Getting evidence into policy and practice: perspective of a health research funder.

“We have in hand most of the information we need to facilitate a new golden age of medicine. And what we don’t have in hand we can get fairly readily by wise investment in targeted research and intervention.” This “dangerous idea” (Ewald, 2007) was put forward by Paul Ewald, an evolutionary biologist. His idea has merit and is consistent with the way we, at the Canadian Institutes of Health Research, think about knowledge translation, which is our term for closing the gap between what we know from research and what we do. From our perspective, knowledge translation (KT) is about making users aware of knowledge or innovations and facilitating their use of it to improve health and health care systems. It is about closing the gap between what we know and what we do (reducing the know-do gap) and about moving knowledge into action. There are other terms in use to describe this concept, many of which are not operationally defined (Tetroe et al., 2008; Graham I.D. et al., 2006) but, at the CIHR, we have developed the following working definition: “Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system. This process takes place within a complex system of interactions between researchers and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.” An examination of the meaning of the specific concepts in this definition allows a more in-depth understanding of what we mean by KT. Synthesis in this context means the contextualization and integration of research findings of individual research studies within the larger body of knowledge on the topic. A synthesis must be reproducible and transparent in its methods, using quantitative and/or qualitative methods. It could take the form of a systematic review; follow the methods developed by the Cochrane or Campbell Collaborations, or other methods; and may synthesize qualitative or quantitative findings. Meta-analyses, realist reviews, narrative syntheses, meta-syntheses and practice guidelines are all forms of synthesis. Dissemination involves identifying the appropriate audience, and tailoring the message and medium to the audience. Dissemination activities can include such things as summary/briefings to stakeholders, educational sessions with patients, practitioners and/or policy makers, engaging knowledge users in developing and executing dissemination/implementation plan, tools creation, and media engagement. The exchange of knowledge refers to the interaction between the knowledge user and the researcher resulting in mutual learning through the process of planning, producing, disseminating, and applying existing or new knowledge. Ethically sound knowledge translation activities are those that are consistent with ethical principles and norms, social values as well as legal and other regulatory frameworkswhile keeping in mind that principles, values and laws can compete among and between each other at any given point in time. The term application is used to refer to the iterative process by which knowledge is put into practice or policy and has been illustrated in the action cycle of the knowledge to action process (see Figure 1) Implicit in the CIHR definition is the notion that evaluation and monitoring of KT initiatives, processes, and activities are key components of KT. Given the complexity of behavior change and the multiple factors that can influence it in positive and negative ways, there is growing recognition that application efforts could and should be guided by conceptual models or frameworks (McDonald et al., 2004; The