With a little help from our friends: Collaborative research partnerships in three workplace-based occupational disease research projects

1.1.(Integrated) knowledge translation

The field of knowledge translation confirms that “research to practice” is difficult to achieve in all fields including healthcare, education, and the social sciences. The gap between research findings in the field of occupational health and safety, and their use by practitioners also continues to be a challenge. The research on knowledge translation that has examined methods to bridge this gap has highlighted the benefits of the collaboration of researchers and practitioners/partners during the research process. The Canadian Institutes for Health Research, Canada’s largest federal funder of health research has taken the lead in advocating for this collaborative method of research. They call it “Integrated Knowledge Translation” (iKT) [1, 2]. The research on iKT has found that the collaborative research model: 1) improves the likelihood that the researchers and practitioners/partners will increase their understanding and value of each others’ world [2–6]; 2) rebalances what is considered ‘expertise’ [4]; 3) increases the networking across the groups and therefore the spread of knowledge [3–5, 7]; and 4) results in findings that are more significant than either group could individually contribute [4].

Despite this growing literature, how to achieve a well-integrated collaboration between researchers and practitioners/partners has not been clearly defined. There is yet to be a blueprint on which to base iKT activities. The literature has been criticized for not including sufficient details of the process [8]. The practitioners/partners are often only involved to a limited extent in the research [9]. There is no underlying theory that reinforces the research; this can be a barrier to cross-project learning [2]. The evaluation of the implementation of iKT is often considered anecdotal and hence inadequate [2].

1.2.Intermediaries as knowledge users and research partners

Another issue worth highlighting is that the practitioners who become partners on an iKT study can include anyone with a stake in the potential findings and who could use the findings. They could be decision-makers that come from the community, industry, clinicians, government policy-makers, or the media [10]. Hence using the catch-all-phrase, “partners”, is appropriate. In healthcare, the partners in a research study could be the patients, the clinicians, the hospital administrators, or healthcare policy-makers. In occupational health and safety, the partners in a research study could be the workers, supervisors, managers, owners, health and safety associations, industry organizations, organized labour, or government policy-makers. The partners who join a research team could represent themselves or represent their organizations.

In many projects, the ability to reach the end-users of research findings (patients or workers, in the two fields respectively) is a logistical challenge. For expediency’s sake, it makes more sense for researchers to have research partners who are “intermediaries” – organizations, associations, societies, or unions who have existing networks of relationships with the end-users and ways of communicating with them. These intermediaries are trusted and are considered credible communicators. They understand the context and cultures of the end-users (processes, political and social ties, limitations, and infrastructure). Importantly, they are able to adapt the research findings to the end-users’ needs [2].

Despite these advantages, there has been limited examination in the field of occupational health and safety of how health and safety organizations, industry associations, policy-makers, suppliers of goods and services, membership organizations, educational organizations, government agencies, or others [11] can be partners and collaborators in research.

Responding to this need, nearly a decade ago, based on research conducted in the early 2000’s (published in 2010), members of this article’s research team attempted to evaluate the involvement of intermediaries as research partners in three workplace-health interventions [12]. The intermediaries were four Ontario-based health and safety associations. The analysis was conducted in the early years of iKT. It explored whether the researchers and the intermediary associations had found the collaboration worthwhile and worth repeating. The associations as partners on the study helped the researchers recruit the workplaces, navigate the workplaces’ hierarchies, territorial barriers, and organizational politics, and gain the cooperation of the workers. The study concluded that the relationship was worth repeating, and that future efforts should focus on building rich relationships through “frequent interactions, exchanges of information, and the opportunity to work on mutual projects”. It also identified the need for future research to clarify the collaborative model. This 2010 study helped inform the approach taken by the authors in their subsequent collaborative research projects. However, the 2010 study did not fully answer the question “What are the elements of the iKT collaborative partnership of researchers and knowledge users that could predict success?” These are the questions that this study attempts to answer.

1.3.Expanding our knowledge of the role of intermediaries

This present study has attempted to respond to the identified shortcomings in the larger iKT literature and to build on the 2010 study with intermediaries. The present study examines the iKT collaborations of researchers and intermediary practice partners (IPP) in three projects: one provincial and two national. These three workplace-based iKT projects were respectively named Sun Safety at Work Canada, the Burden of Occupational Cancer, and Completing the Picture (Table 1 offers a comparison of the three studies). The common objective of the projects was examining ways to prevent or reduce occupational exposure to carcinogens. The studies were multidisciplinary and had researchers from multiple research centres. However, they were either led or co-investigated by researchers from the Occupational Cancer Research Centre (OCRC), a provincially-funded research centre based at Cancer Care Ontario.

