The lion's tail and knowledge boundaries are two analogies referred to in the lead essay by Lindstrom, MacLeod and Levy. These may be helpful but require slight readjustment. Grabbing onto the lion's tail implies one reality and one intersection point, whereas the old analogy of the blind men and the elephant shows that various perspectives are required. Integrated knowledge translation refers to user involvement throughout the research process. Participatory models are one form of integrated knowledge translation, but caution is required to help maintain the knowledge boundaries. There is the real danger of one group becoming "pickled," or having unbalanced osmotic pressure from another group, resulting in destroyed "cell wall" boundaries. Neither researchers nor users should morph into each other but should, rather, fulfill unique roles within a respectful, trusted research relationship. Lessons learned at the Manitoba Centre for Health Policy teach us that collaborative health services research takes time, money, mutual understanding and respect (including respect from academic institutions for this paradigm of research). This requires a dedicated centre of core group scientists willing to devote the necessary time. Diffused networks may not be stable enough to maintain the long-term relationship building required for the intersection of researchers and decision-makers.
In 1990, the Quebec Social Research Council - a body financing social research in Quebec, Canada - launched a new policy encouraging the development of social research units within health care organizations. Through financial incentives, it encouraged the implementation of long-term collaborations between researchers and practitioners with the purpose of transforming both scientific knowledge production and professional practices. This paper examines the perceptions of researchers and practitioners regarding the attributes and the usefulness of this collaborative research policy.
A self-administered survey was sent to all the researchers (n = 146; response rate 78.1%) and practitioners (n = 204; response rate 44.1%) involved in the 21 collaborative research teams funded in 1998. T-tests were performed in order to assess the difference between the perceptions of researchers and practitioners in five key dimensions of collaborative research.
The results showed that, contrary to expectations, researchers and practitioners shared fairly similar views regarding the various dimensions of collaborative research. They both agreed that their involvement within collaborative research teams had contributed to the development of new skills and practices but had not facilitated their participation in external activities nor their involvement in networks and organizations that influence environments in which public policies and practices are deployed. They also both encountered some difficulties in putting the dimensions that they highly valued into practice.
Collaborative research within health care organizations succeeded in fostering the implementation of new modes of knowledge production and intervention. Nevertheless, special attention needs to be given to the development of strategies to reduce the discrepancies between values and practices.
The performance of Canada's primary care sector remains lacklustre relative to other wealthy industrialized countries, and it has been suggested that a lack of investment in research and evaluation may be a cause. One approach to improving and sustaining primary care research is through research networks. Over the past few years, significant investments have begun to be made in developing primary care networks in Canada. While Canadian experience in this area is relatively new, in the United Kingdom primary care research networks were first established in the 1980s. Initially developed at a local level, these have more recently been incorporated into large-scale national networks. This paper reviews the UK experience and highlights potential lessons for the development of networks in Canada.
Notes
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This implementation study was part of the Ostrobothnia Depression Study, in Finland, which covered implementation of motivational interviewing (MI) and behavioral activation (BA) within regional public psychiatric secondary care. It aimed to evaluate the mid-term progress of implementation and related factors. Altogether, 80 therapists had been educated through the implementation program by the point of the mid-term evaluation. Eligible information for evaluation was gathered using two questionnaires (q1, q2) with a one-year interval. A total of 45 of the 80 therapists completed q1, 30 completed q2, and 24 completed both questionnaires. Professional education was the only background factor associated with adopting the interventions (q1: p=0.059, q2: p=0.023), with higher education indicating greater activity. On the basis of trends such as changes in overall usefulness score from q1 to q2, the most involved therapists were slightly more likely to adopt MI/BA. Our experience so far suggests that encouraging staff to begin using new interventions during education is very important. The Consolidated Framework for Implementation Research was found to be a useful tool for constructing the evaluation.
Implementation of an innovative grant programme to build partnerships between researchers, decision-makers and practitioners: the experience of the Quebec Social Research Council.
This paper examines a grant programme developed by the Quebec Social Research Council in the 1990s to encourage the building of research partnerships between researchers, decision-makers and practitioners. In particular, it studies the perceptions of key participants concerning the reasons behind the programme's successful implementation and growth.
In addition to secondary data about institutional involvement in the programme, 10 researchers and administrators were consulted as key informants. The method of concept mapping was used in order to draw out a consensus on the different factors associated with the successful implementation of the programme.
The participants identified 10 main factors that help explain the programme's successful implementation. These factors were then grouped into a model containing four dimensions: the leadership and coherence shown in the programme's implementation; the presence of a favourable political and social conjuncture; the programme's responsiveness to the needs of health and social services institutions; and the programme's responsiveness to the needs of the university milieu.
Although this model remains specific to the prevailing situation in Quebec at the time of its application, it may help stimulate reflection and contribute to an understanding of how research policies can encourage partnerships between researchers, practitioners and decision-makers.
Strategies to facilitate an understanding of successful collaborations between researchers and policy makers in the article "Twisting the Lion's Tail: Collaborative Health Policy Making in British Columbia" have relatively good face validity and fairly good construct validity. It's been my experience, however, that strategies that work for one project don't necessarily work for others and strategies that work for parts of one project don't always work for other parts of the same project. What seems important is that health policy collaborators establish clarity on roles, responsibilities and rules of engagement for specific projects, knowing prospectively that these will vary across time and depending on the nature of a project.
Over the past four years, despite low resource allocations to the North, northern residents and community organizations have taken significant initiatives towards the development of health research. In this commentary, we present a model for the development of northern health research based on our experiences in establishing the Institute for Circumpolar Health Research (ICHR) in the Northwest Territories. It is hoped that the lessons we have learned will inform decision-makers and encourage them to make strategic investments to support further health research capacity and institutional development within the North. Factors that have enabled the development of a health research institute in the North include leadership, a vision for health research, and the engagement of key partners and stakeholders. Challenges arise in the development of appropriate governance and policy for health research. There is an urgency to target resources to support the development of policies and governance for health research in northern jurisdictions. Both academic and community-based research need to be strengthened.
To describe researchers' experiences with involving health system managers and public policy-makers (i.e. decision-makers) in the research process, and decision-makers' experiences with the research process, including their assessments of the benefits and costs of the involvement, and their recommendations for facilitating it.
We conducted semi-structured interviews with principal investigators and research staff for the seven research programmes funded by the Canadian Health Services Research Foundation in the 1999 and 2000 competition years, and with the decision-makers they involved in the research programmes.
We identify three models of decision-maker involvement--formal supporter, responsive audience, and integral partner--each of which yielded important contributions to the research process. Four factors--the stage of the research process, time commitment required, alignment between decision-maker expertise and programme needs, and an existing relationship between the researcher and decision-maker--influenced the role played by decision-makers.
While on balance a beneficial experience, the further promotion of decision-maker involvement in the research process should involve helping researchers and decision-makers identify strategic opportunities for decision-maker involvement and support the costs associated with the involvement. Consideration should also be given to undertaking and evaluating interactions between researchers and decision-makers outside of the research process.
Medical science historically focuses on biomedical research about causes and treatment of disease. McMaster Child Health Research Institute (MCHRI), in Hamilton, Ontario, Canada, takes a different approach to research about lifelong health in children with varied chronic conditions. Staff at MCHRI propose to develop research programs to help "children with complicated lives and their families" meet the challenges of growing up in the face of threats to their health and development in order to help both children and families reach their full potential. This "noncategorical approach" to health services research is timely for addressing chronic childhood illnesses and disabilities across the life span.
