Knowledge transfer interventions on cancer in Africa and Asia : a scoping review

In 2020, breast cancer was the most common cancer in the world, accounting for 11.7% of the 19.3 million cancers diagnosed worldwide. Its incidence continues to rise, particularly in southern countries, and equity in breast cancer is a major concern. Cancer control capacity is inadequate in many countries, including those in Africa and Asia. Effective implementation strategies adapted to these specific contexts are needed to optimise progress in cancer diagnosis, treatment, survival and end-of-life care in these regions.

The purpose of this scoping review is to identify knowledge transfer (KT) interventions that have been implemented in African and Asian contexts in an effort to improve cancer control. This review is conducted to inform an intervention research project on the knowledge transfer role of breast cancer patient organisations, which is part of a larger project on the experiences of breast cancer patients in Mali, Benin and Cambodia.

The use of research evidence to inform practice, decision-making, and public policy is increasingly seen as a key approach to achieving universal health coverage (1) . Similarly, there has been a growing interest since the 1970s in using knowledge from the experience of patients and carers to inform public policy (2).

Research on knowledge transfer has identified interactive strategies, based on exchange between producers and users, as the most likely to promote the adoption and use of research-based knowledge (3). The few studies conducted in Africa show that attitudes and opinions towards research are one of the main determinants (4) and that the use of knowledge brokers can facilitate the processes but their ability to influence policy decisions at the national level is limited (5). However, the processes that facilitate the knowledge transfer in a given context have yet to be documented, especially in West Africa, where still few initiatives to support evidence-informed policy and practice are implemented and evaluated (6) and where the active patient has no place whatsoever (7).

In the area of cancer in particular, a preliminary search of the JBI Evidence Synthesis identified only reviews of knowledge translation interventions in cancer control in Canada but no review on this topic in Africa and Asia. A review of systematic reviews (8) showed that the challenges of knowledge transfer in the field of cancer were many and that some approaches were promising. However, most of the interventions carried out had for the most part not been evaluated and/or researched, the primary data were of poor quality and the systematic reviews were not very rigorous. In addition, the approach to KT for cancer appears to be disparate and unsystematic. This makes it very difficult to synthesise data, to improve the overall research enterprise, and to build from one study to another. In conclusion, the authors call for the mobilisation of a large number of researchers and the production of high quality research in this field, given the vast area that has not been studied.

For this reason and in order to include as many and as diverse interventions as possible, the research team adopted a broad definition of knowledge transfer for this review, that of the Fonds québécois de recherche, which states that knowledge transfer refers to “all efforts made to publicise and recognise research activities and results with a view to their use by practitioners, decision-makers and the general public, whether or not the process is interactive” (9).

The scoping review methodology was chosen for the same reason. It will allow us to identify the nature and extent of research evidence (Grant & Booth, 2009) on our topic and areas of interest by mapping the available literature, identifying sources of evidence, and identifying key concepts and theories. The choice of a systematic review may result in an insufficient number of references for analysis.

What is known about cancer knowledge transfer interventions implemented in Africa and Asia?

Sub-questions (specific objectives):

• What interventions (actors/activities/tools) have been used to promote the appropriation and use of knowledge on cancers by stakeholders (decision-makers, health professionals, carers (associations, relatives, social services, patients, etc.)

• What have been the outcomes/impacts of these interventions? What conclusions and recommendations have been drawn from these results?

• What factors helped or hindered the KT process when these interventions were implemented?

• What theories, frameworks or models were used to inform the design or content of the interventions?

• What strategies were used to evaluate the interventions ?

Participants

Our review considers cancer in the broadest sense, rather than a specific condition/population.

Therefore, using our definition of knowledge transfer, the review will include papers that address interventions that focus on at least one of the following audiences: the general public, patients, carers, healthcare professionals, civil society organisations, decision-makers.

Concept

Our review focuses on knowledge transfer interventions in cancer control.

Articles relating to fundamental, translational and clinical research (clinical trials/randomised pilot trials, biobanks) are excluded, as are articles on skills or technology transfer and medical education.

