Integrated knowledge translation (IKT) in health care: A scoping review

Abstract

Background
Integrated knowledge translation (IKT) refers to collaboration between researchers and decision-makers. While advocated as an approach for enhancing the relevance and use of research, IKT is challenging and inconsistently applied. This study sought to inform future IKT practice and research by synthesizing studies that empirically evaluated IKT and identifying knowledge gaps. Methods
We performed a scoping review. We searched MEDLINE, EMBASE, and the Cochrane Library from 2005 to 2014 for English language studies that evaluated IKT interventions involving researchers and organizational or policy-level decision-makers. Data were extracted on study characteristics, IKT intervention (theory, content, mode, duration, frequency, personnel, participants, timing from initiation, initiator, source of funding, decision-maker involvement), and enablers, barriers, and outcomes reported by studies. We performed content analysis and reported summary statistics. ResultsThirteen studies were eligible after screening 14,754 titles and reviewing 106 full-text studies. Details about IKT activities were poorly reported, and none were formally based on theory. Studies varied in the number and type of interactions between researchers and decision-makers; meetings were the most common format. All studies reported barriers and facilitators. Studies reported a range of positive and sub-optimal outcomes. Outcomes did not appear to be associated with initiator of the partnership, dedicated funding, partnership maturity, nature of decision-maker involvement, presence or absence of enablers or barriers, or the number of different IKT activities. Conclusions
The IKT strategies that achieve beneficial outcomes remain unknown. We generated a summary of IKT approaches, enablers, barriers, conditions, and outcomes that can serve as the basis for a future review or for planning ongoing primary research. Future research can contribute to three identified knowledge gaps by examining (1) how different IKT strategies influence outcomes, (2) the relationship between the logic or theory underlying IKT interventions and beneficial outcomes, and (3) when and how decision-makers should be involved in the research process. Future IKT initiatives should more systematically plan and document their design and implementation, and evaluations should report the findings with sufficient detail to reveal how IKT was associated with outcomes.

Full text

S Y S T E M A T I C R E V I E W Open Access
Integrated knowledge translation (IKT) in
health care: a scoping review
Anna R. Gagliardi
1*
, Whitney Berta
2
, Anita Kothari
3
, Jennifer Boyko
3
and Robin Urquhart
4
Abstract
Background: Integrated knowledge translation (IKT) refers to collaboration between researchers and decision-makers.
While advocated as an approach for enhancing the relevance and use of research, IKT is challenging and inconsistently
applied. This study sought to inform future IKT practice and research by synthesizing studies that empirically evaluated
IKT and identifying knowledge gaps.
Methods: We performed a scoping review. We searched MEDLINE, EMBASE, and the Cochrane Library from 2005 to
2014 for English language studies that evaluated IKT interventions involving researchers and organizational or policy-
level decision-makers. Data were extracted on study characteristics, IKT intervention (theory, content, mode, duration,
frequency, personnel, participants, timing from initiation, initiator, source of funding, decision-maker involvement), and
enablers, barriers, and outcomes reported by studies. We performed content analysis and reported summary statistics.
Results: Thirteen studies were eligible after screening 14,754 titles and reviewing 106 full-text studies. Details about IKT
activities were poorly reported, and none were formally based on theory. Studies varied in the number and type of
interactions between researchers and decision-makers; meetings were the most common format. All studies reported
barriers and facilitators. Studies reported a range of positive and sub-optimal outcomes. Outcomes did not appear to
be associated with initiator of the partnership, dedicated funding, partnership maturity, nature of decision-maker
involvement, presence or absence of enablers or barriers, or the number of different IKT activities.
Conclusions: The IKT strategies that achieve beneficial outcomes remain unknown. We generated a summary of
IKT approaches, enablers, barriers, conditions, and outcomes that can serve as the basis for a future review or for
planning ongoing primary research. Future research can contribute to three identified knowledge gaps by examining
(1) how different IKT strategies influence outcomes, (2) the relationship between the logic or theory underlying IKT
interventions and beneficial outcomes, and (3) when and how decision-makers should be involved in the research
process. Future IKT initiatives should more systematically plan and document their design and implementation, and
evaluations should report the findings with sufficient detail to reveal how IKT was associated with outcomes.
Keywords: Integrated knowledge translation, Decision-making, Health system planning, Scoping review
Background
It has long been suggested that partnerships between
those who produce research and those who use it are
likely to enhance the relevance of research and facilitate
its use [1, 2]. A variety of terms have been used to label
this concept, each are subtly unique, and none are
viewed as the over-arching or gold-standard term [3]. In
the health sector in Canada and elsewhere, this co-
production of knowledge is commonly referred to as
integrated knowledge translation (IKT) and defined as an
ongoing relationship between researchers and decision-
makers (clinicians, managers, policy-makers, etc.) for the
purpose of engaging in a mutually beneficial research
project or program of research to support decision-
making [4]. IKT is viewed as an approach or set of
processes that can lead to the generation of knowledge for
optimizing health care delivery systems and improving
health system performance and associated outcomes [5].
