Evaluation and Program Planning 53 (2015) 10–17

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Evaluation and Program Planning

journal homepage: www.elsevier.com/locate/evalprogplan

Knowledge brokering in public health: A critical analysis of the results

of a qualitative evaluation
Christian Dagenais a,*, Marie-Claire Laurendeau b, Mélodie Briand-Lamarche a
a
Université de Montréal, C.P. 6128 Succ. Centre-Ville, Montréal, Québec H3C 3J7, Canada
b
McGill University Health Center, 687, Pine Avenue, Montréal, Québec H3A 1A1, Canada

A R T I C L E I N F O A B S T R A C T

Article history: Empirical data on the processes underlying knowledge brokering (KB) interventions, including their
Received 20 November 2014 determining factors and effects, remain scarce. Furthermore, these interventions are rarely built on explicit
Received in revised form 19 June 2015 theoretical foundations, making their critical analysis difficult, even a posteriori. For these reasons, it
Accepted 5 July 2015
appeared relevant to revisit the results of a qualitative evaluation undertaken in the province of Quebec in
Available online 8 July 2015
parallel with a Canada-wide randomized controlled trial (RCT) evaluating various KB strategies in public
health. This paper looks critically at the theoretical foundations of the KB interventions in light of two
Keywords:
conceptual models: (1) the dissemination model underlying the KB interventions used in the Canadian
Knowledge brokering
trial and (2) a systemic KB model developed later. This critical analysis sheds light on the processes
Qualitative evaluation
Critical analysis involved in KB interventions and the factors influencing their implementation and effects. The
conclusions of the critical analysis are consistent with the systemic model, in which interpersonal
contact is an essential condition for effective KB interventions. This analysis may advance knowledge in
the field by enhancing our understanding of the role of knowledge brokers as essential mediators in KB
processes and outcomes.
ß 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Background
Public service imperatives for accountability and performance,
combined with an overabundance of information (on the Internet
and elsewhere), highlight the need to increase the use of scientific
knowledge to inform action and decision-making in various service
sectors, including health (Boaz, Baeza, & Fraser, 2011; Bowen &
Zwi, 2005; Grimshaw, Eccles, Lavis, Hill, & Squires, 2012; Nutley,
Walter, & Davies, 2009; World Health Organization, 2004). For this
reason, knowledge translation (KT) and knowledge brokering
(KB) interventions are presently experiencing a remarkable boom
(Boaz et al., 2011; Bowen & Zwi, 2005; Canadian Health Services
Research and Foundation, 2003; Cinq-Mars, Labadie & Souffez,
2010; Dagenais, Somé, Boileau-Falardeau, McSween-Cadieux, &
Ridde, 2015; Dobbins, Robeson, Ciliska, Hanna, Cameron et al.,
2009; Grimshaw et al., 2012; Lefort & Laurendeau, 2006; Lomas,
2007; Nutley et al., 2009; Ridde, Dagenais & Boileau-Falardeau,
Abbreviations: KB, knowledge brokering; KT, knowledge translation.
* Corresponding author.
E-mail addresses: christian.dagenais@umontreal.ca (C. Dagenais),
marie-claire.laurendeau@muhc.mcgill.ca (M.-C. Laurendeau),
melodie.briand-lamarche@umontreal.ca (M. Briand-Lamarche).
2013; Russell et al., 2010; Ward, House & Hamer, 2009; World
Health Organization, 2005). However, these interventions are
theoretically less robust and more difficult to implement than is
generally believed and are sometimes based more on beliefs
concerning their efficacy than on actual evidence (Graham et al.,
2006; Grimshaw et al., 2012; Grol, 2001). Many barriers to the use of
scientific knowledge persist, including the intended users’ limited
capacity to obtain such knowledge, to assess its quality and
implications for action, and to access it in a format tailored to their
specific needs and context (Campbell et al., 2009; Choi et al., 2005;
Dobbins, Rosenbaum, Plews, Law & Fysh, 2007; Kajermo et al., 2010;
LaPelle, Luckmann, Simpson & Martin, 2006). Moreover, since
researchers and intended users usually come from very different
cultures, there is a gap, or ‘‘semantic distance’’ (Cinq-Mars et al.,
2010), between their respective ways of understanding and
communicating knowledge (Choi et al., 2005; Dobbins et al.,
2007; Lavis, Robertson, Woodside, McLeod & Abelson, 2003; McNie,
2007). Given that more interactive approaches are associated with
greater use of research evidence, it follows that the intended users
should be actively involved in such interventions (Dobbins et al.,
2007; Grimshaw et al., 2012; Nutley et al., 2009; Ward et al.,
2009). Although minimal interaction between producers and
users of scientific knowledge will usually be enough to fill a small

http://dx.doi.org/10.1016/j.evalprogplan.2015.07.003
0149-7189/ß 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/
4.0/).
