This work, part of the Practical Tips for Library and Information Professionals series, was developed to provide creative tips-based approaches and best-practice ideas supporting innovation and adaptation in the constantly changing library environment. Grounded in theory, but not overly theoretical, this guide will assist librarians in seeking new ideas and inspiration to achieve continuous professional development (CPD). Acronyms abound, but since this book originates from the United Kingdom, the jargon differs. Authors have conveniently provided a “List of Abbreviations.”Staff in any organization are the most valuable asset. Ensuring the continued development of that staff to not only perform optimally, but also to thrive can be a challenge. Perhaps even more difficult than encouraging adaptation to change is encouraging individuals to challenge themselves to move forward in their careers or job satisfaction.In this volume, the manager can find advice on a variety of topics, such as enabling others to plan, evaluate, and reflect on their personal development; appraising and setting goals; linking personal objectives to organizational objectives; managing performance; locating funding to attend and host events; planning formal development activities such as courses and conferences; accessing informal activities; using social media as a development tool; understanding the role of professional associations and networks; and mentoring, shadowing, coaching, and other modes of networking.A significant strength of this volume lies in its organization. For each tip, the authors provide an “Overview” of the tip or activity followed by other information including “Best for,” the context where this tip is best applied; “More,” examples of how the tip or activity can be adapted; “Watch out,” practical advice on pitfalls that can happen when using the outlined approach; and “References,” the research that supports the practice.Section 1, “Theories,” includes a particularly valuable set of efficiently written descriptions of major theories of human behavior, learning, and development along with an introduction as to why familiarity with these theories can ground the manager or leader interested in developing staff. These nine theories can be quickly scanned with the option for more reading, if so desired. Section 2, “Infrastructure,” provides an overview of basic organizational structures that are necessary for learning and development to occur. These twenty-two topics, from “Work-force Planning” to “Effective Hand-over,” include tips on recruitment, interviewing, performance appraisal, team building, and exit procedures. Section 3, “Activities and Tools,” succinctly covers a fairly comprehensive list of sixty-eight ideas and methods to aid individuals in meeting a variety of career development goals. Listed in alphabetical order, these activities can predominantly be incorporated into a person’s work day.Provided tips can enhance such everyday activities as attending or running meetings, training staff, writing reports, and presenting at conferences. The essence is that career development is a continuous process, not necessarily requiring protected time, though such topics as reflective writing and social media are also addressed. CPD is the heart of a successful and satisfying career.The authors did not intend the book to be read in a linear fashion but to serve as a reference tool. Each tip provides an overview and details, guidance on timing, and issues to consider when employing the technique. The work is a pathfinder for continuous professional development, regard-less of available money and time. The authors provide numerous figures and tables to support the text, with a list of figures and tables. The index is cross-referenced. References include both classic works and current resources.Making Alignment a Priority (MAP) toolkit. Gil Young, the National Health Service Library and Knowledge Services Workforce development manager for the Health Care Libraries Unit North, also was noted as a Chartered Institute of Library and Information Professionals Fellow and Mentor of the Year. Both authors have additional experience in academic and public libraries.Tracey Pratchett, currently knowledge and library services manager at Lancashire Teaching Hospitals, served as the joint project lead for the This book is recommended for all library types as part of a librarian’s library. Although the tips and activities could be utilized by professionals in any field, the examples are specific to libraries. One could safely place this title in general collections for other managers to use or for those seeking a reference for personal professional development.


In today’s society, stress is more and more often a cause of disease. This makes stress management an important target of behavior change programs. Gamification has been suggested as one way to support health behavior change. However, it remains unclear to which extend available gamification techniques are integrated in stress management apps, and if their occurrence is linked to the use of elements from behavior change theory.The aim of this study was to investigate the use of gamification techniques in stress management apps and the cooccurrence of these techniques with evidence-based stress management methods and behavior change techniques.A total of 62 stress management apps from the Google Play Store were reviewed on their inclusion of 17 gamification techniques, 15 stress management methods, and 26 behavior change techniques. For this purpose, an extended taxonomy of gamification techniques was constructed and applied by 2 trained, independent raters.r=.17, P=.20), or stress management methods .Interrater-reliability was high, with agreement coefficient (AC)=.97. Results show an average of 0.5 gamification techniques for the tested apps and reveal no correlations between the use of gamification techniques and behavior change techniques (This leads to the conclusion that designers of stress management apps do not use gamification techniques to influence the user’s behaviors and reactions. Moreover, app designers do not exploit the potential of combining gamification techniques with behavior change theory. In today’s society, many people suffer from chronic exposure to stress , which iA person’s well-being, however, does not solely depend on his or her exposure to stress, but also on the way he or she copes with stress . Coping Stress management apps, like all behavior change programs, must be based on evidence-based content from behavior change theory, such as behavior change techniques  and streGamification, that is, the use of game elements in nongame contexts, is aimed at making interventions (including mobile apps for behavior change) more enjoyable, motivating, and engaging . As a reIndeed, gamification has already been suggested to positively influence user self-management ,25. MoreIn fact, it could already be shown that the implementation of gamification in form of rewards for diabetes patients  and combRegardless of these facts, gamification in the context of health and wellness  as well Interestingly, the association between gamification techniques found by Lister and colleagues was only due to the motivational behavior change aspects, namely, social support, providing incentive, goal setting, cognitive strategies, and self-efficacy. Regarding the use of theoretical content, the authors concluded that these apps were greatly lacking in all three categories . These findings are in accordance with the assertion that the development of health apps is currently lacking efficient and selective implementation of gamification . WhereasAccording to the mechanics, dynamics, and aesthetics (MDA) model of Hunicke at al , three lFor this purpose, an extended taxonomy of gamification techniques was developed. As no universal list of game elements exists, a list of features that are found in most but not necessarily in all games  was collIn the last step, all 17 gamification techniques were assigned to one of four categories: economic, social, performance-oriented, or embedding-focused. Economic gamification techniques include economical aspects such as “rewards” , which aIn addition to the number of used gamification techniques, this study also examined the correlation between gamification and the evidence-based content as presented by Christmann and colleagues . They inThis study was the first to investigate the use of gamification techniques in apps aimed at stress management. Its goal was to provide important information on whether designers of stress management apps are trying to influence user behavior through the use of gamification.This study investigated the use of gamification techniques in stress management apps available through Google Play. The selected apps were reviewed by 2 trained, independent raters on their inclusion of 17 gamification techniques  were excluded. In addition, apps targeting anxiety, depression, diabetes, insomnia as well as other medical conditions (n=82), addiction (n=2), weight management (n=13), or beauty and cosmetics (n=2) were excluded from this study. The same was done with apps that clearly focused on content other than stress management (n=8) and apps that could only be used with a wearable device (n=2). Therefore, 73 apps were downloaded and assessed for eligibility.Eleven additional apps had to be excluded during the review process. Since the apps were reviewed over a total of 1 month, 3 of the initially selected apps were no longer available at the time of testing. One app had to be excluded during the review process because it could only be used after entering the user’s credit card data, whereas another app turned out to be solely focused on fitness aspects without any further indication toward stress reduction. One app consisted only of an external website. Another 4 apps turned out to be only accessible via a membership or company code, whereas yet another app could only be used with a wearable device. A basic outline of the selection process can be found in Apps that met all inclusion criteria (N=62) were downloaded, installed, and tested by 2 trained, independent raters in October 2015. For this, raters used the device emulator of the development environment Android Studio 1.3 running Android OS 4.4 Android Studio . This apAs is common procedure ,56, the The reviewing process of this study only included content that was provided by the app itself. Information and features on websites that were linked within the app were not considered. Because all apps allowed the user to progress at his or her own speed, both raters could thoroughly check all features of the apps until it was apparent that no new content was going to be activated. An overall outline of the study procedure is illustrated in Each app received a score between 0 and 17, representing the number of gamification techniques included in the app. If the raters disagreed on the use of a technique, it was noted as included. Supplementary, it was noted whether an app needed an Internet connection to run, showed advertisements, required registration, had additional features available for payment, used links to external websites, and could be used with wearables .To make sure that the evaluation criteria were applied in a consistent manner by both raters, the interrater reliability was calculated according to Gwet’s agreement coefficient (AC) . This stP was