Infection and Immunity Research in Canada – Ensuring Impact

Report from a Workshop: Charting a Course for Knowledge Translation

[ PDF (1.71 MB) | Help ]

Lord Elgin Hotel
Ottawa, Ontario
September 24 & 25, 2008

Workshop planned and hosted by: CIHR – Institute of Infection and Immunity whose mandate is

"to develop and coordinate infection and immunity research on behalf of CIHR and ensure that research results are translated and applied to improving the health and quality of life of Canadians."

October 2008

---

Workshop Highlights

Approximately 40 individuals participated in a workshop in Ottawa September 24 and 25, 2008 to help the CIHR Institute of Infection and Immunity lay a foundation through which to proactively address its Knowledge Translation (KT) mandate. Participants included researchers from various disciplines; representatives from organizations that use research knowledge and individuals with expertise in KT (including from CIHR KT Portfolio) in addition to Institute Advisory Board Members and staff. Deliberations were informed by a background document titled A Framework for Doing Knowledge Translation in Infection and Immunity Research and a Report of Survey Results reflecting input of a convenience sample of III stakeholders.

Through discussion there were ultimately four priority areas that were identified as needing attention and focus in order to move the KT agenda of the Institute forward. Those four priority areas and examples of key actions proposed for each area are described briefly below.

• Facilitation and brokering: There was the clear sense of a need for intermediaries (people or processes) to link researchers with various user audiences. There is a broad range of stakeholders that must be involved for knowledge to be effectively used for societal benefit. There were three main areas in which action was recommended: collaboration with organizations involved in using knowledge; enhanced use of modern information technology, and refinement of CIHR policies and practices to enhance knowledge translation.
  
  
• Capacity building: There were several areas that were seen to influence the ability of the research and research user communities to do knowledge translation. This included information and knowledge resources (such as systematic reviews of KT approaches), knowledge and skills of researchers, and infrastructure (such as access to high-throughput screening for drug discovery). The actions identified were related to the development or identification of resources that enable KT; increasing 'people' capacity to do KT (e.g. training); and increasing KT knowledge and skills among researchers.
  
  
• Evaluation and dissemination of lessons learned: A critical approach to planning and evaluating knowledge translation while doing it was an underlying theme. Examples of actions suggested include locating or commissioning systematic reviews of the effectiveness of KT approaches, critical review of knowledge gained through research funded through CIHR operating grants and seeking results of evaluation of Networks of Centres of Excellence and other agency funding programs with respect to successful KT.
  
  
• Facilitation of translational research (bench to bedside): Because the majority of researchers involved with the Institute are biomedical researchers, the component of KT that deals with the transition from biomedical research to clinical application is particularly important. Enhanced access to infrastructure that enables translational research (e.g. medicinal chemistry screening capacity, informatics) and increased opportunity for interdisciplinary research are examples of directions suggested.

---

Table of Contents

• Background
• Objectives of the Workshop
• Setting the Stage
• Priorities for Knowledge Translation:
  • Facilitation and Brokering
  • Capacity Building
  • Evaluation and Dissemination of Lessons Learned
  • Facilitation of Translation Research (Bench to bedside)
• A Proposed Action Plan:
  • Priority for Action: Facilitation and Brokering
  • Priority for Action: Capacity Building
  • Priority for Action: Evaluation and Dissemination of Lessons Learned
  • Priority for Action: Facilitation of Translational Research
• Addressing the Framework
• Final Reflections
• Next Steps
• Appendices
  • Appendix 1: List of Workshop Participants
  • Appendix 2: List of potential priorities identified in first round of discussions
  • Appendix 3: A Framework for Doing Knowledge Translation in Infection and Immunity (Executive Summary)
  • Appendix 4: Presentations: Mark Bisby, Bhagirath Singh and Ian Graham

---

Background

Following the International Review of CIHR¹, and in anticipation of entering the next phase of the Institute's leadership, the Institute of Infection and Immunity (III) held a workshop of key stakeholders to help chart a course for the future with respect to knowledge translation (KT). The Institute has responded proactively to public health challenges arising in the first years of its existence and the International Review noted that the III has had some notable accomplishments in KT (e.g. responding rapidly to public health issues).

In the current Strategic Plan of III, one of five strategic goals was identified as:

"Encourage and facilitate knowledge translation in all fields and sectors related to the Institute mandate."²

The values that guide Institute decisions, strategies and actions are excellence, innovation, collaboration, transparency and accountability.