 C. Dagenais et al. / Evaluation and Program Planning 53 (2015) 10–17
‘‘semantic distance’’, a wider gap will require more intensive
exchanges between them.
Knowledge brokering (KB) involves the use of intermediaries, or
‘‘brokers’’, as mediators between researchers and intended users to
help them better understand each other’s languages and eliminate
barriers to the use of scientific knowledge (Canadian Health
Services Research and Foundation, 2003; Dobbins, Robeson et al.,
2009; Lomas, 2007). Knowledge brokers can play several roles
(Knight & Lightowler, 2010; Pennell et al., 2013; Phipps & Morton,
2013; Ward et al., 2009; Wright, 2013) including: knowledge
management, offering users valid information tailored to their
settings and needs; liaison, facilitating direct contacts and
collaboration between producers and users of scientific knowl-
edge; and training, developing users’ capacity to access, evaluate
and apply such knowledge as needed. A recent literature review
adds the roles of assessing user expectations and adjusting activities
to better fit them (Dagenais et al., 2015; Ridde et al., 2013).
However, although the nature of KB and the broker’s role are now
better understood, conclusive evidence concerning the effective-
ness of such interventions remains scarce, particularly where
decision-makers are concerned (Dagenais, Queuille, & Ridde, 2013;
Dobbins, Hanna, Ciliska, Mankse, Cameron et al., 2009; Ward et al.,
2009). The available information on the topic suggests that KB
promotes the use of research evidence to inform decision-making
while also improving the quality of the knowledge used in such
circumstances (Dagenais et al., 2015; Office of Chief Researcher
Knowledge Transfer Team, 2005; Ridde et al., 2013; van Kammen,
de Savigny & Sewankambo, 2006).
The dearth of evidence-based data paved the way for the first
Canada-wide empirical research project on a KB intervention in
public health (Dobbins, Hanna et al., 2009). The aim of that 1-year
project, funded by the Canadian Institutes of Health Research, was
to foster ‘‘instrumental use’’ of research evidence by public health
decision-makers for planning health promotion programs addres-
sing healthy body weight in children. In parallel, a qualitative study
was undertaken in the province of Quebec to collect more
information on the implementation process, conditions for
effectiveness, and perceived effects of the KB strategies used as
interventions.
The aim of this paper is to revisit the results of the qualitative
evaluation. It looks critically at the theoretical foundations of the
KB interventions in light of two conceptual models: (1) the
dissemination model underlying the KB interventions used in the
Canadian trial and (2) a systemic KB model developed later. These
two models are presented at the beginning of Section 3. We
believe that the description of this work could be useful to the
community of evaluators.
1.1. Descriptions of the Canada-wide project and of the
Quebec qualitative study
1.1.1. The Canada-wide project
The Canada-wide project used a randomized controlled trial to
assess the relative effectiveness of three KB strategies of varying
intensity to increase the use of research evidence by decision-
makers from all the 108 Canadian public-health organizations for
planning health promotion programs addressing healthy body
weight in children. The three strategies were (in increasing order of
intensity): (1) a personal email message addressed to the decision-
makers by the broker, inviting them to access the www.
Health-Evidence.ca website and its online registry of research
syntheses and systematic reviews on healthy body weight
promotion; (2) in addition to the website access, tailored messages
accompanied by research summaries and full-text scientific
articles sent by the broker to the decision-makers for 7 consecutive
weeks; and (3) the previous components, bolstered by email and
11
telephone interactions, along with a face-to-face meeting between
each decision-maker and the broker to facilitate understanding
and foster ulterior use of the new knowledge.
In the protocol for the Canada-wide study, the public health
units were first stratified based on to population: public health
units serving a population of fewer than 50,000 persons, those
serving between 50,000 and 250,000 persons, and those serving
more than 250,000 persons. The units were then randomly
assigned to one or another of three intervention groups. Of the
108 public health organizations across Canada that agreed to
participate in the study (97 anglophone and 11 francophone
organizations), 34 were assigned to the intervention strategy that
included access to a knowledge broker, of which 30 were
anglophone organizations and 4 francophone.