calculated for the number of gamification techniques and the scores of behavior change techniques as well as for stress management methods in each app [Mean, standard deviation, and range were calculated for the sum of gamification techniques. To determine whether a linear relationship exists between the occurrence of the content from behavior theory and gamification techniques, correlational analyses were performed. For this, the Spearman correlation coefficient r and statistical significance each app .The 62 stress management apps included an average of 0.5 (range 0-2) gamification techniques, with a standard deviation of 0.7. The sum score of gamification techniques for each app  was implemented most often, followed by “parallel communication systems” (n=3). In contrast, the aspects “social pressure,” “real world prizes,” “teams,” “competition,” “marketplace and economies,” “ranks of achievement,” “narrative context,” “agents,” and “avatars” were never included . To summBeside the use of gamification techniques, this study also considered several additional aspects regarding the selected apps. In this context, it has to be emphasized that a considerable number of apps included external links to other websites (n=40), thus utilizing additional sources for features and information. The display of advertisements was found in as many as 26 apps. Thirteen of all reviewed apps required Internet connection. Furthermore, 6 apps only included text content and were, therefore, rated as pure electronic book (e-book). The frequencies of all additional aspects investigated in this review are displayed in P ≤.01), the Spearman correlation was applied to see whether an association existed between the use of gamification techniques and the use of the evidence-based content [r=.17, P=.20) as well as gamification techniques and stress management methods  could be found.Since the gamification data was positively skewed  of the apps, no app included more than 2 techniques. In fact, as much as 68% (42/62) of the sample did not use any gamification technique at all. Thus, even though some app developers tried making use of gamification to some extent, these findings indicate little to no use of gamification techniques in the context of free stress management apps for Android. Therefore, it can be concluded that app designers have not been trying to impact user behavior through the implementation of gamification techniques.These results contradict those presented by Payne et al , who fouRegarding frequency of use, “feedback” was the most often implemented technique. This is a positive result, as “feedback” is not only a gamification technique but also a common technique for promoting behavior change . It has These findings differ significantly from those of Lister and colleagues , who repWhereas some apps reviewed in this study made use of “digital rewards,” “levels,” and “secondary game objectives,” this was only the case to a very small degree. These aspects were only found in 2 apps. Nonetheless, app designers should make more intensive use of these techniques. As rewards are a common feature in other gamified interventions, designers could provide points , a tokenThe gamification techniques “3-D environments,” “leaderboards,” and “time pressure” were included only once. On the one hand, game designers should consider to make stronger use of “3-D environments,” as such environments may elicit an enhanced recovery from stress . On the Other techniques that were never used included “marketplace and economies,” “real world prizes,” “narrative,” “avatar,” “agent,” “teams,” and “ranks of achievement,” App designers should consider a more extensive use of these techniques. As such, the implementation of a “marketplace and economy”  can help to quantify the value of rewards and objects . It coulThe techniques reported to be used least often in this study differ from those by Lister et al  and PaynConsidering that neither the use of evidence-based content, nor gamification techniques alone is sufficient to ensure both behavior change and app usage ,20, the The lack of correlation found in this study does not match the results of Lister and colleagues , who repBecause the implementation of gamification techniques is directly influenced by app designers and can largely affect user behavior and reactions, designers should carefully consider the effects specific gamification techniques might have on the user. Correspondingly, designers should chose techniques with strong regard to the context of the app they are constructing. Hence, future studies should pay close attention to the levels of dynamics and aesthetics  and, theThe need for improvement suggested by the gamification results also extends to the additional aspects that were investigated in this study. As such, a large portion of the apps included features that require an Internet connection. This approach reduces the time that is needed for installation as well as download and provides the opportunity for larger content. Nevertheless, this aspect might require optimization, since its use makes apps dependent on Internet connections, which may not be available at all times and in all places. This point is even more important for the 10 apps that ran only when an Internet connection was available. Another aspect that needs to be addressed in this context is the fact that as many as 6 out of 62 apps consisted of text only. Therefore, it is hard to see the advantage of such apps over self-support e-books and websites—consumers expect modern technology to be interactive. The user’s perception of the media’s interactivity has great influence on user loyalty . As suchIn view of the MDA framework by Hunicke and colleagues , this stWhereas this study investigated an important aspect with its focus on the quantitative analysis of gamification usage in the sample, it needs to be kept in mind that the integration of game elements alone is no guarantee for successful gamification . Hence, Regarding the implications of this study, one must keep in mind that the results of the correlational analysis are hard to interpret due to the low mean and the standard deviation of the number of gamification techniques in the sample. A possible reason for the low mean of gamification techniques in the current sample could be that this review only focused on free apps. This may have resulted in the exclusion of paid apps with a more extensive use of gamification. Nonetheless, according to AppBrain , 90% of The results of this study clearly reveal that the use of gamification techniques in stress management apps is not very common. This is the case for the implementation of gamification techniques as well as the association of those techniques with evidence-based content (use of behavior change techniques and stress management methods ). It, thThis study was the first to investigate the use of gamification techniques as well as the cooccurrence of gamification techniques and evidence-based content in stress management apps. Moreover, it provides an extended framework for the investigation of gamification usage in mHealth apps.


Background: The current literature proposing criteria and guidelines for collaborative health system research often fails to differentiate between: (a) various types of partnerships, (b) collaborations formed for the specific purpose of developing a research proposal and those based on long-standing relationships, (c) researcher vs. decision-maker initiatives, and (d) the underlying drivers for the collaboration.Methods: Qualitative interviews were conducted with 16 decision-makers and researchers who partnered on a Canadian major peer-reviewed grant proposal in 2013. Objectives of this exploration of participants’ experiences with health system research collaboration were to: (a) explore perspectives and experience with research collaboration in general; (b) identify characteristics and strategies associated with effective partnerships; and (c) provide guidance for development of effective research partnerships. Interviews were audio-recorded and transcribed: transcripts were qualitatively analyzed using a general inductive approach.Results: Findings suggest that the common "two cultures" approach to research/decision-maker collaboration provides an inadequate framework for understanding the complexity of research partnerships. Many commonly-identified challenges to researcher/knowledge user (KU) collaboration are experienced as manageable by experienced research teams. Additional challenges  may be experienced in partnerships based on existing collaborations, and interact with partnership demands of time and communication. Current research practice may discourage KUs from engaging in collaborative research, in spite of strong beliefs in its potential benefits. Practical suggestions for supporting collaborations designed to respond to real-time health system challenges were identified.Conclusion: Participants’ experience with previous research activities, factors related to the established collaboration, and interpersonal, intra- and inter-organizational dynamics may present additional challenges to research partnerships built on existing collaboration. Differences between researchers and KUs may pose no greater challenges than differences among KUs  themselves. Effective "relationship brokering" is essential for meaningful collaboration. Several systematic and other reviews have been conducted: while some are generic,15 while other studies focus on collaborations among health and social care organizations (often for the purposes of enhanced service delivery).However, this research base describes many different kinds of partnerships, and makes different assumptions about who the “partners” are and the purpose of partnership. Some research addresses collaboration among diverse academic disciplines (multi/inter/trans-disciplinary collaboration or “team science”)a) collaboration between academic researchers and specific communities or patient groups (much research is found in the community-based participatory research [CBPR] literature) and, (specific to this study) (b) research-related collaboration between academics and various health and social care organizations or systems.The research focusing on various forms of collaboration between health service researchers and “the community” encompasses both: , differences in barriers, benefits, and strategies may also be expected. A limited number of studies focus on collaboration in health services and policy7 potential benefits of collaboration have been identified as: improved quality of solutions,6 greater research relevance and credibility,18 enhanced capacity of both researchers and KUs,10 greater understanding of partners roles,18 personal and professional development,10 greater likelihood that research will be applied in practice,24 and spin-off benefits such as enhanced skills and networks for future activities.25In spite of this diversity, there is much consensus on potential benefits and commonly experienced challenges. Although there is limited evidence on the impacts of collaboration on patient outcomes or system functioning,28 Other challenges identified include organizational factors; cultural differences between organizations and disciplines6; a need for specialized partnership skills18; the inherent complexity of intersectoral collaboration12; misalignment of researcher and organizational agendas,29 and researcher