Knowledge Translation Origin and History
Despite the onset of knowledge translation as a formalized term decades ago, its components—knowledge and translation—are ancient concepts (Ackerley, 2017, p. 32). Through the years, a plethora of terms and activities have been used to label KT activities across disciplines and countries (Backer, 1991; Lane & Flagg, 2010; McKibbon et al., 2010). If one looks beyond terminology to the essence of the activity itself, the concept, practice, and study of KT are not new (Ackerley, 2017, p. 27).
Marking key moments in KT’s evolution largely depends on its evolving definitions. KT conceptualized as communicating research-based knowledge to meet the needs of society dates back to the Greeks (Backer, 1991). As a field of inquiry, KT can be linked to the beginning of social science in the early 19th century, as illustrated in the work of sociologist Gabriel Tarde, who explored the spread of innovations throughout society as a way of explaining why some innovations were adopted while others were rejected (Backer, 1991).
In health, the related term research utilization has been used for almost five decades (Ackerley, 2017). KT research has dominated in the health context, arguably as a reflection of the urgent, life-or-death nature of health care and the costly consequences of failing to use evidence for improving practice and outcomes (Ackerley, 2017).
The conceptualization of KT presented throughout this monograph crosses several disciplines (e.g., knowledge utilization; diffusion of innovations; technology transfer; evidence-based medicine; quality improvement; knowledge management; communication), each shaping their own focus of interest and terminological preferences. Examples include Rogers’ (2003) work in diffusion of innovations in rural sociology, nursing research utilization, and more recently, dissemination and implementation research in the United States; KT and KM in Canada; knowledge transfer and research capacity in the United Kingdom; and the “know-do” gap in Australia (Ackerley, 2017; Lane & Flagg, 2010; McKibbon et al., 2010; Straus, Tetroe, & Graham, 2009). This breadth in terminology and application highlight efforts to name and present KT in ways specific to particular disciplines. The following sections describe key factors shaping KT’s notable evolution (Ackerley, 2017, p. 27).
Knowledge Translation During the 20th Century
The evolution of KT during the 20th century has been shaped by three successive waves of activity, each with a unique focus and level of political support (see Backer, 1991). Our conceptualization of evolving KT waves primarily centers on events in the United States and Canada, where the term has been documented in detail. Where available, examples from other countries also are noted. Note that Backer’s historical summary uses the term knowledge utilization (as opposed to knowledge translation), defined as “research, scholarly, and programmatic intervention activities aimed at increasing the use of knowledge to solve human problems” (Backer, 1991, p. 226).
Wave 1: 1920–1960
The focus of KT between 1920 and 1960 was primarily on how individuals adopted innovations. The Research Committee on Social Trends, established in 1929, was the first official initiative designed to maximize the impact of science on society’s needs (Backer, 1991). In the late 1930s and early 1940s, agricultural technology advanced rapidly, and Ryan and Gross (1943) examined the diffusion of hybrid corn to farmers in Iowa. In 1962, their highly cited, seminal work illustrating the characteristics of innovation adopters informed Rogers’ influential diffusion theory (Backer, 1991).
Wave 2: 1960–1980
From 1960 to 1980, KT broadened to the dissemination and utilization of innovations resulting from research and demonstration activities. At the user level, KT’s focus was on innovation adoption by both individuals and organizations (Backer, 1991). In the 1960s and 1970s, the United States established several institutes, programs, and offices promoting the application of federally funded research, including the National Institutes of Mental Health. National investments in knowledge utilization were largely motivated by the goal of stimulating economic growth through advancing technology and a need to increase the application of innovations emerging from various areas of research (e.g., defense and space; health, education, and human services) (Backer, 1991).
In the United States, the federal emphasis on knowledge utilization led to several important developments in the field (Backer, 1991):
- The number of dissemination activities increased (e.g., creation of clearinghouses by federal agencies to increase research and knowledge access; publications and other printed materials).
- Research studies began to test the effectiveness of dissemination and utilization strategies such as print materials, films, videotapes, organizational development, technical assistance, conferences and workshops, and participant observation.
- KT developed as a distinct field of professional and scholarly activity, with its own journals (e.g., Journal of Technology Transfer [1975], Knowledge in Society [1988]), professional societies (e.g., Knowledge Utilization Society, 1985), and university programs (e.g., Center for Research on Utilization of Scientific Knowledge at the University of Michigan).
Although KT flourished in the United States during this time, with the Reagan administration came significant reductions in federal funding, and some KT initiatives were terminated as a consequence.
This wave marked another noteworthy moment for KT. In 1972, an article included in the MEDLINE database was indexed for the first time under the term “knowledge translation” (cf. Greenhalgh & Wieringa, 2011). The article, published in French, discussed measures to promote the application of laboratory discovery research to improve disease diagnosis or treatment. These activities corresponded to what the National Institutes of Health’s (NIH’s) Roadmap for Medical Research has labelled T1 or “bench to bedside KT”; with T2 describing the rest of the continuum (i.e., namely, the transfer of findings from clinical studies to practice settings) (Kon, 2010). This initial NIH conceptualization of two basic steps of translation was then further refined and expanded to include T3 (i.e., moving evidence-based guidelines and treatments into health practice) and T4 (i.e., evaluation of real-world health outcomes of guidelines/treatment applications in practice) (Kon, 2010).