The results of the KB intervention were published in
2009. Unexpectedly, tailored messages (strategy 2) proved to be
the most effective strategy, particularly in settings with a stronger
research culture (Dobbins, Hanna et al., 2009). A positive, though
not significant, trend associated with more intensive contact with
the knowledge broker was also noted in settings where the
research culture was weaker. These results highlighted the
importance of considering the impact of possible interaction
between the KB intervention characteristics and those of the
setting in which the intervention is implemented.
1.1.2. The Quebec study
The parallel study, conducted as part of, and concurrently with,
the Canada-wide research project, was nevertheless distinct from
the evaluation being conducted by the Canadian team. It focused
only on the francophone participants in the study who had been
provided with broker services, and it did not undertake any
comparisons with the other knowledge translation strategies
evaluated in the Canada-wide study. This study was made possible
by separate funding from the Quebec Ministry of Health and Social
Services, but the research report (Lefort & Laurendeau, 2006) has
not yet been published elsewhere.
The Quebec broker was recruited according to the same criteria
as were used in the Canada-wide project: training in public health;
familiarity with child health promotion programs; experience in
program evaluation; sound knowledge of the health and social
services system; teaching skills; and ability to communicate in
French and English. The broker also participated in a training
workshop offered by the Canadian research team. Since the
Canada-wide project included French-speaking sites, the qualita-
tive study in Quebec focused on those selected to receive the most
intensive form of KB intervention, in order to collect more in-depth
information on the implementation process, conditions for
effectiveness and perceived effects. The Quebec broker thus had
regular interaction with the participating sites (e.g., two face-to-
face meetings, weekly phone and email contacts). The KB
intervention was conducted in several stages. The first contact
with the broker, conducted by phone before the website was
online, helped identify users’ knowledge needs and expectations
regarding the intervention. Respondents said they did not have
enough time to search for and read research literature but were
interested in receiving tailored summaries translated into French.
Three respondents stated they already benefited from other
sources of information on healthy body weight in children (e.g.
the healthy-schools component of the provincial Kino Quebec
physical activity program), but none of the respondents reported
having any kind of affiliation with universities. Their information
needs were focused on the existence of similar health promotion
programs in their area and on the availability of evidence-based
data about these programs’ effectiveness. They also wanted to keep
in touch with the broker, but did not express any other expectation
than eventually meeting face-to-face in their own setting.
12 C. Dagenais et al. / Evaluation and Program Planning 53 (2015) 10–17
The Canada-wide launch of the Health-Evidence.ca site, which
was planned to occur immediately after the initial contact with the
broker, was delayed by 3 months because of unanticipated
difficulties in getting it online. To maintain the relationship
developed with the respondents in the meantime, the broker sent
them various recent French documents about healthy body weight
in children (e.g. research articles, government advisories, reports
by expert committees). When the website was launched, the
broker also sent them, as promised, French translations of the
research summaries accompanied by the full-text articles in
English for 7 consecutive weeks, and thereafter maintained regular
contact by email and phone.
The broker’s site visits began 2 months after the website was
launched, or 5 months after the initial contact, almost midway
through the intervention. The meeting objectives, content and
procedure were adjusted to fit the respondents’ requests (e.g.
they all requested to invite colleagues and partners involved in
program decisions). The site visits offered an opportunity to: (1)
clarify the intervention’s goal and the broker’s role in light of
each site’s context and specific needs; (2) better explain the new
knowledge and its practical implications; and (3) discuss
anticipated barriers to knowledge use and ways of overcoming
them. As such, the broker’s role in the site visits was not limited
to knowledge management but also included liaison and
training. In the workshop attended by the respondents and
the broker toward the end of the implementation period,
participants were able to: (1) share experiences and thoughts;
(2) collect perceptions concerning the intervention’s impacts;
and (3) look critically at the intervention and its relevance for
other settings.
2. Methods
2.1. Research approach
A multiple-case study approach was adopted (Patton, 1990;
Yin, 1989). Four sites were treated as separate analysis units, and
the implementation process was documented for each one. The
analysis was carried out in two stages, with an individual analysis
of each case being conducted in each of the four sites, followed by a
cross-sectional analysis of all the cases (Miles & Huberman, 1994).
