Observations

About 15 meetings will be observed from the beginning to the end of the project period in order to capture the different phases of the project: planning, analysis, interpretation and writing up results. Three researchers will be involved in the data collection. One observational researcher (the first author) will be present at every meeting. In addition, two experienced field researchers (author numbers three and four) will alternately be present at every third FYSIOPRIM meeting. Organising the data collection with the use of three observers is anticipated to give a rich material as well as contributing to the validation of data. Our assumption is that being present as a researcher adds value beyond listening to a tape recorder. Getting a feel of the ambience among the participants—and what Goffman19 refers to as rules of conduct in the particular setting—might add valuable information.

Meetings will be recorded for their entire duration, transcribed verbatim and complemented by the observational researchers’ notes. Accuracy in transcriptions and close attention to language will be necessary, since KT involves practices that are largely linguistic in nature. KT happens through speech acts such as summarising, repeating, questioning, rephrasing or arguing and the use of various changing words to denote and emphasise meaning. In order to capture these and the participants’ talk as situated social action, we will use Jefferson's system of transcription, which shows the precise beginning and ending of overlapping talk, intonation aspects and timed pauses.20 We will also use a field diary to record activities and interactions. The aim of the field diary is primarily to capture what the recordings do not provide. Notes may consist of observations of non-verbal aspects such as body language and how material objects such as technology or documents are used.21

Although the ethnographic methods used are rather traditional, our interest in KT practices calls for a different focus than that of many other ethnographic studies (this approach will also guarantee the participants’ anonymity). Inspired by microethnographic studies, we are concerned with the situations produced in the interaction between individuals rather than the individuals themselves.22 Our interest is not in how participants manage their professional expertise, but in the sense-making process. The interaction process is at the centre of our study. Examples of questions and topics guiding the data collection are as follows: What sort of topics and dilemmas do the participants take a common interest in? Who are responding to what sort of questions in various situations, in what way and with what effect? What sort of arguments are raised as the participants reflect, discuss and try to define a particular problem? What problem-solving approaches are suggested with what effect? When and how is an argument legitimised in clinical experience, scientific evidence or both? How is coherence between research evidence and clinical practice argued? When are missing links between research and practice a problem of concern? What sort of examples and arguments provide opportunities for meaningful engagement from whom? When do two or more of the participants commonly trigger disagreement with an initial statement?

Reflection meetings

Immediately after a coordinators’ meeting, the observational researcher sends a résumé of her observations/preliminary analysis to the PI of FYSIOPRIM and the co-researchers. A meeting is then set up (reflection meeting) as soon as possible and no later than 1 week after the observations in order to discuss the résumé. The purpose of the reflection meetings is twofold: (1) an analytical purpose: The researchers and the PI of FYSIOPRIM discuss possible interpretations of the observed situations. The observational researcher's résumé forms the basis for the discussion, as well as the co-researcher's and the PI's reflections and notes. (2) A dissemination purpose: the three researchers present their preliminary findings to the PI of FYSIOPRIM.

Based on the preliminary findings, the PI may plan the possible steps in order to improve KT in the future meetings and other activities. However, the three researchers do not take part in this action planning. The PI of FYSIOPRIM writes a short résumé of actions taken which is handed over to the researchers before the next coordination meeting. Changes made by the PI based on preliminary findings might have an influence on KT among the participants in FYSIOPRIM. However, such influence is not seen as problematic, but as a facilitator of new forms of KT between the participants, which in turn will be subject to further observation.

Interviews

We will also conduct supplementary interviews with the participants. At least 10 interviews will be conducted (5 researchers, 5 clinicians). Re-interviewing or more interviews might become necessary. The observational researcher will be conducting the interviews together with the two co-researchers who will be present in two interviews each. Interviews will be organised in relation to (before or after) FYSIOPRIM meetings. All interviews will be tape recorded and transcribed. Transcription will include conversation, yet exclude utterances like uh, ah and intonation. Pauses will be marked, but not timed.

Interviews will not follow a common interview guide but questions will be developed continuously for each interview, based on observations and reflection meetings. However, the interviews will be organised based on the following general topics: (1) we will ask the participants to describe situations which they have found particularly interesting and/or challenging. We will further discuss the characteristics of these situations and elaborate on the barriers to and facilitators of knowledge translation. (2) The researchers will present situations for the participants that have struck them as particularly interesting and/or challenging with regard to the translation of knowledge. Such a situation might be an utterance that seems to change the direction of the overall discussion or, in contrast, an utterance that seems to be marginalised or ignored. The interviewees will also be asked to comment on the researchers’ preliminary analysis. Characteristics of the selected situations as well as barriers and facilitators for KT will be discussed.