concern about objectivity and research independence.18 Researchers also identify academic reward systems as a challenge to collaboration.30Time and resource limitations, challenges of communication, and issues related to power are the most common challenges identified.a) environment , (b) membership, (c) process and structure, (d) purpose (including shared vision and objectives), (e) communication, and (f) resources.6 Sibbald et al identified four characteristics associated with successful partnerships: (a) partnership built on existing relationship; (b) alignment of researcher/KU agendas; (c) participation of skilled researchers, and (d) regular multi-modal communication.26 Salsberg et al identified the most commonly referenced strategies for effective partnerships as: (a) development of an advisory structure; (b) development of research agreements, (c) use of group facilitation techniques, (d) hiring staff from the community of study; and (e) frequent communication.27 Many authors identify trust and respect, along with opportunities for face-to-face interaction and clear roles and expectations as essential.35 Others stress the need for brokering, boundary-spanning or coordinating roles, as well as skills in change management.36Several conditions associated with successful partnerships have also been identified. Wildridge et al identified 20 critical success factors under the categories of: (22 research has rarely differentiated between: (a) research activities emerging from existing partnerships, and collaborations created for the purpose of the research activity itself; or (b) proposals responding to KU priorities, and those soliciting KU support for researcher-initiated proposals. Nor has there been investigation into whether partnerships built on existing partnerships face similar challenges to newly developing ones. Much of the research on partnerships is based on assumptions of researcher-driven initiatives,37 often with newly developing partnerships rather than established and supported collaborations. In addition, the voice of KUs is often absent.38While different indicators have been suggested for early and mature partnerships,a) is initiated by a health system identified need, (b) builds on an existing collaboration, and (c) reflects “criteria associated with success” for such partnerships identified in the literature. While Kothari et al suggest partnership indicators to assess the entire life of a collaboration22 this paper focuses only on the phase of developing a team, focusing the research question and developing a research grant proposal. This lens is important given the limited proportion of research applications that are successful, and the impact of previous collaborations on subsequent research activity.This paper addresses a gap identified in the literature on collaboration for the purposes of HSPR; and the characteristics associated with success in cases where the partnership: (a) solicit participant perspectives on, and experience with, on HSPR collaboration in general, (b) identify characteristics and strategies associated with effective researcher/KU partnerships, and (c) provide guidance for development of effective partnerships.Research objectives were to:   was established to lead implementation and evaluation of a primary care innovation in one Canadian province. Funding was obtained to support implementation and implementation evaluation. The project evaluator (SB), experienced in collaborative research and evaluation, together with IB, led a collaborative evaluation designed around KU questions. Design and results of this multi-year evaluation are reported elsewhere.Based on initial evaluation findings, the SC was successful in obtaining, early in 2013, a Planning Grant  to explore the feasibility of submitting a proposal to conduct research into several questions emerging from the evaluation. Researchers new to the collaboration joined the partnership at this point: all had previous experience in collaborative KU-led research activities. This grant supported a provincial forum for both KUs and researchers on latest evidence related to the innovation; two separate pre-proposal planning events  to identify research priorities and discuss strategies for further investigating the innovation; as well as proposal development activities. The proposed research team  developed a major funding proposal submitted in late 2013. Research activities described in this paper were conducted with this research team.Planning and proposal development activities were designed to reflect guidance for researcher/KU partnerships available in the current literature.Following proposal submission (early 2014), all signatories to the funding proposal (n = 19) were invited to participate in a confidential semi-structured in-person or telephone interview, conducted by a research assistant (LAH). Questions explored participants’ perspectives on, and experience with, both this specific collaboration, and research collaborations in general (Box 1). Participants were contacted by the Principal Investigator (PI) (IB) by email, who requested consent for LAH to contact them for an interview. Interviews were audio-recorded and transcribed. Interview length ranged from 15 minutes (new team member) to 45 minutes, reflecting both length and intensity of participant involvement in the collaboration.40 was conducted independently by SB  and LAH (process of rapid identification of themes from review of audio recordings in conjunction with field notes - Rapid Identification of Themes from Audio Recordings [RITA]).41 Interview questions provided the focus for cross-case analysis : manual coding using word processing software was employed. Using an open-coding approach,42 interview data were then reviewed again for previously unidentified or unexpected themes. Subsequent re-readings of the transcripts focused on overall perspectives of individual participants, noting similarities or differences in responses or perspectives between participants based on role (KU/researcher), experience with previous research initiatives, and relationship with the research topic. Subthemes emerging from initial categories  were further refined  with categories adapted after re-analysis of transcripts. Following independent analyses, SB and LAH met to share results of their analyses, to discuss themes identified, and to ensure that contextual data  only accessible through listening to the audio files was incorporated. No major differences between the two analyses were found, and consensus was reached on themes.In order to maintain confidentiality, only SB and LAH had access to the transcripts. Analysis, which used a general inductive approach,A summary of themes, with many examples of de-identified quotes, was then shared with IB and IG . Themes were discussed and refined (two iterative meetings) by the three senior authors, focusing on less expected findings and alternate interpretations of data. Learning from the interviews was compared with the current literature in order to develop guidance for future collaborative research activities. Following approval of the draft article by the four authors, the manuscript was circulated to all participants with a request for feedback.43Strategies to help ensure trustworthiness included transcribing interviews verbatim; independent coding by two researchers; inclusion of research and decision-maker perspectives in further refinement of themes; searching for divergent cases; practice of reflexivity (including group discussion of assumptions); and respondent validation (“member-checking”) with research participants.Of 19 potential participants, 16 completed an interview. . Four participants were classified as researchers, 11 as KUs, and one as a “hybrid” researcher in a decision-maker role. All researchers and many of the KUs had previous experience in health system research activities, allowing them to compare this activity with other experiences. All KUs were senior decision-makers in the provincial health department, a regional health authority, or the University Faculty of Medicine. Fifty percent were male. While most KUs had been involved since the beginning of the initiative, four joined following initiation of the innovation, and two  were not involved until the stage of developing the major grant proposal. Several team members provided feedback on the circulated draft article: all supported interpretation of the findings.1. Could you confirm for me when you first became involved in the (NAME) initiative? What was your role?2. Do you feel full use was made of your expertise? .3. How did you find the experience of developing a research funding proposal in collaboration with researchers/decision-makers?a. Have you been involved in joint researcher/KU proposal development activities in the past?i. If yes, in what ways was this experience similar or different?b. What, from your perspective are some of the benefits of the collaborative approach to research?c. What were some of the challenges you encountered?d. Did you ever find the collaboration experience frustrating? e. How did you find communication between decision-makers and managers and the researchers? (Probes: Any difficulties or frustrations?)f. Were there are any personal or professional benefits to you in being involved in research collaboration? (Probe for specifics).g. What may have made your involvement more satisfying?4. What suggestions would you have for similar teams thinking of building a research/KU team for research purposes?5. Is there anything else you think would be useful for me to know?After summarizing participant perspectives on the perceived benefits of participatory research, this paper will focus on challenges experienced with established partnerships; and suggest guidance for partnership research built on existing collaborations.Both researchers and KUs expressed overwhelming support for collaborative approaches to research, and expressed similar perspectives on the benefits.“Basically that it’s the only way to go. With something that’s trying to do a system redesign with the objective of primary care renewal to not have a collaborative process I feel would really be very short-sighted” (KU02).KUs with more research experience were more likely to identify benefits to a collaborative approach, and to comment on differences between various approaches to such partnerships.“Some of the projects [I have been involved with] tend to be very, you know, university, sort-of, researcher type focus: “I am doing this.” This was different because it really had the end-user stakeholder piece clearly identified. I think that is the strongest piece of this. You’re actually deliberately having to identify the knowledge users and the people that are involved in the managing of the system. So it creates that link deliberately at the start” (KU30).a) research-related impacts, (b) organizational/health system benefits, (c) benefits to individual participants, and (d) benefits to society. Only one participant observed no benefit (I’m not sure I can see a lot of benefits at this stage.…I think there needs to be a lot more evolution in order to get there) (KU12).Benefits identified can be classified as: (meeting a need”), quality (“enriches the research methodology and the research itself” KU11), and likelihood of use (more likely to be used because the decision-makers have a sense of ownership of it) (R28).Both KUs and researchers clearly articulated benefits of collaboration to research relevance .