The individual case analyses produced thorough descriptions of
the dynamics involved in implementing the KB intervention and of
its impact on the use of evidence in organizational decision-
making. The cross-sectional analysis was useful for exploring
contextual factors associated with the implementation of the KB
intervention, identifying points of convergence and divergence,
providing information to help identify favorable and unfavorable
conditions for the KB strategy implementation, and assessing the
relevance and importance of this strategy for the public health
system. A directed content analysis then compared the implemen-
tation processes across the four sites and identified conditions that
supported or hampered the KB intervention (Hsieh & Shannon,
2005). Ethical considerations were taken into account and are
presented in the published KB interventions results paper
(Dobbins, Hanna et al., 2009).
2.2. Participants
Four French-speaking sites participated in the study. Three
were public health regional units in Quebec and the fourth was a
School Communities in Action program in New Brunswick. The
decision-makers interacting with the brokers in the study were
chosen by the participating sites. With the brokers, these were our
respondents in this study. They were women with different profiles
who were all natural intermediaries in their respective settings. Two
were planners and program developers, while the other two were
coordinators of children’s health promotion programs.
2.3. Data sources
Qualitative data from a number of sources were compiled on an
ongoing basis to minimize potential mnemonic bias. Three sources
were the same as those collected for the Canada-wide project: (1)
documentation from each site relating to the organizational context
and existing healthy weight programs for children; (2) information
reported in the broker’s daily log regarding the documents provided,
contacts with respondents, requests received and problems
encountered; and (3) the broker’s own impressions and thoughts,
also noted in the log. To enrich the Quebec qualitative study, two
complementary sources of data were added to those collected for the
Canadian trial: (4) the summary report of a face-to-face workshop
attended by the respondents and the broker 1 month before the
intervention ended, at which they shared their experiences and
thoughts; and (5) respondents’ perceptions of the KB intervention’s
effects, collected in three sites through a self-administered
questionnaire (two sites) and a semi-structured telephone interview
(one site), 7 months after the intervention ended.
2.4. Analysis and data processing
Data on the same themes were first triangulated to corroborate
the information collected from various sources and to strengthen
internal validity (Laperrière, 1997; Miles & Huberman, 1994). For
each site, directed content analysis (Hsieh & Shannon, 2005) was
then conducted and preliminary summaries of the analyses were
submitted to the respective respondents for validation. Finally, a
cross-sectional analysis compared the KB intervention procedures
across the four participating sites.
3. Results and discussion (critical analysis)
For a more thorough and nuanced critical analysis, the results of
the qualitative study are presented here in the light of 2 conceptual
models: (1) the Framework for the Dissemination and Utilization of
Research for Health-Care Policy and Practice (Dobbins, Ciliska,
Cockerill, Barnsley & DiCenso, 2002), which inspired the develop-
ment of the Canada-wide empirical research project; and (2) the
ISF model, or Interactive Systems Framework for Dissemination and
Implementation (Wandersman, Duffy, Flaspohler, Noonan, Lubell
et al., 2008), developed more recently to facilitate the implemen-
tation of prevention programs in public health. These 2 models are
presented briefly below.
3.1. The dissemination model
This model, presented in Fig. 1, is derived from a clinical model
(Rogers, 1995) describing a five-step process for disseminating
innovation (knowledge, persuasion, decision, implementation,
confirmation). The model also incorporates concepts relating to
evidence-based decision-making and includes four categories of
factors that can influence research use, specifically: (1) innovation
characteristics: users’ perceptions of the potential benefits (the
‘‘relative advantage’’) of using an innovation; compatibility, the
degree to which the innovation is consistent with the existing
organizational culture; complexity, the users’ perceptions of the
difficulty involved in using the innovation; the feasibility of the
changes required to make it happen; and the ‘‘observability’’ of the
changes following use of the innovation; (2) organizational
characteristics, including the organization’s size, structure, culture,
climate, functioning, communication channels and decision-
making processes; (3) environmental characteristics of the broader
 C. Dagenais et al. / Evaluation and Program Planning 53 (2015) 10–17
Fig. 1. Framework for the dissemination and utilization of research for health-care policy and practice (Dobbins et al., 2002).
system in which the organization is embedded, such as legislative
context, economic and political infrastructure and links between
institutional, community and private sector partners; and (4)
individual characteristics, which are factors influencing use of
knowledge by different individuals, including their age, education,
role in the organization, decision-making authority, credibility
among colleagues and partners, familiarity with research culture,
etc. It is important here to emphasize that none of these four
categories of factors relates to interpersonal contact between
individuals or on the processes needed to implement changes.
