In a recent study of Canadian healthcare organizations, Ellen et al. describe four key categories of KT supports for evidence-informed decision-making: roles that promote research use; ties to researchers outside the organization; technical infrastructure; and training programs to enhance staff capacity building. The survey described in this paper aims to increase understanding of how best to implement the fourth category, with the important caveat that training is ideally only one component of a broader strategy to increase the individual, organizational and in this case, provincial use of research evidence.
Our expectation of response numbers was modest, given survey fatigue, busy schedules, potential confusion over KT terminology or frustration with its perceived jargon, the survey length, and what seems to be a growing discomfort in the Canadian healthcare and academic sectors with data stored outside Canada (we used SurveyMonkey, which is based in the U.S.). Despite these concerns, the number of responses surpassed our expectations. We attribute the rate to the KT champions who distributed the link to the survey under their own signatures within their organizations. The keys to their doing so were our existing partnerships aimed at increasing evidence use in BC, our engagement with them throughout the development of the survey, our offer to provide regional results for their own use, and our intent to support them in delivering KT training programs and services based on the findings. While results include a good balance between respondents who are research producers and research users across the province, understanding of KT training needs of groups that were not as well represented in our survey (not-for-profit, government and private sectors) will be important.
That most respondents consider KT important to their work and are interested in learning more about it is perhaps not surprising, given that people who complete surveys tend to have a high interest in the topic[21, 22]. This interest is consistent with our experience to date in offering general KT skills workshops, which have been oversubscribed. The survey described in this paper was designed to move beyond general interest to specific training needs as well as other aspects important to training.
Four out of five respondents are interested in each KT skill listed, suggesting that demand would be high for any of the topics offered via training. Research producers are most interested in learning more about dissemination and general KT skills; research users are most interested in learning more about application and exchange skills. While these findings can be acted on, it will be important to bear in mind the subjectivity of this needs assessment and the importance of an objective component, for example based on core competencies. Of note is that respondents rate the importance of KT to their work as high, yet the highest demand for training is at the beginner level. This may suggest that people do not feel knowledgeable enough to perform the KT tasks necessary for their roles. The fact that the survey relied on respondents to interpret ‘beginner, intermediate, and advanced’ training levels makes this finding difficult to interpret; see more on this finding in Strengths and Limitations, below. Also of note is that knowledge exchange is rated third in ‘importance to respondents’ work’ of the four components of KT (dissemination, synthesis, exchange, and application), yet had the highest overall interest in terms of skill-building. We are unclear as to the reason for this discrepancy. It may relate to the order and/or specificity of the survey questions themselves. That is, the question ‘How important to your work is knowledge exchange’ was asked first and included a general definition and description of ‘exchange’. Immediately following this question respondents’ were asked to indicate their interest in learning more about six very specific training topics related to exchange (see Additional file1). The specificity of the topics themselves may have served to spark interest in respondents in a way that a general definition and description of exchange did not.
Survey findings suggest that training formats should be flexible, easily accessed, and cost-effective. There is most interest in small group sessions as a learning format, and more likelihood that people will attend a KT workshop over most other activities. While results confirm the value of workshops in the province, it is also apparent that cost constraints and time commitments are the biggest barriers to participating in them. Offering a range of options—in terms of formats as well as fees—will increase the likelihood that more people can participate. It will be important to explore creative training models in order to move beyond more traditional didactic training where participants with similar backgrounds ‘learn and leave,’ with little opportunity to apply what they have discovered or talk about their experiences as they attempt to incorporate what they have learned in practice. For example, training that offers a mix of workshop-based and practice-based components, and that provides ongoing mentorship and specific problem-based learning, could be explored. A mix of participants in terms of professions could help build understanding of cultural and language differences, encourage integrated and end-of-grant KT activities and partnerships, and address a perceived barrier noted in our survey by healthcare providers and administrators—and to a lesser extent researchers—for opportunities to interact. Before designing training opportunities, further exploration of the evidence that shows what is most effective for whom will be necessary. For example, small group learning, distance education and communities of practice show promise for healthcare practitioners, while tools provided by funding agencies are recommended as a strategy for supporting researchers’ learning. The preferences of policymakers, and best practices in training for this group, seems to be less clear. Indeed, existing literature on training tends to explore opinions, ideas, and likelihood of participating, rather than effectiveness of training formats and topics themselves. There is a huge opportunity in launching a KT training program to explore what works best for whom, as well as immediate, medium and longer term outcomes.
