Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review

Abstract

The literature on ‘knowledge translation’ presents challenges for the reviewer because different terms have been used to describe the generation, sharing and application of knowledge and different research approaches embrace different philosophical positions on what knowledge is. We present a narrative review of this literature which deliberately sought to highlight rather than resolve tensions between these different framings. Our findings suggest that while ‘translation’ is a widely used metaphor in medicine, it constrains how we conceptualise and study the link between knowledge and practice. The ‘translation’ metaphor has, arguably, led to particular difficulties in the fields of ‘evidence-based management’ and ‘evidence-based policymaking’ – where it seems that knowledge obstinately refuses to be driven unproblematically into practice. Many non-medical disciplines such as philosophy, sociology and organization science conceptualise knowledge very differently, as being (for example) ‘created’, ‘constructed’, ‘embodied’, ‘performed’ and ‘collectively negotiated’ – and also as being value-laden and tending to serve the vested interests of dominant élites. We propose that applying this wider range of metaphors and models would allow us to research the link between knowledge and practice in more creative and critical ways. We conclude that research should move beyond a narrow focus on the ‘know–do gap’ to cover a richer agenda, including: (a) the situation-specific practical wisdom (phronesis) that underpins clinical judgement; (b) the tacit knowledge that is built and shared among practitioners (‘mindlines’); (c) the complex links between power and knowledge; and (d) approaches to facilitating macro-level knowledge partnerships between researchers, practitioners, policymakers and commercial interests.

Appeals to evidence for the resolution of wicked problems: the origins and mechanisms of evidentiary bias

“…Yet critical policy authors have countered that there is a need to move beyond a 'naïve rationality' (Russell et al 2008) that assumes evidence is somehow outside politics. Instead, these authors point to the reality that public policy decisions fundamentally involve choices between competing social values and competition between interest groups (Head 2010;Lin 2003;Greenhalgh and Wieringa 2011;Russell et al 2008). Appeals to evidence that particularly recommend policymaking be guided by evidence hierarchies have been further critiqued as imposing de facto political priority to those issues where research has already been conducted, or which are conducive to evaluation via experimentation (Barnes and Parkhurst 2014;Parkhurst and Abeysinghe 2016).…”

Translating evidence into healthcare policy and practice: Single versus multi-faceted implementation strategies – is there a simple answer to a complex question?

“…Despite the language of translational pipelines and bridging the gaps between evidence and policy or practice, real-life experiences rarely follow a straightforward rational or linear pathway (1,2). This is due to factors such as the contestable nature of evidence, the multiple influences on decision-making and the effect of contextual variables at a micro, meso and macro level (3,4).…”

Taking Power, Politics, and Policy Problems Seriously

“…As Greenhalgh and Wieringa 33 have recently observed of the KT canon generally, we need a "wider range of metaphors and models" that "allow us to research the link between knowledge and practice in more creative and critical ways" and "move beyond a narrow focus on the 'know-do gap' to cover a richer agenda." In urban health, at the very minimum, these models will need to account for urban policy making as a process, not a discrete event, and will not shrink from the idea that policy, especially equity policy, is informed by politics.…”