The three projects varied in duration from 2.5 to four years. They differed in the number of researchers and IPPs (from one organization to 12). They have all recently completed their funding cycles. The IPPs were involved from the inception of the studies through to their evaluation but were not necessarily involved at every stage of the process.

A decision was made by the researchers to focus this study on qualitative feedback from the IPP representatives about their experiences on the three projects. A decision was made not to examine the experience of the researchers, but to focus only on the intermediaries’ perspectives (this is a difference from the 2010 study that included both perspectives). Through 22 one-on-one interviews and one two-person interview, the researchers sought to examine the nature of the iKT activities/collaborations that facilitated the partnership; the enablers and barriers; the iKT approaches that were adopted; and the impact the partnership had on the intermediaries’ dissemination of the research findings.

The research questions that framed this study are:

2.1.Sun Safety at Work Canada

The aim of the Sun Safety at Work Canada project was to enhance sun safety for outdoor workers. The funder was the Canadian Partnership Against Cancer. The cross-Canada project team that led the project included 5 researchers, 9 intermediary practice partners (IPPs), and a total of 15 staff were engaged over the 2.5 years of the project. (The project has been described in more detail in three manuscripts [13–15].)

The project’s IPPs had different mandates, but their focus was broadly on preventing occupational disease or preventing skin cancer in particular. Although the IPPs were categorized as policy or practice, individuals often spanned multiple roles. In the project, the IPPs helped recruit the workplaces and supervise the project’s knowledge brokers. When findings became available, the IPPs integrated those into their dissemination/diffusion activities. The IPPs helped design the evaluation strategy including the baseline assessments of the workplaces (study sites), facilitated data collection, helped with creating resources for the workplaces, helped develop a project website and materials for the website, and set up presentations with stakeholder groups. The researchers conducted the qualitative and quantitative data analysis and wrote the reports and manuscripts.

The team met face-to-face four times. They also met monthly by teleconference for one hour in the first six months and then monthly for 1.5 hours. Sub-committees were formed for tackling certain aspects of the project and they met by teleconference weekly or bi-weekly.

2.2.Burden of Occupational Cancer

The aim of the Burden of Occupational Cancer project was to assess the number of cancers, cancer deaths and associated economic costs occurring in Canada due to exposure to workplace carcinogens. This four-year project was funded by the Canadian Cancer Society (CCS). A condition of funding was that a division of CCS should be a partner in the study. CCS’s Ontario Division became the IPP on the study. The project has been described in more detail in a report [16], and a manuscript [17].

The research question (What is the burden of occupational cancer?) was developed by researchers based in four provinces. The project was informed by CCS’s wish to know more about occupational and environmental carcinogens as part of its prevention and lobbying initiatives. From four to eight practitioners from CCS were identified as the primary IPPs for the project. The grant application included a detailed plan for iKT, including an evaluation of the partnership.

Initially, the researchers and a group from CCS prioritized 44 occupational carcinogens and 24 different kinds of cancer. The IPPs were not involved in choosing the study’s methodology or in conducting the data analysis. The IPPs took the lead on disseminating the project’s findings and using the findings in policy advocacy. They were kept up to date during the project’s four years through regular (bi-monthly) informal breakfasts and lunch meetings, as well at more formal meetings that occurred about four to six months apart. There were also conference-style meetings attended by CCS employees from across Canada. At these conferences (one a year), the researchers presented emerging findings.

2.3.Completing the Picture

The aim of the Completing the Picture project was to determine the feasibility of integrating questions about work and work exposures into routine primary healthcare. This three-year project was funded by CCS and the Canadian Institutes for Health Research. Six community Health Centres (CHCs) in Ontario were chosen as the primary health care settings. Two provincial occupational health and safety associations became the IPPs: the Occupational Health Clinics for Ontario Workers, and the Public Services Health and Safety Association. The project’s grant proposal’s knowledge translation strategy included collaboration with the partners, intensive engagement with the CHCs, and a commitment to evaluate the knowledge utilization of the CHCs.

The pilot study has been described in more detail in two manuscripts [18, 19]. The research question and the project’s design were formulated in consultation with the two IPPs. The grant was written by the researchers and received sign-off and letters of support from the IPPs. The budget covered the expenses that might be incurred by the partners for their involvement with the study.

This project was less explicitly laid out as an iKT partnership, since emphasis was given to the relationship building between the knowledge broker on the research team and the CHCs. However, the two IPPs helped recruit the CHCs to the study. They helped develop study tools. In the early stages of the project, the researchers and IPPs met once per month, and then several times per year in later stages at each of the IPP’s individual workplaces.

