Developing a valid and reliable assessment of knowledge translation (KT) for continuing professional development program of health professionals

Foundation of knowledge translation (KT)

The universal “know-do” gap (i.e., the difference and gap between theory, knowledge, evidence or research, and practice, application, policy or decision) remains a critical challenge even in the contemporary world (Pablos-Mendez & Shademani, 2006; Santesso & Tugwell, 2006; Mustard, 2010; Grimshaw et al., 2012; Atchan, Davis & Foureur, 2014; Health Policy Project, 2014; Zhang et al., 2015). Although knowledge possesses an inherent catalytic potential in advancing the globalized society such as inclusive knowledge societies and knowledge-based economy (CEDEFOP, 2014; Pablos-Mendez & Shademani, 2006; Souter, 2014; UNESCO-IBE, 2013), it requires meaningful and contextual applications to elicit desired outcomes (Santesso & Tugwell, 2006; Bassi et al., 2013). Both CPD and KT offer mutually reinforcing strategies (Graham et al., 2006; Davis & Davis, 2010; Kitto et al., 2013) in placing knowledge to work. In essence, this stresses three-sided (i.e., researchers, educators and practitioners) collaboration (Bjørk et al., 2013) that is similar to the European Commission’s (2015) knowledge triangle—education, research, and innovations.

Several authors (Ho et al., 2004; Wallin, 2009; Metzler & Metz, 2010; Kothari & Armstrong, 2011; Straus, Tetroe & Graham, 2011; Sibley et al., 2011; Collisson et al., 2011; Kastner & Straus, 2012; Muntaner et al., 2012; Wolfe et al., 2012; Bassi et al., 2013; Gholami et al., 2013; Urquhart et al., 2013; Bjørk et al., 2013) have espoused the widely accepted Canadian Institutes of Health Research’s (2014) definition of KT as a continuous knowledge processing (i.e., synthesis, dissemination, exchange and application) within a complex interactive system of researchers and knowledge users. Correspondingly, knowledge-to-action (KTA) process (Graham et al., 2006) generally illustrates KT that offers an alternative framework to bridge the know-do gap in the 21st century. It emphasizes the cyclic coexistence of knowledge creation and application. During the creation phase, knowledge needs to undergo a refinement process such as inquiry, synthesis and development. Whereas, the action part involves activities needed for actual knowledge application such as adaptation, intervention, evaluation, and continuation.

Graham et al. (2006) clarified commonly shared concepts of KT. Knowledge transfer exclusively describes a linear top-down approach (Visram, Goodall & Steven, 2014), and one-way (or impliedly can be two-way) process of getting knowledge with no actual application. This concept reflects a mere sending of information to a user (Majdzadeh et al., 2008), though Froese & Montgomery (2014) have viewed knowledge transfer synonymously with knowledge translation. These views concur with Choi & Johanson’s (2012) comparison of the (a) static, (b) dynamic and (c) knowledge translation perspectives of knowledge transfer, respectively. In the same way, knowledge exchange as a two-way process (Visram, Goodall & Steven, 2014) has been conceived to release some restrictions of transfer. Knowledge exchange expands the transfer concept by emphasizing the collaborative roles between the researchers, leaders, and stakeholders. Though this concept expansion, relevant knowledge is available, although involvement may vary throughout the process. Several studies have compounded these terms as knowledge translation and exchange (KTE) to further strengthen the involved interactive mechanisms (Légaré et al., 2011; Wolfe et al., 2012; Visram, Goodall & Steven, 2014). On the contrary, research utilization (or implementation) directs its effort on the sole use of research evidences. This concept shares almost a similar stand with evidence-based practice (EBP) that uses the best evidence as the ideal knowledge in guiding decision and practice (Wallin, 2009; Metzler & Metz, 2010; Atchan, Davis & Foureur, 2014). Lastly, translational research may seem similar, yet it deals with the transfer of basic scientific knowledge to clinical application. In contrast, Grimshaw et al. (2012) embraced the view of translation research as their frames for knowledge translation. This view refers to the second type of translational research, which deals with improving health outcomes using new clinical knowledge. In spite of their differences, these concepts are subsumed under the broader context of KT.

Strategies of Knowledge Translation (KT)

Despite availability of many theoretical supports and models (Sibley et al., 2011; Brehaut & Eva, 2012; Larrivée, Hamelin-Brabant & Lessard, 2012; Thomas et al., 2014), there has been no single strategy for KT (Metzler & Metz, 2010; Gholami et al., 2011; Grimshaw et al., 2012; Kastner & Straus, 2012; Visram, Goodall & Steven, 2014). At large, the Canadian Institute of Health Research (Canadian Institutes of Health Research, 2014) has specified two (2) general KT approaches. The traditional (Kothari & Wathen, 2013) end-of-grant knowledge translation empowers the researcher to make the stakeholders (e.g., users and clients) and their peers aware of the research evidence as knowledge. This translation may involve typical research dissemination (e.g., conferences, presentations, and publications) and intensive activities such as interactive sessions, educational events and knowledge brokering. As for the integrated knowledge translation (IKT), the knowledge researcher and user engage in a meaningful collaboration toward sustainable outcomes. Its strategies may include action research, knowledge co-creation and participatory methods (Tetroe, 2007). Likewise, Collisson et al. (2011) have pointed out that these KT approaches share a direct link with their knowledge production mode. The independent knowledge production leads to the academic merits of end-of-grant KT, while collaborative generation facilitates integrated KT for a direct contextual application.

