Knowledge Translation as Cultural and Epistemic Translation Comment on "Sustaining Knowledge Translation Practices: A Critical Interpretative Synthesis".

This commentary examines the claim made by Borst et al that knowledge translation (KT) should look to Science and Technology Studies (STS), the sociology of translation, and constructionist views on knowledge, and begin to think of the sustainability of a certain practice as construction work in continuous progress, and not as states to be reached once and for all. While endorsing this claim, the present commentary also argues that what it calls the "epistemic reframing" behind the new construal of KT in Borst must be supplemented with approaches that goes beyond the sociology of translation. The commentary claims that this epistemic shift hinges upon a shift in the narrative framing of KT, and that we need to consider the broader narrative and historical ideology of knowledge dissemination behind KT, and that a failure to do so, leaves us with KT seen as a linear transmission of "true" knowledge to peoples and places lacking such knowledge.

The importance of shared meaning-making for sustainable knowledge translation and health literacy.

The aim of the present paper is to describe and discuss how recent theories about translation, bridging medical and humanistic understandings of knowledge translation, in the medical humanities can bring about a new understanding of health literacy in the context of patient education. We argue that knowledge translation must be understood as active engagement with contextual meaning, considering the understandings, interpretation, and expertise of both patient and health care provider (deconstruction of the distinction between biomedical and cultural knowledge). To illustrate our points, we will describe the case of Jim, a kidney transplant recipient who received standard patient education but lost the graft (the new kidney). If we apply Kristeva's view to this context, graft function is not merely biology but a complex biocultural fact. In this perspective, graft function is seen as a phenomenon that embraces translation between health as a biomedical phenomenon and healing as lived experience, and that opens for shared meaning-making processes between the patient and the health care provider. In Jim's case, this means that we need to rethink the approach to patient education in a way that encourages the patient's idiosyncratic way of thinking and experiencing, and to transform health information into a means for sustaining Jim's singular life - not biological life "in general." The patient education programme did not take into consideration the singularities of Jim's biographical temporality, with its changes in everyday life, priorities, attitudes, and values. Hence, we claim that health literacy should involve a simultaneous interrogation of the patients and the health professional's constructions of knowledge.

Intervening on health literacy by knowledge translation processes in kidney transplantation: A feasibility study.

BACKGROUND: Patients awaiting kidney transplantation need to be prepared ahead of the upcoming transplantation by developing targeted pre- and post-transplant knowledge. On this background, we designed a new health literacy intervention, including a film and a counselling session, based on motivational interviewing for dialysis patients provided by dialysis nurses. AIM: To explore patients' and nurses' experiences of the feasibility and acceptability of the intervention, focusing on the patient as a prepared knowledge actor. DESIGN: An explorative qualitative study. PARTICIPANTS AND METHODS: Data included in-depth interviews with nine patients and three nurses who participated in the intervention. The interviews were audiotaped and analysed following Kvale and Brinkmann's method for thematic data analysis. FINDINGS: Three main themes were identified: a different kind of health intervention stimulating new insight; a challenging kind of health conversation and changed relationships and increased security. CONCLUSIONS: Both the patients and the nurses had an overall positive attitude toward the intervention, providing a kind of dialogue to prepare dialysis patients going through kidney transplantation. The nurses found the MI methodology to be challenging. When introducing a comprehensive communication method like MI, potential training and supervision needs for the nurses must be addressed.

In what ways do cultural contexts influence the knowledge translation process for health decision-making and what are the implications for policy and practice?

This report explores how knowledge translation ( KT) and cultural contexts are conceptualized and utilized, with a focus on health policy-making theory and practice. KT takes place within cultural contexts that can powerfully frame what policy problems are and what type of research is accepted by policy-makers. This is illustrated with studies from the COVID-19 pandemic regarding the use of face masks across cultures and of the influence of cultural contexts on KT and evidence-informed decision-making arising from the Black Lives Matter movement. Many Indigenous cultures conceptualize physical health in a holistic manner that encompasses both social and ecological aspects, which are often not considered in the biomedical understanding of health. Effective KT within local cultural contexts requires going beyond general categories ( such as Indigenous culture) and assumptions about particular types of culture. Some KT models and frameworks include local context as a factor in translation, identifying community-, culture- and language-focused strategies to improve cultural competency for health-care interventions. Policy considerations are suggested that support the adoption of complex understandings of cultures in knowledge production, communication, translation and use.

In what ways do cultural contexts influence the knowledge translation process for health decision-making and what are the implications for policy and practice?

This report explores how knowledge translation (KT) and cultural contexts are conceptualized and utilized, with a focus on health policy-making theory and practice. KT takes place within cultural contexts that can powerfully frame what policy problems are and what type of research is accepted by policy-makers. This is illustrated with studies from the COVID-19 pandemic regarding the use of face masks across cultures and of the influence of cultural contexts on KT and evidence-informed decision-making arising from the Black Lives Matter movement. Many Indigenous cultures conceptualize physical health in a holistic manner that encompasses both social and ecological aspects, which are often not considered in the biomedical understanding of health. Effective KT within local cultural contexts requires going beyond general categories (such as Indigenous culture) and assumptions about particular types of culture. Some KT models and frameworks include local context as a factor in translation, identifying community-, culture- and language-focused strategies to improve cultural competency for health-care interventions. Policy considerations are suggested that support the adoption of complex understandings of cultures in knowledge production, communication, translation and use.