The III recognizes that most of the research in infection and immunity done in Canada is not directly linked with the activities of the Institute. Nevertheless, there is potential for this large body of research to contribute directly and indirectly to a range of benefits for Canada and the health of its citizens. The Institute wishes to be more focused and proactive with respect to KT and therefore this workshop was held to further understanding of how these benefits could be realized to an even higher degree than they are at present, and how the Institute could assist with this process.

Approximately 40 individuals participated in the workshop that was planned and supported by III. Participants included researchers from various disciplines and various roles; representatives from organizations that use research knowledge and individuals with expertise in KT (including from CIHR KT Portfolio) in addition to Institute Advisory Board Members and staff. Deliberations during the workshop were informed by a Report of Survey Results reflecting input of a sample of III stakeholders (researchers, research users and other interested parties) and by a background document titled A Framework for Doing Knowledge Translation in Infection and Immunity Research.³

The purpose of this workshop was to lay a foundation through which the Institute of Infection and Immunity could address its KT mandate proactively. Given the challenges that this Institute has been faced with since inception (e.g. SARS, HIV/AIDS, contaminated water), and the compelling pressure to respond in a way that would make a difference for the health of Canadians, this Institute is in a particularly good position to do foundational work in KT that may be of benefit to other Institutes and CIHR as a whole.

Objectives of the Workshop

1. To recommend key priorities for the next 3 years to help stimulate, facilitate and support efforts to ensure that research done in infection and immunity results in positive benefit for Canadians and Canada.

2. To recommend key actions through which III, working alone or in collaboration with others, should address the priorities.

3. To consider and suggest refinements to a framework for planning, doing and evaluating KT within the community of infection and immunity researchers.

Setting the Stage

Three speakers provided comments to stimulate discussion and set the stage so that participants were aware of key directions and mandates of the Institute of Infection and Immunity and of the KT Portfolio of CIHR. The presentations are included in Appendix 4.

Mark Bisby, former Vice President of CIHR and with a biomedical background, opened the workshop with some observations about how science and societal expectations have changed in the past decade. This notion was perhaps best captured when he compared directly two statements from federal budgets. In 1998, the wording used in the Canadian federal budget documents to justify an increase in the MRC (the precursor organization of CIHR) budget was:

"to provide research grants, scholarships and fellowships for advanced research and graduate students."

By 2008, this had become:

"The granting councils will... partner with public and private stakeholders to ensure that practical solutions are found. CIHR will be provided with (an additional) $34 million per year for research that addresses the health priorities of Canadians, including the health needs of northern communities, health problems associated with environmental conditions and food and drug safety."

Bhagirath Singh, Scientific Director of the Institute of Infection and Immunity provided an overview of the mandate, strategic priorities and directions of the Institute. In addition, he reminded participants of the lengthy and complex nature of the process from discovery to effective application in the real world. He quoted an article published in Science in 2008⁴ that provided data showing the median time from the earliest journal publication or patent to the time of a highly cited clinical study (a proxy for uptake and use of the information). This article cited median times for translation as described above as 16.5 years for an intervention that was not refuted in any way.

Ian Graham, Vice President of Knowledge Translation at CIHR, provided an overview of the KT mandate and strategic directions within his portfolio. He emphasized that KT is not optional for CIHR as it is enshrined in the legislation that created CIHR. He reviewed relevant sections of the legislation and provided key perspectives on how CIHR views KT. KT is seen to consist of four key components: knowledge synthesis, dissemination, exchange, and ethically sound application. CIHR is focusing its KT activities through two general categories: end-of-grant KT; and integrated KT. End-of-grant KT refers to the dissemination and communication activities undertaken by researchers once they have research findings appropriate for dissemination. Integrated KT is defined as a research approach that engages potential knowledge-users as partners in the research process in a collaborative or participatory manner that is usually solution-focused. One important conceptual tool that is used for understanding KT is the "Knowledge to Action Cycle" that can be used to think through KT in many different contexts, including commercialization (a form of KT).