Another KT strategy integrates modern technology to yield a Technology-Enabled Knowledge Translation (TEKT) (Bassi et al., 2013; Urquhart et al., 2013). This strategy embodies the convergence of technology and innovation with KT, which supports information collection, production and distribution (Pablos-Mendez & Shademani, 2006; Majdzadeh et al., 2008; Urquhart et al., 2013). Several scholars (Ho et al., 2004; Bassi et al., 2013) have maintained positive views on TEKT’s potentials for online education, web-based intervention, and integrated systems. Similarly, informatics-based knowledge translation optimizes the utilization of information systems for adjunctive mechanisms such as clinical decision support systems and healthcare information systems (Kastner & Straus, 2012). Relatedly, social media open up new opportunities in reinforcing knowledge translation activities and interactions (Hamm et al., 2013). In other situations, the social environment becomes the strategic center of knowledge translation such as the community of practice (Lencucha, Kothari & Rouse, 2007; Urquhart et al., 2013), virtual community (Bassi et al., 2013) and community-based settings (Kothari & Armstrong, 2011).

Interestingly, most KT strategies tend to hold educational activities (Zwarenstein & Reeves, 2006; Majdzadeh et al., 2008; Wallin, 2009; Reitmanova, 2009; Davis & Davis, 2010; Straus et al., 2011; Wahabi & Al-Ansary, 2011; Grimshaw et al., 2012; Larrivée, Hamelin-Brabant & Lessard, 2012; Armstrong et al., 2013; Bassi et al., 2013; Thomas et al., 2014). Regardless of whether a standalone or combined intervention is used, KT activities may include learning activities (e.g., seminar, lectures, workshops, outreach, trainings and meetings) (Graham et al., 2006; Wahabi & Al-Ansary, 2011; Grimshaw et al., 2012; Armstrong et al., 2013; Bassi et al., 2013; Urquhart et al., 2013) and CPD (Grimshaw et al., 2006; Pablos-Mendez & Shademani, 2006; Santesso & Tugwell, 2006; Davis & Davis, 2010; Metzler & Metz, 2010). Under these circumstances, KT and CPD can be overlapping and confusing (Graham et al., 2006). Kitto et al. (2013) expounded the harmonies, distinctions, and associations of these academic domains. Both KT and CPD aspire to improve collaborations, services, and outcomes, though their underlying approach may differ. CPD gives attention to developing competence and performance of health professionals (Enriquez et al., 2015), whereas KT ensures quality information and tools for the stakeholders. Despite their differences, KT and CPD maintain a mutual relationship and share common challenges. KT adapts theoretical foundations from CPD, while CPD exploits KT as a strong rationale for its strategies.

IRV-KT as a valid and reliable tool

The study findings confirm the validity of the IRV-KT tool. As expected, this instrument would provide valid measures of KT learning, because it was developed using substantial sources. Its strength as a learning tool primarily rests on its capacity to offer reproducible results in both technical (i.e., style and format) and instructional (i.e., content and learning process) aspects of KT as a desirable outcome of a CPD program. The IRV-KT is also reliable in assessing KT constructs of ‘creation’ and ‘action’ that resulted in commendable overall tool reliability.

KT, an area of interest in continuing professional education, is a constructive response to fill in the gray space within the “know-do gap” (Bero et al., 1998; Thompson et al., 2007). For instance, it has been reported that high-quality evidence is not found in actual professional practice (Majumdar, McAlister & Furberg, 2004; Larrivée, Hamelin-Brabant & Lessard, 2012; Negrini et al., 2018). In the field of education, the IRV-KT tool could serve as a potent instrument to ascertain KT competency outcomes among health professionals as lifelong learners in eliciting evidence-based policies, decisions, and practices.

IRV-KT as a reflective and meaningful assessment

The IRV-KT tool is considered useful because it can cultivate a more profound reflection on self-performance and authentic functioning knowledge. Further, it provides a concrete mechanism for metacognitive thinking through awareness of one’s learning (Montagna, Benaglio & Zannini, 2010). Self-reflection has been proven as a valuable exercise in both learning (Semradova & Hubackova, 2015) and instruction (Williamson, 2018). In previous literatures, it is being used to evaluate teaching methods, strategies, and approaches (Klimova, 2014). Reflecting on one’s learning further improves critical thinking and insight that are directly translatable to actions and changes of behavior (Lew & Schmidt, 2011; Asselin & Fain, 2013; Gardner, 2013).

It is essential to assess KT among health professionals for it directly impacts practice quality (Pablos-Mendez & Shademani, 2006). The IRV-KT tool boasts its capacity to identify key processes of knowledge translation through its constructs. It focuses on specific, concrete tasks (and not purely theoretical dimensions) involved in epistemic construction and application. Thus, educators can be significantly benefitted from the direct utilization of this tool in the field of health sciences and healthcare, more so in the CPD learning context.

IRV as a practical tool development framework

Like in the previous study (IL Ong, MJS Diño, MMP Calimag & FA Hidalgo, 2017, unpublished data), using the IRV framework and its procedures can produce valid and reliable reflective assessments. It provides a down to earth framework that is easy to incorporate in real-world scenarios. The demand for instruments focusing on Knowledge Translation is increasing (Ellen et al., 2017), but remains to be a gray area of literature (Chen et al., 2017). Whilst most are focused initially on validity and reliability concepts (Hinkin, Tracey & Enz, 1997), fewer studies have dwelt on the pragmatic educational usage of research instruments. In these cases, the expeditiousness of using the IRV framework is a valuable add-on in developing more assessment and research tools with practical value.