute to the research process as a collaborator. This is no isolated employment role. What the new emphasis on knowledge has brought ( in the Knowledge Society) is not only a new emphasis on the quality, quantity and use of knowledge, but in new work roles, in other words, the rise of the “Knowledge Worker” who holds the key to production within their minds and in their practices with other professionals.
Just to name a few “Knowledge Worker” roles: Knowledge Brokers help foster not only document-to-document services, networking and communicating innovation, but connecting people-to-people. The term “Linking Agent” is one I’ve seen often in regards to Innovation, related to Technology Transfer agents in Universities or Organizations. The informationist is an odd term but it is one found in the literature referring to a movement for Librarians and Information Professionals whose function it is to ensure evidence-based health practice. It is being the specific liaison for Health Knowledge and Health Practice. The implication is that “Health care providers don’t or can’t take time to review evidence” so a reshaping of knowledge roles is necessary with librarians coming Clinically driven, not library driven, with required medical standards. The Medical Library Association has been holding conferences to develop this idea further. Librarians are being hired to be engaged in very specific job roles as Funding Linkers: either to be the head of funding strategies or as linkers to researchers in health organizations. So, job roles have changed, as well, skills training has also changed…especially in Library and information Science. This is the reality of the evolution of society.
With every change in Knowledge, there is a change in Knowledge Work, from the Scriptorium of Monks, to the printing press used by Martin Luther’s followers, to the changes leading to modern knowledge connectivity and convergence of technology.
So, unlike the stereotypes of the last few decades where the librarian’s work is considered quite bookish and static, I take my role from the original librarians: the scholarly engagement in Knowledge work but applied in a modern and untraditional role. Information Retrieval in the vast sea of information. Organization of Information using Bibliographic software such as Endnote. Records Management Web and Database: understanding how to construct databases, websites, what makes a good digital library, database or web resource, systems analysis to be a liaison between managers and computer technology experts. Project consultation and Research Collaboration in co-author reports and papers. So, it is in this light all these changes that I’m going to talk to you about Knowledge Translation, as a knowledge worker, and as someone engulfed in this type of literature for the last 3 years.
This is a basic search for the exact phrase “knowledge Translation”. [Read from Slide]
From my experiences over the last 3 years, I can tell you that the literature of Knowledge Utilization, Transfer, Dissemination, Diffusion of Innovation, of which Knowledge Translations is conjoined, is a dispersed literature, spanning all different kinds of subject areas. As my slide indicates, there are resources located in many different databases and library types. I’ve found valuable sociological knowledge theory in computer science and engineering journals. For example, try searching for knowledge based topics in the IEEE databases here at the UofS. As proposed by JK Larsen, there is also problem with terminology, what she called a “Terminological Tangle”. Research Utilization, Implementation, Policy Researcher Gap, Knowledge Transfer and Utilization overlaps with the concepts of Evidence Based Decision and Policy Making….its a super cluster of terminology…to use a different context, its like being at a party of people you know very well, but each person is speaking a different language, or if you do understand them, they may be speaking a different dialect, applied in a different culture. In other words, a mental muddle.
Also, from my experience reviewing different resources, I’ve notice a variety of perspectives. Now, lets focus in on just “Knowledge Translation” itself.
I’ve found references to Knowledge Translation that date back to 1978. There are references to policy knowledge Translation, especially in education. Here we see an early use of KT involves new knowledge roles, “Linkers” as Beal calls them, who would help shape a research project to communicate results to different stakeholders.
Notice here, the application of “Knowledge Translation” in this early context is clearly separated from the Utilization function. There is an attempt to define discrete areas of activity and knowledge work, even if just tacitly.
