Integrating Ethics and the Knowledge-To-Action Cycle

This section presents the KTA-E cycle. As a conceptual framework, this cycle illustrates the iterative relationship between knowledge creation and knowledge translation and some of the potential ethical considerations at steps along the way. It builds on the work of Graham et al., 2006.Footnote 1 The framework addresses the complete lifecycle of scientific knowledge relevant to researchers funded by CIHR and includes a wide variety of elements from data collection to sustaining knowledge use. All of the materials presented in this workbook are informed by, and map onto, this conceptual framework.Footnote 2

Defining terms

The Knowledge-to-Action process represents the process of knowledge creation and its translation into practice and policy. It is considered iterative, dynamic, and complex, both concerning knowledge creation and knowledge application (action cycle), with the boundaries between the creation and action components and their ideal phases being fluid and permeable. The action phases may occur sequentially or simultaneously and the knowledge phases may influence or be drawn upon during action phases. The cyclic nature of the process and the critical role of feedback loops are key concepts that underlie this conceptual model. While knowledge can be empirically derived (i.e., research based) the framework encompasses other forms of knowing such as contextual and experiential knowledge as well.

Within KTA, the Knowledge creation or the production of knowledge, is composed of three phases: knowledge inquiry (first-generation knowledge), knowledge synthesis (second-generation knowledge), and creation of knowledge tools and/or products (third-generation knowledge). As knowledge is filtered or distilled through each stage in the knowledge creation process, the resulting knowledge becomes more synthesized and potentially more useful to end users.

Knowledge translation is described by CIHR as a “dynamic and iterative process that includes synthesis, dissemination, exchange, and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.”Footnote 3

Ethics has been described in many ways. Most approaches tend to contrast perceived opposites. For instance, a legalistic approach might contrast “right” and “wrong,” while an approach to ethics that is grounded in a religious perspective would highlight the contrast between what is considered “good” and what is seen as “bad.”

In bioethics and research ethics review exercises, a ‘principled approach’ is most often used to invoke principles that are perhaps as close to universal as is possible, such as beneficence, non-maleficence and justice. This principled approach is invaluable to bioethicists and those conducting research ethics reviews, but it will not be deeply explored in the context of the present education package. Instead, the intent of this material is to help users develop an ‘ethics lens’ without resorting to any particular approach or training in philosophy.

Thus, for the purposes of this workbook, we will use a pragmatic approachFootnote 4 to ethics that is primarily about developing the skills for a critical analysis of relations of power and context.This approach includes thinking critically about who has power and voice in a situation and who is (unintentionally?) silenced; who benefits and who does not, and in what contexts? This pragmatic approach to ethics asks analysts simply to consider each element in a given situation and note the potential consequences, rather than to apply any received ideas about good and bad, right or wrong. In other words, the goal of this approach is to develop the practical skills to recognize ethical issues and to decide on the most socially defensible course of action.

Taken together, these understandings of the processes comprising the KTA-cycle, together with a pragmatic approach to ethics, results in the CIHR KTA-Ethics cycle, which is a framework that encompasses the complete lifecycle of scientific knowledge.

Explanation of the CIHR KTA-Ethics Cycle

Figure 1 provides a visual overview of the complete conceptual framework starting with problem identification. The knowledge creation figure (Figure 2) covers topics such as, “knowledge inquiry, knowledge synthesis, and knowledge tools/products” (Graham et al., 2006). This phase in the lifecycle of scientific research begins with establishing partnerships and seeking funding and then moves on to the recruiting and data collection phases of research. Some of the ethical issues that can emerge from these topics are highlighted in the tables that accompany each figure. For example, when forming research questions, researchers should be aware of the ways in which contextual factors may influence their choices and how their decisions affect stakeholders, among other things. After data are analyzed, conclusions are drawn, and results are published, the cycle moves towards the knowledge translation of results, which may involve conducting additional research. As the situation warrants, the cycle may either continue with another iteration of knowledge creation, or move towards knowledge translation. The cycle is iterative and may move between knowledge creation and knowledge translation many times in a single inquiry.

