Effective knowledge translation approaches and practices in Indigenous health research: a systematic review protocol

There are still large health disparities between Indigenous and non-Indigenous people in Canada and in many other countries worldwide [1, 2]. Research is well positioned to provide evidence of health disparities as well as test and evaluate approaches that can improve peoples’ health. In population health research, effective knowledge translation is critical to implementing program and policy changes that require shared understandings of knowledge systems, assumptions, and practices. The term knowledge translation (KT) is commonly used among health researchers and literature in Canadian contexts and is akin to terms used in other disciplines such as knowledge mobilization, synthesis, dissemination, transfer and exchange, knowledge to practice, and knowledge sharing [3–7]. Literature on KT emerged in the early 1990s in the Canadian context but used inconsistent terminology and conceptual frameworks for how knowledge is put into action [7, 8].

While terminology and concepts related to KT are constantly evolving, KT in Canadian health research contexts is often defined as “the process(es) through which knowledge is transformed into action” [9]. The term knowledge translation has been widely adopted, promoted, and prioritized by government funding agencies and research institutions as a way of making research visibly relevant and valuable [10]. In the context of Indigenous research in Canada, it has been suggested that appropriate KT is about sharing knowledge in ways that are “locally developed and contextualized” [11] and the pre-existing integration of knowing and doing that [Indigenous] people have been doing for a long time [12]. For this review, we are looking for KT that explicitly links knowledge (including Indigenous concepts of knowing and doing as being inseparable), learned from the research process or findings, to specific actions.

The impetus for this review was a recognition that mainstream KT initiatives and language do not necessarily resonate with Indigenous ways of knowing and doing. Indigenous scholars have critiqued mainstream KT as inadequate—inappropriate in some cases—for Indigenous health research contexts [9, 11, 13]. Mainstream concepts of KT are based on the premise that knowledge is acquired through ‘evidence-based’ research and that putting this knowledge into action is KT [14]. However, if KT is about sharing knowledge in contexts where the knowledge is both relevant and valued, KT may be inseparable from research itself in studies where researchers and research participants/informants exchange information throughout all research phases—from the development to the end-of-project phase. Indigenous views of what constitute knowledge, whose knowledge is shared with whom, how knowledge is shared, and in what contexts particular knowledge is relevant suggest that KT activities are inseparable from research activities.

Indigenous people have epistemologically and contextually specific health knowledge and practices that have been historically suppressed and ignored in research practices [15]. More specifically, mainstream research on Indigenous people has largely been void of culturally relevant, meaningful, engaging, contextual, or decolonizing knowledge. Instead of a colonial lens that assumes what research is ‘good’ for Indigenous people, decolonizing research with Indigenous people aims to develop, synthesize, and apply knowledge within Indigenous communities and contexts [15]. Smylie proposed that Indigenous KT in health research be defined as “Indigenously led sharing of culturally relevant and useful health information and practices to improve Indigenous health status, policy, services and programs” [12] or “sharing what we know about living a good life” [16].

While research practices, protocols, and approaches used in Indigenous contexts are improving, systemic and insidious inequities built into research institutions and funding agencies that inhibit Indigenous peoples’ control over, input into, and benefits from research remain [17, 18]. For example, mainstream research methodologies require specific types of adherence to and evidence of reliability and validity that are incompatible with (or exclude) Indigenous ways of knowing and doing [19]. The paucity of randomized controlled trials (RCTs) with Indigenous populations suggests that researchers are excluding Indigenous people from studies rather than considering the use of participatory research methods in RCTs that offer culturally relevant findings [20]. What counts as rigorous knowledge in Indigenous contexts is frequently at odds with mainstream concepts of knowledge, and furthermore, how knowledge is shared in Indigenous contexts is not necessarily valued, understood, or supported by research and funding institutions. Indigenous research, in contrast to mainstream research practices, requires researchers to self-locate¹, openly share the purpose and motivation of a study, safeguard sacred Indigenous knowledge, have a decolonizing focus, and ensure community benefits through research [18, 19, 21, 22]. For research to adequately and respectfully engage and serve Indigenous peoples, we contend that wise and Indigenous research practices (including KT) must be better understood by non-Indigenous researchers, research institutions, research funders, and Indigenous communities engaged in research alike. The term wise practices is used to replace the terms best and evidence-based practices and reflect the inclusion of Indigenous knowledge and practices as core and robust sources of information. Madeleine Kētēskwew Dion Stout [23] argues that wise practices offer more than what many university-based and non-Indigenous researchers include as scientific evidence.

In Canada, researchers engaging with Indigenous peoples are expected to adhere to principles such as the four R’s of research—respect, reciprocity, relevance, and responsibility [24]—and the Ownership, Control, Access, and Possessions (OCAP®) principles [25], among other guidelines for Indigenous research. There is, however, little to no mention of such principles in mainstream KT activities or best practices to direct, or hold accountable, researchers in developing their KT plans. Many research institutions and non-Indigenous researchers conducting research involving Indigenous peoples remain unaware of how Indigenous principles differ from mainstream KT practices.

KT activities are widely endorsed and required in research designs. However, there is a dearth of published literature on how to practice, document, and evaluate Indigenous KT. In addition to conducting a preliminary search for documents that would meet our inclusion criteria, the research team reviewed two scoping reviews: (1) an unpublished paper on how KT is defined in Indigenous health research contexts [26] and (2) a paper on evaluated or assessed KT approaches in the Circumpolar North [27]. Published and grey literature draw attention to gaps between epistemic assumptions of Indigenous and non-Indigenous KT models and practices; however, there is no systematic review on the effectiveness of Indigenous KT in health research to date. Indigenous scholars have highlighted that KT strategies with Indigenous peoples must be re-conceptualized, further developed, and evaluated [9, 13, 15, 16, 28–30].

The aim of this review is to provide the evidence and basis for recommendations on wise practices for KT language and research in Canada (and abroad) to improve Indigenous health and wellbeing and/or access to services, programs, or policies that will lead to improved health and wellbeing. This systematic review aims to answer the question what are the promising and wise practices for “knowledge translation” in the Indigenous health research field? Identifying wise and promising practices will provide the basis for changes in research methods, knowledge, or circumstances that improve Indigenous wellbeing and determinants of health. This systematic review is also intended to eventually inform an Indigenous KT evaluation framework within Canada.