Translational research is concerned with finding practical applications for the latest fundamental discoveries. It enables knowledge and innovative technologies to be rapidly translated into diagnostic and therapeutic applications for the benefit of patients (10). Academic clinical research aims to define and validate the best possible strategies for the diagnosis and treatment of cancer. Knowledge transfer, as defined in this review, occurs downstream of this process, in the phase of integrating validated treatments, devices and practices in the health care system, scaling up to the whole population.

In addition, articles dealing with the training of health professionals in relation to the traditional curriculum of their discipline and the transfer of skills between health professionals are excluded as they do not correspond to our definition of knowledge transfer.

Based on the assumption that there is a paucity of scientific literature on this topic in Africa and Asia, the research team decided not to limit the review to references that evaluated the effectiveness of the interventions implemented. Interesting references that do not include an evaluation of the strategy implemented may be included and discussed with the authors at a later stage if relevant.

Context

This review covers Africa and Asia. Other regions are excluded.

Types of Sources

This review will consider both qualitative and quantitative studies reported in peer-reviewed empirical publications. In addition, systematic reviews that meet the inclusion criteria will also be considered, depending on the research question. Abstracts, commentaries and editorials will be excluded. Experimental and quasi-experimental interventions will be considered.

The proposed scoping review will be conducted in accordance with JBI’s methodology for scoping reviews (11). We have chosen the scoping review approach because this review is an initial exploratory study that aims to provide an overview of the of knowledge transfer interventions implemented in Africa and Asia and to map the available evidence in this area.

Search strategy

Knowledge transfer is a concept developed by different scientific disciplines. There are a variety of terms used to refer to it. The research team will refer to the research strategy of the systematic review of reviews by L. Langer, J. Tripney & D. Gough on the Use of Research Evidence in Decision-Making (12) to define the descriptor terms and the free terms to build its search strategy.

The search strategy for the bibliographic databases will be developed by the research team in collaboration with a librarian. An initial limited search of MEDLINE will be carried out to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles will be used to develop a full search strategy for Embase, Emcare, ERIC, APA Psycinfo, Medline (see Appendix 1). These databases were selected on the basis of the subject areas covered by the indexed references (education/teaching for ERIC, social and behavioural sciences for APAPsycinfo, biomedical sciences for Embase and Medline and paramedical sciences for Embase) and the quality of the indexing and the references. In addition, Medline, Psycinfo, ERIC, Embase and Google Scholar will be used as reference journals for the development of the search strategy.

If the number of selected references is too small, the search will be extended to Google Scholar.

The search strategy, including all identified keywords and index terms, will be adapted for each included database and/or information source. The reference list of all included sources of evidence will be screened for additional studies.

Studies published in French and English will be included. Studies published up to March 2023 will be included.

Study/Source of Evidence selection

Following the search, all identified citations will be collated and uploaded to Covidence and duplicates will be removed. Titles and abstracts will then be screened by two independent reviewers for assessment against the inclusion criteria for the review. The full text of selected citations will be assessed in detail against the inclusion criteria by two independent reviewers. Reasons for exclusion of full-text evidence that does not meet the inclusion criteria will be recorded and reported in the scoping review. Any disagreements between the reviewers at any stage of the selection process will be resolved by discussion, or with an additional reviewer. The results of the search and the study inclusion process will be fully reported in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flow diagram.

Data Extraction

Data will be extracted from the papers included in the scoping review by the lead reviewer using a data extraction tool based on that used by Brouwers et al. (8) who conducted a review of systematic reviews of knowledge transfer interventions in cancer control to better understand the evidence base for implementation strategies in this field. The exploratory work of this Canadian team on this topic has allowed the development of a typology of the nature of knowledge transfer interventions in the field of cancer, on which we will base our analysis. To this end, the data extracted will include specific details on: (i) intervention name/label; (ii) intervention definition and purpose; (iii) theories, frameworks, or models used to inform the design or delivery of the intervention; (iv) limiting and facilitating factors, (v) geography (where the intervention was tested); (vi) stakeholder involvement (who and how); (vii) key outcomes (viii) evaluation strategy; (ix) sustainability and replicability and (xi) recommendations and conclusions.

