Reframing knowledge translation for health policy in Kenya: actors, practices and the constitutive role of context.

Abstract

Background: Knowledge translation (KT) is regarded as important for supporting evidence-informed health policy-making. While KT models have moved beyond linear understandings of the evidence-policy relationship, they continue to underplay the politics that shape how evidence is produced, framed, interpreted, negotiated and used during policy-making. As a result, KT strategies are often designed for policy processes that bear little resemblance to real-life policy-making.

Methods: This study argues for a reframing of KT for policy as an embedded and politically situated process. To inform this reframing, we examined how KT happens during health policy-making in Kenya. We examined who engages in KT, how they do it, in which spaces and the outcomes of these practices. Data were collected through in-depth interviews with a range of policy actors (n = 35), nonparticipant observations (52 h) and document reviews (n = 34). Data analysis was informed by the study's conceptual framework.

Results: The findings show that KT was enacted by a range of actors, including policy-makers themselves. These actors practised both so-called structured and fluid forms of KT and mobilized evidence to inform, advocate, justify or contest policy positions. In addition, KT happened in both formal and informal spaces. Strategic framing of evidence and other relational activities were central to mobilizing evidence. The outcomes of these practices were often relational and incremental. Importantly, context constituted KT by shaping what counts as evidence, whose voices were influential, and where action was possible.

Conclusions: This study offers a practise-based understanding of KT by reframing it as a contextually-constituted, situated practice that requires adaptive system-oriented approaches.