How does integrated knowledge translation work? A realist review

Integrated knowledge translation (IKT), or research co-production, is a research approach where researchers and knowledge users carry out a study as equal partners. A growing evidence base demonstrates that IKT produces research findings that are useful, usable and used. Despite knowing how IKT works, we have yet to ascertain how it operates. We conducted a realist review to examine the key mechanisms thought to explain how IKT approaches work in relation to the generation of research in the healthcare sector. The research question was the following: what are the necessary conditions (context) and key mechanisms that explain the success of IKT in the healthcare sector? We conducted the review in two phases. During phase 1, we collaborated with knowledge users and scoped the literature to develop preliminary program theories. In phase 2, we inductively tested the preliminary program theories against the literature. We searched OVID Medline, Embase, PsycINFO, the Cumulative Index of Nursing and Allied Health Literature, Social Sciences Abstracts, and ABI Inform for empirical articles published between 2002 and 2017. An updated search included Embase and OVID Medline articles published between 2017 and 2020. The review includes 84 papers. We included articles written in English that focused on the health sector; encompassed the co-generation of research with researchers, policy-makers, administrators and/or practitioners; and evaluated the IKT approach. In analysing the retained articles, we produced three program theories by looking for common patterns and challenging and refining these theories. We postulate three program theories about how teams of researchers and knowledge users work to generate research. We identified three important conditions: infrastructure, role clarity and power sharing. Under particular infrastructure arrangements, effective partnerships are mechanisms that lead to the production of research findings relevant to knowledge users. Role clarity also triggers effective partnerships. With power sharing, synergy is a mechanism that leads to the use of findings. We identified different conditions (contextual factors), including infrastructure, role clarity and power sharing, in which IKT produces research findings that are of relevance to knowledge users and used in health settings. Effective partnerships are necessary but an insufficient mechanism for actual use of research findings, and must occur before the mechanism of partnership synergy. This work contributes to our understanding of how to enhance the uptake of evidence by presenting three program theories and a consolidated, mid-range theory of IKT.