“I think you get better questions and there’s also a quality check because…if you misinterpret the data (Name) is likely to tell you you’ve got it wrong.…And also we’re understanding the limitations of the data before we even start” (R29).“If the researchers had gone off and done this on their own, and we weren’t kind of part of the study in some capacity, we probably would have paid less attention to it and it probably wouldn’t have resonated. We would have wondered, ‘Well did they consider this? Did they consider that? Why did they do this?’” (KU11).Many placed strong emphasis on the potential organizational/health system benefits of collaboration: Organizational benefits of increased research impact on decision-making and practice, greater likelihood of research use, and enhanced ability to integrate evidence with policy, were commonly discussed.“It has much bigger potential for impacting decision-making, and physicians, in the healthcare process.” (R34).“It’s the opportunity to bring research, practice and policy together” (KU02).Other benefits identified were earlier opportunities for action; enhanced credibility for organizational decisions; and increased organizational understanding of research and research processes.“There’s also opportunity, in a collaboration like this, that you might be able to get some feedback about what’s working and what’s not, during the course of the research project… you’re not necessarily having to wait till the end of two or three years to hear what the research might show. You’ve maybe got a little more insight into what’s working and what’s not” (KU11).that’s really, really energizing” (KU15) for creative problem-solving; to provide ‘reflective space’ in an often hectic environment ; and link diverse programs and participants who may not (without the structure provided by the requirements of partnership research) have an opportunity for information-sharing and joint problem-solving.Perhaps most importantly from the perspective of participants, collaborative research has the potential to provide a supportive environment ““You don’t often get the opportunity to sit down and exchange ideas with people from various [backgrounds], from academic, from leadership, clinicians. We don’t do enough of that in moving the system forward” (KU07).“It really makes you protect time to think about what you’re doing and who your partners are, sort of on the system side…it brings everybody’s eyes to the same problems at the same time” (R28).Many also highlighted a range of personal and professional benefits to involvement. These included the direct benefits of learning related to research (KU’s) or the healthcare topic (both KUs and researchers):“It was very good for me to learn more about, and get some background on [topic of research]” (R34).“I learned a lot along the way about those [research] requirements, coming through it with pretty fresh eyes. To see the approach and the knowledge and the discipline that goes into how to, from an evidence-based perspective, get data. So that’s the thing I’m not often exposed to….I don’t think I had an appreciation for the complexity of the level of rigor and detail that’s required to put a proposal like that together for submission” (KU15).Some participants also discussed the benefits of enhanced job satisfaction; exposure to alternate ways of approaching problems; potential career benefits; and development of personal and professional relationships.“The fun factor for me has been really good” (R31).“Seeing how the different players or different stakeholders inform that process and how they interact together and work in collaboration in the process” (KU10).“Connections, relationships with people at [the health department] that I wouldn’t have otherwise, that are going to carry over to the future work that I am doing” (R33).Building connections for new projects…” (KU30).“Benefit…being able to say, or put on your CV, that you’ve participated in a collaborative research project” (KU11).“Some participants also identified a moral imperative to conduct research that was directly applicable to problems facing both the health system and society, and to be accountable to tax-payers funding the research.“Because where either use of our time or our taxpayers’ funds are involved, of which we are stewards, we have an obligation to get the best value out of that” (KU12).45 at the individual, organizational, and system level.46 This paper, however, reports on collaborative HSPR research that met key partnership criteria .Barriers to research collaboration have been identifiedthe time crunches are really tight”: [KU30]) as a challenge to meaningful collaboration; however, researchers on the team found that timelines were generally manageable, due largely to the fact that the research had emerged from an existing system-driven initiative with an established structure.Our research confirms earlier findings related to the importance of time .“Nor did resources – at this early stage – present difficulties as the planning grant had supported several collaborative activities, as well as administrative support for proposal development activities.“One good thing was we got that planning grant so we could actually have those two meetings and meet with the decision-makers face to face and I think that is really good” (R34).the complexity of trying to pull together a funding proposal when you’ve got that number of people,” including scheduling of meetings, was noted as a challenge within the time frames.Many KUs commented positively on the support provided to meet many of the funding requirements . However, “a) orientation to the research process, methods and requirements, and (b) communication about progress of the grant. Researchers did not report challenges related to understanding the program and the issues, perhaps because they had the opportunity to review materials on development of the initiative and to attend the provincial forum providing latest evidence on the intervention.Consistent with existing research, several issues related to communication were also identified, particularly by KUs. These can be grouped into two major categories: , many KUs felt that more time was needed on these aspects.“I think my advice would be to take more time and kinda walk through [the process]. ‘This is the granting agency we’re dealing with… this is their name…these are the kind of grants that they issue. And these are some of their expectations. And they fund this kind of research but they don’t fund this kind of research. And here’s the deadlines that we’re working towards’…because I think that decision-makers can get kinda lost and get a little confused and maybe don’t want to look stupid so they won’t ask the question” (KU11).Some terms don’t mean anything - even ones that we didn’t think to define. That label or methodology wouldn’t have meant anything to me” (KU12).“Researchers agreed that additional time was needed for orientation and capacity building:I also think there’s challenges in general around understanding of what we mean by evaluation, research, performance measurement, accountability, monitoring” (R28).“In spite of implementation of a multifaceted communication plan , several KUs expressed frustration with communication, indicating that more, and more regular, communication is needed than is generally expected by researchers. The gap following communication of successful submission seemed to create the greatest difficulties, even though all were informed of the expected months-long wait time to hear of results.My biggest comment would be, ‘Why don’t I know anything about it?’ You know. How, if you have all these people signing papers and saying thing…I mean I have…submitted my CV for crying out loud, you know? Somewhere in there I’m on this but I know nothing about it” (KU21).“The challenge of communicating with new members who had not had the benefit of participation in earlier developmental activities was also noted.“So the whole issue of you bringing new people on board, and maybe other people drop off, how do you keep that same level of awareness and commitment, is something that I’d look at more” (R29).The challenges of both time and communication, however, were experienced as “to be expected” and manageable by most team members.“I usually expect that there might be some delays and you might not get the information when you want….There are always difficulties with the language in the way that different people use a bit of different terminology, but those will resolve” (R34).respectful’ environment and lack of observed conflict in these early stages. We found, however, that participant experience in: (a) previous research activities, (b) factors related to the current collaboration itself, and (c) dynamics inherent to the organizational context posed the greatest challenges to the team: these challenges also interacted with time pressures and communication in complex ways.Many participants commented on the ‘We found that assessment of the current collaboration was viewed through the “lens” of past research experience.First, there was often strong concern about traditional “academic” research, and perceived funder support for it.My view of the research community, to be very frank with you, is, quite honestly, extremely self-serving. That researchers believe they have a divine right to explore a topic they’re interested in and that government has an obligation to support them in doing that.…I found it extremely offensive that we think that we should provide 95% of the available funds to sort of pure research, which we can keep uncontaminated by any relevance in application, and then begrudgingly give 5% of it to stuff like [name of funding program]” (KU12).“Second, previous experience with research supposedly based on “collaborative” principles (but which had not been experienced as such) was observed to contribute to skepticism that affected future involvements . As one researcher observed:“Maybe their past experience with researchers hasn’t been very positive and it’s been, ‘We want this information and you have to do it for us.’ And they thought maybe we were working in that same mode, that it was kind of researcher-driven curiosity stuff as opposed to, ‘Everything we’re asking for it’s because the decision-makers actually need this’” (R33).We found some unanticipated downsides to building on an existing collaboration. One area of dissatisfaction related to clarity and expectations around roles. The research team proposed the senior provincial and regional decision-makers (co-chairs of the SC for the innovation) as the “key decision-makers” and framed questions around their articulated priorities for health system decision-making. Some, however, did not view this process as sufficiently participatory. Perhaps because of previous involvement in the collaborative evaluation, some KUs had developed expectations of an active participatory role that only became apparent during the confidential interviews. Some stated that they would have appreciated a direct request and discussion about what their role would be, rather than their role being assumed.“My personal feeling is that I would have liked to have been more involved, and not just as a knowledge user but recognized as a potential researcher. And I don’t know whether or not that’s appropriate…but it would have made it…would have stroked my ego more….I might have been more involved…not just making comments on the side for adaption. Ya, I think I would have had a higher investment” (KU03).