Decision-making research in health care settings shows
that complex problems require complex solutions involv-
ing input from individuals with different expertise and
* Correspondence: anna.gagliardi@uhnresearch.ca
1
University Health Network, Toronto, Canada
Full list of author information is available at the end of the article
© 2016 Gagliardi et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Gagliardi et al. Implementation Science (2016) 11:38
DOI 10.1186/s13012-016-0399-1
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perspectives and iterative, generative processes to for-
mulate, execute, and evaluate solutions [6]. Collabora-
tive knowledge generation, as promoted through IKT
approaches, involves ongoing, dynamic interactions
among researchers and decision-makers, and repre-
sents an ideal means by which to address complex
health care problems [7].
Empirical research in health care settings has demon-
strated the concrete benefits of IKT. For example, in-
person contact with researchers has been repeatedly
cited by decision-makers as the most influential factor de-
termining their use of research evidence [8, 9]. Interviews
with participants of nine researcher-decision-maker part-
nerships funded by the United Kingdom National Health
Service revealed that all achieved improved clinical care
through a variety of IKT approaches [10]. An exploratory
study of a partnership among university administrators
and Scottish health authority social workers revealed
several impacts including enhanced dialogue among
partners about priority health issues, and incorporation of
research results into a training curriculum for social
workers. As a result, social workers reported the use
of research in formal health authority processes and
enhanced skill and confidence in using research in
their practice [11].
IKT appears to improve the uptake of research into
policy and practice through a variety of mechanisms.
Collaboration between researchers and decision-makers
may reveal differing perspectives, expectations, and
values, leading to greater understanding and improved
communication, which creates trust and a shared vision
that enable more effective and sustained partnership,
thereby contributing to the capacity for IKT [12]. On a
practical level, decision-makers can inform research
questions that are relevant to practice or policy; refine
research methods and/or data analysis; interpret findings
based on their contextual knowledge; and disseminate or
implement findings or products [13]. Decision-makers
benefit from interaction with researchers through a
broadened reflection on their own activities, enhanced
knowledge and skills, information about other pertinent
research, and new contacts with other researchers or
decision-makers [14]. Researchers benefit as they gain
a nuanced understanding of the policy or practice
environment, develop and pursue research questions
that have real-world applicability, and, through on-
going conversations with decision-makers, interpret
results with a deeper understanding of contextual cir-
cumstances which, in turn, enhances the usefulness of
the research findings.
Despite the emerging evidence of IKT’s positive impact,
IKT is not yet widely practiced or well understood. Re-
search directors in Canada reported that researchers tend
to use traditional means of conducting and disseminating
research rather than IKT approaches [15, 16]. Similarly, a
recent survey of health policy experts active in 30
European countries revealed little use of IKT other than
isolated instances of embedded researchers in government
research institutes or on advisory committees [17]. Lack
of engagement in IKT may reflect an inability to overcome
the challenges inherent in coordinating complex,
protracted initiatives with multiple stakeholders holding
different views and pursuing different interests, or it may
reflect a lack of incentives for researchers and decision-
makers to engage in the more protracted and, hence,
costly processes of knowledge co-generation [18, 19].
Reflection on the challenges faced by researcher-decision-
maker partners that investigated primary care networks
resulted in several recommendations to facilitate IKT
including the following: identify partners with pre-
established links to ease and expedite interaction; establish
clear expectations about role, scope, and contribution to
foster trust and avoid role confusion and misconceptions;
put in place mechanisms that initiate and support
dialogue among partners; and jointly assess progress and
implement changes as needed [20]. A case study based on
three health service delivery programs found that IKT ac-
tivities were dynamic and not linear and highly influenced
by the complex context within which decisions were being
made including social and political norms [21]. When IKT
was formally incentivized with considerable funding
through national initiatives, the number of interac-
tions and projects increased but the research process
was characterized as largely investigator-driven, and
there was limited impact on health service delivery
and outcomes [22, 23].
Clinicians, researchers, and research funders have
emphasized the need to understand how to foster and
achieve IKT in the health sector [24–28]. The purpose
of this study was to characterize the nature of research
in this area, describe IKT strategies that were empirically
evaluated, reveal whether sufficient research is available
to undertake a systematic review of the effectiveness of
various IKT approaches, and also identify knowledge
gaps for future IKT research.
Methods
Approach
Initially, we had intended on a systematic review;
however, based on our preliminary searches which re-
vealed a paucity of studies that have actually evaluated
IKT approaches or strategies, we reverted to a scoping re-
view. A scoping review was conducted using approaches
promoted by Arksey and O’Malley [29] and Levac et al.
[30]. This type of review is used to examine the extent,
range, and nature of research activity for a particular topic.