The draft data extraction tool will be modified and revised as necessary during the process of extracting data from each included evidence source. Modifications will be detailed in the scoping review. Any disagreements that arise between the reviewers will be resolved through discussion, or with one or more additional reviewers. Where appropriate, authors of papers will be contacted to request missing or additional data as necessary.

There is no conflict of interest in this project.

Appendix I: Search strategy

Search sources

Embase

Emcare

ERIC

APA Psycinfo

Medline

Search query

Step 1

TI(KT OR “community based practice*“ OR “community engagement“ OR “community utilization” OR “community utilisation” OR “community dissemination” OR “community diffusion” OR “research uptake” OR “research utilization” OR “research utilisation” OR “research dissemination” OR “community diffusion” OR “community uptake” OR “evidence utilisation” OR “evidence utilization” OR “evidence uptake” OR “knowledge utilisation” OR “knowledge utilization” OR “knowledge dissemination” OR “knowledge diffusion” OR “knowledge uptake” OR “knowledge mobilization” OR “knowledge mobilization” OR “research use*” OR “evidence use*” OR “data use*” OR “knowledge use*” OR “knowledge application*” OR “knowledge exchange*” OR “knowledge translation*” OR “research translation*” OR “knowledge transfer*” OR “research transfer*” OR “knowledge broker*” OR “research adoption” OR “knowledge adoption” OR “knowledge sharing” OR “evidence to policy” OR “research to policy” OR “knowledge to action” OR “research to action” OR “research into practice” OR “use of evidence” OR “use of research” OR “uptake of research” OR “uptake of evidence” OR “utilisation of research” OR “utilisation of evidence” OR “impact of research” OR “learning use” OR “learning adoption” OR “learning transfer” OR “leaning mobilization” OR “learning mobilisation” OR “engagement strateg*“)

OR

(EMB.EXACT.EXPLODE(“community based surveillance”) OR EMB.EXACT.EXPLODE(“patient participation”) OR EMB.EXACT.EXPLODE(“community based rehabilitation”) OR EMB.EXACT.EXPLODE(“community health nursing”) OR EMB.EXACT.EXPLODE(“patient attitude”) OR EMB.EXACT(“translational research”) OR EMB.EXACT(“research utilization group”) OR EMB.EXACT.EXPLODE(“learning”) OR EMB.EXACT(“knowledge management”) OR EMB.EXACT(“attitude to health”) OR EMB.EXACT(“health care facilities and services”) OR EMB.EXACT(“knowledge”) OR EMB.EXACT(“health promotion”) OR EMB.EXACT.EXPLODE(“attitude”) OR EMB.EXACT(“translational medicine”) OR EMB.EXACT.EXPLODE(“medical information”) OR EMB.EXACT.EXPLODE(“patient-reported outcome”)

OR

MESH.EXACT.EXPLODE(“Community Health Nursing”) OR MESH.EXACT.EXPLODE(“Community Medicine”) OR MESH.EXACT.EXPLODE(“Community Networks”) OR MESH.EXACT.EXPLODE(“Community Health Planning”) OR MESH.EXACT.EXPLODE(“Community-Institutional Relations”) OR MESH.EXACT.EXPLODE(“Community Support”) OR MESH.EXACT.EXPLODE(“Community-Based Participatory Research”) OR MESH.EXACT.EXPLODE(“Community Resources”) OR MESH.EXACT.EXPLODE(“Community Health Services”) OR MESH.EXACT.EXPLODE(“Community Health Centers”) OR MESH.EXACT.EXPLODE(“Community Integration”) OR MESH.EXACT.EXPLODE(“Comprehensive Health Care”) OR MESH.EXACT.EXPLODE(“Patient-Centered Care”) OR MESH.EXACT.EXPLODE(“Primary Health Care”) OR MESH.EXACT.EXPLODE(“Patient Participation”) OR MESH.EXACT.EXPLODE(“Patient Acceptance of Health Care”) OR MESH.EXACT.EXPLODE(“Health Knowledge, Attitudes, Practice”) OR MESH.EXACT.EXPLODE(“Health Promotion”) OR MESH.EXACT.EXPLODE(“Knowledge Management”) OR MESH.EXACT.EXPLODE(“Translational Research, Biomedical”) OR MESH.EXACT.EXPLODE(“Knowledge”) OR MESH.EXACT.EXPLODE(“Translational Science, Biomedical”) OR MESH.EXACT.EXPLODE(“Information Dissemination”) OR MESH.EXACT.EXPLODE(“Health Information Exchange”) OR MESH.EXACT.EXPLODE(“Health Information Management”) OR MESH.EXACT.EXPLODE(“Patient Reported Outcome Measures”)

