Authors: Elizabeth Estey M.A., Janet Smylie, M.D., & Ann Macaulay, M.D. for the CIHR - Institute of Aboriginal Peoples' Health.
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There are many different and complex descriptions of knowledge translation (KT), and no single agreed upon definition. One definition that has been used to describe KT in Aboriginal contexts is: sharing what we know about living a good life. This is quite different from the Canadian Institutes of Health Research (CIHR), which defines KT as: a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system. As the CIHR further explains: "this process takes place within a complex system of interactions between researchers and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user."
In Western science-based contexts, KT has also been described by its purpose: to reduce the know-do gap. Closing the know-do gap is a recent concern for the Western research community, as the worlds of research-based knowledge and action have traditionally been separated. This separation of knowledge and action comes from a different paradigm than Aboriginal knowledge traditions, where knowledge is often inherently practical. "Sharing what we know about living a good life" speaks to the fact that Aboriginal people have been doing and applying their own science for centuries: rich oral traditions, experiential knowledge, and cross-cultural sharing form the foundations of the KT tradition. This rich history of KT in Aboriginal communities provides a framework for researchers and policy-makers interested in Aboriginal health to learn from and integrate into their work.
The combination of a rich history of KT in Aboriginal communities and growing interest in KT among the Western scientific research community provides a unique opportunity to develop partnerships to utilize and apply knowledge to improve Aboriginal health and well-being. These partnerships are particularly important today, as large disparities in health status continue to exist between Aboriginal and non-Aboriginal populations. KT approaches that are driven by Aboriginal community members and their knowledge systems will be the most effective in addressing these health status disparities.
The Ethics of Knowledge Translation
Aboriginal KT – using research to create positive change – is an ethical issue and pursuit. Canada's Aboriginal (First Nation, Inuit, and Métis) Peoples are Canada's First Peoples; as such, they have unique rights and responsibilities. Thus, research involving Aboriginal people requires particular consideration. Ethical guidelines have been articulated by national organizations, including the recent CIHR Guidelines for Health Research involving Aboriginal People and a new version of chapter nine – "Research Involving Aboriginal Peoples" – of the Tri-council Policy Statement. The 4 R's of research – respect, reciprocity, relevance, and responsibility – originally described by Kirkness and Bernhardt are embedded in each of these guidelines and provide a simple framework for understanding and engaging in Aboriginal research ethics. The Ownership, Control, Access, Possession (OCAP) principles also provide guidance about how to conduct ethical health research with First Nations communities. Overall, these documents highlight the importance of including Aboriginal people in research and policy-making. This requires a focus both on the knowledge that is used and gathered and on the process of translation. These areas are discussed in detail below.
Knowledge: Understanding the "K" of KT
There are many different types and sources of knowledge that must be respected by the worlds of research and policy. Respect for a multiplicity of perspectives is built into many Aboriginal knowledge traditions. This is contrary to some non-Aboriginal settings, where knowledge gained through rigorous research methods, such as randomized controlled trials (RCTs), receives the most attention and credit. Thus, increased recognition and understanding of the strength and time-tested traditions of Aboriginal knowledge systems is essential to creating greater respect for different ways of knowing and building strength and depth into Aboriginal health research and policy-making.
Understanding and building on the many sources of knowing is necessary to fill the large gaps in our knowledge about all Aboriginal health –status First Nation, non-status First Nation, Inuit, Métis, rural and remote Aboriginal, and urban Aboriginal health. Such knowledge must be carefully evaluated and analyzed. For instance, continuing to apply Western science-based evidence perspectives will only further marginalize Aboriginal ways of knowing and perpetuate Aboriginal/non-Aboriginal inequities. This is particularly the case for Aboriginal health interventions, which are complex both in terms of the intervention and the community context and are not easily evaluated by the standard RCTs. The multiplicity of knowledge sources, therefore, requires a multiplicity of evaluation approaches.
Translation: Understanding the "T" of KT