“I think clarity of role and clarity of what the expectations are. ‘So what is your role?’ If you are a decision-maker and get an occasional email, is that it?” (KU02).In spite of general confidence among partners, dynamics within the health system  created greater difficulties than anticipated. Some issues only became apparent as the result of the interview process, and challenge the common view that primary tensions in research partnerships are those between researchers and KUs.First, we found some “disconnect” between the priorities of the senior leadership (who had clear ideas of the research questions they wished addressed) and many of the team members  who were being called on to actually provide information to prepare the grant. This disconnect was experienced by both researchers and KUs, and led to some breakdown of communication.“And the other challenge…I mean I understand why this happens, is…you could have a really good discussion with people and they’ll say, ‘Yep,’ that’s exactly what they want, and then they go off and do things, not realizing that what they’re doing is contrary to what they said they wanted.…I believe that they do want those questions asked. But the mechanisms, to operationally make sure that their staff are following their directives seems to be missing. And of course, as the outsiders, we can’t do anything about that” (R29).“I think certain groups [within our organization] have dropped the ball when they were asked to do something” (KU03).Second, the complexity of both the healthcare system, and the number of players from different organization also presented some challenges and frustrations.“Some of the frustrations on the part of the researchers with complex organizations like healthcare are the many stakeholders and the real difficulty in pin-pointing who has responsibility….There’s sometimes good reason but there’s no one individual who can push a button and make a decision. And I think sometimes [from] the researcher side, it’s just really hard until you’re in the organization, to have an understanding of that. It seems nonsensical” (KU28).“Just trying to get things done…things that would take five minutes…you might be chasing for months….And often…you’re trying to do things collaboratively, but there’s something that has to be done, for example by the region, or by the Minister of Health, or whatever it is, and until that gets done, everything gets held up. And that I find really quite frustrating” (R29).Third, we found “behind the scenes” tensions among different levels of the health system, different sectors, and specific individuals. While not necessarily apparent to researchers, these differences in agendas and perspectives appear to create a greater challenge than do commonly assumed differences between the “cultures” of researchers and KUs.“You’re framing the questions in terms of sort of a binary, like researchers vs. decision-makers and I think that actually implies a level of homogeneity of those two groups that didn’t exist. There are a bunch of different research perspectives and a bunch of different decision-maker perspectives and just the sheer number of those different perspectives regardless of category made it more complex” (KU12).This is not to say that differences between researchers and KU were not recognized.“And I think decision-makers, KUs, might often inadvertently disrespect researchers, the rigors of research and the time it takes, because they’re used to working reactive and fast. And then when you start wanting to really dive into proper methods, there isn’t a lot of patience for it. So I think some work still needs to be done on understanding those two worlds and most people don’t” (KU28).However, many saw these differences as a source of strength, and understanding of the pressures of the other’s role was often articulated.“And it’s not about everyone being homogenized to become researchers…it would be great if they (the decision-makers) learned more about research, but the intent of the project isn’t to make them researchers, or make researchers policy-makers. So co-creating, like helping people understand what the roles are and negotiating those…” (R31).Finally, significant frustration was expressed by several KUs about what appeared to be a lack of thoughtful planning by the health system in prioritizing and taking leadership on organizational research priorities, including what was perceived as lack of willingness to commit resources to investigate important health services issues. In the absence of clear processes and partnership criteria, some KUs were inclined to interpret the research initiative as researcher-driven . It even led to some skepticism about the benefits of engaging in applications for research funding.“The other question that’s come to my mind is, if it’s not funded does that mean that we should not proceed with some aspects or do we…have a back-up plan if we feel the work’s important enough to inform immediate activity? So I’m just a little concerned that you can then put all of your eggs in the [research funding] basket…And I think that’s a conversation (that) we may want to have” (KU2).“I think researchers trotting off because they’ve made a connection or because somebody’s approached them, I think, you know, checking in early with somebody more senior in the organization to say, ‘We’re interested in studying (X). So-and-so has approached us and has expressed an interest. Is there anybody else we should be working with?’ Because I could see researchers maybe getting engaged or involved with maybe not the most appropriate people, or not necessarily the most enlightened” (KU11).incentivizing,” “they don’t need to pay for [the research]”).These concerns were, on the whole, not evident to researchers who viewed the potential of receiving research funding as wholly positive  challenges to proposal development. For example, senior decision-makers had several clear questions they hoped to address. These priorities were clearly articulated in team meetings, and led to brainstorming by researchers and some KUs about how the research could best be designed in order to address these questions. As criteria were still being finalized for selection of early adopter sites, one suggestion was to select sites based on criteria that would facilitate measurement of factors of concern to KUs. Analysis of interviews revealed diverse interpretations of these discussions: while researchers felt that they were, through brainstorming, attempting to come up with a strategy that would best address KUs needs, this was not the interpretation of all KUs:“From the point of view of the researchers, we want a nice distribution of data points so that should enter into the criteria for picking sites. And you know, from my point of view, while I’m totally supportive of research and I think that we want our practice to be evidence informed and one of the ways to do that is to support research, it’s clearly the tail wagging the dog. The objective is to actually advance the health system and an intermediate step to that is to actually get the right providers employed in the right clinics. So, you know, to undermine that objective for the sake of having a nicer mix, a nicer sample from a research point of view was a non sequitur to me” (KU12).a) enabling preconditions for partnership research; (b) supporting research team formation; (c) promoting team effectiveness; (d) facilitating proposal development; (e) guidance for proposal submission, and (f) guidance following proposal submission.Our analysis, confirmed by respondent validation activities, identified several factors perceived as contributing to the creation of successful research partnerships developed in response to decision-maker priorities. These conditions and activities can be categorized under the headings of: ; and – ideally – interest in research.b. Communication of the rationale for selecting KUs for grant participation to all stakeholders. Participants recognized that it could be challenging to include all key stakeholders in research addressing complex system issues. The importance of ensuring a meaningful role for those involved in day-to-day operations was also stressed.trotting off because they’ve made a connection” (even if this was not the most appropriate one), experienced researchers also recognized the challenge of linking with appropriate KUs, and the importance of a facilitator (a “relationship” broker”) who could assist in determining who they should be partnering with.c. Identification and support for the role of a “relationship broker.” While KUs spoke with frustration about researchers ““Having your senior partners, that when there is an issue you can have a chat with them to say… ‘OK, we kind of need help from this part of your organization.’ … So that policy-maker/decision-maker people actually kind of step up when there are barriers or challenges are in the way” (R31).Recognition of the time and skills needed to play such a brokering role is also needed.“Just recognition that KU engagement is a skill. And you could just say often times researchers are oblivious to, are not as aware of, the organizational culture, and nuances. And so without somebody brokering that relationship, there’s less meaningful input and more barriers to participation” (KU28).d. A credible structure to support collaboration. In our case, a province-wide Steering Committee, chaired by senior provincial and regional decision-makers, was the obvious structure to support the collaboration and provided needed credibility. We also identified the importance of jointly developing processes  that are realistic and based on KU needs, and ensuring a clear understanding of how administrative support will be provided.e. Clear expectations, roles and responsibilities of team members. Various team members had diverse perspectives on what was expected of members of the collaboration.3. Promoting Team Effectiveness. We found several factors were associated with team effectiveness:voice was valued”). This may be even more important to an established team that may have higher expectations of engagement. Very few team members were interested in just “signing on.”a. Sufficient time for team development. Many emphasized the importance of opportunities for KUs to provide “real” input into the concept and proposal .“If the Health Economist asks me a clinical question, or I have a Health Economy question that’s, you know, less than a first year basic questions, I don’t know anything about it, that I could feel comfortable asking that question in an environment of such high-power people because that’s not my area of expertise” (KU7).c. Common vision and purpose. Participants emphasized the importance of building shared understanding on which the proposal can be built:“…a sense of shared vision and shared purpose at the beginning because we have such a diverse participation and diverse location” (KU15).