Topics covered by the Knowledge Translation side of the cycle begin with the process of reviewing and adapting knowledge to a particular context and then selecting and applying that knowledge (Figure 3). Experience gathered through monitoring and evaluating knowledge allows the cycle to move towards next generation research and continued knowledge translation.

When used together, the figures in this section should help the user locate the entirety of their work within the lifecycle of scientific research, identify and think through some of the ethical issues particular to that phase of the cycle, consider how their work relates to earlier and later phases of the cycle, and identify what ethical issues they should anticipate both in the short and longer term.

Diagrams of the CIHR Ethics Cycle

This section provides illustrations of the KTA-E cycle. It is important to note that the explanations shown in the accompanying tables are provided for illustrative purposes only and are not intended to be exhaustive. Readers will notice that activities at stages 5, 6 and 7 of the knowledge creation side of the cycle are distinguished by their colour which is different from the rest. This distinction is deliberate and intended to show the activities such as collection of data, recruitment of participants, and REB submission that are typically associated with ethics in research only account for a small portion of the ethical issues inherent in the full lifecycle of science.

Figure 1. The Complete KTA-E Cycle

Table 1: Ethical considerations on entering the KTA-Ethics Cycle as shown above

Step Activity Some potential ethical considerations
0 Identify the (research or KT) problem.
  • Influence of disciplinary and epistemological lens;
  • Influence of socio-political context;
  • Priority-setting process;
  • Agenda-setting process;
  • Stakeholder engagement;
  • Power and voice: whose concerns are addressed; who is (unintentionally silenced)?
  • Social responsibility of research

Figure 2. The Knowledge Creation portion of the KTA-E Cycle

Table 2: Ethical considerations in KC activities illustrated above

Step KC activities Some Potential Ethical Considerations
1 Establish partnerships choice of collaborators; concern for equity; agency; influence; …
2 Form research question Stakeholders involvement; influencing context; framing; theory used; …
3 Design project resources/capacity available; theory used; methodology used (scientific validity); …
4 Seek funding choice of funder; obligations to funder; public/private funding; …
5 REB submission protection of participants; privacy; informed consent; data stewardship; Conflict of Interest (CoI); …
6 Recruit participants (if necessary) protection of participants; privacy; informed consent; data stewardship; CoI; …
7 Collect data protection of participants; privacy; informed consent; data stewardship; CoI; …
8 Analyse data methodological choices; role of collaborators; …
9 Draw conclusions implications for individuals; groups and populations; CoI; …
10 Publish results Authorship; choice of publication venue; publication bias; negative results; …
11a Towards KT of results selection of evidence; …
11b Further research Responsible stewardship of funds; …

Figure 3. The Knowledge Translation Portion of the KTA-E Cycle

Table 3: Ethical considerations in KT activities illustrated above

Step KTA activity Some Potential Ethical Considerations
1 Review and select knowledge KT theory; publication bias; data access; intellectual property; negative results; …
2 Adapt knowledge to context Honouring local knowledge; voice; agency; …
3 Assess barriers to use Concern for equity; access issues; …
4 Apply knowledge (intervention) Resource allocation; equity; opportunity costs; intellectual property; …
5 Monitor knowledge use Potential CoI; roles; responsibilities; …
6 Evaluate application of knowledge (intervention) Criteria-setting; potential CoI; …
7 Sustain knowledge use Sustainability concerns; capacity-building; robustness; opportunity costs; …
8a Towards next generation research Selection of evidence; responsible stewardship of funds; …
8b Toward continued KT Selection of evidence; responsible stewardship of funds; …

Footnotes

Footnote 1

Graham, I., Logan, J., Harrison, M., Straus, S., Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in knowledge translation: Time for a map? The Journal of Continuing Education in the Health Professions. Vol. 26(1), 13–24.

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Footnote 2

Allen K, Flamenbaum J. Ethics in the Science Lifecycle: Broadening the Scope of Ethical Analysis (ch 6.1), in Straus S, Tetroe J, Graham ID (2013). Knowledge Translation in Health Care (2nd ed). Oxford: Wiley-Blackwell.

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Footnote 3

Canadian Institutes of Health Research website, section on knowledge translation.

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Footnote 4

This pragmatic approach to ethics is inspired by the work of Ludwig Wittgenstein and Michel Foucault.

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