Barriers and facilitators to knowledge translation activities within academic institutions in low- and middle-income countries

Abstract

The barriers and facilitators of conducting knowledge translation (KT) activities are well-established but less is known about the institutional forces that drive these barriers, particularly in low resource settings. Understanding organizational readiness has been used to assess and address such barriers but the employment of readiness assessments has largely been done in high-income countries. We conducted a qualitative study to describe the institutional needs and barriers in KT specific to academic institutions in low- and middle-income countries. We conducted a review of the grey and published literature to identify country health priorities and established barriers and facilitators for KT. Key-informant interviews (KII) were conducted to elicit perceptions of institutional readiness to conduct KT, including experiences with KT, and views on motivation and capacity building. Participants included representatives from academic institutions and Ministries of Health in six countries (Bangladesh, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria). We conducted 18 KIIs, 11 with members of academic institutions and 7 with policymakers. KIIs were analysed using a deductive and inductive coding approach. Our findings support many well-documented barriers including lack of time, skills and institutional support to conduct KT. Three additional institutional drivers emerged around soft skills and the complexity of the policy process, alignment of incentives and institutional missions, and the role of networks. Participants reflected on often-lacking soft-skills needed by researchers to engage policy makers. Continuous engagement was viewed as a challenge given competing demands for time (both researchers and policy makers) and lack of institutional incentives to conduct KT. Strong networks, both within the institution and between institutions, were described as important for conducting KT but difficult to establish and maintain. Attention to the cross-cutting themes representing barriers and facilitators for both individuals and institutions can inform the development of capacity building strategies that meet readiness needs.

A mixed methods study to develop a tool to assess institutional readiness to conduct knowledge translation activities in low-income and middle-income countries

“…We conducted a qualitative study with participants in academic institutions in six countries (Bangladesh, Democratic Republic of the Congo (DRC), Ethiopia, India, Indonesia and Nigeria) to identify barriers and determinants of institutional capacity to conduct KT activities across diverse LMICs contexts, and found that soft-skills (ie, communication, self-awareness and adaptability), robust networks, and alignment between institutional priorities and incentives are important factors that shape institutional capacity to conduct KT activities in LMICs. 9 While strategies such as trainings, mentorship and institutional leadership engagement have been developed to address these barriers and determinants, 10 11 these strategies have been mostly applied to academic institutions in high-income countries (HICs), [12][13][14] with limited empirical evidence of their effectiveness in LMIC settings. 15 Irrespective of the strategies enacted to address barriers to conducting KT activities, academic institutions need to be self-aware of their role in KT and their readiness to undertake relevant KT activities addressing priority health issues to be successful.…”

“…The results from the consultation process are described in more detail elsewhere. 9 The constructs identified from the literature review and the cross-cutting themes from the consultation process were organised into a quantitative tool with 5 domains and 76 items, with new items developed for the themes. A total of nine additional questions on demographics, facilitators, and barriers to doing KT were added to translate the tool into a survey questionnaire (online supplemental appendix 1).…”

“…The five final factors that emerged from the analysis were named (1) institutional climate, (2) organisation change efficacy, (3) prioritisation and cosmopolitanism, (4) self-efficacy, and ( 5) financial resources, based on their item characteristics and the underlying theories for those items. 9 Factor 1 contains six items and was labelled 'institutional climate' because each item described aspects of their institution, colleagues, and leadership. Factor 2 contains five items and was labelled 'organisation change efficacy' to capture organisational members' shared beliefs in their joint abilities.…”

“…We sought to develop a robust organisational readiness tool designed to reflect these contextual factors specifically for KT activities. We know that while LMICs are diverse, certain barriers and determinants of institutional capacity to conduct KT are generalisable across diverse LMIC contexts, 9 and evaluating readiness of academic institutions to conduct KT along these barriers and factors may provide a starting point for enacting KT practices in specific LMICs. However, like most KT and implementation research endeavours, such readiness assessments…”

Characteristics and Methods for Mapping and Evaluating Knowledge Translation Platforms: a Scoping Review Protocol

“…Translating research evidence into policy and practice, or knowledge translation (KT), entails a "dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products and strengthen the healthcare system" (9). Limited institutional support and/or buy-in from leadership and relevant stakeholders for KT has been linked to several challenges (10,11,12,13,14), for example: poor infrastructure and inadequate nancial and technical resources speci cally for KT, inadequate soft skills, relationships and networks amongst evidence producers and evidence users negative attitudes and poor knowledge about what KT is and how to do it, and scarce local research evidence relevant to micro-level policy and practice, amongst others (10,11,12,13,14).…”