Stakeholder Engagement in Knowledge Translation
Knowledge Users and Stakeholders
The translation of evidence-based knowledge occurs in the service of KUs, defined as individuals who are “likely to be able to use research results to make informed decisions about health policies, programs and/or practices” (CIHR, 2015, para. 22). We propose a slightly broader definition, such that KUs are individuals who are likely to benefit from research evidence in a manner that need not be instrumental (i.e., the term “use” implies practice, behavior, or policy change). For instance, KUs may benefit from new knowledge and understanding in symbolic or conceptual ways.
Stakeholders also can be KUs and, in particular, have something to gain or lose as a result of the outcomes of a project, program, or process (Hovland, 2005). Identifying relevant stakeholders early on in the research process can and should inform their potential involvement in KT activities by identifying their needs or desires with respect to the project goals (this will inform evaluation), whether they are primary (key, directly involved) or secondary stakeholders, and by analyzing their degree of interest in and influence over the project outcomes. Clarity about stakeholders’ needs and concerns helps to manage their expectations, ensures active and constructive engagement in the project and its evaluation, and informs how to deal with stakeholders who do not share the project’s aspirations. Understanding the needs and expectations of both KUs and stakeholders informs the planning of research processes and KT.
A common way of classifying KT activities is by the role played by KUs and stakeholders in the process of producing, interpreting, and sharing knowledge and the timing of their involvement. This classification distinguishes between end-of-grant KT and integrated KT (CIHR, 2015).
- End-of-grant KT refers to the dissemination of findings generated from research once a project is completed through publications, conference presentations, policy briefs, and other forms of communication, with KUs having a minimal or non-existent role in the knowledge production process (CIHR, 2015).
- Integrated KT (iKT) has been defined as an ongoing relationship between researchers and KUs (decision-makers, clinicians, administrators, policymakers, patients), spanning all stages of research from formulating research questions to data analyses and interpretation and co-development and execution of KT activities. The goal of iKT is to promote mutually beneficial and meaningful decision making (Gagliardi, Berta, Kothari, Boyko, & Urquhard, 2016).
Engaging Knowledge Users and Stakeholders
KUs and stakeholders can be engaged in the research and translation process through iKT, which requires managing the needs and preferences of a heterogeneous group of individuals who may be located in diverse settings (Smits & Denis, 2014). Since KUs may differ in their knowledge needs, engagement styles, and perspectives, KU engagement can be useful for KT planning and execution. Identifying KUs requires considering their knowledge needs and how they may contribute to the development and deployment of the KT plan. KT outputs or deliverables need to consider the needs of particular KU audiences. Wickremasinghe and colleagues (2016) outlined the needs of four distinct groups of KUs:
- Academics and researchers need access to critically appraise research, identify research gaps, and replicate previous research.
- Advocates need to access overviews of research findings and evidence-based case studies to support advocacy work and the promotion of changes in policy and practice.
- Policymakers need to have an accurate and complete understanding of validated concepts, experiences, and technical knowledge relevant to the development of new policies and the revision of old policies.
- Professionals and practitioners need to have access to validated concepts, experiences, and technical knowledge to inform the implementation of policies and best practices.
To this list we would add consumers and patients (Banner et al., 2019).
In addition to considering the needs of KU audiences, effective KT must take into account KU preferences for dissemination format, modality and channel of communication, use of language (jargon terminology, plain language), prior assumptions, type of knowledge, level and quality of evidence, and relevance of outcomes (Gagliardi et al., 2016; Wickremasinghe et al., 2016). Consideration of these elements is important given that researchers and KUs can have different views on what constitutes evidence or what aspects of the evidence are most important or relevant. For instance, researchers tend to define evidence as knowledge produced through a systematic and scientific process, whereas practitioners, decision-makers, and policymakers define it more broadly as a combination of research findings and experiential knowledge (Lomas, Culyer, McCutcheon, McAuley, & Law, 2005). Similarly, lack of clarity in terminology can also widen the gap between knowledge creators and users (Dixon, Elliot, & Clarke, 2016). While these differences are generally acknowledged in the literature, there is a need for concrete guidance on how to minimize inherent differences in order to achieve truly integrated KT (Dixon et al., 2016).