A scoping review generates a profile of the existing litera-
ture on that topic and identifies gaps, thus serving as a
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foundation for future reviews or primary research. Such
reviews do not attempt to synthesize quantitative findings
or assess the quality of the literature. The five-step
approach (scoping, searching, screening, data charting,
data analysis) was carried out iteratively as the state of the
literature on IKT became clearer. We did not assume a
theoretical stance or interpretation because that is not
customary in a scoping review. Given that this review
ultimately did not identify IKT characteristics that lead to
beneficial outcomes, consultation with experts to validate
or interpret the findings was not carried out [30]. The
Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) criteria guided the conduct and
reporting of the review [31]. Data were publicly available
so institutional review board approval was not necessary.
A protocol for this review was not registered.
Scoping the inquiry
To plan for the full-scale scoping review, a preliminary
scan of relevant literature was undertaken by searching
MEDLINE with the MeSH terms “participatory research”
or “interdisciplinary research”or keywords “knowledge
exchange”or “integrated knowledge translation.”Search
results were first screened by all investigators to begin to
understand how IKT was operationalized and then
discussed by email and a teleconference. This knowledge
was used to establish the research purpose, plan a more
comprehensive search strategy, and generate eligibility
criteria based on the PICO (population, intervention,
comparisons, outcomes) framework. Populations refer to
researchers and organizational or system-level decision-
makers in health care settings including clinician man-
agers, health care managers, and policy-makers involved
in academic initiatives (finite or ongoing projects, stud-
ies, groups) that used or were based on IKT approaches.
Partnerships may have been initiated by researchers or
decision-makers where the goal was evidence-informed
decision- or policy-making, or they could have a dual
purpose—to generate knowledge through empirical re-
search and to resolve practical problems. Non-research
partnerships formed solely for quality improvement or
to seek input from researchers were not eligible. Studies
that focused on front-line providers and clinical
decision-making were excluded, as were those focusing
on patients or consumers. Although all are legitimate IKT
partners, they were considered beyond the boundaries of
the current review. The intervention of interest was
IKT, defined as collaboration between researchers and
decision-makers in the research process including
establishing the research questions, deciding on the
methodology, recruiting and/or collecting the data,
interpreting the results, and disseminating the find-
ings [32]. In particular, this review examined the IKT
activities that comprised or promoted collaboration,
which we refer to collectively as “approaches”but, in the
absence of a universally accepted taxonomy, may also be
referred to as strategies, mechanisms, methods, activities,
or processes. Decision-makers could take part in one or
more of these functions but not solely in dissemination or
implementation. All studies included in the review
explicitly described and evaluated IKT strategies.
Study comparisons mayhaveevaluateddifferentIKT
approaches and associated barriers, enablers and im-
pacts, either alone or in comparison with typical,
non-IKT approaches to research, or with other types
of approaches for promoting collaborative research.
Outcomes included but were not limited to know-
ledge, attitudes, beliefs, partnership formation (shared
understanding of issues, common language, etc.),
behaviors, and outcomes, while recognizing that one
objective of the scoping review was to identify the
range of reported impacts.
Eligible study designs included randomized controlled
trials, interrupted time series, observational studies
(retrospective, prospective, before-after or comparative
cohorts), surveys, qualitative research, case studies, or
mixed methods research. Studies were not eligible if
they
concluded that IKT was needed without having
described and evaluated it
described the planning or development of an IKT
initiative without having evaluated it
examined issues of authorship among research
collaborators
focused on online communities (i.e., interaction or
data collection by social media), translational
research (i.e., from wet lab to clinical application), or
collaborations between physicians and industry
described action research, community-based
interventions, practice-based quality improvement
initiatives (researchers describe conditions in the
setting within which they are embedded where the
overall goal is quality improvement), practice-based
research networks (groups of clinicians or institutions
that jointly deliver patient care), or interorganizational
networks or quality improvement collaboratives that
sought to disseminate knowledge to front-line
providers or improve service delivery and
outcomes but do not undertake research
were publications in the form of editorials, opinion
articles, protocols, abstracts, proceedings, or
conceptual analyses
if the description of the partnership lacked detail
such that it was unclear if decision-makers
participated in research activities
or if research methods used to evaluate the IKT
initiative were not provided.
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Systematic reviews were not eligible but were used to
identify eligible primary studies.
Search strategy and screening process
A comprehensive literature search was conducted by
using several indexed sources. The principal investigator
(ARG) and a trained research assistant conducted all
searches with guidance from a medical librarian. It has
been noted by other researchers that the IKT literature
is not consistently indexed [33, 34] so several search
strategies were tested by the medical librarian to
optimize the retrieval of a few IKT citations known to
the investigators (specificity) and, in particular, to
increase the likelihood that all relevant studies would be
retrieved (sensitivity). The MEDLINE search strategy is
shown in Additional file 1 (we used the search shown on
line 84). MEDLINE, EMBASE, and the Cochrane Library
were searched on 1 February 2015 from 2005 to 2014
inclusive. A 10-year time span was likely to capture most
relevant literature since IKT is a relatively new
phenomenon in the health care sector. Pairs of investiga-
tors screened titles and abstracts according to specified
eligibility criteria. Rather than resolving selection differ-
ences, all those selected by at least one reviewer were
retrieved since ultimate judgment about the inclusion
must often be reserved until the full text is examined.