“People to be honest and upfront about what their goals are and I mean, if it’s just to produce a research project, [or] about creating an excellent piece of research that improves policy and healthcare delivery...if we are on that same page to begin with” (KU07).by far the best format for communication because you get way more out it in a shorter period of time” (KU10). These meetings were felt to bring an “added level of depth” and to allow team members to “really engage in a dialogue” (KU15).d. Opportunities for ‘face to face’ meetings. Many felt that in-person meetings were ““Certainly, one good thing was that we got that planning grant so we could actually have those two meetings and meet with the decision-makers face-to-face.…Quite often you only get to attend meetings by phone or you only get through to some other person and they just sign off…” (R34).Others stressed the importance of informal and social events in team building.“There were also social events, which I also think are really important to get to know people outside of work….My sense was people were really open and they were listening and asking questions. I think we underestimate the importance of building those personal relationships, because when you’re dealing with researchers and KUs, you need to develop trust. They get to see you - that you’re kind of a normal person and you talk about stuff other than research” (R31).While in our case these meetings were possible through specific meeting grant funding, creativity may be needed to find financial support for such in-person activities.e. Appropriate team orientation. Participants felt that researchers should be prepared to address topics such as: background on the funding program; time lines and deliverables; roles and expectations; support for logistical tasks; key research concepts; and similarities between research, evaluation, performance measurement, and related concepts. KUs should be prepared to provide background on the service/issue, current related initiatives, and to identify any issues that may pose challenges to completing the task.f. Jointly developed “rules of engagement.” We found that it was necessary to jointly negotiate roles of each team member, communication strategies, costs and compensation for grant development and proposed research activities, data access, ownership of findings and dissemination plans.4. Strategies to support proposal development. Development of a fundable proposal is the first concrete deliverable expected from this preparatory work: we found that the following factors were associated with joint agreement on a research proposal.a. A research question that is both important to KUs and feasible within the focus of, and funds available through, the grant. A collaborative team must develop mechanisms to work through different perspectives and come to consensus on the research question (an activity that may take much more time than anticipated).b. Good project management to ensure that funder timelines are met. Participants commented on the importance of adequate logistical support in ability to ensure deadlines were met.c. An effective relationship broker. Although time constraints risk making this phase simply task oriented, participants highlighted the importance of a relationship broker role to flag potentially sensitive areas or misunderstandings, negotiate relationships between team members with diverse perspectives, and facilitate communication.“So yeah, there was a lot of, some conflict I guess, quiet conflict. But I think there’s some brokering at the coordinator role, a ton of work brokering that. The role itself is a kind of make-or-break role and if you’re not good at it, you could really break it. Like how to get hold of the CEO [Chief Executive Officer] of an organization and bring them on board quickly, and get their CV in there and their buy in…communicating with the right people in the right way. Logistics. Understanding the culture in which they work, respectful engagement” (KU28).This role is also necessary to ensure that the there is support for the (often) complex logistical requirements of grant development and submission: ensuring that KU have support to complete such tasks as CV development.“I think without that support, I would have found it very challenging. So I think for people like me, that aren’t as exposed to the rigor of those requirements, that would be essential. That there be that capacity-building for it and helping people understand what the next steps in the process were” (KU15).5. Activities following proposal submission. Finally, our experience suggests that attention is required to support ongoing collaboration after the proposal is submitted and team members have been notified. The 6-8 month waiting period for the funding decision often results in KUs “forgetting” details of the grant, given the many other tasks and issues they are addressing at any point in time.“There were long periods where you didn’t hear much about, you know, where’s this thing at? And it could be because there was nothing going on” (KU30).There are a number of limitations to this research. First, it interviewed team members from only one initiative (with the specific partnership characteristics noted earlier), in the Canadian healthcare setting. In addition, the research activities described were being developed in the context of multi-level system wide reform: although activities were focused on one innovation, many other inter-related primary care initiatives were underway at the same time. While findings may not, therefore, be directly transferrable to smaller, project-based activities, they provide focused insight into the challenges of collaborations that meet the criteria for effective partnerships identified in the literature, and where partnerships are developed around decision-maker priorities: a current knowledge gap. They also address another common gap in the research: the failure to include the voices of KU partners.10 Benefits in this category appear not to be limited to directly research-related issues. Rather, both researchers and KUs emphasized the learning that resulted from exposure to diverse skills and perspectives (ways of looking at problems): this transferable learning may be one of the greatest benefits to collaboration.Our research confirms many of the findings identified in the literature on potential research benefits of collaboration. We also found a number of reported benefits related to what is often referred to as “capacity building.”26Perspectives on time and resource limitations and communication barriers were similar between researchers and KUs in this setting. However, perhaps because the researchers interviewed were experienced in collaborative research, most challenges highlighted in the literature  while experienced, were largely expected: they were seen as part of the job and did not pose serious obstacles .Our research has highlighted, however, additional potential challenges related to past experience with research, history of the existing collaboration, and dynamics among KUs themselves, illustrating how these dynamics may play out in development of research proposals. While building on an existing collaboration may provide the research partnership with a strong foundation, past history may contribute to additional challenges. In such situations, it is important to recognize the expertise of individual KUs and explore with them potential roles and anticipated contributions; to be clear about roles and expectations; and to develop strategies to orient any members recently added to the partnership.6 this research identified the importance of both organizational complexity, and the diversity of inter and intra-organizational perspectives. While not always visible to researchers, these dynamics may have an enormous impact on collaborative research activities.While organizational culture has been identified as a factor in promoting effective partnerships,47 This hypothesis has led to the creation of the role of ‘knowledge broker’ (KB), intended to interpret between the two cultures. Our work with an established KU/researcher team, however, questions the usefulness of this division, as differences in cultures (and agendas) were found as much among KUs as between researchers and KUs.Our findings suggest that the primary tensions in partnership research may not always be between researchers and decision-makers .49 and illustrated the diverse roles that so-called knowledge brokers (KBs) may play. To date, however, much emphasis on such roles has been on transferring knowledge between various stakeholders rather than facilitating relationships, and the diversity of roles has not allowed for confident assessment of benefits.48 Reframing the role to focus on “relationships” rather than “knowledge” may be useful. To be effective, the relationship broker requires in-depth knowledge of organizational culture(s); knowledge of the individual ‘players’ associated with the issues; coordination resources to help ensure timelines are met; protected time; and research experience.This research also highlights the importance of a knowledgeable “relationship” broker (as distinct from a knowledge broker), who can navigate, not simply between researchers and KUs, but among potentially competing KU agendas and relationships, both within the team, and across different organizations. Many authors have identified the importance of some form of “boundary spanning” role in effective collaborations,Coordination of so-called collaborative research proposals is, however, often managed from within an academic centre by a research assistant (often a student who may or may not have this experience) rather than by hiring staff from the community of study. Our experience supports previous research suggesting that situating such a role within the partner organization (possible in our case through planning grant funds) is more likely to be effective; and may be a consideration in setting criteria for collaborative funding programs.system change require broad engagement, suggesting that it may be useful for funders to reflect this complexity in RFP guidelines, timeframes, evaluation criteria, and targeted funding programs to support collaborative grant proposal planning. Without the planning grant support for relationship and proposal development activities (from which this activity benefited), true engagement would not have been possible – even given an established partnership – in the available time frame.This research also raises implications for research funders. Inclusion of KUs may present additional time, logistical and interpersonal challenges. Research proposals focusing on 50 While many frameworks outlining categories of research impact have been developed,55 recent research suggests that in practice these indirect benefits may be undervalued.56Wait times inherent in grant timelines of many major funders pose challenges to collaboration: creative strategies to facilitate timely decisions on decision-maker initiated grants are needed. Also of potential interest to research funders is the strong emphasis given by participants to organizational and health system benefits of collaborative research. This may serve a reminder that, in measuring research impact, it is important to look beyond direct utilization of research findings, and attempt to capture benefits arising from the research process itself.After several years of “collaborative” research funding opportunities, many KUs have experience with how such collaboration is generally interpreted and managed by researchers. Requirements by major funders for researchers to have KU partners have created an environment where many researchers feel they must form partnerships with knowledge-users even if this is not