The aim of the interviews is threefold: (1) preliminary analysis of data through discussion of selected sequences/situations (2) validation in terms of adding information and (3) providing additional data for further analysis.23

Documents

Much of the interaction in the group is based on written documents. These comprise journal papers (or extracts from them), documents such as drafts of research plans, suggestions for questionnaires to be used, data collection plans, etc. In addition, results of the ongoing research or papers recently written may also be distributed. The documents are most often produced by the researchers and may be sent out as a foundation for the discussions in the coordinators’ meeting. The documents may be modified as a result of the discussions and redistributed in updated versions. Hence, the documents cannot be seen as passive reflections of events, but as actors taking part in the situational interplay.24 Furthermore, the documents capture and preserve processes of change throughout the data collection period and reflect in this way a translation history within the group.

Analytical tool

One of the reasons why the practice of KT is poorly understood may be that KT is a rather abstract notion. Not unlike concepts like ‘discussion’ or ‘reflection’, KT refers to a form of activity that is difficult to observe. We know that we are doing it, but we do not know what we do when we are doing it. In the first 6 months of our project (the pilot phase), we have developed analytical tools that may enable us to open this black-box. The tool development is partly based on observations and preliminary analysis and partly on a reading of the theoretical literature. The purpose of our analytical tools is to operationalise KT research by breaking it down into observable entities.

In our further analysis, we have decided to concentrate on three aspects of knowledge: (1) knowledge objects, (2) knowledge forms and (3) knowledge positions. While a knowledge object refers to the immediate topic or piece of content addressed by someone intending to create or communicate knowledge (a muscle function, an experience of pain, etc), the knowledge form refers to ways of organising or communicating this knowledge (theories, prognosis, probabilistics, examples, anecdotes, questions, etc). The knowledge position is the point of view from which the knowledge is created or used (clinician position, basic/clinical researcher position, policy-maker position, patient position, etc)

The concept of knowledge objects is influenced by Annemarie Mol's25 study of ontology in medical practice. Mol demonstrates that the objects of knowledge vary with the practices in which they are manipulated. Her ‘atherosclerosis’ case is, for instance, a slightly different phenomenon depending on specialty or treatment. According to Mol, a disease, a condition or a body part is not one ‘object in the middle waiting to be observed’; rather, it represents a multiplicity of realities or substances depending on the many practices related to it. Our perspective is also inspired by studies which have pointed to the diversity of ‘worlds’ existing within scientific and clinical practice.16 ,23 ,25 This illustrates how the object or ‘world’ in question will necessarily be different or alter through the translational chain, depending on the practice with which it is handled. Translation thus implies repeated shifts between objects. In the observed discussions, the researchers may, for instance, present a test procedure based on research showing that motor control patterns are altered in patients with neck pain. The clinicians might claim that the procedure does not test the phenomena they believe are of importance. Rather, they would focus on the patient’s fear avoidance behaviour as a limiting factor. In our study, we focus on how the participants manage to integrate objects as different as individual pain, joint function and basic functions in their talk and still maintain coherence in discussions.

The concept of knowledge forms is influenced by rhetoric of science and more precisely the concept of topos drawn from classical rhetoric.26 Topos originally means ‘place’ and is to Aristotle a general argument base or template on which individual arguments are built. Some examples highlighted by Aristotle are definitions, induction, consequences and division.26 When we present our knowledge in scientific articles or in face-to-face communication with peers, we also build on templates or structures that make our arguments credible or recognisable as knowledge to the reader or listener.27 Which forms are accepted or recognised may vary radically from one knowledge culture to another. For qualitative researchers, a case analysis may, for instance, be an adequate knowledge form, while many quantitative researchers primarily express their knowledge through probabilities. When it comes to clinicians, anecdotes of individual patients may qualify as knowledgeable.

Our third analytical concept, knowledge position, is inspired by Karin Knorr-Cetina’s23 theories on epistemic cultures. In Knorr Cetina's studies, these are cultures related to scientific practice; different scientific practices exhibit different epistemic cultures. Scientific practice in our case is a means not only to create knowledge, but to include all practices involved in the KT chain. In encounters between different epistemic cultures, some positions are possible while others are excluded. Positions are different from roles because they are not tied to the individual. They belong to the situation rather than the person. The situations decide which positions are possible for the participant to take, not individual characteristics or choices. This means that knowledge positions such as teacher/student, expert/non-expert or even researcher/practitioner are flexible and altering entities that may shift from one situation to the other.