If more than one publication described a single study
and each presented the same data, the most recent
was included.
Data charting and analysis
A data charting form was developed and piloted by the
team to collect information on the country in which the
research was conducted, study design, underlying theory
used to design the IKT intervention or analyze the find-
ings, the IKT intervention, enablers and barriers, and
any reported outcomes. Based on the Workgroup for
Intervention Development and Evaluation Research
(WIDER) reporting checklist [35], details about the
intervention included content (nature and goal of the
program and/or IKT partnership), mode of delivery
(specific types of IKT activities in which partners were
involved), duration and/or frequency (timing of IKT ac-
tivities), participants (who was involved in specific IKT
activities), and personnel (who coordinated or led IKT
activities). Time from initiation, the entity that initiated
the partnership, and source of funding were also noted.
All investigators charted data from eligible studies.
Summary statistics were used to describe the number
of studies by country, year of publication, and study
design; whether the IKT initiatives employed single or
multi-faceted interventions; and whether they were
designed based on theory. Relational analysis was used
to summarize study findings [36]. With this technique,
all data from eligible studies were perused to identify
each unique instance of an IKT approach or strategy,
enabler, barrier, and outcome. This approach allowed
gaps in the IKT literature to be identified. These data
were added to the IKT approaches or strategies,
enablers, barriers, and outcomes identified in studies ref-
erenced in the background of this manuscript and then
compiled in a summary of IKT conditions, influencing
factors, and outcomes. This approach made clear what
was known and not known about IKT interventions. To
further understand knowledge gaps, we identified poten-
tial associations between the characteristics of IKT strat-
egies, contextual factors, and outcomes by categorizing
IKT as used in eligible studies based on type of engage-
ment (conceptualization or planning, recruitment or
data collection, interpretation, and dissemination or
implementation) [33]; time from initiation; entity that
initiated the partnership; source of funding; and the
reported barriers, enablers, and outcomes. Outcomes
were categorized in relation to study objectives as posi-
tive (all reported outcomes were positive or improved)
or mixed (some reported outcomes were positive/im-
proved and some were negative/not improved).
Results
Search results
After duplicate titles were removed, the initial search
resulted in 14,754 unique articles. Screening of titles and
abstracts excluded 14,648 articles, leaving 106 as poten-
tially eligible. Screening of full-text items excluded an
additional 93 articles: no partnership (57), no evaluation
(17), ineligible publication type (9), focus on clinical
quality improvement (6), not health care (3), duplicate
study (1), leaving 13 that were eligible for inclusion (Fig. 1).
Charted data appears in Additional file 2 [37–49].
Characteristics of eligible studies
Studies were published between 2005 and 2014. Ten of
13 studies were published in 2013 or 2014 and one each
in 2005, 2006, and 2009. Four studies were conducted in
Canada, four in the UK, two in the USA, and one each
in Lebanon, the Netherlands, and Sweden. Five studies
were based on a mixed methods design, five on a case
study design, and three on qualitative interviews.
IKT activities used in partnerships
No studies explicitly mentioned the use of theory upon
which the IKT initiative or any of its component strategies
were based. Table 1 summarizes the characteristics of IKT
partnerships in eligible studies. The content or focus of
partnerships varied from specific health topics, for ex-
ample, implementation of a depression intervention [38]
or studying the impact of environment on breast cancer
[45], to very broad initiatives that conducted applied
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health services research to ultimately improve population
health [47]. The most common activities or modes of
interaction were meetings (i.e., team, working group,
committee, board) or presentations (i.e., conferences,
workshops). Five of 13 studies reported the duration and/
or frequency of specific activities [37–39, 46, 47]. While 8
of 13 studies mentioned the categories of participants in-
volved, 1 of those studies reported the number and/or
type of participants involved in specific activities [38].
While all but 4 of 13 studies mentioned modes of inter-
action [39, 41, 43, 44], authors provided few specific
details about when these activities took place and who
was involved. For example, in one study, authors reported
that team meetings involving an unspecified number of
senior managers and medical directors were held periodic-
ally over a 3-year period [46]. No studies reported
personnel who organized or led the activities.
Enablers and barriers of IKT
Table 2 lists 9 enablers and 15 barriers of IKT reported
across studies. All studies reported both barriers and
enablers.
Outcomes of IKT
Table 2 lists the outcomes of IKT that were reported by
studies as positive (12) and sub-optimal (7). There was
little overlap across studies. For example, the most com-
monly reported benefit was the development of capacity
among researchers and decision-makers for engaging in
IKT in 7 studies, and the next most commonly reported
benefit was enhanced value for research among
decision-makers in 4 studies. Many other benefits and
all sub-optimal outcomes were unique to individual
studies. Most studies reported measures that reflected
the more immediate impact of IKT on partnership
formation, for example, mutual understanding of
language, work style, needs and constraints, or general
views about research or the collaborative process. Fewer
studies reported measures that reflected the interim or
longer term impact of IKT. For example, 4 studies
assessed whether research was used for decision-making.