Wave 3: 1990s
The 1990s saw a continued emphasis on KT and strategic partnerships between federal and local agencies to transfer knowledge into action to improve health, education, and human services, as well as further refinements in how KT was conceptualized. For example, Backer (1991) proposed a hierarchical, four-level model to classify federal KT programs across diverse sectors (health, education, human services, defense, aeronautics, space administration, and transportation).
- Level 1: Dissemination (D)—Programmatic activities are limited to dissemination through publications, information clearinghouses (e.g., National Institute on Aging).
- Level 2: D + Utilization (U)—Programmatic activities include both dissemination and activities promoting utilization through targeted funding, technical assistance, and other avenues. (e.g., National Cancer Institute; U.S. Department of Veterans Affairs).
- Level 3: D + U + Research on knowledge user (KU) processes (R)—Programmatic activities support dissemination and utilization as well as research on knowledge utilization (e.g., National Institute on Disability and Rehabilitation Research).
- Level 4: D + U + R + Integrated System for Knowledge Utilization (I)—Programmatic activities include dissemination, utilization, and research, all conducted under an integrated plan for a knowledge utilization system, including a clear policy for the federal agencies (e.g., Office of Educational Research and Improvement).
In Canada, the genesis of KT can be traced to the creation of the Canadian Health Services Research Foundation (CHSRF) in 1996, with its mission to support evidence-informed decision-making in health care through funding research, building capacity, and transferring knowledge (CHSRF later became the Canadian Foundation for Healthcare Improvement). In 1999, CHSRF organized a seminal national workshop encouraging efforts to translate research evidence to meet the needs of decision-makers.
Wave 4: Contemporary Trends in Knowledge Translation (post-2000)
Setting international priorities to reduce the evidence to practice and policy gap (e.g., Grimshaw, Eccles, Lavis, Hill, & Squires, 2012) has characterized the period post-2000. In the United States, this has taken the form of unprecedented investments in KT research. For instance, NIH expressed its “profound commitment […] to do whatever is necessary to rapidly exploit the revolutionary advances of the past few years for the benefit of our people” (Zerhouni, 2003, p. 72). In 2006, NIH introduced the Clinical and Translational Science Award program with the goal of funding 60 centers over six years, at an annual cost of U.S. $500 million (Greenhalgh & Wieringa, 2011; NIH, 2007).
In 2000, the government of Canada established the Canadian Institutes for Health Research (CIHR) from the former Medical Research Council as Canada’s national health research funding agency. Playing a central role in CIHR’s mandate from its beginning, KT is reflected in the agency’s mission and the Parliamentary act under which it was established. KT is integral to CIHR’s strategic plan, with management roles and structures specifically dedicated to KT, including KT specific funding mechanisms (McLean et al., 2012). In 2004, Canada’s SSHRC similarly prioritized knowledge mobilization to ensure social and/or economic impact (Ackerley, 2017).
In 2006, the Cooksey Report in the United Kingdom introduced a comprehensive strategy to guide translational research in both basic and clinical sciences, leading to the formation of the Office for Strategic Coordination of Health Research (Cooksey, 2006). Translational medicine was recognized as a key area of focus for the newly established office and was allocated a significant portion of the £1.7 billion budget (Greenhalgh & Wieringa, 2011).
With an increased international emphasis on KT has come significant growth in KT research and practice and recognition of the imperative for disseminating research evidence and emerging best practices. Several new journals were founded during this time, with 27 journals listed on the NCBI index of medical journals containing the term “translational,” 18 of which have been launched since 2008 (Greenhalgh & Wieringa, 2011). In the post-2000 era, implementation science also has emerged as a burgeoning research field. Across Europe, approximately 20 national research and government agencies have implemented research translation systems, including a multimillion-euro network of European biomedical translation hubs based on existing research centers. This initiative followed the United States’ initiative to institute a consortium of 60 clinical and translational science centers (CTSCs) based at universities and medical centers across the country (Butler, 2008).
In the United States, within the field of disability and rehabilitation research, the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; formerly known as the National Institute on Disability and Rehabilitation Research, NIDRR) steered early and influential KT work. NIDILRR is a federal agency that funds applied research, training, and development with the end goal of improving the lives of people with disabilities. From early on, NIDILRR’s mission strongly emphasized the discovery and application of new knowledge to improve well-being and functioning among people living with disabilities (National Research Council, 2012).
NIDILRR’s long-range plan for 2018–2023 places KT as central to promoting the effective use of research discoveries, innovations, and products developed with NIDILRR funding (NIDILRR, 2020). In concrete terms, this means that NIDILRR has and will continue to integrate KT systematically into all funding programs and grant operations by incorporating KT requirements into the grant competition process, providing educational KT support to grantees, and identifying opportunities to promote the use of knowledge and products generated from NIDILRR-funded research.
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