The KT portfolio is currently working on many resources and processes designed to enhance KT within the CIHR community. Current strategic priorities and actions were summarized and a list of current activities provided. This includes a wide range of things such as:

• A KT guide for researchers and for peer/merit reviewers that is specific to CIHR themes/pillars
• Developing a citizen engagement framework
• Piloting a research reporting system (end of grant reports)
• Developing evaluation tools to assess the impact/success of partnerships
• Fine tuning a research impact and evaluation framework
• Promoting grants (Meeting, Planning and Dissemination) that enable end of grant KT
• Implementing the Open Access policy
• Developing an RCT results reporting policy

Priorities for Knowledge Translation:

Identifying priorities for knowledge translation within a large area such as infection and immunity is a significant challenge; the community of researchers, and those who work with research knowledge in various settings, is large and diverse. The group discussed dimensions to consider during the process of identifying where efforts should be focused. These dimensions that could ultimately influence the specific areas in which to focus included:

• The type of research evidence available
• Presence and role of partners
• Ability of potential users to respond to research knowledge, and their specific needs for new knowledge
• Health challenge or crisis that requires response and reaction from the research community
• Availability of infrastructure to enable change (increased use of research knowledge)
• End of grant reporting mechanisms
• Identification of actors and resources
• Cross training efforts
• Reactive and proactive elements
• Knowledge about gaps between "what is known" and "what is done," where high impact is possible
• Evaluation of KT outcomes

With respect to priorities for attention, a lengthy list of priorities was identified. Through discussion and expression of support by individuals present, seven of the priorities from the longer list were identified as most important and through the course of the day the top priorities were collapsed into four larger categories which are described below. The longer and more detailed list is included in Appendix 2 for reference purposes.

The top seven priorities for III originally identified were:

1. Act as a knowledge broker between researchers and various relevant target audiences.
2. Enhance infrastructure to support KT across the spectrum of research and application.
3. Increase the capacity for researchers to do KT through focus on trainees and KT training components.
4. Invest in methods to evaluate KT
5. Facilitate translational research (bench to bedside).
6. Close loops on programs already funded; i.e. what did we learn from a strategic RFA? What new knowledge or research related outputs emerged from a strategic initiative?
7. Develop and institute a process involving a broad range of stakeholders (researchers, end users, intermediaries) to set priorities for knowledge translation in infection and immunity.

Through further discussion, these priorities were collapsed into four categories that incorporated the aspects above:

• Facilitation and brokering
• Capacity building
• Evaluation and dissemination of lessons learned
• Facilitation of translational research (bench to bedside)

Facilitation and Brokering

There was the clear sense of a need for intermediaries (people or processes) to link researchers with various user audiences. It was acknowledged that there is a broad range of stakeholders (researchers, end users, intermediaries including health professionals and industry) that must be involved for knowledge to be effectively used for societal benefit. Stakeholder input across the range of research activity is important including the setting of priorities for knowledge translation in infection and immunity.

Capacity Building

There were several areas that were seen to influence the ability of the research and research user communities to do knowledge translation. This included information and knowledge resources (such as systematic reviews of KT approaches), knowledge and skills of researchers and infrastructure (such as access to high-throughput screening for drug discovery).

Evaluation and Dissemination of Lessons Learned

A critical approach to planning and evaluating knowledge translation while doing it was an underlying theme. This included such things as considering KT theories and models, and the nature of research evidence before planning and implementing various strategies to support KT; evaluating KT strategies when implemented; and reporting on the success or failure of these strategies.

Facilitation of Translation Research (Bench to bedside)

Because the majority of researchers involved with the Institute of Infection and Immunity are biomedical researchers, the component of KT that deals with the transition from biomedical research to clinical application is particularly important. There were a couple of very specific areas identified that participants deemed essential in supporting more translational research, e.g. development of specific technical and IT platforms and more opportunities to work across disciplinary boundaries.

A Proposed Action Plan:

There were many actions identified that addressed one or more of the priorities identified. To the extent feasible in a short period of time, participants identified the entity most likely to be in a position to address the action and also (if it wasn't the Institute of Infection and Immunity) what the role of the Institute should be. The proposed actions are identified in the tables below and are associated with the priority most closely aligned (although some addressed more than one priority). The actions identified have been organized into related themes in the tables below. The general themes under which specific actions have been identified have been suggested by the report writers. The specific suggestions underneath the categories were given by participants at the Workshop. Potential time horizons for each of the actions are suggested (short, medium and long term).