their interest. Consequently, many KUs have had experience with so-called collaborative research that has coloured their expectations of future partnerships. Few may have experience with authentic research collaborations driven by decision-maker priorities rather than researcher interests, creating challenges for researchers interested in developing a research agenda around KU priorities. Researchers committed to collaborative research are advised to develop strategies to assess potential partners’ past experience, and explicitly outline their assumptions and motivations for collaboration. While KUs in our study remained supportive of the principle of collaborative research, they also expressed a number of frustrations about the current funding environment, as well as common research practice. This suggests that the current review process may not be optimally effective in recognizing (or giving appropriate weight to) genuine collaboration in response to health system needs.Conditions and Activities Associated with Successful Partnerships in order to provide concrete guidance for specific early stages of partnership development. Integration of our research with the existing literature on research collaboration suggests a number of recommendations for developing successful research partnerships in response to KU priorities. This guidance is relevant for KU organizations, researchers, and research funding bodies. a) driven by KU priorities, and (b) based on an existing partnership. A number of practical guidelines for developing research proposals in such an environment are proposed: these build on existing literature and reflect the findings that while (in established collaborations) many challenges are manageable, previous experience with research activities, factors related to the established collaboration, and interpersonal, intra-, and inter-organizational dynamics may pose unanticipated challenges. The previous focus on addressing challenges related to differences in the researcher-KU role should be expanded to strategies for responding to differences in roles, perspective and agendas of all team members.This paper is one of the first to explore both KU and researcher experience with participation in collaborative HSPR initiatives: , Ottawa ON, Canada Planning Grant [RFN #126820]. In addition, Ian D. Graham is the recipient of an inaugural CIHR Foundation Grant [FDN #143237].This study was approved by the University of Manitoba Health Research Ethics Board, Winnipeg, MB, Canada file number HS15442 (H2012:222).Authors declare that they have no competing interests.SB designed the study in collaboration with IB and IG. Interviews were conducted by LAH. SB led the analysis and interpretation, in collaboration with all authors. SB drafted the manuscript IB, IG, and LAH provided critical review and revisions. All authors approved the manuscript.1School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada. 2Health Services Integration, Winnipeg Regional Health Authority, Winnipeg, MB, Canada. 3Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada. 4eHealth Centre of Excellence, Centre for Family Medicine, Kitchener, ON, Canada.“Relationship brokering” may be a more useful concept than “knowledge brokering” in promoting and supporting established researcher/knowledge user (KU) partnerships.Differences between research and KU cultures identified in the literature may pose no greater challenges to collaboration than differences among KUs  themselves.Experienced teams often find commonly identified challenges to collaboration  manageable.Health organizations that proactively determine their research priorities and criteria for research engagement are likely to experience more satisfactory research partnerships.Effective health services and policy research (HSPR) partnerships are encouraged by funder support for planning and preparatory activities; recognition of health system costs and contributions; responsiveness to KU time constraints; and strategies to identify and support system-driven health initiatives.The health system is facing complex challenges that require collaboration between researchers, policy-makers, and practitioners. One of biggest challenges is the development of collaborative researcher/knowledge user (KU) teams to develop and conduct relevant research. This research identifies guidelines for promoting effective research partnerships. More effective partnerships will increase the likelihood that research conducted to improve healthcare delivery will address important questions and be useful in practice.


The importance of effective translation of health research findings into action has been well recognized, but there is evidence to suggest that the practice of knowledge translation (KT) among health researchers is still evolving. Compared to research user stakeholders, researchers (knowledge producers) have been under-studied in this context. The goals of this study were to understand the experiences of health researchers in practicing KT in Manitoba, Canada, and identify their support needs to sustain and increase their participation in KT.Qualitative semi-structured interviews were conducted with 26 researchers studying in biomedical; clinical; health systems and services; and social, cultural, environmental and population health research. Interview questions were open-ended and probed participants’ understanding of KT, their experiences in practicing KT, barriers and facilitators to practicing KT, and their needs for KT practice support.KT was broadly conceptualized across participants. Participants described a range of KT practice experiences, most of which related to dissemination. Participants also expressed a number of negative emotions associated with the practice of KT. Many individual, logistical, and systemic or organizational barriers to practicing KT were identified, which included a lack of institutional support for KT in both academic and non-academic systems. Participants described the presence of good relationships with stakeholders as a critical facilitator for practicing KT. The most commonly identified needs for supporting KT practice were access to education and training, and access to resources to increase awareness and promotion of KT. While there were few major variations in response trends across most areas of health research, the responses of biomedical researchers suggested a unique KT context, reflected by distinct conceptualizations of KT , experiences (including frustration and lack of support), and barriers to practicing KT .The major findings of this study were the continued variations in conceptualization of KT, and persisting support needs that span basic individual to comprehensive systemic change. Expanding the study to additional regions of Canada will present opportunities to compare and contrast the state of KT practice and its influencing factors.The online version of this article (10.1186/s12913-017-2573-9) contains supplementary material, which is available to authorized users. The transfer of health research findings into practice has traditionally been slow and inefficient, taking up to 17 years for established evidence to reach patients . The resThe overarching goals of KT have been widely embraced in health research, exemplified by many funding agencies now requiring explicit consideration of KT in their submissions . Such reThere is a need for active, theory- and evidence-informed strategies to engage health researchers in practicing KT. Despite their role as key stakeholders in the knowledge-to-action process, researchers have been relatively under-studied in this context. Prevailing models of KT emphasize the importance of preliminary work to explore current practice, gaps, factors influencing behaviour, and adaptation of potential solutions for specific contexts, prior to developing interventions .This study was conducted in the Canadian province of Manitoba. Manitoba is the fifth-largest province in Canada, with more than half of approximately 1.2 million residents concentrated in one urban centre. There are four public universities that are all engaged in health research to some degree, with one institution administering doctoral and medical degrees. The goals of this study were to understand the experiences of health researchers in practicing KT in Manitoba, and identify their support needs to sustain and increase their participation in KT. The specific objectives were to explore: (i) how health researchers conceptualize knowledge translation; (ii) KT strategies and activities practiced by health researchers; (iii) barriers and facilitators health researchers have experienced in practicing KT; and (iv) desired supports for facilitating KT practice.identify the problem (objectives i and ii), assess barriers and facilitators to knowledge use (objective iii), and tailor to local context (objective iv) using qualitative descriptive design, a methodology that comprehensively summarizes an issue or event using everyday terms , and certainly it’s important to have experts with that skill.” KT was a relatively new concept for most participants, some of whom discussed how it was a reflection of a changing and evolving culture. P10  remarked, “People now value this sort of work [KT], and are calling for it, and are paying for it”. Others, some with experience in participatory action research and/or evidence-based practice, felt it was simply a new term for existing practices. As P14  reflected, “I recognize that we were already doing… that [KT]. But hadn’t really called it by that name before”.Half of the participants described KT as either challenging, time-consuming, and/or complex, often recognizing the need for specific expertise. P1  said “Knowledge isn’t really very useful unless it gets into the hands of people who… would apply that knowledge.” Five participants highlighted the importance of KT by making reference to researchers ‘working in silos’ and the ‘ivory tower’ of academia. As P16  put it “I work in real life settings, where research needs to matter on the ground on a daily basis, not just in the ivory tower of academia”. More than half of participants considered the practice of KT a professional duty: “It’s a fundamental requirement of the way that we do business here” . Others qualified the value of practicing KT in relation to the specific research context: “All circumstances and situations are different from researcher to researcher, and the field” .The most common discussion of the importance of KT related to the context of relevant and useful research. P20  explained that “As a group, participants described a range of experiences in practicing KT. Almost all participants described using dissemination strategies. Targets of these activities included both traditional academic audiences , and non-academic audiences . Some participants specifically identified a lack of KT practice experience, such as patient engagement, outside of traditional dissemination.Among those who reported working with stakeholders throughout the research process, advisory groups, relationship-building, and collaborative discussions were employed. A few participants discussed use of participatory action research, including a participant-led photo-voice project. One participant who also held a clinical leadership position described enacting policies in that role to “force” evidence-based medical practice. Some participants discussed conducting