Processes of knowing in the translation of a health communication intervention for dialysis patients awaiting kidney transplantation.

OBJECTIVE: To strengthen patients' health literacy and their role as active knowledge actors, we developed a health communication intervention including a film-viewing and counselling session for patients awaiting kidney transplantation. We aimed to explore processes of knowing in the translation of the intervention. METHODS: We applied an ethnographic research approach, observing nine intervention sessions with patients and dialysis nurses. Afterwards, the patients and the nurses were interviewed in-depth. Data were analysed using Engebretsen's modified version of Lonergans' four-step model of knowing. RESULTS: The following knowing processes were identified: i) Knowing as meaning-making; ii) Knowing as acquiring confidence; and iii) Accessing professionals' and peer experts' knowledge. Divergent considerations were taken by the different knowledge actors, which had a direct influence on the knowing processes and knowledge translation. CONCLUSIONS: The findings support active interactions between patients and healthcare providers in processes of knowing. These include self-conscious approaches and critical questioning in both parties. PRACTICE IMPLICATIONS: For transplant professionals, this study demonstrates knowing processes in a real-life context. It also spotlights professional skills and attitudes regarding the importance of self-conscious questioning and a critical interrogating position (for both patients and providers).

Towards a translational medical humanities: introducing the cultural crossings of care.

In this introductory essay, we will present a translational medical humanities approach where the humanities are not only an auxiliary to medical science and practice, but also an interdisciplinary space where both medicine and the humanities mutually challenge and inform each other. First, we explore how medicine's attempt to tackle the nature-culture divide is emblematically expressed in the concept and practice of knowledge translation (hereinafter KT). Second, we compare and contrast KT as an epistemic ideology and a socio-medical practice, with concepts and practices of translation developed in the human sciences. In particular, we emphasise Derrida's understanding of translation as inherent in all meaning making, as a fundamentally textual process and as a process necessarily creating difference rather than semantic equivalence. Finally, we analyse a case from clinical medicine showing how a more refined notion of translation can enlighten the interaction between biomedical and cultural factors. Such a translational medical humanities approach also requires a rethinking of the concept of evidence in medicine.

Cultural crossings of care: An appeal to the medical humanities.

Modern medicine is confronted with cultural crossings in various forms. In facing these challenges, it is not enough to simply increase our insight into the cultural dimensions of health and well-being. We must, more radically, question the conventional distinction between the 'objectivity of science' and the 'subjectivity of culture'. This obligation creates an urgent call for the medical humanities but also for a fundamental rethinking of their grounding assumptions.Julia Kristeva (JK) has problematised the biomedical concept of health through her reading of the anthropogony of Cura (Care), who according to the Roman myth created man out of a piece of clay. JK uses this fable as an allegory for the cultural distinction between health construed as a 'definitive state', which belongs to biological life (bios), and healing as a durative 'process with twists and turns in time' that characterises human living (zoe). A consequence of this demarcation is that biomedicine is in constant need of 'repairing' and bridging the gap between bios and zoe, nature and culture. Even in radical versions, the medical humanities are mostly reduced to such an instrument of repairment, seeing them as what we refer to as a soft, 'subjective' and cultural supplement to a stable body of 'objective', biomedical and scientific knowledge. In this article, we present a prolegomenon to a more radical programme for the medical humanities, which calls the conventional distinctions between the humanities and the natural sciences into question, acknowledges the pathological and healing powers of culture, and sees the body as a complex biocultural fact. A key element in such a project is the rethinking of the concept of 'evidence' in healthcare.

Expanding the knowledge translation metaphor.

BACKGROUND: Knowledge translation (KT) is a buzzword in modern medical science. However, there has been little theoretical reflection on translation as a process of meaning production in KT. In this paper, we argue that KT will benefit from the incorporation of a more theoretical notion of translation as an entangled material, textual and cultural process. DISCUSSION: We discuss and challenge fundamental assumptions in KT, drawing on theories of translation from the human sciences. We show that the current construal of KT as separate from and secondary to the original scientific message is close to the now deeply compromised literary view of translation as the simple act of copying the original. Inspired by recent theories of translation, we claim that KT can be more adequately understood in terms of a 'double supplement' - on the one hand, KT offers new approaches to the communication of scientific knowledge to different groups in the healthcare system with the aim of supplementing a lack of knowledge among clinicians (and patients). On the other, it demonstrates that a textual and cultural supplement, namely a concern with target audiences (clinicians and patients), is inevitable in the creation of an 'autonomous' science. Hence, the division between science and its translation is unproductive and impossible to maintain. We discuss some possible implications of our suggested shift in concept by drawing on pharmaceutical interventions for the prevention of HIV as a case. We argue that such interventions are based on a supplementary and paradoxical relation to the target audiences, both presupposing and denying their existence. More sophisticated theories of translation can lay the foundation for an expanded model of KT that incorporates a more adequate and reflective description of the interdependency of scientific, cultural, textual and material practices.