3.2. The ISF model
Developed in a public health context, the Interactive Systemic
Model (ISF), presented in Fig. 2, was aimed at bridging the gap
between research and practice created by linear KT and KB
interventions (consistent with the dissemination model) that were
focused primarily on knowledge itself. The model encompasses
three interdependent subsystems and fosters the development
13
of prerequisite conditions for knowledge use, namely: (1) the
‘‘knowledge synthesis and translation system’’, which uses different
methods to summarize information and to convert (translate) the
scientific knowledge to make it easier for the intended users to
understand; (2) the ‘‘support system’’, which supports the work of
those who will have to implement the innovations and enhances
individual and organizational capacity for using knowledge; and
(3) the ‘‘delivery system’’, which supports the implementation of
prevention programs. Like the dissemination model, the ISF model
considers a set of individual, organizational, community and
contextual factors that can influence the implementation of
prevention programs, but it also incorporates other aspects
consistent with a systemic vision. For example, individual factors
also include motivation and attitudes toward change; organiza-
tional factors, include leadership, commitment, support for
implementation and access to infrastructures supporting capacity
development; community factors, include collective efficacy,
quality of social fabric and collective empowerment; and contextual
factors, accessibility of scientific knowledge and research evidence,
14 C. Dagenais et al. / Evaluation and Program Planning 53 (2015) 10–17
Fig. 2. Interactive systems framework for dissemination and implementation (National Center for Injury Prevention and Control Division of Violence Prevention of the CDC,
undated).
as well as the availability of all kinds of other resources in the
environment.
3.3. Analysis of results
According to the qualitative data collected, the KB intervention
appeared to have facilitated the first of the five stages of the
dissemination model (i.e., knowledge). The respondents’ com-
ments, in particular, highlighted factors influencing this first stage.
The research summaries in French were greatly appreciated, while
respondents found the original English articles more difficult to
understand. Moreover, they reported that the content of the
tailored messages was not sufficiently integrated with other
available sources of information to enable them to fully grasp the
implications of the new knowledge. Given that lack of clarity in the
message can be a major barrier to decision-making (Innvaer, Vist,
Trommald & Oxman, 2002; Kajermo et al., 2010), the new
knowledge did not appear to have been provided optimally, even
though tailored messages were shown to be the most effective KB
method in the Canada-wide project, especially in settings with a
more research-oriented culture (Dobbins, Hanna et al., 2009).
The second stage of the dissemination model (persuasion),
pertaining to the perceived relative advantage of the new
knowledge, appeared to have occurred during the broker’s site
visits. According to the respondents, these visits constituted a
turning point in the KB intervention process. Before the site visits,
the broker’s role was mainly one of knowledge management. The
face-to-face meetings gave the broker the opportunity to play
liaison and training roles (Ridde et al., 2013; Ward et al., 2009) as
well. The respondents particularly appreciated the broker’s
support in helping them to understand and interpret the new
knowledge. In the meetings, the broker also helped the respon-
dents analyze its implications for action and identify factors likely
to impede knowledge use.
‘‘The exchanges were very concrete and included a description
of the regional context of ongoing programs; identification of
difficulties encountered and impediments to action; links between
new knowledge and practice; and questions on the implications of
the information for approaches, programs, and interventions
already in place’’ (Lefort & Laurendeau, p. 44).
Based on the data collected, after the broker’s site visits,
respondents perceived the new knowledge as being more
integrated with other sources of information.
‘‘The actions already under way were validated, many compar-
isons were made between the recommendations and guidelines
from the provincial organization Kino-Québec, and some results that
were incongruent with them were discussed. Links were made
between the recommendations derived from the reviews and the
approaches found to be effective in addressing other issues, such as
smoking’’ (Lefort & Laurendeau, p. 45).
According to the data collected during the workshop and in the
post-intervention follow-up, the third stage (decision), in which
knowledge is adopted in anticipation of later use, may have occurred
at the very end of the implementation period. The respondents from
three sites clearly expressed their intention to use the new
knowledge to guide their programming choices, conveying a sense
of the organization’s greater readiness at this point (Gervais &
Chagnon, 2010). As for the final stages of the dissemination model
(implementation and confirmation), nothing indicates that they
occurred either during or after the KB intervention.
With reference to the ISF model (Wandersman et al., 2008), the
KB intervention may have had an impact on two of the model’s
three subsystems by strengthening certain prerequisites for
knowledge use in the participating settings. Those two subsystems
were the understanding of the new knowledge and the ability to
analyze its implications for action. However, the KB intervention
had no apparent impact on the third subsystem, the actual
application of the new knowledge.