Priority for Action: Facilitation and Brokering

Action	Timeline: (S)hort (M)edium (L)ong term	Who?	Notes
Collaboration with Organizations Involved in Knowledge Use
Establish Joint Venture with partners to enhance KT with a view to enhancing all partners' ability to contribute to KT (and not duplicating).	M-L	III and partners	This was envisioned as an ongoing resource and opportunity for knowledge exchange (as opposed, or perhaps in addition to, the 'Strategic initiative' approach that has characterized III partnerships to date, where activity was focused, intense and time limited toward a specific end. Various purposes for the Joint Venture were discussed, including setting of joint priorities with knowledge using organizations; provision of focused KT support for researchers (materials and processes).
Leverage not for profit disease charities with respect to their value to influence decision makers (including health system managers and politicians)	M	CIHR and III	This could include consideration of things such as identifying appropriate federal and provincial government agencies/committees to target; and/or advocacy for the creation of suitable mechanisms to help ensure KT.
Coordinate and collaborate to disseminate key messages from partner organizations (e.g. CATIE, Kidney Foundation, Canadian Diabetes Association)	S	III and partners	Many organizations exist at least partially for the purposes of knowledge brokering and effecting change in various audiences with respect to health issues. Build on this resource to share research results in infection and immunity.
Enhanced Use of Modern Information Technology
Better web interface (Web 2.0) for public and other researcher access to research results as provided in end of grant reports and lay abstracts of current CIHR-funded research.	M	CIHR	Don't reinvent wheels. Include research results from organizations other than CIHR. (Collaboration with other health research funders).
Improve CIHR interface with various users using the web.	M	CIHR	Explore social networking models (Wikis, Facebook, Twitter, etc.). Offer enrolment site for CIHR-funded clinical trials.
Provide ongoing user friendly web receptacle with respect to ongoing initiatives and current research results.	M	III as lead for later cross-CIHR application
Refinement of CIHR Policies and Practices to Enhance KT		The current status of these suggestions should be discussed with CIHR – KT Portfolio. They have many activities 'in the works.'
Include KT enabling funds in core operating grants.	S	CIHR	Expenses related to KT activities are currently allowable in operating grant proposals.
Have end of grant/initiatives meetings with partners to take stock and communicate results; plan actions.	S	III and researchers	To some extent, this is already enabled by existing mechanisms – end of grant supplements and the Meetings, Planning and Dissemination Program of CIHR.
Mining final end of grant reports to transform findings into useful pieces for target audiences.	S-M	CIHR	End of grant reports will be available soon. A plan should be developed in the short term to determine how final reports will be used and for what purpose. Will require significant investment by CIHR in knowledge brokers able to appreciate significance of findings reported.
Regularized notice of III when publications accepted so that III can be prepared for media enquiries and can leverage opportunities.	S	III as lead for later cross-CIHR application	Researchers would do this, but expectation would need to be created by III.

Priority for Action: Capacity Building

Action	Timeline: (S)hort (M)edium (L)ong term	Who?	Notes
Develop or identify resources that enable KT
Host a KT Forum with III stakeholders that would build on documented successes and focus on developing materials and approaches in consultation with users.	S	III
Create KT case studies that can be used as the basis for short courses for new investigators.	S	III and KT Portfolio	If there were several modules (including case studies) available to assist researchers with thinking through KT, that would be helpful.
Locate, or commission if not available, systematic reviews of KT approaches including that of training approaches for trainees.	S	KT portfolio	The principle here was that KT efforts initiated should be done on the basis of evidence reflecting effective approaches. Cochrane Collaboration databases may be a good resource for this.
Learn from others about successful KT practices; (CHSRF and Myth Busters); social marketing experts; locally targeted.	S	CIHR and III	"Think globally, act locally" applies strongly to KT.
Increase 'People' Capacity to do KT
More training opportunities in medicinal chemistry, medical statistics, health economics, and other disciplines and fields required for translational research.	M-L	III and researchers	Senior researchers across Canada will have to be involved to realize this. III can advocate and influence (and possibly provide incentives).
Enable the training of trainees with respect to KT.	S-M	CIHR	Through financial incentives (e.g. setting aside a KT trainee position in grants with a strong KT component)
Invest in training and funding of knowledge brokers in various settings.	S-M	III	Establish a KT position at III to help ensure researchers are aware of, and engage in KT opportunities where results warrant same. (Broker knowledge and opportunities internal to CIHR and its partners).
Work with knowledge user partners to improve their capacity to use research knowledge.	M	III	E.g. include knowledge users as part of the research team
Course buy out to enable KT at end of grant.	M	CIHR	The availability of course release time would enable a researcher to focus on KT when results warrant dissemination and exchange.
Increase KT Knowledge and Skill Among Researchers
Expand KT components in new investigators meeting held regularly.	S	CIHR
Increase expectations with respect to how investigators describe KT in each of their grants.	S	CIHR	CIHR – KT portfolio is developing templates for KT planning.
Provide opportunities and incentives for more researchers to feel comfortable as communicators of their research field to the public.	S-M	CIHR