The IPPs were not involved in the day-to-day implementation at the CHCs, data collection or analysis. At the time the members from the two IPPs were interviewed, the project was not totally complete and only preliminary findings were available. Hence the IPPs had not initiated any disseminationactivities.

3.1.Ethics

Ethics approval from the Waterloo Region Community Research Ethics Office was granted for the Sun Safety at Work Canada and the Completing the Picture projects, as well as for this sub-analysis of the three projects’ iKT relationships. Ethics approval for the Burden of Occupational Cancer study was obtained from the University of Toronto Research Ethics Board. The individual participants (IPPs) consented to having their data published once all identifying information was removed.

3.2.Study design

This study is based upon phenomenology theory and understanding. It is a contained piece of condensed study based on the experiences gained from three individual projects, that seeks to understand one phenomenon, from the perspective of the participants, based upon a conceptual framework [20]. We used this approach in order to gain a deeper understanding of the dynamics of the experience of the IPPs during their participation in these collaborative research partnerships.

3.3.Conceptual model

The conceptual model for this project’s evaluation of iKT was adapted from Gagliardi et al.’s (2016) “Summary of IKT approaches, influencing factors, and outcomes” [2]. This model is an outcome of the authors’ scoping review on iKT in healthcare. They included all constructs that were identified in their scoping review and noted that some were less strongly represented in the literature than others. Their model depicts any iKT approach as having Enablers, Barriers and Conditions that precede and influence it. Examples of enablers in the model include having capacity or infrastructure, having clear expectations and responsibilities, and having high level recognition and commitment. Examples of barriers in the model include not having time for iKT, having differing timing, and having differing values. The iKT approaches are the activities undertaken to support iKT such as writing evidence briefs, making a web portal, and consultation. The conditions might include the complexity of the health services issue, involvement in different stages of the project, and the current phase of the project. The iKT approach leads to Outcomes, which include relevance of the research, quality of the research, and learning about research. To review the full list of constructs, (see Fig. 2).

Fig.2

Summary of iKT approaches, influencing factors and outcomes. Reproduced from Gagliardi et al. [2]. No changes were made. Creative commons license http://creativecommons.org/licenses/by/4.0/.

Congruent with Gagliardi et al.’s (2016) model, this study identified a wide range of issues concerning enablers, barriers, conditions, iKT approaches, and outcomes of iKT partnerships. In the same way as the Gagliardi et al.’s model reflected a scoping review of iKT in healthcare, we have used some elements of that model, modified other elements, and omitted those which were deemed not relevant for this study (see Fig. 1).

Fig.1

An analysis of the preconditions, approaches, enables and barriers that lead to successful outcomes for Integrated Knowledge Transfer (Adapted from Gagliardi et al., 2016).

3.4.Data collection

Interviews were conducted face-to-face from June 2015 to May 2016. The 21 interviewees were the partners on the three projects - seven from each project. All IPPs who were not researchers were included regardless of their level of involvement in their project. Interviewees were categorized as policy-makers (2), practitioners (17), or both (2). The two in the “both” category had practitioner and policy-maker roles in different organizations. The experience of participants in the study ranged from less than five years to over 30 years in private, not-for-profit, and government organizations. Roles spanned from lower-level professionals up to Vice President and President/CEO levels.

The interviews were conducted wherever the IPPs felt most comfortable; most often in their office. Sometimes interviews were conducted at a café or restaurant. All the interviews were one-on-one with one exception (two participants). All participants agreed to be audio recorded with one exception. Audio recordings were transcribed verbatim. Interviews lasted from 30 minutes to one hour, with a total of almost 13 hours of audio recordings.

An interview guide was developed according to an initial conceptual model. As the study progressed, the interview guide evolved so as to explore emerging themes. The conceptual model has also gone through a number of iterations as we have come to learn more about the characteristics of successful collaborative researcher-practitioner partnerships. Figure 1 reflects this emerging knowledge. The interviews focused on the enablers and barriers, conditions, and outcomes of the iKT approach. They specifically explored project leadership, trust, relationships, money, role definition, what worked well and not so well in the partnership, and what the partners learned from the experience.

3.5.Data analysis

The interviews were listened to multiple times to understand tone and to gain a deeper understanding of meaning. Transcripts were thematically coded in NVivo10 using constructs in the conceptual model as a priori codes. A “framework analysis” method was used to analyze data in order to generate findings that would be more applicable to practice change [21]. A matrix was developed that organized the three projects along the horizontal axis and the codes along the vertical axis. Data were added to the matrix in the appropriate cell corresponding to the study and the code. This analysis method is supported by Miles, Huberman and Saldaña [22] as it helps with distilling the data and organizing it for ease of comparison (e.g., some codes were not strongly supported across all three projects, and sometimes new themes emerged). As new themes emerged, new codes were added to the matrix allowing for an inductive analysis. In a second-level analysis, our main themes were compared to the variables identified by Gagliardi et al. (2016) in their review of iKT in healthcare [2, Fig. 2].

