Knowledge Brokering in Communication Sciences and Disorders

Merriam Webster defines knowledge as “information, understanding, or skill that you get from experience or education,” (Merriam-Webster, n.d.). Research evidence is one form of knowledge that is generated through application of the scientific method, whereas experiential knowledge is gained through experience (McCain & Kampourakis, 2019). Clinicians in communication sciences and disorders (CSD) often rely on both scientific and experiential knowledge to guide their practices, but they potentially rely on experiential knowledge more (Fulcher-Rood et al., 2020). For instance, speech-language pathologists (SLPs) noted that their number one source of information for assessment practices was discussions with other colleagues (Denman et al., 2021).

Unfortunately, there is a gap between knowledge generated from scientific research evidence and knowledge gained via the experiential learnings of clinicians (Douglas & Burshnic, 2019; Olswang & Prelock, 2015). This gap slows the generation of clinically relevant knowledge through the research process, thus negatively impacting the populations served by clinicians (Restifo & Phelan, 2011). Knowledge brokering is one way to encourage the bidirectional exchange of ideas between researchers and clinicians (Gluckman et al., 2021). As such, the following review article outlines definitions of knowledge brokering; describes attributes and activities of knowledge brokering, including domains of knowledge brokering; illustrates data to support the role of knowledge brokering; and provides a tool for teams to reflect upon their own knowledge brokering capabilities.

What Is Knowledge Brokering?

Knowledge brokers have been referred to as organizations or individuals that cultivate relationships and networks, so that knowledge reaches and is used by all relevant stakeholders. Knowledge brokers are often thought of as bridges between two realms, such as researchers and clinicians (Gluckman et al., 2021). Although knowledge brokers are sometimes referred to as the human force behind translating research to practice (Bornbaum et al., 2015), it is not always one individual who propels such change. Instead, teams of individuals working together, engaging in the active process of knowledge brokering (or the verb form of knowledge broker), are often required. Because researchers and clinicians both have the goal of improved student, client, or patient outcomes, this foundation may be a productive starting point for forming these connections and networks. Bartelink et al. (2019) define knowledge brokers as “professionals who connect people on both sides of a boundary or facilitate knowledge exchange between different worlds …” (Bartelink et al., 2019, p. 81). The different worlds of clinical practice and clinical research require individuals or organizations who are committed to connecting these worlds.

Knowledge producers are traditionally considered persons representing the research sphere, although increasingly, there is a focus on knowledge cocreation involving clinicians, researchers, and even clients themselves as part of a bidirectional process (Jull et al., 2017; Project Bridge, 2020). Knowledge users, also known as end users or stakeholders, can range from clinicians, administrators, and policy makers to patients and their families. Knowledge producers and knowledge users frequently lack opportunities to interface in typical research or clinic settings. A knowledge broker would create networks and mediate relationships with the goal of linking knowledge directly among these clinicians, clients, patients, families, and researchers.

For example, CanChild is a research and education center based out of McMaster University with an emphasis on knowledge brokering (CanChild, n.d.). In addition to other resources, the center outlines skills that knowledge brokers optimally possess. Effective knowledge brokering is ideally a mix of personal attributes, evidence gathering, critical appraisal, communication, and mediation skills (see Table 1). Even one of these areas requires a level of knowledge and skills that can be overwhelming if the responsibility rests on only one individual. Take, for instance, critical appraisal, knowledge brokering activities should be cognizant of both traditional levels of evidence (e.g., a meta-analysis of randomized controlled trials is a higher level of evidence than a case study) and the multitude of experiential learnings that happen at the level of direct clinical service provision. Personal attributes include enthusiasm, flexibility, and credibility, and communication skills valued in knowledge brokering are strong oral and written communication as well as demonstrated active listening skills. Finally, mediation skills related to knowledge brokering refer to conflict management skills, the ability to assemble teams and foster collaboration, and relationship building.

For a more feasible alternative to individual responsibility, Kislov et al. (2017) advocate for the process-oriented approach of knowledge brokering, shifting away from the individual as the knowledge broker and toward the development of brokering teams to engage in the process. Such knowledge brokering teams, composed of individuals representing a diverse set of professional backgrounds and possessing complementary skills, are required to meet the demands of the knowledge brokering process and ensure that information is mobilized into action.

Domains of Knowledge Brokering

The primary three domains of knowledge brokering widely recognized in the literature are (a) information management, (b) linkage and exchange, and (c) capacity building (Bornbaum et al., 2015; Oldham & McLean, 1997; Ward et al., 2009). Inherent across these three domains, knowledge brokers must be constantly evaluating the local context and facilitating the appropriate knowledge translation activities for that specific context (Glegg & Hoens, 2016; Jull et al., 2017). Ideally, all stakeholders can contribute to this iterative knowledge brokering process. Clinicians, researchers, administrators, policy makers, and formal knowledge broker professionals can (and should) work together toward this collective brokering of knowledge (Kislov et al., 2016). Figure 1 presents a model with the three primary domains of knowledge brokering.