As predicted by the two conceptual models, other factors also
influenced implementation. Certain characteristics of the new
knowledge, such as the delivery of tailored messages in French and
compatibility with the organization’s existing culture, had positive
influences. On the other hand, the new knowledge was perceived
as being insufficiently integrated with other available sources of
information and its complexity was deemed relatively high. This
may be due to the ‘‘semantic distance’’ phenomenon mentioned
earlier (Mitton, Adair, McKenzie, Patten & Perry, 2007). Since none
of the participating sites had any connection with universities, the
gap between the academic culture and that of the decision-makers
was probably substantial. Direct interaction with the broker during
the site visits helped reduce this gap. Furthermore, the decision-
makers’ personal characteristics, especially the fact that they were
in a good position to act as natural intermediaries in their
respective settings, greatly facilitated implementation of the KB
intervention (Bowen & Zwi, 2005; Lavis, Robertson et al., 2003;
Thompson, Estabrooks & Degner, 2006). They acted as a
 C. Dagenais et al. / Evaluation and Program Planning 53 (2015) 10–17 15

communication channel, extracting the knowledge that seemed
most useful and circulating it to colleagues and partners, thereby
confirming both its relevance and credibility (Gano, Crowley &
Guston, 2007; Heaney, 2006; McNie, 2007; Mitton et al., 2007). The
respondents also played a strategic role during both the broker’s
site visits and the workshop. The scientific literature shows that KT
and KB, if done by individuals who have regular contact with the
intended users, add value to the knowledge and enhance its use
through facilitation and social-influence mechanisms close to a
training role (Carpenter, Esterling & Lazer, 2003; Contandriopou-
los, Lemire, Denis & Tremblay, 2010; Nutley et al., 2009; Wilson,
Brady & Lesesne, 2011). With regard to organizational character-
istics, the respondents from three sites reported that they made
program decisions as a team. This is consistent with the research
literature, which shows that a collegial culture and a common
vision provide more favorable conditions for knowledge use than
does an organizational culture in which decision-making is
centralized (Gervais & Chagnon, 2010; Greenhalgh, Robert,
Macfarlane, Bate & Kyriakidou, 2004; Lukas et al., 2007).
The goal of the KB intervention was to promote public health
decision-makers’ instrumental use of evidence-based knowledge by
informing their programming choices (Amara, Ouimet & Landry,
2004; Dobbins, Hanna et al., 2009; Nutley, Walter & Davies, 2003).
During the workshop or in the post-intervention follow-up several
months later, three respondents stated their intention to use the
knowledge in this way. Several hypotheses might be advanced to
explain such a late or delayed result. On one hand, the intervention
took place in winter, such that it was not in phase with the usual
planning period for the program (summer/fall) and could thus not be
put to use immediately. On the other hand, the delay in activating
the website postponed regular contacts with the broker by several
months. Earlier involvement with the broker might have boosted the
KB intervention’s intensity and achieved the goal more quickly.
All the same, at the follow-up 7 months after the intervention
ended, 3 of the 4 respondents reported positive outcomes (the
fourth did not participate in the follow-up). This may be due to the
role they continued to play in their respective settings when the
intervention was over, or to their indirect use of the new
knowledge while waiting for a more suitable time for instrumental
use. This hypothesis is supported by the fact that the respondents
reported engaging in several other forms of knowledge use (Amara
et al., 2004; Strauss et al., 2010) both during the intervention and
7 months after it had ended (see Table 1 for examples), including
symbolic use to validate prior orientations and decisions (Bowen &
Zwi, 2005; Lavis, Robertson et al., 2003; Nutley, Walter & Davies,
2007) and process use (Nutley et al., 2007; Patton, 1998) associated
with their involvement in the project and the broker’s liaison role,
both inside the organization (cross-disciplinary collaboration) and
outside (contacts with researchers and partners). Two respondents
also reported a conceptual use of knowledge that influenced their
attitudes toward change (Amara et al., 2004; Nutley et al., 2007)
through the collective reflection process that accompanied the KB
intervention. These results appear promising, given that a recent
review of KB interventions cites only four studies reporting short-
term effects of KB on knowledge use, and only one of them, after
6 months (Ridde et al., 2013).
