Backwards Design or looking Sideways? Knowledge Translation in the Real World; Comment on “A Call for a Backward Design to Knowledge Translation”

Document Type : Commentary


School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada


El-Jardali and Fadllallah provide an excellent summary of the many dimensions of knowledge use, and the breath of issues and activities that must be considered if knowledge is to be put into practice. However, reliance on a continuum (rather than a cyclical, multidirectional, systems) model creates a number of limitations, particularly when promoting evidence-informed action in the areas of health policy and management, where diverse forms of knowledge must be synthesized and decisions made in a rapidly evolving context. We propose a paradigm shift - from viewing Knowledge Translation (KT) as a linear ‘knowledge transfer’ activity, to a commitment to full stakeholder engagement in knowledge production, dissemination and implementation


Main Subjects

  1. Davies H, Nutley S, Walter I. Why ‘knowledge transfer’ is misconceived for applied social research. J Health Serv Res Policy 2008; 13: 188-90.
  2. Walshe K, Rundall TG. Evidence-based management: from theory to practice in health care. Milbank Q 2001; 79: 429-57.
  3. El-Jardali F, Fadlallah R. A call for a backward design to knowledge translation. Int J Health Policy Manag 2015; 4(1): 1–5. doi:  10.15171/ijhpm.2015.10
  4. Best A, Terpstra JL, Moor G, Riley B, Norman CD, Glasgow RE. Building knowledge integration systems for evidence-informed decisions. J Health Organ Manag 2009; 23: 627-41.
  5. Ward V, House A, Hamer S. Developing a framework for transferring knowledge into action: a thematic analysis of the literature. J Health Serv Res Policy 2009; 14: 156-64. doi: 10.1258/jhsrp.2009.008120
  6. Bowen S, Graham I. From knowledge translation to ‘engaged scholarship’: Promoting research relevance and utilization. Archives of Physical Medicine and Rehabilitation 2013; 94: S3-8. doi: 10.1016/j.apmr.2012.04.037
  7. Greenhalgh T, Wieringa S. Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review. J R Soc Med 2011; 104: 501-9. doi: 10.1258/jrsm.2011.110285
  8. Baker GR, Ginsburg L, Langley A. An organizational science perspective on information, knowledge, evidence, and organizational decision-making. In: Lemieux-Charles L, Champagne F, editors. Using knowledge and evidence in health care. Toronto: University of Toronto Press; 2004. p. 86-114.
  9. Bowen S, Graham I. Integrated knowledge translation. In: Straus S, Tetroe J, Graham ID, editors. Knowledge translation in health care: Moving from evidence to practice. 2nd ed. London: BMJ Books; 2013. p.14-23.
  10. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof 2006; 26: 13-24. doi: 10.1002/chp.47
  11. Snowden DJ, Boon ME. A Leader’s Framework for Decision Making. Harvard Business Review” (Harvard Business Publishing); Nov 2007. Available from:
  12. Bowen S. A Guide to Evaluation in Health Research. Canadian Institutes of Health Research, KT Learning Module; 2012. Available from:
  13. Van de Ven AH, Johnson P. Knowledge for theory and practice. Academy of Management Review 2006; 318: 2-21. doi: 10.5465/AMR.2006.22527385
  14. Horowitz CR, Robinson M, Seifer S. Community-based participatory research from the margin to the mainstream. Are researchers prepared? Circulation 2009; 119: 2633-42. doi: 10.1161/CIRCULATIONAHA.107.729863
  15. Cottrell E, Whitlock E, Kato E, Uhl S, Belinson S, Chang C, et al. Defining the Benefits of Stakeholder Engagement in Systematic Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014. Report No.: 14-EHC006-EF AHRQ Methods for Effective Health Care. Available from:
  16. Domecq JP, Prutsky G, Elraiyah T, Wang Z, Nabhan M, Shippee N, et al. Patient engagement in research: a systematic review. BMC Health Serv Res 2014; 14: 89. doi: 10.1186/1472-6963-14-89
  17. Morgan-Trimmer S. Policy is political; our ideas about knowledge translation must be too. J Epidemiol Community Health 2014; 68: 1010-1. doi: 10.1136/jech-2014-203820
  18. Arndt M, Bigelow B. Evidence-based management in health care organizations: A cautionary note. Health Care Management Review 2009; 34: 206-13. doi: 10.1097/HMR.0b013e3181a94288
  19. Behague D, Tawiah C, Rosato M, Some T, Morrison J. Evidence-based policy making: The implications of globally-applicable research for context-specific problem solving in developing countries. Soc Sci Med 2009; 69: 1539-46. doi: 10.1016/j.socscimed.2009.08.006
  20. Montini T, Graham ID. “Entrenched practices and other biases”: unpacking the historical, economic, professional, and social resistance to de-implementation. Implement Sci 2015; 10: 24.  doi: 10.1186/s13012-015-0211-7
  21. Bowen S, Erickson T, Martens P. The Need to Know Team. More than “using research”: the real challenges in promoting evidence-informed decision-making. Healthcare Policy 2009; 4:  87-102.