Priority for Action: Evaluation and Dissemination of Lessons Learned

Action	Timeline: (S)hort (M)edium (L)ong term	Who?	Notes
Locate, or commission if not available, systematic reviews of KT approaches invoked, including that of training approaches for trainees.	S	KT portfolio	It is important to do KT in ways that use research that informs the best way to do that.
Formal grant reporting and program evaluation.	S-M	CIHR	Accountability for ensuring research results are used to contribute to positive outcomes is important.
Information from the body of final reports of research done on a particular topic should be a factor considered when determining strategic priorities for future RFAs.	M-L	III and CIHR	If critical review of a large number of final reports identifies knowledge and results available that should be applied, but aren't; this should influence strategic actions of the Institute with respect to KT.
Seek results of evaluation of NCEs and other agency funding programs with respect to success in KT (including commercialization goals).	M-L	CIHR	We should learn from other endeavours, including international examples, that have set out to do KT.

Priority for Action: Facilitation of Translational Research

Action	Timeline: (S)hort (M)edium (L)ong term	Who?	Notes
Invest in infrastructure that is essential to enable translational research.	M-l	CIHR	Certain resources make translational research sustainable, e.g. medicinal chemistry screening capacity; informatics.
Increase opportunities for interdisciplinary research.	S-m	CIHR and III

In addition to the specific KT actions above, there were several suggested actions that related to communication and awareness activities that would help enable KT. That is, they may be helpful, but are not sufficient to ensure use of research results. Some of the suggestions along these lines included the creation of a 'Health Research Week' (as happens in Australia and Saskatchewan) and doing work to increase the public's support for health research. Greater effort and success in translating the results of CIHR-funded research into improved health for Canadians should also have this effect.

Addressing the Framework

A background document entitled "A Framework for Doing Knowledge Translation in Infection and Immunity Research" (Executive Summary is in Appendix 4 and the full report is available on the Institute website) was provided as a "jumping off spot" for discussion at the workshop. The framework includes four components:

• A high level description of knowledge translation
• A description of outcomes (and related outputs) with which KT is concerned
• An overview of KT as viewed by CIHR (with commercialization viewed as a special case of KT)
• An eight-step process through which researchers think about and plan for knowledge translation as it relates to their own area of research.

Given the limited time for this discussion, participants were asked to comment on five focused questions. Their comments are summarized below.

Question 1: Is the high level description of KT helpful? (Section 3B) Why or why not? What would make it more helpful?

• The definition of knowledge translation elaborated in the paper is broad enough to provide a place for everyone from biomedical to community-based researchers.
• The term "health system" should be defined more widely than the Canadian health system and include impacts on global health.
• It is unclear who the target audience for this document is: III researchers, all CIHR researchers or a broader range. If III researchers are the target audience, the document should be tailored more to their interests and activities.
• There should be more emphasis on the end-users of research and the different audiences for KT.
• Figure 1: Knowledge Trajectory, Outputs and Outcomes, needs to be clarified. A figure that is less linear in presentation would be an improvement.

Question 2: Section 3C talks about the outcomes anticipated as a result of KT. What indicators would you point to that would reflect knowledge translation is occurring in infection and immunity?

• Table 1: Preliminary Indicators of Health Research Impact should include measures of patient satisfaction/understanding under the heading Informed Decision-Making.
• How to measure outputs and outcomes is not clearly understood and which outcomes are relevant depends on context. More evaluation of KT effectiveness is needed as is more research on increasing knowledge uptake, for example, by changing physician behaviour.
• The number of decision support tools or guidelines informed by CIHR research is an important indicator.
• Popular dissemination through websites and other media is absent from Table 1.
• There is a need for CIHR to invest in a knowledge management system that is available to all.