The scientific literature on KT shows that mixed strategies
involving several components (including interactive ones) are
more effective than single-component strategies, especially
passive dissemination strategies (Boaz et al., 2011; Grimshaw
et al., 2012). In the present case, knowledge dissemination
components involving the website and tailored messages were
combined with a more interactive strategy involving direct contact
with a broker. Although all the intervention components were
ultimately provided, their implementation was delayed substan-
tially compared to the planned schedule. The lag in establishing
regular contact between the broker and the decision-makers may
have impeded the development of their ‘‘relationship capital’’
(Gervais & Chagnon, 2010; Thompson et al., 2006), thereby
weakening the intensity of the KB intervention to the point where
it was insufficient to foster instrumental use of knowledge before
the end of the implementation period.
Compared to what could have been expected on the basis of the
dissemination model, the results demonstrated certain short-
comings during implementation, as well as divergences from what
are considered in the literature to be winning conditions for a KB
intervention (Nutley et al., 2009). The more positive KB effects
reported in the qualitative study, as compared with those of the
Canada-wide project, may be due to contextual differences
regarding, for example, the characteristics of the decision-makers

Table 1
Types of evidence use for the duration of intervention and 7 months after the end of the intervention by the knowledge broker.

For the duration of the broker’s intervention 7 Months after the end of the broker’s intervention

Instrumental use
Directly integrated into the decision-making
process, with a problem-solving perspective
Conceptual use
To provide a general understanding
Symbolic use
To validate and support prior decisions
Keep articles so they can be considered when
appropriate time comes (2 sites)
Look for research evidence to fuel decision-making
processes for other issues regarding lifestyle (2 sites)
Make use of physical activity, nutrition and healthy
weight issues, as opportunities to integrate evidence
into team and partner decision-making (1 site)
Consider an integrated program for all issues related
to lifestyle (1 site)
Incorporate evidence in the programming process
(1 site)
Compare with approaches developed in tobacco or
other issues related to lifestyle (1 site)
Share and discuss results with academic researchers
(1 site)
Create cross-disciplinary collaborations on weight
and physical activity issues, discuss relevance of
evidence for decision-making processes regarding
promotion/prevention (1 site)
Confirm relevance of approaches and actions already
underway (4 sites)
Obtain validation of data and recommendations
offered by the knowledge broker, from other official
sources of reference (e.g., Kino-Québec) (2 sites)
When positioning and planning interventions,
incorporate evidence on a regular basis (3 sites),
either:
- Into pre-existing way of doing things for all
lifestyle issues (1 site)
- Into new way of doing things, especially for
lifestyle issues (1 site)
Improve and select new interventions regarding
nutrition and sedentary lifestyle (1 site)
Use and share information on obesity and sedentary
lifestyle with partners (1 site)
Convince school officials to increase time spent
engaged in physical activity at school (1 site)
Use toward positioning and programming
interventions (1 site)
Support existing intervention strategies (1 site)
16 C. Dagenais et al. / Evaluation and Program Planning 53 (2015) 10–17
or their interactions with the broker. In any case, the results of the
qualitative study are very compatible with the ISF model and show
the importance of direct broker–user interaction. It is plausible
that the respondents themselves, in the various roles they were
called upon to play in their own settings over time, helped make
the intervention more ‘‘interactive’’ and ‘‘systemic’’ (Greenhalgh
et al., 2004; Thompson et al., 2006). A recent literature review
showed that direct interactions within formal and informal
networks increased knowledge use by decision-makers, especially
when this knowledge was consistent with the existing organiza-
tional culture (Ridde et al., 2013). The empirical data collected
suggest that the KB intervention may have consolidated individual
and organizational capacities already present in the various
settings and fostered at least the appropriation of the new
knowledge, if not its instrumental use.
The qualitative study also sheds new light on previously
published results showing that tailored messages had a significant
impact in settings with a stronger scientific culture (i.e., formal
university affiliation or established ties with academic settings or
research teams), whereas organizations with a weaker scientific
culture (i.e., no academic connection or only sporadic contacts with
individual researchers) tended to benefit more from broker contact
(Dobbins, Hanna et al., 2009). It appears plausible that settings
with a weaker research culture would need more intensive broker
interaction to reduce the perceived ‘‘semantic distance’’ from the
scientific knowledge and make instrumental use of it (Cinq-Mars
et al., 2010). As the sites that participated in the qualitative study
reported a weak research culture, it is possible that the more
intensive KB intervention proved a better fit for their needs and
context.
