Abstract
Keywords
Introduction
Collaborative approaches to research that help ensure the co-production of contextually relevant research findings and knowledge products are gaining increased attention across disciplines (Graham et al., 2018; Zych et al., 2020). Further, research funding agencies are increasingly requiring collaborative approaches that expand the role of knowledge users to include involvement across the research process (Graham et al., 2018). Integrated knowledge translation (IKT), which draws on participatory action processes in both the creation and implementation of knowledge, has emerged as one such collaborative approach (Straus et al., 2013). As Straus and colleagues suggest, by engaging knowledge users throughout the research process, findings are more likely to be contextually relevant and useful in decision making. In addition, the collective process of designing and engaging in research allows researchers and knowledge users to better understand each other’s perspectives and reduces barriers that typically characterize their relationships (Nguyen et al., 2020; Zych et al., 2020). It is these premises that guided our IKT efforts within the Recreation for Mental Health (R4MH) project, an action-based, interdisciplinary project focused on creating tools and resources to support inclusion of people with mental health challenges in community-based recreation in Nova Scotia, Canada. Our focus on people with ‘mental health challenges’ is intended to include all people who self-identify as living with a mental illness such as anxiety, depression, or schizophrenia, or who experience poor mental health that impacts their quality of life. In keeping with this conceptualization of mental health challenges, we use the term ‘mental health’ to refer not just to the absence of mental illness but also to a sense of mental wellbeing, including the ability to manage the stresses of everyday life (World Health Organization, 2018). Throughout this paper, we refer to ourselves, the authors, collectively as ‘we’ or ‘us’; when referring to ‘researchers’, we are writing of all researchers
Project Context
The Knowledge to Action (KTA) cycle (Graham et al., 2006; Straus et al., 2013) provides a framework to better understand our process. The KTA cycle begins with a knowledge creation process that culminates in the creation of knowledge tools and products. These products are then shared and sustained through an ongoing process that involves identifying and addressing contextual issues and barriers and tailoring knowledge products to respond to these issues, monitoring and evaluating outcomes of knowledge use and refinement of knowledge products in order to sustain knowledge use (Field et al., 2014; Graham et al., 2006). In this paper, we focus on the cyclical process of sustaining knowledge use, and particularly the challenges associated with the inherently never-ending nature of the processes of adapting knowledge products, implementing and evaluating them, and then making further adaptations.
In our case, at an initial knowledge sharing event to bring together practitioners, educators, policy makers and people who self-identified as living with mental health challenges (referred to throughout the paper as First Voice) for the purposes of preliminary sharing, First Voice attendees described feeling unwelcome within community-based recreation contexts (such as in programs at recreation or community centres or recreation spaces like gyms or parks). Likewise, providers of community-based recreation described feeling unsure about how to foster more inclusive settings for First Voice participants. In response to these learnings, we engaged in the knowledge creation phase of the KTA by forming an advisory group, planning and completing several primary research studies (e.g. exploring barriers to participation and best practices in inclusion, Gallant et al., 2019; White et al., 2020), engaging in knowledge synthesis (e.g. integrative reviews regarding benefits of recreation, Litwiller et al., 2017, 2018) and developing a range of knowledge products (e.g. guidelines for socially inclusive recreation, Gallant et al., 2020).
A common thread across all our research projects was that they were designed to respond to challenges and knowledge gaps identified by recreation and mental health practitioners and people with lived experience of mental health challenges. The responsiveness of the projects to current needs of the recreation sector, and the community-based, participatory nature of many of the projects, led to highly relevant research findings, as is common among projects that adopt a collaborative approach (Abma et al., 2017; Zych et al., 2020). Further, because research projects and knowledge products were developed to respond to local needs, they were inherently aligned and tailored to local contexts, in keeping with the KTA cycle. After working with community partners to create useful IKT products, these products took on a life of their own, garnering ongoing feedback and suggestions, such that they demanded ongoing resources to continue the cyclical process of maintaining knowledge products and fostering their continued relevance. As many resources (e.g. grants and associated labour) that supported the project dwindled, we grappled with dilemmas related to how to sustain knowledge use, increase relevance and expand reach.