Although not specifically addressing the question above, a suggestion was made for the addition of a diagram that differentiated KT and impact (i.e. knowledge translation is one process or activity that may lead to impact from research use).

Question 3: Are the sections that describe how KT (including commercialization) is viewed by CIHR clear? (Sections 3D and 3E) What would make this section more helpful?

The view of commercialization expressed is simplistic and the concept of parallels and differences between commercialization and other forms of KT needs more development.

Question 4: Section 3F describes an 8 step process for potential use by researchers in planning KT activities. Does this process make sense? Is it feasible? Why or why not?

• There needs to be a greater emphasis on different stakeholders and what their involvement should be at different points in the process.
• A step-wise process tends to linearize thinking about the process of KT. It is more circular and iterative. Novel perspectives brought to the KT process during the planning and conduct of research will influence and change how it is implemented, its effectiveness and utility.
• "Needs" trump "gaps." Filling gaps is meaningless in the absence of a need.
• Usefulness will depend on who applies it and for what purpose. Grant-writing? Grant reviewing? Will there be time, space and recognition for applying this process?
• The process should include (i) justification of KT, (ii) measuring of effectiveness of KT and (iii) what sort of KT is required.
• There is no mention of the role of media in the KT process.
• Feasibility hinges on respect and uptake of other researchers' outputs.
• To be used as a guideline for researchers, the Process for Planning KT Activities section needs to be shortened to one page or less.

Question 5: Are there any perspective or components missing from the Framework that are essential in order that this document is useful (and used) by the infection and immunity research community?

• Planning for KT needs to be sold as a positive activity that improves the significance, conduct and impact of research rather than another onerous application requirement. The document does not adequately address the motivation for moving in the direction of KT.
• There needs to be evidence-based KT. How do we find out what changes outcomes? What is the impact of current interventions? How do we measure impact?
• Training new investigators in KT is important to create a generational shift and to facilitate shift from mode 1 to mode 2 research.
• In general, the shift from mode 1 to mode 2 science and the enablers for this, e.g. team-building, was not sufficiently elaborated in the framework.
• There needs to be a greater focus on stakeholder involvement in research. There should be more emphasis on the differing perspectives of the various groups that use research.
• Lay reviewers should be included in review panels and their impact on the review process assessed.
• There should be more emphasis on the differing perspectives of groups that use research.
• Is there a role for CIHR as knowledge broker, or is that the responsibility of other organizations?
• End-of-grant reporting requirements must address ethical/privacy issues.
• There needs to be a place for reporting/sharing negative results to avoid needless repetition.
• The risks (e.g. inflated expectations) were not addressed.

Summary

Based on input during the discussion and the post-meeting assessment, the majority of participants judged the Framework paper to be moderately or very useful as a background document to stimulate discussion. One group commented positively on the broad definition of knowledge translation elaborated in the paper. Another found the concrete examples in the appendix useful.

During discussion, several references were made to the need for more emphasis in the Framework document on stakeholders and research users – their various perspectives, inputs and potential roles in both research and the KT process. The need for evidence-based KT and for evaluation of KT interventions and impacts were seen to require more elaboration. The importance of training in KT was not addressed. Finally, there was general agreement that, to be useful as a framework for KT for the research community, the document must be reduced in size. It was felt the contents could form the basis of a short guide for researchers planning KT activities.

Final Reflections

Just prior to dispersing, workshop participants offered some reflections on the deliberations during the workshop. Key points that emerged follow.

Balance is required on several dimensions when thinking about KT in infection and immunity. There is a balance needed between efforts to identify and 'push' or promote the use of research knowledge and attending to the 'pull' from users with respect to what information they need to do their jobs. Both perspectives are needed and may not be related to the same research. There is also a balance of KT efforts needed with respect to when in the knowledge development trajectory KT is consciously addressed. In some cases, how the knowledge will eventually be used or translated should be considered in the very early stages of research; but this is not appropriate in every case.

Better articulation of roles in KT is needed. Perhaps this is a question of balance as well. Not all researchers should be expected to do KT, but some should (or in some situations, they should). However, KT requires specific skills and knowledge, and it may not be researchers who are best positioned to do KT. What are the respective roles of researchers, research institutions, CIHR, or organizations for whom use of research knowledge for the accomplishment of their own aims is a key part of what they do? The challenge is in arriving at an understanding of which individuals or organizations are best positioned to play what role in KT and under what circumstances.