Another example in 1985: Knowledge translation is defined through a technology transfer process: “Technology transfer is the process of taking knowledge generated in a context outside commercial product development activities and bringing that knowledge to bear on development activities.” The focus is the transferring of knowledge across organizational boundaries. Although I use the term “Technological” at the top of the slide to provide a context, the application of the translation of knowledge seems to be in tune with communications flows and organizational structure…does one department know what the other is doing. Now lets turn to modern definitions of KT
This one is provided by the CIHR. The next couple of slides involve definitions of KT or related KT themes from a recent 2006 study by Dr. Carole Estrooks et al. [Read from Slide]
[ Read from Slide ]
It is important at the moment to know that there can be many definitions of KT depending on what you believe KT is. In the same way that it is difficult to define Knowledge, it is equally difficult to define the nature of Knowledge Translation (especially in light of an overwhelming terminology glut: transfer, utilization, diffusion and what have you.) I’m not going to try to account for all of the definitions of knowledge Translation (we could go on and one). For this brief presentation, I’m going to try to account for the different types of articles that utilize the phrase “Knowledge Translation” to describe what they are doing.
This particular article might be considered an example of “bottom up” KT. Instead of going to the theory and then applying it after the research is completed, you go to the community of users and develop your KT strategy from there. In the formation of a CIHR grant, there are components that involve KT…it might be a good strategy to inform them that your KT strategy will require transformation as you work with your participants. Reality can shape your thinking…your everyday Praxis. “The project evaluation confirmed many of the elements of effective knowledge Translation identified in the general literature: the importance of trusting relationships; the need for multidirectional information exchange and an ongoing forum for sharing; and the creation of research relevant to users. It also identified several limitations to how these principles are commonly interpreted and which aspects were most important from the perspective of community partners. The results suggest that much of what is being discovered by researchers about KT is not new, but once stripped of mystifying terminology is equally well understood by researchers and community partners through their other life experiences.” In this case, the study also attempts to answer questions: What are the characteristics of KT? In what contexts is KT successful?
This is taken from a provisional PDF, a progress report, so to speak. “The current use of patient-oriented outcome measures in research and practice is deficient, despite the fact that health care professionals recognize the importance of measuring health outcomes and efforts have been made to transfer available knowledge into practice.” They include in their kt evaluation: traditional workshops, published editorials, scientific articles, textbooks, professional association endorsements, promotion of outcomes databases. As opposed to addressing organizational structure, we see here a focus on the codified components of KT.
There is a distinction made between research findings and tools. Research findings refer to new understandings about the effectiveness or risks of a specific drug such as Does a drug increase the risk of a specific adverse event? Research tools refer to approaches or methods for improving drug use, typically, involving specific protocols, methodologies, technologies or software…in essence, knowledge management…another huge area of knowledge and health. This approach is highly Clinical, focusing on the point of treatment.
In this article, the authors discuss the employment of technology for neonatal care….sustaining life for infants as small as 500grams and as premature as 26 weeks old. The kind of Knowledge Translation and Transfer here is more akin to Systems Analysis. In Systems Analysis job roles and the associated activities are mapped and translated into computer-speak. Example: Parent reads form, makes decision, decision in input to computer for clinical review. Physician A will have to review with Nurse C, etc. etc.
Indigenous Knowledge Translation is a new field with various cultural nuances. There is a whole process of constructing, understanding, and applying knowledge would have to be based on cultural notions of Self-determination lying within Indigenous perspectives, and socio-cultural realities. Here is there a codified KT analysis of the literature, but an application that goes beyond it to the tacit knowledge within people and in this case, a culture. A close, and somewhat commensurable idea, would be “Corporate Memory” in Knowledge Management. Now, I’m going to turn towards the specific areas of Quality End of Life issues and examples.
Part of the Knowledge Translation process may involve institutional mandating. It is not always the case that you can have a government or government agencies on your side, but in this case, there is some support. This is simply meant to reflect that there are systematizing forces at work attempting to foster translation activity.
In this case, we can notice an identified need for Knowledge Translation and Utilization strategies, even if not explicitly defined. Here, it is good to note that KT (and similar vocabulary) is an incredibly valuable phrase simply because it puts such issues on our radar, it focuses our labour and our thought, our praxis if you like…our choice of terminology and our focused labour.
Here is another implicit example: The focus is not knowledge translation, but such processes are embedded in the process of capturing knowledge for a codified guideline.