To perform KT implies altering some or all of these three aspects of knowledge. By analysing shifts in and between them, we might be able to articulate the practices involved in KT.

Analytical approaches

The researchers will organise the knowledge objects, forms and positions into categories using a variety of methods. For instance, data modelling in NVivo V.1028 will be used to code the data into the three domains, in search of variations within and between them.28 The observational researcher (first author) will have responsibility for this software supported first phase of the analysis. This analysis will then be combined with rhetorical analysis, which is a close reading approach, where author number four will have the main responsibility and work partly together with the observational researcher. The aim of this analysis is to capture the forms (topoi) used in presenting the knowledge objects, as well as which rhetorical techniques are used to relate objects and forms to a specific position.29 As part of our close reading, we will first annotate the texts, that is, highlight key words, phrases or anything else that strikes us as significant. Second, we will go deeper into the specifics, drawing on text-analytical and especially narratological tools.30 ,31 Some of the aspects that will be analysed are: the point of view (narrative perspective and voice) required to identify the knowledge positions,31 the choice of words and imagery (eg, metaphors),32 as well as structure, for example, the interplay between different genres27 in order to capture the knowledge forms and description/characterisation in order to identify the objects in question.31

It will be organised into three types of meetings in order to develop the analysis and test the reliability of the findings. (1) Regular and frequent meetings between the three researchers. (2) Meetings between the three researchers and PI in FYSIOPRIM. (3) One extensive meeting with all participants in FYSIOPRIM where the findings will be presented and discussed. In addition, drafts of papers presenting results from the KT project will be sent to all participants in FYSIOPRIM in order to get comments as well as to exert extracontrol of their informed consent.

Possible outcome of the analysis

If our study is successful, it will provide a typology of KT practices. A hypothetical example may illustrate what we expect to gain from our study.

Imagine that the research team presents a draft list of items to be used to generate a database of patient profiles and treatment in primary care physiotherapy. The responsible researcher invites the clinicians to comment on the clinical applicability of the items and to suggest alternative items or wording. One of the clinicians answers by commenting on a question about sex life. The clinician claims that the question, although providing important information for statistical purposes, might be conceived as offensive and thus be detrimental to communication with the patient. She/he tells a story about a situation in which she/he has experienced this.

Out of many possible responses from the researcher, one might imagine three: (1) she/he might stress that the information provided by the question is crucial for statistical purposes and ask the clinician if she/he could formulate the question in another way that is less offensive; (2) she/he might respond by saying that the clinician's comment illustrates that the database has a dual function: to provide information for statistical purposes (research, patient profiles for clinical use) and to facilitate communication. This specific question might thus represent a conflict of interest, and the researcher might invite the group to discuss how to take both these considerations into account and (3) she/he might suggest deleting the question.

In the first hypothetical response, the researcher insists on the knowledge object being an information tool to be used for statistical purposes. She/he also insists on the knowledge form she/he expects from the clinician: a (reformulated) question providing this information. She/he is not willing to move from a position which prioritises statistical purposes, such as optimising the possibilities for comparing results to other studies.

In the second hypothetical response, the researcher is willing to negotiate about the knowledge object. Unlike the first response, the question or the object alters from being regarded as an information tool into being an information and a communication tool. She/he neither insists on a particular knowledge form nor expects the clinician to come up with an alternative question, but invites different kinds of input from the group in terms of a broad invitation for ‘discussion’. Rather than insisting on the position of the statistical user, she/he tries to establish a common position where the participants as co-researchers must jointly decide how to tackle the conflict of interest between getting information and facilitating communication.

In the third hypothetical response, the researcher lets the knowledge object, form and position presented by the clinician settle the matter.

The point here is not that one of the responses is the right one. That depends on contextual factors, like the aim of the cooperation. The point is, however, that the three responses are different and might be said to constitute different KT practices. In the first situation, translation consists of incorporating the input of the clinician into the researcher's knowledge culture or system. KT is integration or incorporation. In the second case, translation is a process that implies creating something new together. The outcome of the translational process is at least to a certain degree common knowledge objects, forms or positions. Translating is sharing or cocreating. In the third and last case, the voice of the clinician is dominant. Translation is the same as adopting the other's position.

Through our study, we might be able to provide a classificatory system for categorising differences and similarities, as well as shifts in and between knowledge objects, forms and positions that can be used as a typology of situations where KT is performed in different ways.