Knowledge Translation: A Paradox Wrapped in a Mental Muddle

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  • 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

    1. 1. Company LOGO Knowledge Translation A Paradox Wrapped in a Mental Muddle By Paul J Graham, MLIS Research Librarian
    2. 2. 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.
    3. 3. Brief History  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 Faceted Analysis  Collaborating in Research Projects and Paper submissions
    4. 4. Praxis & Knowledge Society  A new way of thinking // working with different types of processes that don’t quite fit traditional professional roles:  Knowledge/Information Broker  Linking Agent  Informationist  Researcher (but in different areas)  Fundraising  Funding Research
    5. 5. Knowledge Work Changes
    6. 6. The Librarian’s Work  Information Retrieval  Organization of Information  Records Management  Web and Databases  Project & Information Consultation  Research Collaboration
    7. 7. Overview: Bibliometric Data  Web of Science  52 Results  Health  Academic Search Premier  72 Results  Mix of Health and Knowledge Management  Google Scholar  1, 580 Results  Plus “Health” search term equals 1300 Results
    8. 8. Information Retrieval  Dispersed Literature  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, etc.
    9. 9. Information Retrieval  Knowledge Paradigms  Technology Paradigm  Computer Systems and Data  Innovation Paradigm  Diffusion of innovation for industrial innovation (e.g., Utilizing the Triple Helix Model of innovation.)  Organizational/Business Paradigm  Knowledge Management/Transfer for human resource knowledge sharing (ie., Communities of Practice)  Policy Paradigm  Titanic efforts to apply research based knowledge by policy makers in Health, Science, and Social Science.
    10. 10. Early References to KT Education Based Application  Beal (1978) “Knowledge Translation and Education Policy”  Focuses on the Study of Production and Utilization of Knowledge  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.
    11. 11. 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, Adoption/Utilization  Translation synthesizes and converts scientific research into information useful to product-developers attempting to formulate solutions to practical problems
    12. 12. Early References to KT Technological  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)
    13. 13. Definitions of KT CIHR Definition  Knowledge Translation as the exchange, synthesis and ethically sound application of knowledge—within a complex system of interaction among researchers and users.
    14. 14. 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 practice.
    15. 15. Definition of KT Knowledge Utilization Definition  A common term than either research implementation or translation and of the many terms available, closely related to knowledge translation.  Includes research, scholarly and programmatic intervention activities aimed at increasing the use of knowledge to solve human problems.
    16. 16. Examples of KT: Health Community Perspective  Bowen & Martens (2005) Demystifying Knowledge Translation  To understand KT from the perspective of Community partners  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 research production  Community has a different idea about what is important in KT than researchers
    17. 17. 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
    18. 18. Examples of KT: Health Clinical  Col, N.F. (2005), "Challenges in Translating Research into Practice", Journal of Women's Health,14(1): 87-95.  Dissemination of evidence into clinical practice.  Distinguishes between research findings and research tools  Suggests that KT has focused either on patients or providers but not their interaction or other parties.  Ultimate goal is patient-centred medicine
    19. 19. Examples of KT: Health Technology Paradigm  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 systems.  Communication between clinicians and parents is of critical importance
    20. 20. Examples of KT Aboriginal Health  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 knowledge translation  Linkage between Literacy and KT is identified
    21. 21. QEOL Examples: Mandating Health Policy  CIHR funded Projects http://www.cihr-irsc.gc.ca/e/31940.html  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
    22. 22. QEOL Examples: Implicit Implying a Need for KT  Ross et al (2000) “End-of-Life Care for Seniors: The Development of a National Guide”  “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
    23. 23. 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
    24. 24. QEOL Examples: Explicit Palliative Care  Sloan (1992) “the Hospice Movement: A Study in the Diffusion of Innovative Palliative Care”  Discusses beginning of Hospice movement with roots in England  Conceptual framework is using Roger’s “Diffusion of Innovations” theory  Breaks down innovation adoption into two components  Institutional Adoption  Family-centered adoption at the Individual level
    25. 25. QEOL Examples: Explicit Palliative Care  Degner (2005) “Knowledge Translation in Palliative Care: Can Theory Help?”  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.
    26. 26. QEOL Examples: Explicit Clinical  Valente (2006) “Research Dissemination and Utilization: Improving Care at the Bedside”  Starts with the proposition: Research improves nursing and patient care outcomes  Barriers to Evidence Based Practice include difficulties with analysis, attitude, poor translation of research findings.  Do clinicians actually have the skills necessary for Evidence Based Practice?  Evaluate fact sheets on End of Life issues
    27. 27. QEOL Examples: Fact Sheet
    28. 28. QEOL Examples: Explicit Pain Management  Dooks (2001) “Diffusion of Pain Management Research into Nursing Practice”  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
    29. 29. 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
    30. 30. Information Detective  Search across different databases  Search across different subjects  Thesauri/controlled vocabulary
    31. 31. Section 2: Knowledge System  The philosophy of Ludwig Wittgenstein  The utilization of Wittgenstein’s language philosophy  Knowledge System  The utilization of the social knowledge system for conceptual clarity
    32. 32. Ludwig Wittgenstein
    33. 33. 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:  Organizational culture  Barriers to innovation  Psychological  Differences between Male and Female knowledge use
    34. 34. Mental Muddles  Mental Muddles of Language  Use and Meaning  Private Language  Language Games  Application Apply Wittgenstein’s sensitivity with language within the area of Knowledge Translation and Utilization.
    35. 35. Wittgenstein: Muddles Knowledge Translation Utilization diffusion EXCHANGE Dissemination Production Distribution!! Generation Transfer MANAGEMENT Brokering Implementation The many meanings of KT causes a Mental Muddle! I’m perplexed.
    36. 36. Wittgenstein: Clarity  Ludwig Wittgenstein  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
    37. 37. Knowledge System Concept  Knowledge System as Organizing Concept  A theory of organizing the Knowledge Utilization concept championed by Holzner and Marx, 1979.  Production  Organization (Storage and Retrieval)  Distribution  Utilization  Implementation
    38. 38. Knowledge Cycle Implementation Production Storage Retrieval Transfer Utilization Knowledge System Holzner & Marx, 1979
    39. 39. Family Resemblances Production Storage & Retrieval Dissemination Utilization Creation Generation Transfer Exchange Translation Diffusion Application Implementation Organization Representation Management Integration
    40. 40. Organization of Information **Broker Knowledge Terms Research Studies Theoretical Base Policy Production Organizational Culture CoP Technology Storage & Retrieval Barriers to Innovation Learning Organization Organizations Transfer Motivational Factors Systems Theory Innovation Utilization Gender analysis Epistemic Communities Individual Implementation Bibliometric LifeWorld
    41. 41. State of the Literature  CONCLUSIONS  Disperse, but KT is a relatively new term in use.  Little consensus on terminology  Wide use of similar theories  A need for precision and definitional clarity Any Questions?

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