Now we turn to a more explicit example: Discusses the diffusion of the Hospice concept. They champion a continual evaluation process along with a process of diffusion of innovation: “As Hospice programs are implemented, there should be a communications infrastructure that allows for continuing appraisal of the success for failure of the program..”
Although there are articles like this one which do not apply knowledge in the context of the setting, it is an important article nonetheless for it provides ensures that your colleagues are aware of these initiatives. To simply say, we have a new role, a new task…….things are changing.
In this case, the terminology is widened to take in “Dissemination, Utilization” as well as Translation. They focus on the “Reader Friendly Fact Sheet” which emerged from staff nurses reports of topics that are important to practice. They give novice nurse researchers, students, and staff the knowledge required to apply evidence and they also increase staff nurse use of research as basis for practice (by doing so they increase involvement with research). This publication also raises the issue of unpublished studies, and practices that are not disseminated. Are your practices codified?
Notice here in this example of a fact sheet how their language has changed, Its not “References” or “Bibliography” but “Says Who”.
This is example of the overlapping issues of KT within QEOL issues… Pain management is an important part of end of life issues. Here we see a move away from Knowledge based terminology, looking to other grounded theory for application. In this case, using the famous book by Rogers on Innovation diffusion.
[Read from Slide]
[Read from Slide] End here if not enough time
Ask you to join me for a brief sojourn into the philosophical world.
Wittgenstein is a favourite of mine. Inherited millions of dollars and gave it all away to his sisters saying that since they were already corrupted with wealth they really couldn’t become anymore corrupted with a few extra million…some credit him with the first plans of a jet engine…and in World War I, fighting for the Germans, he refused to leave the prisoner of war camp until all the soliders under his command were first treated and released. How does Wittgenstein apply to Knowledge Translation?
There is conceptual clarity that is needed. [Read from Slide]
[Read from Slide]
The knowledge system represents all the different facets of knowledge production and use, a knowledge cycle.
Estabrooks et al. (2006) reported that the most comparable relation to Knowledge Translation was Diffusion of Innovations, sharing many of its characteristics. Here, what she is doing is implicitly applying a type of Family Resemblances technique for which we might group as shown in the areas shown above in the slide.
Furthermore we could group similar activities together using a faceted analysis so that we could come to some conceptual clarity on the issue. This is meant not only as an organizational tool, but a tool for designing a research project in the KT areas.
Knowledge Translation: A Paradox Wrapped in a Mental Muddle
A Paradox Wrapped in a Mental Muddle
By Paul J Graham, MLIS
Agenda for Presentation
Presentation in two major sections:
1. Everyday Praxis:
An evaluation of the Knowledge Translation
literature based on everyday thinking and
acting within the Knowledge Utilization
Project over 3 years.
2. Knowledge System Strategy
A resolution of the conceptual difficulties
using Wittgenstein’s Family Resemblance
theory and Holzner & Marx’s (1979)
Knowledge System concept.
Employed by Dr. Harley Dickinson for
Knowledge Utilization and Policy Implementation
(KUPI) group, Summer 2003
Engaged in retrieving and organizing the various
literature on Knowledge Utilization
Investigated many Knowledge resources and
finding a way to classify resources through a
Collaborating in Research Projects and Paper
Praxis & Knowledge Society
A new way of thinking // working with
different types of processes that don’t
quite fit traditional professional roles:
Researcher (but in different areas)
The Librarian’s Work
Web and Databases
Project & Information
Overview: Bibliometric Data
Web of Science
Academic Search Premier
Mix of Health and Knowledge Management
1, 580 Results
Plus “Health” search term equals 1300 Results
Resources (articles, conference reports, etc.) are scattered
among various databases.
Although my main focus has been social sciences, you
cannot take anything for granted. I’ve found valuable
social science resources in both Engineering and
Computer Science Journals.
Terminological Tangled Vocabulary
There is a diverse terminology
Transfer, Diffusion, Translation, Exchange, Utilization,
Computer Systems and Data
Diffusion of innovation for industrial innovation (e.g.,
Utilizing the Triple Helix Model of innovation.)