Communication is necessary, but not sufficient for KT. Knowledge translation is a complex, multifaceted process involving many variables and influences.

Knowledge needs to be managed. Someone (or more likely some organization) needs to 'manage' research knowledge – to monitor its growth, to assess its potential and to enable knowledge to move and be shared in such a way as potential benefit is realized.

Given the high degree of translatability of infection and immunity research (e.g. immediate impacts on design and operation of public health surveillance systems), and its past successes, III has an opportunity to position itself as a leader/test-bed among the Institutes in experimenting with and implementing cross-CIHR strategies and initiatives in KT in collaboration with KT portfolio.

Next Steps

The discussion and debate throughout the workshop was spirited and thoughtful. Participants engaged energetically in the challenge of thinking through how best to support and make KT possible, given that it is a clear mandate of CIHR and there are specific expectations of important stakeholders such as the federal government, and increasingly of all Canadians.

With respect to the proposed actions, it was clear from input from the representatives from the KT portfolio that there is much action from that group that addresses some of the directions identified in the workshop. Determining with more certainty if current developments underway address the priority actions would be an important first step before proceeding.

This report will be circulated to participants in the workshop for their review and input. The Institute of Infection and Immunity will work in collaboration with the KT Portfolio to identify specific actions and directions through which to assertively address the KT priority identified in the Strategic Plan.

---

Appendix 1: List of Workshop Participants

Participant	Title	Organisation
Barreto, Luis	Vice President Public, Scientific and Medical Affairs	Sanofi Pasteur CIHR - III Advisory Board
Bilodeau, Marc	Associate Professor Medicine	Université de Montréal
Bisby, Mark	Consultant	Formerly Vice-President, CIHR
Bray, Judy	Assistant Director Associate Director	CIHR - III CIHR - ICR
Brehaut, Jamie	Scientist Ottawa Health Research Institute	University of Ottawa
Dutz, Jan	Scientist Child and Family Research Institute	University of British Columbia
Flicker, Sarah	Assistant Professor Environmental Studies	York University
Graham, Ian	Vice President KT Portfolio	CIHR
Griffiths, Mansel	Director Canadian Research Institute for Food Safety	Guelph University
Guimond, Josee	Director Research Programs and Partnerships	Canadian Diabetes Association CIHR – III Advisory Board
Halperin, Scott	Professor Pediatrics and Microbiology & Immunology	Dalhousie University
Heathcote, Jenny	Head, Division Patient Based Clinical Research	Toronto Western Research Institute
Hill, Warren	Senior Research Analyst	BC Centre for Disease Control CIHR – III Advisory Board
Hosein, Sean	Science and Medicine Editor	Canadian AIDS Treatment Information Exchange, CHARAC
Jurkovic, Leah	KT Sector Specialist KT Portfolio	CIHR
Kubes, Paul	Director Calvin, Phoebe and Joan Snyder Institute of Infection, Immunity and Inflammation	University of Calgary
MacDonald, John	Coordinator Inflammatory Bowel Disease Review Group Cochrane Collaboration	Robarts Research Institute
Magnan, Jacques	Interim President and CEO	Alberta Heritage Foundation for Medical Research
Malo, Gwen	Associate Strategic Initiatives	CIHR – III CIHR - ICR
Moor, Bruce	Assistant Director	CIHR – III
Nekka, Fahima	Quebec Scientific Director	MITACS (Mathematics of IT and Complex Systems)
Richardson, Carol	Manager External Relations, Strategic Initiatives and Evaluation	CIHR - III
Rogers, Tim	Director Knowledge Exchange	Canadian AIDS Treatment Information Exchange
Royce, Diana	Managing Director	AllerGen NCE
Singh, Bhagi	Scientific Director	CIHR - III
Sokol, Pam	Professor Microbiology and Infectious Diseases	University of Calgary
Spiegel, Jerry	Director, Global Health Liu Institute for Global Issues,	University of British Columbia
Tackaberry, Eileen	Research Manager Centre for Biologic Research	Health Canada
Tolomiczenko, George	Executive Director Research and Scientific Liaison	Crohn's and Colitis Research Foundation
Toth, Janie	Executive Director	PrioNet Canada (NCE)
Valvano, Miguel	Professor and Chair Microbiology and Immunology	University of Western Ontario
von Messling, Veronika	Researcher	Institut national de la recherche scientifique (INRS)
Wolfs, Wim	Director National Research Program	The Kidney Foundation of Canada
Wong, Tom	Director Community Acquired and Health Care Acquired Infections	Public Health Agency of Canada
Wright, Gerry	Director M. DeGroote Institute for Infectious Disease Research	McMaster University
Wu, Gill	Professor Kinesiology and Health Science and Biology	York University CIHR-III Advisory Board