Characterization of IKT initiatives
Table 3 characterizes the IKT partnerships, strategies,
and conditions in eligible studies. Most partnerships
were initiated by governments that provided dedicated
resources for the initiative (7 of 13 studies). This did not
appear to be associated with successful outcomes. Of the
7 studies with dedicated funding from government, 2
achieved positive, 4 achieved mixed, and 1 achieved sub-
optimal or no impact on measures that were reported.
All 8 studies that reported timing of the evaluation with
respect to time from initiation of the partnership had
existed for a minimum of 2 years; thus, partnership
maturity did not appear to be associated with outcomes.
The number of different types of interaction between
researchers and decision-makers did not appear to be
associated with outcomes; in the 4 studies that achieved
positive impact in all outcomes reported, the number of
types of interaction ranged from 1 to 8 (based on data in
“Mode”column of Table 1). Many studies did not expli-
citly report how decision-makers were involved through-
out the research trajectory. Among those that provided
such details, decision-makers were most often involved
in conceptualizing or planning research (10 studies) and
in disseminating or implementing the findings (7 studies).
One study reported that decision-makers were involved
throughout the research process and achieved positive re-
sults on all reported outcomes. In contrast, three studies
achieved positive results on all reported outcomes when
Fig. 1 PRISMA diagram of eligible studies
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Table 1 Description of IKT initiatives in included studies according to WIDER criteria [35]
Study Content (program focus) Mode (IKT approaches/activities) Duration, frequency, timing Participants Personnel
El-Jardali 2014 [38] Evidence-based health policy-making Evidence briefs, deliberative
dialogues, priority setting, training
sessions, rapid response service, web
portal
NR Researchers, policy-makers, other
stakeholders from many countries
(NR by activity)
NR
Eriksson 2014 [39] Health promotion Consultation, meetings, conferences,
annual progress reports, joint
research, steering group,
coordinating committee, working
groups
Varied from monthly
to annual meetings
Politicians, public clinicians, agency
representatives, researchers (NR by
activity)
NR
Khodyakov 2014 [40] Depression Meetings, working groups, training
sessions, web portal
Biweekly meetings,
4 months
Researchers, clinicians, social workers,
policy-makers, counselors, clergy
(mean 20–25 by event)
NR
Kothari 2014 [37] Women’s health Team meetings, priority setting,
applying for research funding, joint
research, web portal
NR Researchers, partners, trainees from
many countries (NR by activity)
NR
Kislov 2014 [41] Applied health research on a range
of topics
NR Quarterly meetings,
3 years
NR NR
Hoeijmakers 2013 [42] Public health knowledge sharing Meetings, training sessions, joint
research, steering committee, board
of governors, public relations
NR NR NR
Martin 2013 [43] Prevention, early detection, self-care,
rehabilitation
NR NR NR NR
Murnaghan 2013 [44] Youth health, prevention of chronic
disease
Meetings, planning sessions,
presentations; print, web, and media
communications
NR Policy-makers, health authority and
agency representatives, researchers
(NR per activity)
NR
Rycroft-Malone 2013 [45] Applied health research on a range
of topics
NR NR Board, managers, health authorities,
committees, researchers (NR per
activity)
NR
Soper 2013 [46] Applied health research on a range
of topics
NR NR NR NR
Van Olphen 2009 [47] Breast cancer Joint research, meetings,
presentations
NR NR NR
Patten 2006 [48] Priority setting practices Team meetings, joint planning NR Clinicians, managers, researchers
(NR by activity)
NR
Bowen 2005 [49] Health promotion Workshops Three 2-day yearly
events, 5 years
Health authority personnel,
researchers (NR by activity)
NR
NR not reported
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decision-makers were involved in only some aspects of
the research process.
Summary of the IKT conditions, influencing factors,
and outcomes
Figure 2 shows a summary of IKT approaches, enablers,
barriers, conditions, and outcomes that were initially
compiled from background literature and expanded with
items that emerged from this study. This summary pre-
sents the enablers, barriers, and conditions that have
been reported to influence the IKT approach and a range
of possible outcomes relevant to IKT partnerships. Given
the small number of eligible studies, limited detail about
IKT, and mixed findings, the relationships between en-
ablers, barriers, contextual conditions, and outcomes re-
main unclear. As more IKT studies are reported in the
literature, the barriers, enablers, and outcomes might be
further organized into higher order categories with pro-
posed indicators. In the short term, this framework may
be used by others to prospectively plan IKT projects/
programs and their evaluation.
