What About the Elephants in the Room?

by Rick Austin May 1, 2014 04:22 PM

ResearchImpact honcho and long-time friend of Research Into Action, David Phipps, recently published a journal club discussion of this fairly widely-known article by Grimshaw, et al., “Knowledge translation of research findings,” about KT and its effectiveness.


The ResearchImpact journal club is intended to foster discussion, so David raises more questions than he answers, but then, that’s the point.


His very first question has to do with the Grimshaw article’s assertion that the most valuable unit of knowledge is the “up-to-date” systematic review. David points out that systematic reviews, by their nature, take time, cost lots of money, and are not popular projects for original researchers. He asks, who will pay for them, who will do them, and do we really know that they are influential in decision- and policy-making?


The Grimshaw article’s emphasis on systematic reviews reveals, in my mind, a narrow view of what is effective, and why. The implicit attitude is that if we can just get good evidence into people’s hands, they can’t help but make useful, evidence-informed decisions. Particularly in the political policy arena, evidence is never sufficient; politicians view policy through the lens of what’s good for them. Self-interest trumps science every time.


Since he’s writing a journal club review for ResearchImpact, of course David is going to point out that the Grimshaw article barely mentions the role of knowledge brokers in knowledge translation. That’s indeed a curious omission when you consider that three of the five authors of the paper are Canadian, and are intimately familiar with the goals of the Canadian Institutes for Health Research (CIHR).


Perhaps it was beyond the reach of either the Grimshaw article or David’s discussion, but two major considerations that receive no play here are the issues of scope and sustainability. A consideration of the scope of a KT effort is implied in the Grimshaw article’s fifth key question, “With what effect should research knowledge be transferred?” Unfortunately, this is disposed of in a single, brief paragraph. Scope considerations are also indirectly raised in Melanie Barwick’s KT Planning Template, as it asks questions about partner roles, goals, strategies, and impact. What’s needed is an explicit discussion of what the researcher or knowledge broker expects to achieve: how wide, how deep, how many people?


The other elephant in the room is sustainability. Human nature being what it is, no one-shot knowledge translation campaign is going to achieve much. If you dispute that, consider tobacco. The Surgeon General’s office, the CDC, the FDA, the National Cancer Institute, the American Lung Association, the Campaign for Tobacco-Free Kids, and innumerable local health departments have been flogging the dangers of tobacco for more than 40 years, and yet we still have more than 50 million Americans using tobacco in one form or  another.


Discussing these big issues up front carries no guarantee that they will be resolved; time, money and energy are all finite resources. But at least they can be part of a realistic debate. What other issues should we be including in a realistic discussion of knowledge translation goals?

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