Appendix 2: List of potential priorities identified in first round of discussions

1. Determine what knowledge is available and which addresses a gap between what is known and what is done.
2. Develop and institute a process involving a broad range of stakeholders (researchers, end users, intermediaries) to set priorities for knowledge translation in infection and immunity.
3. Invest in methods to evaluate KT.
4. Act as a knowledge broker between researchers and various relevant target audiences.
5. Close loops on programs already funded; i.e. what did we learn from a strategic RFA? What new knowledge or research related outputs emerged from a strategic initiative?
6. Respond to challenges to the health of the Canadian public.
7. Target key audiences in a programmatic way (rather than episodic).
8. Increase the capacity for doing KT within trainees working and studying in infection and immunity.
9. Encourage interdisciplinary and inter - institutional collaboration.
10. Develop case studies that demonstrate successful KT within the fields of infection and immunity and share them widely. (One obvious example is community based research; the Institute already has a track record. Writing this up could provide a model for writing up other case studies).
11. Increase the prominence and importance of KT in ongoing programs. (Consider building on recent successes or current opportunities).
12. Document what KT successes have already happened.
13. Make it much easier to access reports or processes that synthesize results.
14. Facilitate translational research (bench to bedside).
15. Enhance infrastructure to support KT across the spectrum of research and application.

Appendix 3: A Framework for Doing Knowledge Translation in Infection and Immunity (Executive Summary)

The Canadian Institutes of Health Research's (CIHR) Institute of Infection and Immunity (III) is sponsoring a workshop to seek input to a plan through which the Institute can address its knowledge translation (KT) mandate proactively. This report is a background document intended to support workshop deliberations.

Both the CIHR and the III are mandated to engage in KT, which includes any activity that facilitates or increases the use of knowledge or the likelihood that it will be used in such a way as to facilitate progress toward health related outcomes of interest. CIHR describes two types of KT – integrated (i.e. occurs through the research process) and end-of-grant (i.e. occurs upon completion of the research project). The ultimate goal of either is to influence some setting within society where it could be useful in effecting change in health related outcomes.

The Knowledge to Action framework used by CIHR depicts the KT process. Categories from this framework were used to identify examples of KT from within the infection and immunity research communities to date. Examples of the following components were identified: integrated KT; knowledge synthesis, knowledge tools and products, problem identification, knowledge adaptation processes, assessment of barriers to KT selection; and tailoring of interventions and knowledge exchange opportunities.

A framework to assist in doing knowledge translation in the infection and immunity communities is proposed. The framework includes: a high level description of knowledge generation and KT in the specific context of infection and immunity research; a description of the outcomes (and related outputs) with which KT in infection and immunity research is concerned; an overview of KT as viewed by CIHR; commercialization as a special case of KT; and finally an eight step process through which researchers can think about and plan for knowledge translation as it relates to their own area of research.

There are four major entities involved in helping to ensure that infection and immunity research knowledge results in benefit to the health system and Canada. These are the communities of researchers themselves, the Institute of Infection and Immunity that provides strategic leadership in this area, the KT Portfolio of CIHR which assists with advancing KT across the full spectrum of health research and last, but not least, a wide ranging group of organizations across Canada that use research knowledge to advance their own objectives related to immune mediated and infectious diseases. All of these entities will be involved in the deliberations of the workshop to lay important foundations for enhanced KT in infection and immunity.

---

1. The report of the International Board of review can be found on the CIHR website.
2. The full Strategic Plan can be found on the CIHR website. In addition to the strategic goals identified, the Institute also identified five priority health areas in which to focus: emerging infections and microbial resistance; immunotherapy; Pandemic Influenza Preparedness; vaccines of the 21st century; HIV/AIDS.
3. Both of these documents are available on the Institute website.
4. Contopoulos-Ioannidis et al. Life Cycle of Translational Research for Medical Interventions, Vol. 321, 5-6.