Purpose and Rationale
In 2006, Graham et al. noted that ‘interest in the sustainability of knowledge use is relatively recent, and so there has not been much research into this important aspect of the KTA process’ (p. 21). More recently, other researchers confirm the need to ‘better understand what influences, enhances, or challenges sustainability’ (Davies & Edwards, 2013, p. 238). The purpose of this paper is to discuss the dilemmas we encountered because of the enduring popularity of some of our IKT products, particularly related to negotiating shared decision making and ownership of IKT products with community partners. Based on our experiences, we suggest some recommendations for negotiating the evolution of IKT products and sustaining the KTA cycle.
Overview of the R4MH Project
The R4MH project was an action-based project led jointly by Dalhousie University, Recreation Nova Scotia (RNS) and the Canadian Mental Health Association, Nova Scotia Division (CMHA). The project was oriented around a shared interest in enhancing social inclusion and improving mental health, particularly for people experiencing mental health challenges, through recreation participation. Development of activities for the project began in (2012), with most engagement activities taking place from 2013 to 2017, including three multi-day provincial symposia that featured IKT activities, along with four regional networking and professional development events for mental health and recreation practitioners, and other stakeholders. This work was guided by a 16-member advisory committee that included First Voice advocates, practitioners from recreation, mental health, education and community services sectors from across Nova Scotia, Canada, as well as a five-person management team made up of leaders from the university, RNS and CMHA. As is common among IKT-focused projects (Zych et al., 2020), the project engaged strong and continued stakeholder representation through our advisory committee and project management team. These community stakeholders drove the direction of the project, the scope of knowledge exchange, as well as the focus of the research projects, questions and IKT efforts.
Funding for the overall project was provided by the province of Nova Scotia through a provincial community mental health project grant to support development of initiatives that would address strategic priorities within Nova Scotia’s Mental Health Strategy. Notably, the project was not funded to support research per se; instead, it was funded to support evidence-based project activities. Although a subtle distinction, this funding model meant that there was an underlying tension about where and how to best allocate limited project resources. For example, despite funds for project activities, additional funding was needed to support research-related activities (e.g. funding for food, space and audio equipment associated with interviews and focus groups, micro grants to pay honoraria to First Voice participants). Throughout the duration of the project, the research team managed several research projects that sought to respond to evidence gaps identified by project stakeholders (i.e. advisory committee members and the broader recreation and mental health communities). These affiliated research projects were led by four different research team members who assembled diverse research teams and secured funding through various research grants. The projects themselves varied considerably in terms of scope, research questions and research methods; many engaged diverse participants, including First Voice, along with recreation practitioners and others. Over the lifetime of the project, we collectively published 12 peer-reviewed papers related to this work, delivered over 30 conference presentations and engaged in nine IKT processes, including targeted meetings at local libraries (e.g. with First Voice advocates and recreation practitioners) and regional and provincial symposiums and workshops for several aspects of our work.
Overview of R4MH IKT Products
Key R4MH IKT Products.
Tensions Related to Maintaining IKT Products
To introduce the tensions associated with maintaining IKT products, we share a story that exemplifies these challenges. As noted in Table 1, we developed a half-day training session based on our research findings, which is offered by our main community partner organization to recreation staff and organizations upon request. In a meeting focused on preparing for a conference presentation related to our IKT products, our community partner shared the exciting news that a facilitator from their organization had flown to several provinces across the country to offer the training in-person and that the training and game were being translated into French and learning activities were being modified so that the game could be made more useful in some French-speaking, northern Indigenous communities. However, the training was developed based on research that we had completed in our province through interviews and focus groups with local First Voice participants who were predominantly English speakers, non-Indigenous and situated within a distinct socio-political context. Indeed, interest in adapting the training and game to other contexts and populations did not end here. More locally, interest has been expressed by our community partner organization in adapting the materials to centre 2SLGBTQ+ individuals and also for African Nova Scotian culture and lived experiences, recognizing that these populations experience barriers to recreation participation that may be compounded by not just mental health stigma, but other systems of oppression (i.e. settler colonialism, homo-and transphobia and racism).