Empirical evidence suggests that iKT in health care contexts enhances the use of scientific evidence. Specifically, iKT leads to more citations by decision-makers, improved clinical outcomes, enhanced communication among stakeholders, and enhanced skills and confidence in using research by the end-users (Gagliardi et al., 2016; Jolibert & Wesselink, 2012). A review of the peer-reviewed literature on stakeholder engagement in comparative effectiveness research and patient-centered outcomes research found that reports of stakeholder engagement were highly variable in content and quality (Concannon et al., 2014). While there was frequent engagement with patients, engagement with clinicians occurred less frequently, and engagement with KUs in other key decision-making groups across the health care system was infrequent. Stakeholder engagement was more common in earlier (prioritization) stages of research than in later (dissemination and implementation) stages. The roles and activities of stakeholders were highly variable across research and program reports.
Although research generally points to enhanced impact with KU and stakeholder engagement, it remains unclear which engagement strategies are most effective and that work best in different contexts (e.g., Camden et al., 2015; Gagliardi et al., 2016). Comprehensive descriptions of KT strategies are commonly absent in research reporting within the rehabilitation sciences, for instance, and stakeholder engagement outcomes are rarely evaluated (Camden et al., 2015). Future research could improve methods by identifying how different iKT strategies influence outcomes to clarify the relationship between the logic or theory underlying iKT interventions and beneficial outcomes, and determine when and how decision-makers and other KUs should be involved in the research process (Gagliardi et al., 2016). Future iKT initiatives should be systematically planned, implemented, evaluated, and reported with sufficient detail to reveal how iKT was associated with outcomes.
To address this gap, Boaz and colleagues (2018) proposed several “design principles” for stakeholder engagement based on a review of the literature and their own experience with engaging stakeholders in a longitudinal study. Defining stakeholders as “individuals, organizations or communities that have a direct interest in the process and outcomes of a project, research or policy endeavor” (Boaz et al., 2018, p. 5), they proposed principles within three broad categories—organizational, values, and practices—to guide undertaking, monitoring and evaluating of stakeholder engagement (see Table 1 for the full list).
Table 1. Summary of Design Principles for How to Engage Stakeholders in Research
| Organizational |
|---|
| 1. Clarify the objectives of stakeholder engagement |
| 2. Embed stakeholder engagement in a framework or model of research use |
| 3. Identify the necessary resources for stakeholder engagement |
| 4. Put in place plans for organizational learning and rewarding of effective stakeholder engagement |
| 5. Recognize that some stakeholders have the potential to play key roles |
| Values |
| 6. Foster a shared commitment to the values and objectives of stakeholder engagement in the project team |
| 7. Share understanding that stakeholder engagement is often about more than individuals |
| 8. Encourage individual stakeholders and their organizations to value engagement |
| 9. Recognize potential tension between productivity and inclusion |
| 10. Generate a shared commitment to sustained and continuous stakeholder engagement |
| Practices |
| 11. Plan stakeholder engagement activity as part of the research program of work |
| 12. Build flexibility within the research process to accommodate engagement and the outcomes of engagement |
| 13. Consider how input from stakeholders can be gathered systematically to meet objectives |
| 14. Consider how input from stakeholders can be collated, analyzed, and used |
| 15. Recognize the identification and involvement of stakeholders is an iterative and ongoing process |
Source. Reprinted with permission (Creative Commons Attribution 4.0 International License) from Boaz et al., 2018.
A recent systematic review of 48 studies on patient engagement to improve quality of care found that the main enablers of engagement were related to techniques to improve the design, recruitment, involvement and leadership action, and to create a receptive context (e.g., enable patients or carers to set the agenda; enable time to develop strong and trusting relationships; strive for a wide representation of patients at all stages; Bombard et al., 2018). A quarter of the studies formally evaluated patients’ experiences of the engagement process. While most experiences were positive—increased self-esteem, feeling empowered, or independent—some patients sought greater involvement and felt that their involvement was important but tokenistic, especially when their requests were denied, or decisions had already been made.
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