Knowledge Management/Transfer for human resource
knowledge sharing (ie., Communities of Practice)
Titanic efforts to apply research based knowledge by
policy makers in Health, Science, and Social Science.
Early References to KT
Education Based Application
Beal (1978) “Knowledge Translation and Education Policy”
Focuses on the Study of Production and Utilization of
Responds to critics of Knowledge Systems thinking by
presenting various non-linear stages
In Knowledge Translation, “Linkers” translate the
available knowledge into terms applicable to the
clients’ formulation of their problems.
Exchange of knowledge between users and
producers of knowledge is stressed.
Early References to KT
Agriculture / Rural Development
Beal (1980) “Knowledge Generation, Organization Dissemination and
Utilization for Rural Development”
A “Communication Systems” paradigm is
championed, a system with interrelated functions.
Production, Management, Translation, Development, Dissemination,
Translation synthesizes and converts scientific
research into information useful to product-developers
attempting to formulate solutions to practical
Early References to KT
Grantham (1985) “Technology Transfer: The Organizational Role”
Addresses organizational components of
Knowledge adoption and diffusion
Critical to the discussion is the reframing of
knowledge from the “knowledge translation” stage
to product development stage
Discusses this in light of organizational
communication (e.g., Weber)
Definitions of KT
Knowledge Translation as the exchange,
synthesis and ethically sound application
of knowledge—within a complex system of
interaction among researchers and users.
Definition of KT
Implementation Research Definition
Aims to uncover the influences on health
care practitioner’s beliefs, choices and
decision making in order to identify what
combination of methods would achieve the
behavioral shifts required to improve
Definition of KT
Knowledge Utilization Definition
A common term than either research
implementation or translation and of the
many terms available, closely related to
Includes research, scholarly and programmatic
intervention activities aimed at increasing the use
of knowledge to solve human problems.
Examples of KT: Health
Bowen & Martens (2005) Demystifying Knowledge Translation
To understand KT from the perspective of
Over 100 Semi-structured interviews with project
stakeholders over first 3 years of project
Identified many facets from the theory: trust,
relationships, multidirectional info exchange, relevant
Community has a different idea about what is
important in KT than researchers
Examples of KT: Health
Clinical and Policy Implementation
MacDermid et al (2006) Defining the effect and mediators of two Knowledge
Translation strategies designed to alter knowledge, intent and clinical
utilization of rehabilitation outcome measures
Criticism of national initiatives for KT
Physical / Occupational Therapists (n=144) recruited
to test two KT strategies at 3 sites in Canada
Stakeholder Hosted Interactive Problem Based Seminar
Online Problem-Based Tutorials
Includes a KT impact assessment
Examples of KT: Health
Col, N.F. (2005), "Challenges in Translating Research into Practice",
Journal of Women's Health,14(1): 87-95.
Dissemination of evidence into clinical
Distinguishes between research findings and
Suggests that KT has focused either on
patients or providers but not their interaction
or other parties.
Ultimate goal is patient-centred medicine
Examples of KT: Health
Yang et al. (2005) “Conceptual Framework of Knowledge
Management for Ethical Decision-Making Support in
Neonatal Intensive Care”
Associated with Decision-support systems
Transfer/translation of knowledge means a system
which improves clinical decision making.
