Intersectionality & KT

• • KT practitioners use frameworks to design KT projects.
  • Intersecting social factors (e.g., age, education, gender identity) can have significant impacts on KT projects.
  • Intersectionality (Figure 1) explores the complex nature of intersecting social factors and their interaction with compounding power structures (e.g., media, education system) and forms of discrimination (e.g., sexism).^1-5
  • Currently, KT frameworks do not fulsomely explore individual-level social factors and how they interact with wider systems to produce unique human experiences.
  • The purpose of this research study is to support KT practitioners to use an intersectional approach in their work. To do this, we are enhancing existing KT frameworks with an intersectional lens and creating tools and training to support taking an intersectional approach in KT. Specifically, we are exploring how to support KT interventions that target older adults.

References

• Collins. Routledge. 1990. https://trove.nla.gov.au/version/21207078.
• Crenshaw, K.U. Chi. Legal F. 1989;139.
• Crenshaw, K. The politics of law: A progressive critique. 1990;195.
• Crenshaw, K. Stanford Law Review. 1991;43(6), 1241-1299.
• Hankivsky O et al. Int J Equity Health. 2014;13:119. doi:10.1186/s12939-014-0119-x.
• Cochrane Equity Methods. PROGRESS-PLUS.
• O’Neill et al. Journal of Clinical Epidemiology. 2014;67, 56-64.
• Simpson, J. Canadian Research Institute for the Advancement of Women (CRIAW). 2009.
• Etherington, C., Rodrigues, I. B., Giangregorio, L., Graham, I. D., Hoens, A. M., Kasperavicius, D., Kelly, C., Moore, J. E., Ponzano, M., Presseau, J., Sibley, K. M., & Straus, S. (2020). Applying an intersectionality lens to the theoretical domains framework: A tool for thinking about how intersecting social identities and structures of power influence behaviour. BMC Medical Research Methodology, 20(1), Article 1. https://doi.org/10.1186/s12874-020-01056-1
• Presseau, J., Kasperavicius, D., Rodrigues, I. B., Braimoh, J., Chambers, A., Etherington, C., Giangregorio, L., Gibbs, J. C., Giguère, A., Graham, I., Hankivsky, O., Hoens, A. M., Holroyd‐Leduc, J., Kelly, C., Moore, J. E., Ponzano, M., Sharma, M., Sibley, K. M., & Straus, S. E. (2022). Selecting implementation models, theories, and frameworks in which to integrate intersectional approaches. BMC Medical Research Methodology, 22(1). https://doi.org/10.1186/s12874-022-01682-x
• Kelly, C., Kasperavicius, D., Duncan, D., Etherington, C., Giangregorio, L., Presseau, J., Sibley, K. M., & Straus, S. (2021). ‘Doing’ or ‘using’ intersectionality? Opportunities and challenges in incorporating intersectionality into knowledge translation theory and practice. International Journal for Equity in Health, 20(1), Article 1. https://doi.org/10.1186/s12939-021-01509-z
• Rodrigues, I. B., Fahim, C., Garad, Y., Presseau, J., Hoens, A. M., Braimoh, J., Duncan, D., Bruyn-Martin, L., & Straus, S. E. (2023). Developing the intersectionality supplemented Consolidated Framework for Implementation Research (CFIR) and tools for intersectionality considerations. BMC Medical Research Methodology, 23(1), Article 1. https://doi.org/10.1186/s12874-023-02083-4

We acknowledge that the work of our Canadian Institutes of Health Research (CIHR)-funded team grant was conducted on unceded lands that were the traditional territories of many people, including the Algonquin, Cree, Dakota, Dene, Huron-Wendat, Mississaugas of the Credit River, and the Musqueam Peoples, and on the homeland of the Métis Nation. We acknowledge the harms of the past. We are grateful for the generous opportunities to conduct work and share knowledge on these lands.

In 2017, the CIHR launched an opportunity for team grants in gender and KT. This opportunity (sponsored by the Institute of Gender and Health) was developed to recognize that the field of KT had yet to thoughtfully integrate gender into its research agenda. The objectives of the CIHR team grant competition were to generate evidence about whether applying sex- and gender-based analysis to KT interventions involving human participants improves effectiveness, thereby contributing to improved health outcomes; contribute to a broader knowledge base on how to effectively and appropriately integrate gender into KT interventions; and facilitate the consideration and development of gender-transformative approaches in KT interventions.