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Information Management Domain and Examples

Information management, also known as knowledge management, is the most common conception of knowledge brokering. In this domain, knowledge brokers interpret and summarize evidence into accessible forms for stakeholders. They may conduct evidence search and retrievals, appraise the quality of evidence, or match stakeholders to relevant information sources. This information, made available to clinicians, may come from a variety of sources, including internal and external sources.

Institutions may have internal resources that are embedded into the workflow to support the identification of best practices for specific populations or conditions. For example, the Shirley Ryan Ability Lab (formerly the Rehabilitation Institute of Chicago) has an internal resource as part of a knowledge translation project: the Battery of Rehabilitation Assessments and Interventions (BRAIN) project (Moore et al., 2018). The BRAIN project, developed in 2009, consists of information about evidence-based practice (EBP) that has been evaluated, summarized, and made available on the organization's intranet. Its purpose is to increase accessibility of EBP to the physical therapy, occupational therapy, and speech-language pathology clinicians working at the Shirley Ryan Ability Lab. The BRAIN project was developed by clinicians who have volunteered to be specialists in specific practice areas. These volunteer specialists participate in a training and consult with a medical librarian and expert clinician who are available for additional support. On the basis of a survey of clinician perceptions of BRAIN at preimplementation, 3 years postimplementation, and again at 6 years postimplementation, clinicians reported that the resource increased use of outcome measures and evidence-based interventions in clinical practice (Moore et al., 2018).

Other resources within CSD that draw largely from the information management domain include knowledge brokering websites such as the American Speech-Language-Hearing Association (ASHA) practice portal, which provides resources on clinical and professional topics, with the goal of facilitating clinical decision making and increasing practice efficiency (ASHA, 2021). Additional examples include the Speechbite website (Speechbite, 2021), the Informed SLP (The Informed SLP, 2021), and the Speech Research Centre (Speech Research Centre, 2021). Therapy Insights (Therapy Insights, 2017) and Honeycomb Speech Therapy (Honeycomb Speech Therapy, 2021), all of which serve as resources that translate evidence into therapy materials and patient education handouts. Honeycomb Speech Therapy also presents ideas on case studies with example goals utilizing specific evidence-based approaches. While not an exhaustive list, these are examples of credible, information management-based resources to promote diffusion of knowledge in CSD.

Linkage and Exchange Domain and Examples

The second domain, linkage and exchange, highlights the interpersonal and relational functions of knowledge brokering. This domain leverages the social capital that knowledge brokers have within stakeholder communities. Linkage and exchange knowledge brokers are often trusted community members within the setting or organization in which the knowledge is being brokered. They may facilitate collaboration between stakeholders through workshops, forums, or relationship building activities and may also have dedicated time to focus on the development, maintenance, and facilitation of networks and communities of practice. Importantly, the linkage and exchange roles described may facilitate navigation of the cultural and power divide existing between scientists and clinicians (Metz et al., 2020; Restifo & Phelan, 2011). There are several examples of linkage that support this phase of knowledge brokering, each of which may involve more formal versus informal roles. At the Massachusetts General Hospital (MGH), the Occupational Therapy (OT) Clinical Specialist role provides an example of a knowledge brokering role that addresses linkage and exchange in a more formal capacity. OT Clinical Specialists on the neurology service at MGH spend 70% of their time in clinical care, with the remaining 30% allocated for supporting clinical practice and professional development of staff, as well as leading quality improvement initiatives (Ranford et al., 2019). The flexibility afforded by the “70/30” role in supporting research initiatives was highlighted in the above referenced paper by Ranford et al. (2019), which described interdisciplinary stroke recovery research at MGH. Specifically, authors reported how this dedicated time allowed for participation in weekly research meetings, developing roles and responsibilities for other OTs, and maintaining general operations within the interdisciplinary research team. These initiatives are one example of formal organizational structure to support linkage and exchange. Such roles also happen informally through department leaders who share their background experience and training to support more junior team members or those who provide informal mentorship to colleagues. Productive relationships, and the cultivation of these relationships, are often the unseen work of a knowledge broker focused on linkage and exchange.

Capacity Building Domain and Examples

Knowledge brokering also involves capacity building. This can occur both at the individual and organizational levels. At the individual level, capacity builders can foster self-reliance through teaching stakeholders the analytic and interpretive skills necessary to translate research findings. At the organizational level, capacity builders address program development, advocate for resources to develop knowledge products, and support senior staff and decision makers in integrating evidence into their decision making.