Translation of ideas is needed between all people and
Communication between clinicians and parents is of
Examples of KT
Smylie et al. (2006) “Culture-Based Literacy and Aboriginal Health”
Indigenous conceptualizations of literacy must build
on Indigenous perspectives/understandings
Supported through review of relevant literature
including Knowledge Translation strategies
Researchers are working in with Indigenous
communities, as partners, to pilot models of
Linkage between Literacy and KT is identified
QEOL Examples: Mandating
CIHR funded Projects
QEOL Care Coalition of Canada (2005) “Framework for
a National Strategy on Palliative and End of Life Care”
Sustainable, Well Funded National Strategy
Utilizing the knowledge already in place
“Of Life and Death” Senate report 1995
“Still not there” Senator’s Report 2005
QEOL Examples: Implicit
Implying a Need for KT
Ross et al (2000) “End-of-Life Care for Seniors: The Development of a
“Although the care of individuals who are dying and of
their families has greatly expanded during the past
decade, issues related to the needs of seniors who are
dying have not been systematically addressed”
A need for dissemination of Best Practices
Identifying Models of service
Ensure autonomy and independence
Facilitate emergence of national network
Ensure wide access to guide
QEOL Examples: Implicit
Implying a Need for KT
Hinds et al (2001) “End of Life Decision Making by Adolescents, Parents,
and Healthcare Providers in Pediatric Oncology: Research to Evidence
Based Practice Guidelines”
Recognized need for a type of translation of
knowledge into codified, acceptable guidelines
Study samples guardians and/or parents, healthcare
providers, adolescents using open-ended questions
For pediatric oncology, guidelines offer assistance
with end-of-life decision making in a structured
manner that can be formally evaluated and
individualized to meet patient / family needs
QEOL Examples: Explicit
Sloan (1992) “the Hospice Movement: A Study in the Diffusion of Innovative
Discusses beginning of Hospice movement with roots
Conceptual framework is using Roger’s “Diffusion of
Breaks down innovation adoption into two
Family-centered adoption at the Individual level
QEOL Examples: Explicit
Degner (2005) “Knowledge Translation in Palliative Care: Can Theory
Provides examples of KT strategies
Represents an attempt at “Enlightenment” or
“Conceptual” Knowledge Utilization
Little to say about actual application of KT within an
End of Life care context.
QEOL Examples: Explicit
Valente (2006) “Research Dissemination and Utilization: Improving Care at
Starts with the proposition: Research improves
nursing and patient care outcomes
Barriers to Evidence Based Practice include
difficulties with analysis, attitude, poor translation of
Do clinicians actually have the skills necessary for
Evidence Based Practice?
Evaluate fact sheets on End of Life issues
QEOL Examples: Explicit
Dooks (2001) “Diffusion of Pain Management Research into Nursing
Pain management is an example of an evidence
based challenge for Nursing
Roger’s “Diffusion of Innovation” theory utilized in a
Case Study application
Applies theory in Nursing context using diffusion
components: early adopters, nature of innovation,
social system, and communication patterns
Summary of Examples
All of the examples I provided used
different knowledge terminology when
referencing their objectives
Different objects to each study
Different overlapping concerns
Implicit vs. Explicit
Empirical vs. Conceptual
Tacit vs. Codified
Section 2: Knowledge System
The philosophy of Ludwig Wittgenstein
The utilization of Wittgenstein’s language
The utilization of the social knowledge system
for conceptual clarity
Definition: Mental Muddle
Definitional Dregs and the Mental Muddle
(From Estabrooks et al, 2006)
Includes many concepts
Knowledge & research Utilization, Diffusion of
Innovation, Nursing Knowledge Models, etc.
Also may includes types of studies:
Barriers to innovation
Differences between Male and Female knowledge use
Mental Muddles of Language
Use and Meaning
Apply Wittgenstein’s sensitivity with language
within the area of Knowledge Translation and
The many meanings
of KT causes a
Family Resemblances Theory – Defining a Game
How do we recognize that two people we know are related to
one another? We may see similar height, weight, eye color,
hair, nose, mouth, patterns of speech, social or political
views, mannerisms, body structure, last names, etc. If we
see enough matches we say we've noticed a family
resemblance. We are all familiar (i.e. socially) with enough
things which are games, and enough things which are not
games so that we can categorize new activities intuitively
according to resemblances
Knowledge System Concept
Knowledge System as Organizing Concept
A theory of organizing the Knowledge
Utilization concept championed by Holzner
and Marx, 1979.
Organization (Storage and Retrieval)
Holzner & Marx, 1979
Organization of Information
Utilization Gender analysis Epistemic
Individual Implementation Bibliometric LifeWorld
State of the Literature
Disperse, but KT is a relatively new term in
Little consensus on terminology
Wide use of similar theories
A need for precision and definitional clarity