In defining what is knowledge, it seems that information is a building block. But then, what transforms information into knowledge? I am confronted by the assumption that knowledge should be based on scientific evidence. If we follow that argument, then whatever information I have accumulated that is not evidence-based cannot be knowledge? I am stuck!
Perhaps, it is more helpful to look at this question from another perspective – how do we use information? The way we use information has less to do with its scientific strength, but more to do with what is necessary for the task at hand. Different types of information, such as tacit knowledge and experience, compete for our attention. Often, the scientific strength of knowledge is not enough for us to use it!
In a recent systematic review, it was proposed that the use of knowledge is influenced by its relevance, legitimacy and accessibility. Therefore, knowledge is more likely to be used if it is perceived as important and practical in a particular situation. However, this is always mediated by individuals, who have opinions, preferences and interests. An interesting point was made – that if an individual’s understanding of the implications of a piece of knowledge is in conflict with their own opinion or preference, then they may ignore or contradict the evidence. This is consistent with the concept of leakage from the pipeline of evidence, where clinicians who do not agree with or feel able to use the evidence will not do so!
Therefore, it seems important to recognise that the process of creating scientific knowledge for practice is not the same as the process of using scientific knowledge in practice. There is a third process, knowledge exchange or brokering that can facilitate this transition across what is commonly called the knowledge-practice gap. This suggests a collaborative approach between individuals who have the expertise to create knowledge (researchers) and those who are using knowledge (clinicians), where both are focussed on understanding the local context and the way the knowledge is being used, and specifically how the research evidence can compete with the other forms of information clinicians use.