Knowledge Creation: Is it Undervalued?
The flow of reproductive health information has been greatly influenced in recent years by knowledge management approaches. In a world of information overload, KM seeks to deliver the right information to the right people at the right time. This “avoiding information overload” strategy—while useful in many contexts—has had, in my opinion, an undesirable side effect: It undervalues the creation of new knowledge. Many KM efforts focus on the organization, adaptation and sharing of existing knowledge, to the exclusion of guiding and nurturing new knowledge. Advocacy for, planning for, and steering research agendas toward the creation of new knowledge in a given issue area has been particularly de-emphasized.
A recent example of this effect is the technical statement on Hormonal Contraception and HIV issued in February by the World Health Organization’s Department of Reproductive Health and Research. This statement was motivated by the release of a study in October 2011 suggesting a strong association between the use of injectable hormonal contraception and HIV risk (the “Heffron study”). The statement was the result of a technical consultation convened on 31 January–1 February 2012 “to re-examine the totality of evidence on potential effects of hormonal contraception on HIV acquisition, disease progression, and infectivity/transmission to sexual partners”. The convened group specifically considered whether Medical Eligibility Criteria for Contraceptive Use should be changed to reflect accumulating evidence. The group concluded that “currently available data neither establish a clear causal association with injectables and HIV acquisition, nor definitively rule out the possibility of an effect” and that “use of hormonal contraceptives should remain unrestricted if a strong clarification was added to the MEC, which reflected the difficulties the group had with the data, the need for an enhanced message about condom use, for both male and female condoms, and other HIV prevention measures, and the need for couples to have access to as wide a range of contraceptive methods as possible”. They noted that “further research is essential” and that “[t]hese recommendations will be continually reviewed in light of new evidence.”
The recommendations are a conscientious response by knowledgeable and committed public health professionals to a frightening and potentially deadly knowledge gap. The technical consultation which produced the recommendations involved 75 experts from a wide range of fields. They applied sound KM approaches—identifying, organizing, and sharing existing knowledge. But they did not address the knowledge that does not yet exist. There was no guidance on the design and implementation of future research and no plan for developing this guidance.
Organizations like the International Community of Women Living with HIV have called for a concrete research plan:
“Because the WHO acknowledges that ‘expansion of contraceptive method mix and further research on the relationship between hormonal contraception and HIV infection is essential,’ UNAIDS, WHO, and funders need to urgently commission research now so that we can understand the relationship that we have speculated about for so long. WHO must also delineate next steps and share details of the continuing and planned research.”
To respond to this call, funding and policymaking bodies must analyze existing knowledge gaps, design research that seeks to fill these gaps, adapt existing research to new priorities, and anticipate future knowledge gaps. In this effort they should receive the enthusiastic support of knowledge managers and workers newly committed to nurturing the creation of knowledge. We knowledge workers can use our organization and synthesis skills to help identify research gaps and to document and integrate contributions toward filling them. We can deepen our knowledge evaluation activities to include evaluation of evidence as well as products and programs. We can include research design and research-to-practice methodology in our knowledge sharing activities. We can advocate for resource expenditure on knowledge generation and nurture. We can reclaim researchers and teachers as our valued audiences.
While appreciating the gravity of the evidence presented in the Heffron study and addressed in the technical statement, we knowledge workers can also embrace the opportunities for professional and humanitarian re-dedication that they provide. At the heart of this deliberation are millions of women simultaneously at high risk of unwanted pregnancy, maternal mortality and HIV/AIDS. As much as we may be tempted to try to help them by controlling knowledge, in the long run we must contribute by expanding knowledge.
 Heffron R, Donnell D, Rees H, et al. Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. Lancet Infections Diseases, 2012, 12:19-26.