Given the high interest in KT training, finding enough trainers will be a challenge. Possibilities include encouragement and incentives for local KT leaders to share their knowledge and experience, and exploring the addition of train-the-trainer components into existing and new training initiatives. Building on existing training initiatives, and working across the province on a shared overall training program with flexibility for local adaptations, has the potential to maximize expertise and also resources as well as enable the setting of common objectives and measurement indicators.
Finally, as indicated earlier, while KT skills training is a key component of organizations’ support for evidence based decision making, it alone is not sufficient to increase the use of health research evidence. Some respondents in their comments drew a connection between organizational culture and time: without increased awareness and understanding of KT from leadership and staff, commitment to making KT a priority from management and others, and supportive structures that allow or require KT in the workflow, time will continue to be an issue. Just as one training intervention is not enough to result in a meaningful change in performance, building KT skills is only one component of developing a more supportive environment for KT. While funding agencies can address some organizational barriers (e.g., access to resources, opportunities for interactions between researchers and users of evidence, KT funding), results suggest the importance of working with partner organizations to address context-specific barriers to practicing KT and, importantly, to evaluate how specific mechanisms promote research engagement by organizations.
Strengths and Limitations
Strengths of the survey described in this paper include the large response rate, broad focus, and ability to determine differences among professional groups. An additional strength is the positioning of the survey as one component that will help build health research capacity provincially, which will force us to look at training in context of other support necessary. While we hope these strengths will offset the limitations of this survey, these must still be acknowledged.
Despite the high number of responses, because of the nature of surveys—primarily quantitative, with little opportunity to understand the subtleties of responses—there is a need for caution in interpreting the findings so as not to overlook their complexity. For example, we were interested in the seeming disconnect between the fact that respondents consider KT important to their work, but that the highest demand for training is at the beginner level. We noted that healthcare practitioners were consistently more likely to report needing beginner level training than the average. One might conclude that responsibility for KT is included in many job descriptions, but people do not know enough about how to do it. However, this conclusion would probably be false. Healthcare practitioners are expert at incorporating many types of evidence and knowledge, both tacit and explicit, into their work (Vicky Ward, personal communications, 2012). Ward questions whether KT has been professionalized to such an extent that people think there it is a ‘right’ way to do it that they need to be taught. We agree with Ward on the importance of legitimizing the ways in which people are already using evidence in practice and policy, and supporting them to learn more from each other, ideally in the way they are already practicing.
Another complexity results from using an online survey to find out about a topic as complicated as knowledge translation. Despite our efforts to use jargon-free language, we do not know that people understood the questions exactly as we meant them to be understood. Twelve people commented that the language in the survey was inaccessible. Admittedly, 12 out of nearly 1,100 people is not a high percentage, but these were people who chose to comment (i.e., respondents were not asked about the language level of the survey), and presumably these were also people who are interested in and therefore know something about KT. It is conceivable that even our efforts at clarity resulted in some misunderstandings. It is certainly the case that these efforts painted a less-than-ideal picture of KT from our perspective. For example, we were not entirely happy with dividing KT into four areas—dissemination, exchange, synthesis and application—because in practice these are artificial distinctions and can lead to the perception that KT is a linear process starting with knowledge generation and ending with its application. However, we did need to ask about interest in specific skills as there are important distinctions among them in terms of learning; therefore we compromised our position.
Two more factors suggest caution in interpreting the findings. Although a lot of information was generated by many people, there are a) many things we did not hear, and b) stakeholders from whom we heard little. On the first point, the survey format and length did not allow for gathering information about, for example, how many courses a year might people take, or whether they would prefer a basic understanding of KT over in-depth training on one aspect, or how we might build on their existing knowledge and resources they have used. On the second point, despite a good response rate from many stakeholder groups, others were under-represented, for example, policy makers in government. Another group that was under-represented were healthcare providers whose work involves ‘translating knowledge’ but who may not be familiar with KT terminology and may have little interest in learning it or no patience for its perceived jargon. We were urged by a few respondents to find ways other than the survey to explore the needs and existing expertise of these stakeholders. For these and other reasons, we would not consider our results to be generalizable beyond those who answered the survey. However, we do suggest that the findings are robust enough to proceed with the development of training opportunities in partnership with healthcare and research organizations around the province.