4.1.Enablers and barriers

The seven enablers and barriers that emerged included having: adequate capacity; defined project roles; the right partners; an inclusive project leader; mutual respect; good communication; and shared values and priorities. Lacking these was considered a barrier.

4.2.Outcomes

There were tangible outcomes of the iKT partnerships that were mentioned by the IPPs. The outcomes that were highlighted included: 1) improved relevance and quality of the research findings; 2) enhanced learning about the others’ “world”; 3) enhanced access to other information and contacts; 4) improved use of research in practice and policy; 5) dissemination and diffusion of the research findings; 6) development of trust and goodwill; and 7) continued collaboration on new projects.

5.1.Negotiating aspects of engagement

The Canadian Institutes for Health Research says that ideally, a collaborative iKT research study, should include the knowledge users in every aspect of the research process: 1) research question generation; 2) selection of methodology; 3) the intervention and implementation; 4) data collection; 5) data analysis and interpretation; 6) writing manuscripts; and 7) dissemination/diffusion [1]. However, the three projects in this study did not include the partners in all stages of the research process. Boundaries were set at the outset by the researchers, and these boundaries were never challenged by the IPPs. Overall, the IPPs were happy with the scope and level of their involvement. Although perhaps not an explicit reason for setting these boundaries at the projects’ outsets, it may have been that the IPPs believed that they lacked the requisite expertise to engage in all aspects of the research process. For example, the skills possessed by epidemiologists that enable them to select and adapt a methodology for estimating the social and economic burden of occupational cancer, and then carry out the analysis, is not a skill set that practitioners necessarily have, nor is it one that is easily taught.

Although full involvement in these very technical and specialized decisions might not be feasible, a level of involvement in the choice of methodology and data analysis is still possible. For example, formative qualitative findings could be shared with practitioners with relative ease, and the practitioners’ contribution to the interpretation of the meaning of these results would be valuable. However, what we heard from the IPPs on all three projects was that these tasks were outside their scope of practice both personally and in their organizational role. Partners thought it would be beneficial to learn these skills, but it was not feasible given all their other priorities outside of the project.

Thus, in these three iKT projects, there was a balance between inclusion and practicality. The partners were welcome to be a part of the full research process, but it was understood that sometimes they would select activities where they thought their expertise would be most valuable. For example, the partners were more willing to help with identifying major elements in existing sun-safety materials, writing, editing, or contributing to plain-language communications, engaging their network to recruit workplaces and then later disseminate findings, and helping to give presentations to workplaces on occupational health and safety or occupational diseaseissues.

5.2.Investing time in the project

One of the biggest barriers that the IPPs encountered regarding their full participation within the research process was time. Research is the primary focus for the researchers, but it is not for the knowledge users. All of the IPPs mentioned they felt they were restrained in their ability to fully participate in their project (or hire someone who could). Despite this, many were still able to participate regularly on their projects. For others, the timing of the project was unfortunately not auspicious. In these cases, the IPPs were in organizations that were undergoing disruptive internal change that precluded them focusing fully on the study.

5.3.Role demands

Higher-level decision makers generally have greater demands on their time, and therefore might be less able to dedicate adequate time to an external research project. Thus, available time and resources might affect which person the organization delegates as the key liaison with the project. However, it is important to consider the role and decision-making power of the individual chosen from the organization and whether their responsibilities align with the role that the project needs them to fill. If the goal of including a specific organization is to have them make significant changes within their organization or to advocate for change externally, then it is important to have a higher-level decision-maker on the team. However, if the purpose of engaging a particular organization is to harness a skill or technical ability, then a different type of employee should be targeted as the representative partner.

5.4.Partners who believe in the project

One of the research projects was attempting to address a problem that some of the IPPs thought was nearly impossible to address. The project’s goal— to find a way to systematically collect information on workplace exposures— was meant to help find a solution to a problem that the partner organization(s) had grappled with in their work. Although this research project was extremely relevant to the intermediary organization(s), some of the partners thought the study’s goal had been tried before and failed, and hence was likely to fail again. Although they thought the goal was desirable, they struggled to buy into the project because they did not believe that it could achieve results. They were doubtful that the problem would or could ever be solved. Thus, their commitment to the research process was conflicted.