While we were excited to hear of the growing interest in the IKT products associated with our work, we felt all these changes would require returning to a primary research process to collect and incorporate relevant data. We therefore have concerns about the ongoing viability of these resources, as they seem to demand growth and tending. Our concerns centre on three tensions related to maintaining the integrity/fidelity of IKT products as they evolve: (1) Lack of alignment of our needs, timelines and resources as scholars with those of community partners; (2) Lack of clarity about decision-making responsibility related to the ongoing evolution of IKT products and (3) The ongoing need to support the evolution of IKT products despite the conclusion of funding and project infrastructure (such as the project advisory committee). Each of these tensions are described in more detail below.
Tension Between Practitioner Needs and Scholarly Needs
Over the course of this project, we came to understand the constraints of our roles as academics and the lack of alignment between practitioner and scholarly needs, issues that commonly characterize collaborative research approaches (Zych et al., 2020). First, there was an inherent tension between adhering to rigorous (and often time-consuming) research processes (e.g. obtaining ethics approval) and quickly responding to stakeholders’ requests for access to information generated by the research process. Then, as each time the project seemed to be nearly finished, an email would find its way to our inboxes with suggested revisions, signalling that the work was still ongoing. Our observation was that ongoing work associated with the project was integrated into the workloads of staff members in our community partner organization but not in our own, since the research funding cycle was complete. Although we are still committed to the causes that drew us to this project in the first place, as academics we felt compelled to direct efforts to securing new research (funding) opportunities. However, our relationships with practitioners using these products also developed throughout the project, and so our sense of accountability to both these relationships, but also to our shared interest in the value of this work has motivated us to re-initiate connection many times, including for the development of this paper.
Another gap between scholarly and practitioner needs that surfaced in the context of this project was the need for researchers to document their ongoing commitment to IKT products that were developed with their involvement. Because ‘productivity’ is a key factor in tenure and promotion decisions, it was important to us to obtain consistent information about the use of the IKT materials. For example, we want to be updated about the number of times training was offered and in what locations. Adding this information to a researchers’ CV (and tying it to a particular grant) demonstrates that the research team developed relationships and buy in, was responsive to community-based needs in terms of undertaking relevant research and produced useful knowledge products. However, busy with the day-to-day work of sharing the products from our research as well as other responsibilities, our key community partner did not often send updates on use of the materials, and we had not established communication processes for doing so. More recently, we mutually decided that they would describe use of the materials in an annual report to be distributed to all research team members.
Lack of Clarity about Decision-Making Responsibility
The collaborative nature of the leadership among researchers, community members and organizations, combined with the completion of the researcher funding cycle, meant that, once action-based project activities were complete, it was unclear which partner organization (i.e. the university or community partner) or even which member(s) of the research team had responsibility for leading changes to IKT products. Ultimately, we want to ensure the IKT resources remained relevant while still being true to the research evidence, and to the values that were fundamental to the project, such as collaboration and privileging of First Voice experience. Further, several of the researchers involved in the project were early career researchers employed in contract roles, which contributed to a lack of stability and continuity with the project, particularly once the active development of IKT resources had ended. Another challenge related to sustaining diverse involvement in the maintenance of IKT products was the lack of financial resources to support First Voice participation through honoraria once the funding cycle for the project was complete. The lack of financial resources meant that some First Voice partners who had been engaged in this work were no longer involved in the decision making and changes that would eventually influence their recreation contexts (through the training of recreation workers). This issue was a significant concern, because we valued First Voice advocates as key decision makers on product content.
Overall, lack of clarity about decision-making responsibility was grounded in concerns that changes to research products may not be evidence-based, thus moving away from the initial goal in developing these products, which had been to share primary research through knowledge mobilization. Our solution to this problem was to maintain authorship on the original version of IKT products, with subsequent versions authored by our community partner organization, and clearly indicating where and when changes had been made.
Concluding the Project
As KT products and resources continued to be updated and revised, the absence of a terminal and identifiable endpoint to the project left us uneasy. This found us, at times, considering applying for additional non-academic funding to carry out work on knowledge products to improve their relevance or utility. However, even when we
We came to realize that the endpoint of the project may be different for different stakeholder groups. From our (researchers’) perspectives, the end of a funding grant for IKT activities prescribed that the game, for example, was considered complete and static, while community partners were eager to make changes based on ongoing feedback. Further, although a strength of the project was to recognize the contributions of First Voice advocates (e.g. in some cases by name and other identifying features) in some IKT materials, the life circumstances of the some of the participants changed and their stories, shared in teaching tools such as videos, needed to be reconsidered. In future, we suggest that IKT materials containing identifiable First Voice contributions should be dated and include a clause noting that at the time of this research, the participant consented that these materials could be shared in the public domain.