OR

SUB.EXACT(“Information Dissemination”) SUB.EXACT(“Research and Development”) OR SU.EXACT(“Knowledge Transfer”) OR SUB.EXACT(“Knowledge Management”) OR SUB.EXACT(“Patient Reported Outcome Measures”)

OR

SUB.EXACT(“Data Use”) OR SUB.EXACT(“Information Utilization”) OR SUB.EXACT(“Learning Strategies”) OR SUB.EXACT(“Information Dissemination”) OR SUB.EXACT(“Research Utilization”) OR SUB.EXACT(“Knowledge Management”) OR SUB.EXACT(“Selective Dissemination of Information”) OR SUB.EXACT(“Evaluation Utilization”) OR SUB.EXACT(“User Needs (Information)”) OR SUB.EXACT(“Patient Education”) OR SU.EXACT(“Patient Centered Care”) OR SU.EXACT(“Client Participation”))

AND

(TI,AB(KT OR “community based practice*“ OR “community engagement“ OR “community utilization” OR “community utilisation” OR “community dissemination” OR “community diffusion” OR “research uptake” OR “research utilization” OR “research utilisation” OR “research dissemination” OR “community diffusion” OR “community uptake” OR “evidence utilisation” OR “evidence utilization” OR “evidence uptake” OR “knowledge utilisation” OR “knowledge utilization” OR “knowledge dissemination” OR “knowledge diffusion” OR “knowledge uptake” OR “knowledge mobilization” OR “knowledge mobilization” OR “research use*” OR “evidence use*” OR “data use*” OR “knowledge use*” OR “knowledge application*” OR “knowledge exchange*” OR “knowledge translation*” OR “research translation*” OR “knowledge transfer*” OR “research transfer*” OR “knowledge broker*” OR “research adoption” OR “knowledge adoption” OR “knowledge sharing” OR “evidence to policy” OR “research to policy” OR “knowledge to action” OR “research to action” OR “research into practice” OR “use of evidence” OR “use of research” OR “uptake of research” OR “uptake of evidence” OR “utilisation of research” OR “utilisation of evidence” OR “impact of research” OR “learning use” OR “learning adoption” OR “learning transfer” OR “leaning mobilization” OR “learning mobilisation” OR “engagement strateg*“))

Step 2

(MESH.EXACT.EXPLODE(“Breast Neoplasms, Male”) OR MESH.EXACT.EXPLODE(“Hereditary Breast and Ovarian Cancer Syndrome”) OR MESH.EXACT.EXPLODE(“Breast Neoplasms”) OR MESH.EXACT.EXPLODE(“Cancer Pain”) OR MESH.EXACT.EXPLODE(“Neoplasms”) OR MESH.EXACT.EXPLODE(“Integrative Oncology”) OR MESH.EXACT.EXPLODE(“Medical Oncology”) OR MESH.EXACT.EXPLODE(“Oncology Nursing”) OR MESH.EXACT.EXPLODE(“Surgical Oncology”) OR MESH.EXACT.EXPLODE(“Early Detection of Cancer”)

OR

EMB.EXACT.EXPLODE(“neoplasm”) OR EMB.EXACT.EXPLODE(“breast tumor”) OR EMB.EXACT(“advanced breast cancer”) OR EMB.EXACT(“breast cancer”) OR EMB.EXACT(“basal like breast cancer”) OR EMB.EXACT(“hereditary breast and ovarian cancer syndrome”) OR EMB.EXACT.EXPLODE(“oncology nursing”) OR EMB.EXACT.EXPLODE(“cancer screening”) OR EMB.EXACT.EXPLODE(“surgical oncology”) OR EMB.EXACT.EXPLODE(“oncology”) OR EMB.EXACT.EXPLODE(“integrative oncology”) OR EMB.EXACT.EXPLODE(“cancer staging”)