retrospective chart reviews as a KT activity, while others described membership in KT organizations or application to KT funding opportunities as indicative of practicing KT. Two participants described participant engagement in a research project, acknowledging the experience as ‘tokenistic’.I think I fall into the gap of the scientist that is often forgotten when people talk about KT. In my opinion KT is very biased”, and “I feel at times as a basic scientist, I’m an oddball for even trying to do KT, and that it’s very much me morphing what I do to fit preconceived desire(s) for KT”. To this end, a few felt that the emerging emphasis on KT-related funding opportunities excluded basic research. “I do have the feeling that there is still lots of basic science and clinical to be done, that doesn’t require this kind of approach, and I worry that, you know, one of the down sides of the emphasis the granting agencies have been putting on knowledge translation – in particular integrated knowledge translation - is that it makes everybody feel like every project has to take this kind of approach” .In describing both experiences and conceptualizations of KT, some participants associated emotions and emotive states with its practice. These ranged from (in one case) excitement, to fear and intimidation, frustration, burnout (among established researchers) and disappointment. As a group, biomedical researchers expressed concerns about being unsupported in practicing KT, and frustration that the emerging field of knowledge translation is developing with seemingly little regard for discovery research. P2  noted, “Participants identified a myriad of barriers and facilitators to practicing KT. Barriers were predominate, and were classified into systemic or organizational, individual, and logistical barriers. Participants from the biomedical sciences described barriers specific to their field (described below). A small proportion of participants felt there were no barriers to practicing KT.“I never found that I got a heck of a lot of any kind of support within the faculty of [X], or within the faculty of [Y] to do that work”. Time constraints and competing priorities such as tenure, funding, research, publications, and teaching were frequently noted. P16  said, “Sometimes it becomes difficult for you to now reach out into the community, for example, to be able to do that, because of time and resources, and you’re actually… involved in teaching, or in governance at [the] university, or research, and you don’t have that as a focus”. Several early career researchers felt that being at an early stage was a detriment to KT, due to academic priorities taking precedence and lack of experience. P2  explained, “As a young investigator, your sole focus in life is getting grants”. Some participants felt that, in general, KT was not recognized as a priority by academic institutions and governing organizations that support Canadian research programs, or society in general.Among systemic barriers, the most frequently reported barrier related to resource allocation and insufficient funds for practicing KT. Multiple participants felt that that there was a lack of support for practicing KT at the institutional level, be it the University, funder, or government, and that the established nature of academic institutions was a barrier to KT. P3  stated, . This point was summarized by P1 : “It’s easy for messages to get skewed a bit in the media, and for people to get the wrong impression”. Another major barrier identified by participants was their lack of skill or ability in practicing KT. P3  noted: “I am not ready to do it because I don’t think I have the skill set to do it, not that I don’t think it’s important - just to be clear. I personally don’t have the skills to do it effectively, so I am reticent to do it and waste everybody’s time.” A few participants expressed disinterest in practicing KT or did not view it as aligning with their research.Individual barriers to practicing KT were numerous. One of the most commonly identified barriers related to dissemination of research results and concerns over the potential for miscommunication between researchers and stakeholders when engaging with the mediaLogistical barriers included difficulties translating a very large body of evidence (and conflicting information), physical barriers when working with rural or remote groups, the current emphasis on training academics to conduct (but not translate) research, and concerns about ethical considerations. For example, some participants expressed concern about Facebook or sharing data when engaging with communities. Two participants from the social, cultural, environmental and population health research pillar mentioned barriers specific to research conducted in rural settings. Namely, they identified weather (flooding), distance (in terms of traveling and the ability to follow up with remote communities), and illness – either theirs personally or public health outbreaks – as barriers to engaging with stakeholders in KT activities in remote communities.“If I identify a new drug or a new way to use a drug, and then I want to go to a big pharma company to back the research to move it to the stage where you are using it in a clinical trial, that actually can’t happen. You get no interest or attraction, unless you’ve already protected that property, with a patent or a license”. P4 described tensions between the desire to share results and the need to obtain a patent: “the challenge here is that I’m a new investigator, and I need to basically show my research to other people to get more funding and to get more recognition. And… but if I do that, I cannot patent the method anymore.”Biomedical researchers noted some barriers specific to the nature of discovery research, namely challenges related to intellectual property concerns and commercialization. P2 succinctly explained, “the whole thing is based on the relationship with these people, whom we think we want to use our research. And so, that all comes down to relationships, which are built on trust.” In contrast to comments of participants who reported lack of funds as a barrier to practicing KT, the ability to access resources, such as funding and personnel, was a facilitator for others. One participant described success in acquiring competitive funding to create a video for dissemination of research findings. Mentorship, experience, and training in practicing KT were also identified as facilitators. Several participants noted personal traits –including drive, passion, and enthusiasm—as facilitators for practicing KT. Numerous participants also mentioned how having trained communications personnel working on or alongside their team was a facilitator for practicing KT. As P27  stated “I do a [newsletter]… about once a month. I don’t think it would have nearly the polish – and hence the appeal – if I did not have a professional work on it”. Finally, a few researchers recognized the value of specific local, national, and international platforms or groups in promoting KT – for example, lobbying groups such as the National Institutes of Health.Maintaining good relationships with stakeholders was identified as a major facilitator for practicing KT, reflected by trust, honesty, frankness, face-to-face interactions, and understanding each other’s roles. As P11  explained; Participants identified a number of needs they felt, if met, would support their engagement in practicing KT Table . The mosHealth researchers represent a critical and understudied KT stakeholder group. This small study makes an important contribution to knowledge translation science by identifying current issues in KT practice among health researchers in Manitoba, Canada, highlighting opportunities to advance the intersection of KT practice and science. The findings also highlight important distinctions between health research pillars with implications for KT scientists and practitioners. Collectively, the results of this study point to a number of next steps for advancing KT practice in health research.A key finding of the study was the broad range - yet distinct and personalized - conceptualizations of KT across researchers. This finding was consistent with previous studies who described strong variations in individual understandings of KT . Such vaWith regards to reported KT practices, in this study most participants acknowledged that there was more to KT than they had included in their own research programs. Although it is not possible to determine in this study what appropriate KT practice is for each individual and their specific project(s), this finding is noteworthy because it suggests that there may be potential to enhance or expand the practice of KT among health researchers. Furthermore, the emergence of negative emotions associated with practicing KT among some participants is also a noteworthy consideration for KT practitioners. Reported feelings of frustration and burnout were from established researchers, whereas those expressing excitement and fear were in the early career stage. Though not specifically identified as a barrier by participants, negative emotions associated with KT may reduce researchers’ involvement in practicing KT, due to the association between emotions and decision-making processes .Finally, the absence of discussion about certain KT practice issues is important. The majority of participants did not make any mention of evaluation of KT practice, indicating that this recognized component of the knowledge-to-action process was not included in their current conceptualization of KT. It might suggest that researchers view the practice of KT evaluation as outside of “research”. Others have also reported a lack of awareness of evaluation strategies for KT activities among researchers , indicatThe examination of barriers and facilitators to practicing KT is critical for tailoring any future interventions to specifically address these factors . Many ofThe distinct barriers described by biomedical researchers contributed to a unique KT context experienced by this group relative to other health researchers in this study. Biomedical researchers also described discrete conceptualizations of KT and perceptions of its practice. This unique biomedical KT context is a critical finding because biomedical research makes up the majority of health research applications received and funded by Canada’s federal funding body . The bioCategorization of research focus using the Canadian health funder’s “pillar” system is an arbitrary designation, and many participants identified with more than one pillar but were required to select only one. Though this research examines a broad group of researchers at various career stages and sectors of Canadian health research, limitations exist in terms of the relatively small sample size and sampling strategy – targeting individuals who are already aware of, interested in, and potentially practicing of KT. It is reflective of only one Canadian region, and is not a national sample. Most respondents were from a single institution, although this reflects the distribution of health research conducted in Manitoba. However, the results suggest that the evolution of KT practice is ongoing and not uniform throughout Canada, highlighting the need for an expanded and comparative analysis of the state of KT practice in Canadian health research.Published calls for KT in health research , 44 refl