Recommendations: Proactive Strategies for Sustaining Knowledge Products
As a research team, we have been able to negotiate the tensions described here because of the strong relational processes that provided a foundation for our work. Relationships among our research team and with community partners were characterized by friendship and mutual support, facilitating genuine discussion about what we valued as important to each partner in the project, what each team member or partner could contribute and what they needed (and still need) to get out of the project. These meaningful relationships and discussions provided a necessary foundation for the tangible actions that are articulated within this list of recommendations. Note that many of these require proactive consideration of potential challenges that may arise from strong and ongoing uptake of IKT products; for the most part we did not realize or anticipate this until after the dilemmas articulated above had arisen:
Document Formal Partnership Agreement With Community Partners
Discuss and agree on who will be responsible for making revisions to knowledge products (including the process they will use to consult with other stakeholders, if relevant) and managing the distribution of these products. In our case, we eventually drew on the expertise of the Legal Counsel Office at our university for help in establishing a legal agreement that sets out the authority and responsibilities of researchers and community partners.
Create Ongoing Communication Channels With Community Partners
Discuss and agree on ongoing methods of communication, such as an annual report from a community partner documenting use of, and any revisions to, knowledge products. While this is important during the active phases of the project (e.g. to guide team meetings or with advisory committee members) it is also important after project funding ends.
Copyright Knowledge Products
Assign responsibility for IKT materials formally by applying for copyright. Copyrighting materials provides both a formal means of assigning ownership (and documenting this on IKT materials), as well as a date on which materials are considered complete and final. Further, the concept of copyright is widely understood, including outside academic settings. Copyrighting (or publishing) makes explicit a final product and its associated publication date, providing a clear way to acknowledge changes and adaptations to research products made following the copyright or publication date.
Assign Expiry Dates
When discussing informed consent with participants and collaborators sharing their First Voice experiences, describe how data, including direct quotations, may be used in IKT materials, including the expected lifetime of those materials. Note a specific expiry date for materials both on consent materials and on the materials themselves. Arrange to re-contact participants to secure ongoing consent if necessary.
Secure Enduring ‘Homes’ For Key Knowledge Products
Seek out (online) venues that can securely store and make available key knowledge products far beyond the lifetime of the project itself. For example, when we published an academic paper about the creation of the practice guidelines (Gallant et al., 2020), we arranged to publish the full guidelines as an appendix that will be available on the journal’s website. We have also used the online venue Community-Engaged Scholarship for Health (ces4health.info), which offers a venue for peer review and publishing of non-traditional research products (Jordan et al., 2011), to publish one of our IKT resources, a presentation introducing mental health and related terms (Fenton et al., 2014).
Plan For First Voice Involvement Throughout The Entire Project
At the outset of a project, carefully delineate time and resources necessary for IKT through all stages of the project. This is, in some ways, an imperfect solution since it is impossible to ensure that funds and expertise are available in perpetuity to support knowledge product updates. However, it can help to carefully articulate your research values and be attentive about bringing those to fruition throughout the project.
Conclusion
While funders are increasingly requiring detailed plans for the creation of knowledge products as part of grant proposals, there is often little incentive to consider how to ensure the ongoing relevance of IKT products, nor to plan for required revisions and updates. Based on the dilemmas we encountered related to the evolution of knowledge products in our project as outlined in this paper, we advocate for proactive attention to ensuring the ongoing relevance of knowledge products, and the timeline and decision-making processes that will be used to manage necessary revisions and updates. We have outlined several recommendations to guide researchers in planning for the evolution of knowledge products, although this list is certainly not exhaustive. We also recognize these recommendations can only be put into practice in the context of mutually supportive and collaborative relationships. As with all community-based research, careful consideration of the needs and priorities of research partners, participants, collaborators and audiences are needed in developing a maintenance plan for IKT products that aligns with the scope, objectives and underlying values of the research itself.
Footnotes
Acknowledgements
Declaration of conflicting interests
Funding
ORCID iD