Table 2 IKT enablers, barriers, and outcomes
Measures Reported findings Studies (n)
Barriers (9) Differing needs and priorities
among participants
5
Lack of skill in or understanding
of IKT processes
5
Attitudes about researchers or
the value of research
4
Goals, roles, and expectations not
clear
3
Lack of incentives to participate 3
Lack of funding or infrastructure
for IKT
2
Little continuity of involvement
due to staff turnover, infrequent
attendance
2
Participants are busy with
multiple responsibilities
1
Geographic distant imposes
limits on interaction
1
Enablers (15) Multiple and varied opportunities
for interaction
4
Strong leadership commitment,
skill, and experience
3
Phased approach to develop
shared language, achieve early
successes
3
Support from facilitators,
champions, and boundary
spanners
2
Clear and agreed upon goals,
roles, and expectations
2
Immersion of researchers in
decision-maker setting/co-
location
2
Formalized branding, structures,
and processes
2
Establish partnership early in the
research process
1
Openness of partners to listen,
learn, and adapt
1
Organizational support for
decision-makers to meaningfully
contribute
1
Dedicated funding 1
Shared governance structures 1
Built on preexisting relationship 1
Availability of data to inform
activities
1
Periodic external review to assess
progress
1
Positive outcomes (12) Capacity developed by
researchers and decision-makers
7
Decision-makers grew to value
research
4
Table 2 IKT enablers, barriers, and outcomes (Continued)
Developed an appreciation for
the collaborative process
3
Enhanced relevance of the
research
3
Decision-maker involvement
sustained through entire process
2
Enhanced mutual understanding
of language, work style, needs,
and constraints
2
Number of collaborative projects
undertaken/completed
2
Influenced policy-making 2
Influenced service delivery 1
Increased diversity of involved
partners
1
Strengthened relationships, trust,
and goodwill
1
Emergence of community
leaders
1
Mixed outcomes (7) Decision-maker involvement
varied across activities
1
Failure to overcome differences
and bridge boundaries
1
Collaborations were temporary 1
Little to no research produced 1
Research not used in policy-
making
1
Greater emphasis on research
publications than stakeholder
engagement
1
Benefits only beginning to emerge 1
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Discussion
This scoping review was conducted to describe the
knowledge base underlying IKT, gleaned from studies
that described and evaluated IKT strategies, and identify
gaps to inform future research. Thirteen studies were
eligible. The most common form of interaction was
meetings, but they varied in nature, aims, and frequency.
All studies reported both barriers and enablers. While
most studies achieved one or more positive outcomes,
studies reported a wide range of positive and less posi-
tive outcomes. Given incomplete and inconsistent
reporting of study design, IKT strategies, and outcomes,
it was not possible to identify relationships between
outcomes and contextual factors related to initiator of
the partnership, dedicated funding, partnership maturity,
nature of decision-maker involvement, presence or ab-
sence of enablers or barriers, or the number of different
IKT activities employed in a given initiative. A number
of studies assessed partnership formation. Given that the
partnerships evaluated were at least 2 years old, it may
not be reasonable to evaluate the influence of research
on decision-making until more immediate outcomes
such as learning about research, awareness and accept-
ance of research, mutual understanding, development of
trust and goodwill, and an appreciation for the collab-
orative process are established. Another scoping review
of stakeholder involvement in rehabilitation research
found that stakeholder preparation was needed to
understand research and fulfill their role [33]. This took
the form of formal and informal training and, in some
studies included in that review, decision-makers were
paid to participate in the training.
To the best of our knowledge, this study is among the
first to attempt to identify the characteristics of IKT
strategies and their potential association with outcomes
using a rigorous approach. Our scoping review is distin-
guished from that of Jagosh et al. who published a realist
systematic review on the effectiveness of community-
based participatory research partnerships that included
276 studies [36]. In participatory, action or community-
based research, the intent is to improve the quality of
service delivery, health equity, or clinical outcomes
where community-identified rather than research-based
solutions are emphasized, or researchers function as
Table 3 Summary of IKT conditions, influencing factors, and outcomes
Study Time from
initiation
(years)
Types of
interaction
(number)
Initiator/
Funding
Decision-maker involvement Enablers Barriers Outcomes
a
Conceptualize
and plan
Recruit or
collect data
Interpret
findings
Disseminate or
implement
El-Jardali 2014 [38] 2 to 3 6 WHO
Dedicated
+NR+++++/−
Eriksson 2014 [39] NR 8 Government
Dedicated
+++++++
Khodyakov 2014 [40] NR 4 Researcher
Research
+NRNR++++
Kislov 2014 [41] 2 NR Government
Dedicated
+NRNR+NR+-
Kothari 2014 [37]2 5 NR
Research
+ + NR + + + +/−
Hoeijmakers 2013 [42] 2 6 Government
Dedicated
+NRNRNR+++/−
Martin 2013 [43] 2 NR Government
Dedicated
NR NR NR NR + + +/−
Murnaghan 2013 [44] NR 6 Government
Dedicated
+ NR + + + NR +
Rycroft-Malone 2013 [45] 3 to 4 NR Government
Dedicated
NR NR NR NR + + +/−
Soper 2013 [46] NR NR Government
Dedicated
NR NR NR NR + + +/−
Van Olphen 2009 [47] NR 3 Researcher
Research
+NRNR++++/−
Patten 2006 [48] 3 2 Health region
NR
+NR+—++NR
Bowen 2005 [49] Over
5 years
1NR
Research
+ NR + NR + + +
a
Outcome refers to beneficial or sub-optimal outcomes as reported by studies: in relation to study objectives
+ all reported outcomes were positive or improved, +/−mixed outcomes (reported outcomes positive/improved and negative/not improved), NR not reported
Gagliardi et al. Implementation Science (2016) 11:38 Page 8 of 12
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

consultants. We chose to define IKT as partnerships
between researchers and organizational or system-level
decision-makers including clinician managers, health
facility managers, and policy-makers for the purpose of
academic research, although those partnerships may have
enabled improvements in service delivery or clinical out-
comes. IKT decision-maker partners are distinct in that
they are specifically selected for their scope of responsibility
and,hence,authoritytoinvokepracticeorpolicychange.