In response to this call, we submitted a grant aimed at helping KT intervention developers use an intersectional approach when designing and implementing interventions to address the needs of older adults. We received feedback from the CIHR peer review committee that substantial concern was raised about our focus on intersectionality. In particular, the Scientific Officer’s notes described that the focus on intersectionality would dilute the focus on gender and needed to be reconsidered. A meeting was subsequently held with the successfully funded team and this issue was raised again. We acknowledge the limitation that our intersectional approach comes at the expense of a minimized focus on gender. However, because intersecting categories, such as gender and age, are experienced together, we ultimately elected to use an intersectional approach as it encapsulates the lived experience of those we aim to impact.

A more significant limitation of our work is that we did not include First Nations, Inuit, and Métis community members in the grant proposal. As such, their needs and perspectives were not included in the research grant and, consequently, funded activities. Our team did not have established relationships or expertise in this area and as such, we felt it was inappropriate for our team to work on a grant in this area.

We strongly believe that consideration of gender and KT for Indigenous peoples should be a primary focus of a distinct team grant.

There are established best practices for community engagement with First Nations, Inuit, and Métis Peoples that begin with principles of collaboration, which take time to develop and must not be tokenistic. The principles for collaboration should ensure authentic engagement, shared respect, trust, and commitment to ensure long-term, mutually empowered relationships. These principles should also ensure that the research-related priorities meet the needs, perspectives, and expectations of the First Nations, Inuit, and Métis Peoples. Indigenous peoples have a long history of conducting research, and this tradition continues today with many Indigenous healers and scholars leading research in various areas. Indeed, there are many Indigenous scholars working in the KT field.

Because the team’s work did not include First Nations, Inuit, and Métis Peoples and involve adhering to the principles that guide their engagement in research, the needs and considerations of these Peoples were not included in the work conducted in this team grant. As such, anyone who is considering using the outputs of this team grant needs to know that they cannot be broadly applied to these Peoples and there may be other more culturally appropriate models/theories/frameworks that are useful to consider. Similarly, because this research focused on older adults (and in particular, chronic disease management in older adults) it does not apply to children and youth.

We believe that any KT intervention work needs to begin with engaging the appropriate community and is only applicable when those communities are engaged throughout the research enterprise. Moreover, intersectionality involves deep immersion in the lived experiences and priorities of those communities. As a result, KT work requires immersive work with various populations and not just key informants to ensure the work meets the needs of the relevant populations.

We thank and acknowledge Dr. Lisa Richardson, Co-Lead, Indigenous Health Education, Faculty of Medicine, University of Toronto, for her time and expertise in reviewing this statement.

• • We thank all those involved in the ongoing work of the “Intersectionality and Knowledge Translation Interventions” project:
    • • Alison Hoens
      • Andrea Chaplin
      • Anik Giguère
      • Bob Paul
      • Cheryl van Daalen-Smith
      • Christine Kelly
      • Danielle Kasperavicius
      • Diana Kaan
      • Diane Duncan
      • Dianne Lalonde
      • Dianne Roedding
      • Greta Bauer
      • Ian Graham
      • Isabel Braganca Rodrigues
      • Jacquelyn Quirk
      • Janet Squires
      • Jayna Holroyd-Leduc
      • Jenna Gibbs
      • Jessica Braimoh
      • Julia Moore
      • Justin Presseau
      • Kathryn Sibley
      • Linda Henderson
      • Lora Bruyn Martin
      • Lora Giangregorio
      • Malika Sharma
      • Matteo Ponzano
      • Melissa Courvoisier
      • Nicole Etherington
      • Olena Hankivinsky
      • Paula Rochon
      • Samira Chandani
      • Sharon Straus
      • Shusmita Rashid
      • Tom Lee

• • 
    Iowa Model with Intersectionality Enhancements.

    

    Consolidated Framework for Implementation Research with Intersectionality Enhancements

    

    Behaviour Change Wheel with Intersectionality Enhancements

Poster Presentations

• Embedding Intersectionality: Building Intersectional Infrastructure for Evidence-Based Implementation Practitioners