Narrowing the knowledge to action gap: A mixed methods exploration of the implementation of knowledge exchange strategies

Abstract

Adolescence represents a time in which many health behaviours related to chronic disease risk are formed and carried into adult life. Schools are considered key settings for adolescent health interventions; however, despite extensive research in this area, schools face challenges implementing interventions at the local level. Knowledge exchange, in which researchers and knowledge users collaborate to discuss and apply research findings, is one strategy to reduce the “knowledge to action gap” between school health research and practice. While knowledge exchange strategies are emerging in school health research, the need for evaluation has been emphasized.

This dissertation explored knowledge exchange strategies within the first phase of COMPASS (2012-2016), a longitudinal study of Ontario and Alberta secondary schools and students. Schools received annual summaries of their students’ health behaviours and a COMPASS researcher (i.e., knowledge broker) supported them in taking action to improve student health. Mixed methods were used to examine influential factors and outcomes of the COMPASS knowledge exchange strategies.

A quantitative analysis of school- and student-level data from the first three years of COMPASS found that school characteristics (e.g., school size, existing health initiatives and relationships with public health units at baseline) and study-related factors (e.g., knowledge broker assigned to the school, knowledge brokering engagement level in previous year[s]) influenced schools’ participation in knowledge brokering. Knowledge brokering engagement was significantly associated with school-level changes related to healthy eating, physical activity, and tobacco programming, but changes were not evident at the aggregate student level.

Qualitative interviews with researchers (n=13), school staff (n=13), and public health staff (n=4) expanded on influential factors and outcomes regarding use of COMPASS findings and knowledge brokering engagement. Knowledge users focused on factors that influenced their use of COMPASS findings more than knowledge brokering (discussing fewer facilitators than challenges). Factors identified by researchers and knowledge users aligned with those that influence implementation of school health interventions. School and public health staff used school-specific findings to inform programming and planning; knowledge exchange provided a platform for partnerships between researchers, schools, and public health units; and also resulted in outcomes for the study and researchers. Further, outcomes suggest knowledge exchange could provide a mechanism to help schools implement a health-promoting schools approach. Altogether, the mixed methods findings raise two considerations: how can we increase school engagement in knowledge exchange and how can we ensure knowledge exchange strategies reach schools that have lower capacity to implement school health initiatives?

This research makes substantive, theoretical, methodological, and practical contributions. Substantively, it provides an evaluation of knowledge translation in school health research. Theoretically, it integrates social constructionism and social ecological theory, addressing the need for theory in evaluating knowledge translation strategies. Further, a mixed methods approach was used to examine both implementation and outcomes, which has been advocated in the literature. Practice implications are discussed related to future knowledge translation strategies in school health and public health research. Lastly, areas for future research are identified.