OR

SUB.EXACT(“Breast Neoplasms”) OR SUB.EXACT(“Benign Neoplasms”) OR MJSUB.EXACT(“Melanoma”) OR SUB.EXACT(“Leukemias”) OR SUB.EXACT(“Terminal Cancer”) OR SUB.EXACT(“Endocrine Neoplasms”) OR SUB.EXACT(“Brain Neoplasms”) OR SUB.EXACT(“Nervous System Neoplasms”) OR SUB.EXACT(“Metastasis”) OR SUB.EXACT(“Glioma”) OR SUB.EXACT(“Cancer Screening”) OR SUB.EXACT(“Cancer”) OR SUB.EXACT(“Neoplasms”) OR SUB.EXACT(“Oncology”) OR SUB.EXACT(“Melanoma”) OR SUB.EXACT(“Leukemias”))

Step 3

(TI,AB(“Sub-saharan” OR “Subsaharan” OR “Western Africa” OR “East Africa” OR “Central Africa” OR Angola OR Benin OR Botswana OR “Burkina Faso” OR Burundi OR “Cabo Verde” OR Cameroon OR “Central African Republic” OR Chad OR Comoros OR Congo OR “Ivory Coast” OR “Côte d’Ivoire” OR Equatorial Guinea OR Eritrea OR Eswatini OR Ethiopia OR Gabon OR Gambia OR Ghana OR Guinea OR Guinea-Bissau OR Kenya OR Lesotho OR Liberia OR Madagascar OR Malawi OR Mali OR Mauritania OR Mauritius OR Mozambique OR Namibia OR Niger OR Nigeria OR Rwanda OR “Sao Tome And Principe” OR Senegal OR Seychelles OR “Sierra Leone” OR Somalia OR “South Africa” OR “South Sudan” OR Sudan OR Tanzania OR Togo OR Uganda OR Zambia OR Zimbabwe OR africa)

OR

MESH.EXACT.EXPLODE(“Africa South of the Sahara”) OR MESH.EXACT.EXPLODE(“African People”) OR MESH.EXACT.EXPLODE(“Africa, Southern”) OR MESH.EXACT.EXPLODE(“Africa, Western”) OR MESH.EXACT.EXPLODE(“Africa, Northern”) OR MESH.EXACT.EXPLODE(“Africa, Central”) OR MESH.EXACT.EXPLODE(“Africa, Eastern”) OR MESH.EXACT.EXPLODE(“Africa”) OR MESH.EXACT.EXPLODE(“Africa South of the Sahara”)

OR

EMB.EXACT.EXPLODE(“Africa south of the Sahara”) OR EMB.EXACT.EXPLODE(“Africa”) OR EMB.EXACT.EXPLODE(“North Africa”) OR EMB.EXACT.EXPLODE(“Central Africa”) OR EMB.EXACT.EXPLODE(“African”)

OR

SU.EXACT(“African Cultural Groups”) OR SU.EXACT(“African Studies”))

Step 4

TI,AB(Asia OR Japan OR Vietnam OR Korea OR India OR Myanmar OR Borneo OR Indochina OR Cambodia OR Bhutan OR Malaysia OR Bangladesh OR Indonesia OR Philippines OR Sri Lanka OR Laos OR China OR Mongolia OR Thailand OR Singapore OR Timor-Leste OR Taiwan OR Nepal OR Maldives OR “Mekong Valley” OR “Asian People” OR “North Asian” OR Asian OR “East Asian” OR “Southeast Asian” OR “South Asian” OR “Central Asian”)