This scoping review, which goes beyond anecdotal ac-
counts, may serve as a springboard to the conduct of future
research that specifically examines researcher-decision-
maker partnerships.
Despite suggestions that lack of funding is a deterrent
to practicing or achieving IKT [3, 18, 19], in this study,
formal IKT partnerships that were specifically initiated
and funded by governments did not appear to eliminate
barriers or report better outcomes compared with other
studies that lacked such infrastructure. This included
four studies evaluating Collaborations for Leadership in
Applied Health Research and Care (CLAHRC) in the
UK [41, 43, 45, 46] and one study evaluating Academic
Collaborative Centres (ACC) for Public Health in the
Netherlands [42]. Both of these national-level initia-
tives involved large-scale investment to foster IKT.
Since partnerships may develop over time, and add-
itional evaluations may be forthcoming, longitudinal
evaluation of these important initiatives is warranted to
identify beneficial outcomes. Another way to interpret
these findings is that other barriers, enablers, or context-
ual conditions may be more important than funding to
the formation and outcomes of IKT partnerships. Such
insight was not afforded by this study because enablers,
barriers, and outcomes were variable across studies and
not consistently recorded or described. In future research,
longitudinal analytic approaches may be useful to evaluate
IKT impact and clarify the relationship between IKT ap-
proaches and outcomes. A time series design, for example,
could be used to systematically track the evolution of part-
nership formation and better pin-point the activities or
Fig. 2 Summary of IKT approaches, influencing factors, and outcomes
Gagliardi et al. Implementation Science (2016) 11:38 Page 9 of 12
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

strategies that move the partnership from the formation
stage into a more functional and active stage.
IKT was poorly and inconsistently described, evaluated,
and reported in most studies, making it challenging to
identify strong thematic areas. However, three important
knowledge gaps were clearly identified. First, some studies
evaluated the IKT initiative but did not describe or detail
the IKT activities. Future researchers are encouraged,
therefore, to capture and report the full extent of IKT ac-
tivities, including the nature or mode of interactive activ-
ities (i.e., brainstorming sessions, data interpretation
sessions, passive dissemination through websites), who is
involved in which activity, who is leading the activity, and
how often activities take place. This cumulative un-
derstanding will allow a nuanced typology of different
IKT models to emerge. Those who plan and imple-
ment and/or evaluate IKT initiatives might employ
the WIDER reporting checklist when they design such
initiatives or report evaluative findings [34]. The
WIDER checklist recommends describing: the interven-
tion (approaches, strategies), mode of delivery (intensity,
duration, timing), intervention content (knowledge
generated or shared), participants and their role (the
characteristics of those sponsoring, delivering, and receiv-
ing the intervention), setting, and adherence or fidelity.
The second knowledge gap to emerge was the lack of ex-
plicit description of underlying theory or logic upon which
IKT approaches and associated activities were selected and/
or evaluated. As the WIDER checklist specifies, details are
needed about how the IKT intervention was developed,
change techniques used in the intervention, and the causal
processes targeted by the change techniques to achieve par-
ticular outcomes. Therefore, future research could focus on
identifying, describing, and testing relevant theory by which
to design and/or evaluate IKT initiatives. First, it may be
useful to conduct an interpretive synthesis of the findings
reported here by analyzing enablers and barriers according
to the context and design of IKT initiatives in the included
studies. A scoping review is an appropriate starting point to
understand the nature of the empirical work in the domain
and to determine if a systematic review is warranted. Thus,
we deliberately maintained a wide focus rather than target-
ing certain aspects of the IKT process. Our findings suggest
that the empirical work in the area is just emerging, and
thus it is premature to embark on a systematic review with
atightfocus.
