Perceived Barriers and Facilitators to Using Knowledge Brokers in Canadian Rehabilitation Settings: A Qualitative Study

Abstract

Background: Knowledge translation experts advocate for employing knowledge brokers (KBs) to promote the uptake of research evidence in health care settings. However, little is known about factors influencing the utilization of KBs, thereby limiting their employment within healthcare organizations. This research aimed to identify factors likely to hinder or promote the optimal use of KBs within rehabilitation settings in Canada.Methods: Qualitative study using semi-structured telephone interviews with individuals performing KB activities in rehabilitation settings across Canada. The interview topic guide was informed by the Consolidated Framework for Implementation Research (CFIR) and consisted of 20 questions covering five domains (characteristics of individuals, inner setting, process, outer settings, and innovation characteristics). All interviews lasted 60 to 90 minutes, were digitally recorded, and transcribed verbatim. We conducted qualitative descriptive analysis combining deductive coding guided by the CFIR. Two independent analysts coded and rated all interviews, then met to review, deliberate and modify the codes as appropriate. A matrix was created by listing the salient codes for each CFIR construct to identify factors (facilitators and barriers) at the individual, organisational, and process level most likely to impact the KB’s success/failure.Results: Twenty-three participants, from five Canadian provinces were interviewed. At the individual level, the majority of participants reported having strong communication skills, being confident about performing KBs activities, and possessing solid clinical experience and prior research skills. At the organizational level, most respondents indicated constantly networking and engaging with clinical teams and different stakeholders, and having an acceptable level of guidance from their managers. Very few participants felt that they received sufficient organizational support (i.e., clerical support and IT support). At the process level, all participants indicated needing evaluation tools to better gauge their performance, and the majority mentioned that they would benefit from having additional training tailored to their roles as KBs.Conclusions: Individual, organisational and process level factors likely to hinder or promote the optimal use of KBs within Canadian rehabilitation settings include skillsets and networking abilities; culture, resources, and leadership support; and the need for specific training for KBs and for evaluation tools to monitor their performance.

Nationwide Environmental Scan of Knowledge Brokers Training

“… 79 Developers of ETOs may have deliberately omitted those skills because KBs tend to naturally possess basic communications and networking skills. 59 , 80 Those types of skills seem to be related to other interpersonal attributes that KBs have (ie, enthusiastic, 56 , 70 , 72 , 81 , 82 proactive, 56 , 81 motivated, 56 , 81 , 82 positive, 56 , 81 , 82 persuasive, 56 , 81 , 82 entrepreneurial, 56 , 81 friendly, 56 , 81 open-minded, 56 , 79 , 81 having emotional intelligence 56 , 69 , 81 , 83 – 85 and intellectual curiosity, 56 , 81 and actively working to engage their peers 82 ).…”

“…Several studies have also emphasized the ongoing networking as an important element in knowledge brokering. 49 , 51 , 59 , 87 , 94 , 95 Considering other health care professions beyond rehabilitation, the linkage approach seems to be commonly adopted by KBs in the context of healthy aging. 96 Similarly, few ETOs prepared participants for a facilitator role, although it was rated as the third role (of five) in importance for task frequency among KBs in rehabilitation 58 and as an essential role of knowledge brokering performed by advanced practice nurses.…”

“… 58 , 82 Given that most KBs did not receive any KB-related training, this may be because of a lack of KBs competence on how to use research skills to fulfill the evaluator role. 58 , 59 On the other hand, ETOs' developers paid less attention to the other types of competency–role combinations, for example, developing communication skills to fulfill the facilitator role, developing mediation skills to fulfill the linking agent role, and providing knowledge and skills related to the information manager role.…”

“…Because of insufficient training, KBs relied on their accumulated experience overtime to perform these roles. 58 In a parallel study, 59 we interviewed 23 rehabilitation KBs to identify the factors that hinder or promote the optimal use of KBs. KBs were not always aware of existing KB-related training, which partly explained why several depended on “on-the-job” learning.…”

“…The lack of available financial support for KBs training was also highlighted by a recent study conducted by our team. 59 Several researchers have emphasized the importance of dedicating a part of professional development funding to KBs who require additional training as this can greatly impact the success of brokering activities 27 47 52 56 69 70 71 72 and positively influence the initiation and the sustainability of the KBs roles 52 70 71 72 One solution might be to offer KBs the possibility of attending online courses available in some provinces.…”