External Drivers of Advancement in Knowledge Translation
The Role of Funders in Shaping Knowledge Translation
Greater involvement of [funding agencies] in all forms of KT is not just the right thing to do: it is essential for the maintenance of the health research enterprise in the face of many competing and compelling demands on the tax base. (Kitson & Bisby, 2008, p. 6)
Motivated by a need to increase accountability and return on public money invested in research and to ultimately improve outcomes, funders around the world have played a crucial role in prioritizing KT and IS. The emphasis on KT adopted by numerous research funding agencies reflects increasing recognition that excellent research does not automatically lead to better outcomes unless it is coupled with high-quality KT directed to multiple audiences, and where appropriate, effective implementation. The impetus to fund and attend to KT on the part of research funders has strengthened the validity and credibility of KT as an emergent substantive field of study in its own right.
Holmes, Scarrow, and Schellenberg (2012, p. 2) argue that it is essential for the funders “to move away from the traditional ‘fund and forget’ model and review their funding priorities, grant review criteria, and research practices, and generally become more active in the space between research results and impact.” Funders are meeting this challenge in various ways. In Canada, funder-supported KT activities have included research chairs; peer-reviewed funding of KT activities resulting from funded research; operating grants; KT education and professional development; KT networks (e.g., www.ktecop.ca); KT conferences; KT integrated in funding requirements to engage researchers, policy-makers, practitioners and the public within the research enterprise (Holmes et al., 2012); inclusion of KT activities in the common curriculum vitae template for national funders; and reporting of KT activities in final funding reports (i.e., CIHR).
In the United States, KT in the form of IS specifically has emerged as a national priority as reflected by the focus, activities, and funding allocations of several national institutes and agencies (Meissner et al., 2013; Morrato et al., 2015):
- The U.S. Department of Veterans Affairs, Veterans Health Administration (VHA) established the Quality Enhancement Research Initiative in 1998 (QUERI) designed to improve VHA health care outcomes by implementing evidence-based treatments with quality.
- The Agency for Healthcare Research and Quality (AHRQ) funds research networks to optimize the transfer of health care research into practice.
- The NIH funds research, conferences, and workshops with an implementation focus.
- The Patient-Centered Outcomes Research Institute (PCORI) has developed merit review criteria for proposals that focus on implementation; published a dissemination and implementation framework and is committed to investing 20% of its funding (approximately $400 million annually) into dissemination and research capacity building.
These efforts have driven the development of the KT and IS fields and been impactful for practice settings, but they come with challenges. An international study examining funding agencies’ perceptions of their role in promoting the use of research findings identified difficulties with determining KT priorities, defining KT, evaluating investments in KT, identifying reviewers with sufficient KT expertise to evaluate KT activities and grants, and establishing a systematic approach to the KT initiatives they fund (Tetroe et al., 2008). Smits and Denis (2014) studied six nations’ main health funding agencies and found similar complexity in integrating science into policy and practice and difficulties in measuring any resulting benefits. In response, several authors have suggested the need for funders to augment their role in supporting KT by providing clear definitions of KT; engaging in KT activities themselves; involving end-users in determining KT funding priorities; facilitating communication between researchers and end-users; requiring a KT plan for all funded research; providing training to reviewers who assess KT plans; and creating funding opportunities to address urgent population needs (Kitson & Bisby, 2008; Tetroe et al., 2008).
Some funding agencies have put these suggestions into play. As noted, NIDILRR has developed and integrated a clear KT framework and systematic evaluation into the fabric of all their funding programs. In Canada, CIHR has supported KT through research chairs, strategic funding opportunities, and project grants since 2000, although the organization could do more to fund IS strategically.
Academic Promotion
At institutions of higher learning, we become greater than the sum of our parts when we extend beyond knowledge transfer to knowledge mobilization, reward educational leadership and multidisciplinary collaborations, legitimize forms of scholarly activity such as advocacy and social justice, value scholarly work that extends beyond peer review, and recognize the creation of tools and resources that create change in communities, especially those at risk. In doing so, we fulfill our mandate of supporting and sustaining an innovative, resilient and diverse society. (Riddell, 2016, para. 8)
More recently, universities are beginning to revise their criteria for academic promotion and tenure to include KT and community-engaged scholarship (Bunton & Mallon, 2007; Cabrera, Roy, & Chisolm, 2017; see also Community-Campus Partnerships for Health, https://www.ccphealth.org). The shift has its roots in Ernest Boyer’s challenge to redefine scholarship to recognize the scholarship of integration, application, and teaching in addition to the scholarship of discovery and publication (Boyer, 1990). Later, Boyer expanded his thesis to include the scholarship of engagement (Boyer, 1996, p. 21). Since then, the concept has been endorsed by several higher education organizations, including the American Association of State Colleges and Universities, the Association of Public and Land Grant Universities, and the Coalition of Urban Metropolitan Universities in the United States. In Canada, the University of Toronto Faculty of Medicine has adopted more inclusive criteria for academic promotion; and Research Impact Canada, a pan-Canadian network of universities, has been formed to maximize the impact of academic research for the public good in local and global communities.
Relatedly, the San Francisco Declaration on Research Assessment (DORA, 2012) made several recommendations toward improving ways in which the output of scientific research is evaluated by funding agencies, academic institutions, and other parties. Developed in 2012 during the annual meeting of the American Society for Cell Biology in San Francisco, the Declaration is now a worldwide initiative covering all scholarly disciplines and all key stakeholders, including funders, publishers, professional societies, institutions, and researchers. Individuals and organizations who are interested in developing and promoting best practice in the assessment of scholarly research are encouraged to sign DORA (https://sfdora.org).
As new generations of scholars begin to favor innovative forms of scholarship, including digital and web-based publications that traditionally have not been valued in retention, tenure, and promotion policies, these are being integrated into promotion criteria in some institutions. For instance, in recognition that social media has become an essential tool for dissemination and outreach, the Mayo Clinic in the United States has outlined new strategies and tools for evaluating the impact of digital scholarship on the academe and general populations, and for recognizing scholars who are engaged in this work. A seminal paper outlines how altmetrics can be used to assess dissemination and impact, and describes a strategy to recognize digital academia on career promotion and tenure (Cabrera et al., 2017).
As Cavallaro (2016) and Riddell (2016) note, paradigm shifts happen slowly. Cavallaro contends that changing policies and institutional culture can be challenging and may require multiple years of sustained effort. He states that few higher education institutions have succeeded in establishing well-articulated policies that would enable or support the recognition of community-engaged scholarship in the tenure and promotion process (Cavallaro, 2016). For more on this topic, we direct you to a special issue of Metropolitan Universities (2016, Vol. 27, No. 2) that examines institutional approaches to the recognition of community-engaged scholarship in faculty promotion and tenure policies and processes. Papers in this issue describe evidence-based approaches to defining and evaluating the quality of engaged scholarship, as well as analyses of the processes and outcomes associated with the adoption and implementation of engaged scholarship in review, promotion, and tenure policies. In addition, Smith, Else, and Crookes (2014) provide a sound review of engagement in academia.