The third knowledge gap pertains to decision-maker in-
volvement. IKT activities most often consisted of meetings
between researchers and decision-makers. However, the na-
ture of those meetings and the level of engagement of
decision-makers in research-related decisions or research
activities were not reported. In some cases, decision-makers
were reported as playing a role in disseminating or imple-
menting the results. It was largely not reported if decision-
makers took part in any way in the conduct of the research
or interpretation of the findings. Given that the nature of
decision-maker involvement was largely under-described,
we cannot say if the involvement of decision-makers
throughout the course of a research initiative, which is the
purported ideal [3], actually achieves better outcomes.
Other studies of IKT also reported that research remained
largely investigator-driven [22, 23], and decision-makers
were often not directly involved as integral partners [14].
Future research must examine a range of IKT approaches
to identify the ideal timing and manner in which decision-
makers must be involved for effective research uptake.
Several issues may limit the interpretation and use of
these findings. The relatively small number of eligible
studies may have precluded identifying with greater
certainty the characteristics and contextual conditions
required to foster and achieve IKT. This may, in part, be
due to the fact that studies about IKT are difficult to iden-
tify. Other researchers have noted that the IKT literature
is not consistently indexed in databases of published re-
search [33, 34]. Screening of search results was challen-
ging due to the large number of search results to assess
and limited detail in the studies by which to ascertain eli-
gibility. This means that the resulting summary of IKT
(Fig. 2) is inclusive of numerous characteristics and condi-
tions that require further evaluation of their association
with outcomes. Although we searched standard indexed
sources of published medical literature, the search strategy
may not have identified all relevant studies. Study retrieval
was limited to journals that are indexed in the three
databases that were searched. We did not search the grey
literature, assuming that most empirical research on IKT
interventions would be found in indexed databases. Many
studies did not provide a full description of the research
methods used or fully describe the research findings for all
components of a case study or mixed methods research.
Most studies collected qualitative data; however, they were
often not complete or sufficiently detailed to extract clear
findings with respect to enablers, barriers, and, in particu-
lar, outcomes. Given limited detail about IKT activities, it
was difficult to chart data; however, we employed a rigor-
ous methodology that complied with standard approaches
for scoping reviews [29, 30], and data were charted inde-
pendently by two investigators for all articles to enhance
reliability. In the absence of a universally accepted
taxonomy with which to refer to IKT approaches, activ-
ities, processes, etc., it was challenging to describe and
summarize how IKT was operationalized in included stud-
ies. Most studies reported one or more positive outcomes
which may represent a bias toward reporting favorable
findings; this is further underscored by the small number
of eligible studies. Insufficient knowledge emerged from
this scoping review to enable a full understanding of the
variety of ways to promote IKT partnerships and engage
Gagliardi et al. Implementation Science (2016) 11:38 Page 10 of 12
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

in interactions. Therefore, we are unable to issue clear or
justified recommendations in this regard. As more re-
search on IKT emerges, this may become possible at some
point in the future. Finally, some scholars [30] have sug-
gested that stakeholders ought to be consulted to validate
and extend the interpretation of scoping review findings.
Given the variation in results across the 13 articles, we
suggest this step is better served in the future when add-
itional research is available.
Conclusions
This scoping review found that most of the IKT initiatives
that were evaluated achieved one or more positive out-
comes. However, few studies were eligible, and IKT activ-
ities were poorly described, evaluated, and reported.
Outcomes did not appear to be associated with initiator of
the partnership, dedicated funding, partnership maturity,
nature of decision-maker involvement, presence or absence
of enablers or barriers, or the number of different IKT ac-
tivities. Based on these findings, we cannot identify the-
matic areas across the studies to recommend particular
IKT strategies or ideal contextual conditions. However, we
generated a summary of the characteristics of IKT that have
been examined and identified additional factors that remain
to be examined. The findings can serve as the basis for fu-
ture reviews, and for planning ongoing research that more
systematically designs, implement s, and evaluates IKT activ-
ities, and reports the findings with sufficient detail to reveal
how IKT was associated with outcomes. Three important
knowledge gaps were identified that lay the foundation for
a research agenda in the area of IKT research.
Availability of supporting data
The data set(s) supporting the results of this article is
(are) included within the article and its additional file(s).
Additional files
Additional file 1: MEDLINE search strategy. (DOCX 17 kb)
Additional file 2: Data extracted from eligible studies. (DOCX 40 kb)
Competing interests
The authors declare that they have no competing interests.
Authors’contributions
ARG and WBB conceived the study, coordinated all aspects of its conduct,
and prepared this manuscript. All authors assisted with study planning, data
collection and interpretation, and drafting the manuscript. All authors read
and approved the final manuscript.
Acknowledgements
This study was undertaken with no funding.
Author details
1
University Health Network, Toronto, Canada.
2
University of Toronto, Toronto,
Canada.
3
University of Western Ontario, London, Canada.
4
Dalhousie
University, Halifax, Canada.
Received: 14 December 2015 Accepted: 5 March 2016
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