Increasing Knowledge Translation Capacity in Low- and Middle-Income Countries: A Model for Implementation Research Training

The paper addresses the persistent "know-do" gap in health service delivery, particularly in low- and middle-income countries (LMICs), where efficacious interventions for neglected tropical diseases (NTDs) often fail to translate into real-world impact due to contextual environmental, geographical, social, and health system factors. It posits that implementation research (IR) can bridge this gap by identifying what works, why, and how to introduce, scale, and sustain solutions within diverse health systems. Framing the IR cycle (engaging stakeholders, identifying bottlenecks, enacting solutions, evaluating change) as a knowledge translation process, the study seeks to identify competencies and pedagogical approaches necessary for effective knowledge translation throughout IR. The purpose is to examine unmet training needs of IR learners in LMICs and propose improvements to IR training to enhance multidisciplinary teamwork, stakeholder engagement, and communication of findings to decision-makers.

A targeted review (November 2019) of peer-reviewed and grey literature mapped global IR training efforts. Scopus was searched using "implementation research" or "implementation science" and "training," yielding 752 results; 19 relevant papers were retained after screening, with one additional TDR paper added manually. A snowball strategy using Google identified limited grey literature examples. Items were categorized in an Excel spreadsheet. Objectives: (1) identify actors (universities, institutes, organizations) involved in IR training; (2) map training modalities (short courses, academic courses, project-embedded training); (3) determine training needs for IR investigators in LMICs. Findings informed subsequent semi-structured interviews.

The study employed a four-phase modified Delphi approach enabling iteration and consensus-building: (1) Literature review as above; (2) Semi-structured interviews with key stakeholders: 10 interviews with individuals from 9 organizations (8 of 10 from LMICs). Interviews explored strengths/weaknesses of IR training, delivery modes, learner profiles, barriers, and recommendations; (3) Virtual dialogues (September 2020): two rounds (four sessions total) with 66 IR researchers, educators, and learners from 18 countries (40 from LMICs), including recent TDR IR MOOC participants. Session 1 reflected on successes, challenges, and integrating gender; Session 2 prioritized gaps and discussed solutions. Breakouts (4–7 persons), facilitators, and shared online input platform were used; (4) Synthesis and peer review: a report integrating findings was reviewed by four experts (implementation research, delivery, policy, M&E, training), revised, and made available via UNU-IIGH. The analysis focused on pedagogical issues for enhancing knowledge translation competencies in IR. The study also mapped three principal IR training modalities: (a) academic postgraduate courses (e.g., MPH); (b) project-embedded training with local teams supported by international experts; (c) short online/face-to-face professional courses (e.g., TDR IR MOOC).

- Existing IR training modalities inadequately support multidisciplinary collaboration: (1) they do not sufficiently account for learners' diverse epistemic and professional backgrounds; (2) they offer limited experiential, team-based learning; (3) they do not acknowledge and support differentiated roles of IR team members (e.g., implementers, decision-makers, practitioners vs. researchers). - Many learners, particularly those without social science or health systems backgrounds, struggle to assimilate core IR concepts in short formats. Short courses often emphasize individual capacity-building rather than collaborative skills such as team-building, communication, and shared research language development. - Stakeholder and community engagement are under-addressed in curricula: the term "decision-makers" spans multiple levels (community leaders, hospital directors, national policymakers, street-level bureaucrats), each with distinct constraints and influence. Courses insufficiently prepare learners to map stakeholders, understand power dynamics (including gender and intersectionality), and engage communities beyond consent/privacy. - Translating IR results into action is weakly covered: learners lack training to package findings for non-technical audiences and to align recommendations with policy/programmatic levers, system-level constraints, and funding needs. Effective translation requires early, continuous engagement with implementers and decision-makers, building trust, and understanding policy processes. - Overall, knowledge translation in IR is a multi-faceted, multi-level process requiring competencies in communication, sensemaking across domains, stakeholder navigation, and advocacy throughout the IR cycle.

Findings demonstrate that current IR training in LMICs often targets researchers and early phases of research (design, data collection, analysis) while neglecting team-based functioning, stakeholder engagement, and policy translation. Addressing these gaps aligns training with the realities of IR as a collaborative, context-sensitive, and policy-connected endeavor, thus directly tackling the "know-do" gap. Proposed solutions include: (1) modular, personalized learning pathways tailored to diverse learner backgrounds and IR roles, incorporating foundational social science and health systems content as needed; (2) stronger emphasis on experiential, team-based learning to cultivate collaboration, communication, and shared vocabulary, with mentorship and reflective components; (3) explicit, practice-oriented training on community engagement, power dynamics, and intersectional gender analysis delivered via didactic, role-play, and case-based methods; (4) development of IR-specific policy translation curricula and experiential opportunities for later IR phases (synthesis, recommendation crafting, stakeholder advocacy), elevating roles for decision-makers and practitioners. These measures strengthen the capacity of IR teams to mobilize multiple knowledge forms and communicate across research, practice, and policy domains, increasing the likelihood of research uptake and sustained impact in LMIC health systems.

The study contributes a consensus-informed framework for enhancing IR training in LMICs by identifying core pedagogical gaps that impede effective knowledge translation. It recommends modular, role-tailored curricula; embedded experiential and team-based learning with mentorship; integration of community engagement and intersectional gender analysis; and IR-specific policy translation training beginning early in the research cycle. These strategies realign training with IR's multi-level, multi-stakeholder nature, improving translation of evidence into policy and practice. Future work should implement and rigorously evaluate modular and team-based training models in varied LMIC contexts, assess mentorship networks' feasibility (including regional mentor matching), develop and test policy translation modules and stakeholder engagement toolkits, and measure downstream effects on research uptake, program implementation, and health outcomes.

The study originated as a progressive activity series to construct a revised IR training framework rather than as a formal empirical study. Participation depended on access to technology and connectivity for online interviews and dialogues, potentially limiting representativeness of perspectives from individuals or institutions with constrained digital access.