This case study has limitations, particularly in terms of
representativeness. Because it was an exploratory study, its
conclusions and results cannot be generalized to all public health
organizations or all KB initiatives. In fact, its results are closely tied
to the intervention characteristics and the settings in which it was
implemented. Any generalization to other settings must be made
with caution.
4. Conclusion: lessons learned
The literature on KB interventions is still very limited (Ward
et al., 2009), and the analysis presented here may help advance
knowledge in the field by enhancing understanding of the roles
played by the broker and other key players during the intervention
(Boaz et al., 2011; Ward et al., 2009). The analysis also revealed
several forms of knowledge use other than the well-known
instrumental one which, although easier to observe, may prove less
sensitive to a KB intervention (Amara et al., 2004; Nutley et al.,
2007; Strauss et al., 2010). It would therefore likely be relevant to
study various forms of knowledge use in more depth, using
different measures and indicators, to better capture the direct and
indirect effects of KB (Hanney, Gonzalez-Block, Buxton & Kogan,
2003; Lavis, Ross, McLeod & Gildiner, 2003; Strauss et al., 2010).
The analysis based on the ISF model confirm the importance of
the interpersonal dimension of KB as a key factor in knowledge
use (Carpenter et al., 2003; Dobbins, Robeson et al., 2009; Haines,
Kuruvilla & Borchert, 2004; Thompson et al., 2006). Direct and
frequent contacts (including face-to-face) between the broker
and the intended users help build ‘‘relationship capital’’. The
presence of a natural intermediary inside the target organization
who relays information and new knowledge to colleagues and
partners is another condition of effectiveness. These results lead
us to wonder about the optimal strategic positioning for a
knowledge broker. Would an insider with a strong research
culture not be the best positioned ultimately to understand
the setting’s context and needs, tailor the KB intervention
accordingly, offer support, foster collaboration and introduce
change in what can be seen as a community of practice (Cinq-
Mars et al., 2010; Nutley et al., 2007; van Kammen et al., 2006;
Ward et al., 2009)?
In summary, the results appear consistent with a systemic
model, in which: (1) interpersonal contact is an essential condition
for effective KB interventions (Carpenter et al., 2003; Wandersman
et al., 2008) and (2) in which knowledge use is assumed to depend
on prior development of individual and organizational capacity as
well as on the creation of a favorable context (Rycroft-Malone et al.,
2002; Wilson et al., 2011). This type of model has both pragmatic
and heuristic value. As we have shown, it can deepen understand-
ing of KB processes, help refine theory and conceptual frameworks
and facilitate critical analysis of interventions deployed to narrow
the gap between research and practice. This work shows the
importance of examining the theoretical foundations of the KB
interventions. We believe that this kind of analysis advance
knowledge in the field by enhancing our understanding of the role
of knowledge brokers as essential mediators in KB processes and
outcomes.
Conflict of interests
The authors declare that they have no competing interests.
Authors’ contributions
CD and MBL contributed significantly to the critical analysis and
wrote the different versions of this manuscript. MCL was the
lead researcher for this study and reviewed all the versions
prepared.
Acknowledgements
The authors would like to thank the team of the original
Canada-wide research project, led by Maureen Dobbins; Louise
Lefort, research assistant and knowledge broker for the qualitative
study; and finally, the Research and Evaluation Directorate of the
Quebec Ministry of Health and Social Services, which funded the
study.
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Christian Dagenais is an expert in the field of knowledge translation and evaluation
research, disciplines he teaches at Université de Montréal where he is associate
professor since 2004. He is also the head of a team of researchers focused on the
evaluation of knowledge transfer activities within their respective disciplines. The
objective of this research team is to develop the field of knowledge transfer research
through interdisciplinary and inter-university collaborations.
Marie-Claire Laurendeau, Ph.D., was Manager of Research and Innovation at the
National Public Health Institute of Quebec, associated with the Department of Social
and Preventive Medicine, University of Montreal until retirement in 2012. She realized,
with various collaborators, many projects in knowledge transfer, including: a knowl-
edge synthesis accompanied by a best practices guide, animate a process of knowledge
transfer network for public health. She is now a psychologist at McGill University
Health Center.
Mélodie Briand-Lamarche, M. Sc., Ph. D. (cand.) has been interested in the issues of
knowledge transfer since 2008, when as a master’s student, under Christian Dagenais
supervision, she had the opportunity of evaluating the implementation processes of a
knowledge transfer initiative. She also served as director of projects for evaluation in a
knowledge transfer center for a year before beginning her doctoral studies in 2011.