An example of an organization that funds knowledge brokering activities of linkage and exchange and capacity building is the Patient-Centered Outcomes Research Institute (PCORI, 2021). This independent, nonprofit organization authorized by the United States' Congress in 2010 provides funding opportunities for patient-centered research. Under their Engagement program, PCORI awards initiatives that build connected communities of researchers and end users. Through their support of communities where researchers, patients, caregivers, policymakers, and other end users work together, PCORI's engagement awards produce end users who are better able to use health-related research to make evidence-informed decisions and to serve as channels to disseminate study results. These knowledge brokering communities also cocreate knowledge, as they are the foundation for future research shaped by the voices of patients and those who care for them (e.g., Project Bridge, 2020).

Within CSD-related research, the Learning Collaborative to Address Disability Equity in Healthcare (LEADERs) is an example of an initiative funded by a PCORI engagement award. LEADERs is led by an SLP investigator working collaboratively with patients with communication and other disabilities, their caregivers, health care disability coordinators, and other researchers. These stakeholders meet biweekly toward a common goal of developing, conducting, and disseminating patient-centered outcomes research related to equitable health care for patients with disabilities. One knowledge cocreation product that has resulted from the LEADERs group is a white paper providing a ranked disability health research priorities list that was reached through consensus building by patient, clinician, research, policy, and payer stakeholders (Morris et al., 2020).

Emerging Data Supporting the Effectiveness of Knowledge Brokering

While it is well accepted that knowledge brokering plays at least some role in closing the knowledge to practice (or the “know-do”) gap, research documenting the effectiveness of knowledge brokering strategies within health and educational settings is still emerging. In addition, outcome variables for knowledge brokering are not well identified in the extant literature, making measuring the effectiveness of knowledge brokering difficult. For example, in their systematic review of the effectiveness of knowledge brokers in health-related settings, Bornbaum et al. (2015) found that among 22 studies reviewed, only eight reported data related to the effectiveness (e.g., measurable changes in knowledge, skills, and/or policies or practices) of the knowledge brokering strategies used. Furthermore, only two of these studies met criteria for methodological rigor to be included in analysis, one of which documented improvement in stakeholder knowledge and practice, whereas the other did not. A separate systematic review (Elueze, 2015) using a narrative synthesis approach not only reported evidence pointing to the value of knowledge brokering as an effective knowledge translation strategy but also identified the need for empirical studies to elucidate the role of knowledge brokering strategies on outcomes.

While much more work is needed, there are recent exemplars that suggest the promise of this approach for further study. For example, knowledge brokering resulted in improved patient outcomes (gait speed for adults in physical therapy; Romney et al., 2020) as well as increased implementation of evidence (adoption of standardized outcome measures) by physical therapists (Romney et al., 2021; Yorke et al., 2021). It can be difficult, however, to fully operationalize the activities and attributes of knowledge brokering, so continued research is recommended.

Call to Action

The gap between research and practice is clearly unacceptable, and one way to potentially close that gap is knowledge brokering. Initial steps in advancing knowledge brokering may look different based on the environmental context of the organization or department. Most organizations do not have the infrastructure to support specific personnel devoted to knowledge brokering, so perhaps partnering with a reputable external source may be a more feasible option. Reaching out to reputable leaders on social media, business partners committed to EBP, or podcasts that work to disseminate research are examples of practical first steps. There are also resources available for honing one's own knowledge brokering skills. The National Health Service out of the United Kingdom offers free knowledge brokering training modules (Knowledge Brokering Training, 2021). The Knowledge Brokering Group out of Australia also offers training and consultation for researchers (Knowledge Brokering Group, 2021).

The attributes outlined by CanChild (n.d.) and Kislov et al. (2017) were adapted by these authors and may be used as a tool for reflection for individuals and organizations considering their knowledge brokering capabilities (see Table 1). Table 1 presents questions that knowledge brokering teams may pose to themselves and one another within each of the skill sets required to engage in effective knowledge brokering. Easily actionable next steps associated with each skill set are provided for teams to further encourage movement in decreasing the research to practice gap.

Evidence to support knowledge brokering activities is only now emerging, but the seriousness of the research to practice gap warrants alternatives to the traditional pipeline of a researcher publishing an article, 17 years passing, and then the implementation of 14% of that practice by a routine clinician in a routine setting (Balas & Boren, 2000). Knowledge brokering (see Figure 1) provides practical tools to decrease the silos and increase productive collaborations between researchers and clinicians with the goal of providing the best care to all the populations we serve. While we are hopeful that the evidence for knowledge brokering will continue to develop, there are low-risk action items (e.g., active listening, relationship building across boundaries, and appreciation of the diversity of contexts in which clinical services are delivered) that readers could incorporate and reflect upon immediately (see Table 1).

Author Contributions

Natalie Douglas: Conceptualization (Lead), Writing – original draft (Lead), Writing – review & editing (Lead). Jennifer Oshita: Writing – original draft (Supporting), Writing – review & editing (Supporting). Megan Schliep: Writing – original draft (Supporting), Writing – review & editing (Supporting). Julie Feuerstein: Writing – original draft (Supporting), Writing – review & editing (Supporting).

Author Notes