Evaluating the implementation of integrated knowledge translation in a multi-country research consortium in Sub-Saharan Africa - a mixed methods comparative case study.

BACKGROUND: Integrated knowledge translation (IKT) is an approach facilitating collaboration between researchers and decision-makers towards evidence-informed decision-making. Increasingly evaluated in various contexts, less is known about the implementation process of IKT, including in low- and middle-income countries. The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) developed, implemented and evaluated an IKT approach across five countries. Here, we examined how the IKT approach was implemented in the African-German multi-country research consortium, investigating project-level context; implementation process, strategy, and outcomes; and exploring intervention core components. METHODS: This process evaluation used a mixed-methods comparative case study design. Following a previously published protocol, the main authors of this paper surveyed and interviewed African CEBHA+ researchers and their partners from policy and practice in 2020/2021 and 2022/2023 and identified relevant IKT-related documents. We drew on our programme theory and implementation science frameworks to undertake qualitative content analysis of interview data and documents. Data was analysed within sites, integrated with descriptively analysed quantitative survey data, and subsequently compared across sites. RESULTS: We enrolled 36 researchers and 19 decision-makers and analysed 92 IKT-related documents. IKT was implemented at the five sites in Ethiopia, Malawi, Rwanda, South Africa, and Uganda. In our cross-site analysis of fidelity and adaptability of IKT, we identified three core components of the IKT approach: (i) continuous tailored engagement between researchers and decision-makers, (ii) researchers' commitment to research impact, and (iii) linking to existing KT routines. The context analysis revealed that IKT implementation was facilitated by local KT structures, pre-existing knowledge translation routines and relationships with decision-makers, senior leadership motivation, and funder support including a dedicated budget for IKT activities. Feasibility of IKT implementation was reduced by administrative challenges, overall project complexity, and conflicting priorities. CONCLUSION: This research leveraged a unique opportunity to study a systematic IKT approach implemented across sites in five African countries in the context of a large international research consortium. The findings can inform IKT design and implementation in other multi-site and multi-country projects. Particularly, the identified core components can guide adaptation and refinement of IKT in contextually diverse settings, including low- and middle- income countries.