OR

MESH.EXACT.EXPLODE(“Asia, Western”) OR MESH.EXACT.EXPLODE(“Japan”) OR MESH.EXACT.EXPLODE(“Vietnam”) OR MESH.EXACT.EXPLODE(“Korea”) OR MESH.EXACT.EXPLODE(“India”) OR MESH.EXACT.EXPLODE(“Myanmar”) OR MESH.EXACT.EXPLODE(“Borneo”) OR MESH.EXACT.EXPLODE(“Indochina”) OR MESH.EXACT.EXPLODE(“Cambodia”) OR MESH.EXACT.EXPLODE(“Turkmenistan”) OR MESH.EXACT.EXPLODE(“Asia, Southern”) OR MESH.EXACT.EXPLODE(“Afghanistan”) OR MESH.EXACT.EXPLODE(“Bhutan”) OR MESH.EXACT.EXPLODE(“Malaysia”) OR MESH.EXACT.EXPLODE(“Pakistan”) OR MESH.EXACT.EXPLODE(“Asia”) OR MESH.EXACT.EXPLODE(“Asia, Northern”) OR MESH.EXACT.EXPLODE(“Asia, Southeastern”) OR MESH.EXACT.EXPLODE(“Asia, Eastern”) OR MESH.EXACT.EXPLODE(“Kyrgyzstan”) OR MESH.EXACT.EXPLODE(“Uzbekistan”) OR MESH.EXACT.EXPLODE(“Bangladesh”) OR MESH.EXACT.EXPLODE(“Indonesia”) OR MESH.EXACT.EXPLODE(“Philippines”) OR MESH.EXACT.EXPLODE(“Sri Lanka”) OR MESH.EXACT.EXPLODE(“Laos”) OR MESH.EXACT.EXPLODE(“Asia, Central”) OR MESH.EXACT.EXPLODE(“Kazakhstan”) OR MESH.EXACT.EXPLODE(“China”) OR MESH.EXACT.EXPLODE(“Mongolia”) OR MESH.EXACT.EXPLODE(“Brunei”) OR MESH.EXACT.EXPLODE(“Thailand”) OR MESH.EXACT.EXPLODE(“Singapore”) OR MESH.EXACT.EXPLODE(“Timor-Leste”) OR MESH.EXACT.EXPLODE(“Taiwan”) OR MESH.EXACT.EXPLODE(“Tajikistan”) OR MESH.EXACT.EXPLODE(“Nepal”) OR MESH.EXACT.EXPLODE(“Maldives”) OR MESH.EXACT.EXPLODE(“Mekong Valley”) OR MESH.EXACT.EXPLODE(“Asian People”) OR MESH.EXACT.EXPLODE(“North Asian People”) OR MESH.EXACT.EXPLODE(“Asian”) OR MESH.EXACT.EXPLODE(“West Asian People”) OR MESH.EXACT.EXPLODE(“East Asian People”) OR MESH.EXACT.EXPLODE(“Southeast Asian People”) OR MESH.EXACT.EXPLODE(“South Asian People”) OR MESH.EXACT.EXPLODE(“Central Asian People”)

OR

EMB.EXACT.EXPLODE(“Philippines”) OR EMB.EXACT.EXPLODE(“Taiwan”) OR EMB.EXACT.EXPLODE(“central Asia”) OR EMB.EXACT.EXPLODE(“Japan”) OR EMB.EXACT.EXPLODE(“South Asia”) OR EMB.EXACT.EXPLODE(“India”) OR EMB.EXACT.EXPLODE(“Copt”) OR EMB.EXACT.EXPLODE(“Nepal”) OR EMB.EXACT.EXPLODE(“Korea”) OR EMB.EXACT.EXPLODE(“Mongolia”) OR EMB.EXACT.EXPLODE(“Bangladesh”) OR EMB.EXACT.EXPLODE(“Sri Lanka”) OR EMB.EXACT.EXPLODE(“Bhutan”) OR EMB.EXACT.EXPLODE(“China”) OR EMB.EXACT.EXPLODE(“Iraq”) OR EMB.EXACT.EXPLODE(“northern Asia”) OR EMB.EXACT.EXPLODE(“Far East”) OR EMB.EXACT.EXPLODE(“Southeast Asia”) OR EMB.EXACT.EXPLODE(“Asia”)

OR

SU.EXACT(“Asians”) OR SU.EXACT(“Asians”)