Outcomes of integrated knowledge translation: A comparative, multi-country case study

Abstract Background Integrated knowledge translation (IKT) seeks to establish continuous relationships between researchers and knowledge users, in particular decision-makers, to enhance evidence-informed decision-making in public health and healthcare. IKT is, however, difficult to evaluate and outcome evaluations remain scarce. The German-African Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) undertook research on IKT and non-communicable diseases in Ethiopia, Malawi, Rwanda, South Africa, and Uganda. Over six years, we implemented an IKT approach and evaluated it according to a pre-defined programme theory. Methods We conducted qualitative interviews and surveys with CEBHA+ researchers and their decision-making partners at two stages (3/2020-2/2021; 9/2022-5/2023) and collected IKT-related documents (see protocol: rdcu.be). Transcripts and documents were analysed using qualitative content analysis and surveys were analysed descriptively, with subsequent integration, cross-case analysis, and revision of the programme theory. Results We collected 92 IKT-related documents; and 55 researchers and decision-makers participated in surveys, focus groups or interviews. Proximal outcomes were collaborative research; capacity-building related to research skills and evidence use; and relationship-building, establishing trust and partnerships. Intermediate outcomes were changes in attitudes and knowledge; decision-makers became attuned to research and researchers increased their understanding of the decision-making context, and developed a vision for research impact. Distal outcomes were the production of applicable research and the consideration of evidence by decision-makers. High opportunity costs associated with IKT implementation constituted unintended effects. Conclusions Our study presents rich, theory-informed insights into IKT outcomes, based in particular on the experience of researchers implementing the CEBHA+ IKT approach. Key messages • A multi-country research collaboration offered an opportunity to examine IKT implementation and investigate proximal, intermediate, and distal IKT outcomes based on a pre-defined programme theory. • Beyond our initial conceptualisation, the IKT approach was linked to researchers developing a vision for ‘research impact’ and gaining a better understanding of the decision-making context.