This commentary examines the claim made by Borst et al that knowledge translation (KT) should look to Science and Technology Studies (STS), the sociology of translation, and constructionist views on knowledge, and begin to think of the sustainability of a certain practice as construction work in continuous progress, and not as states to be reached once and for all. While endorsing this claim, the present commentary also argues that what it calls the “epistemic reframing” behind the new construal of KT in Borst must be supplemented with approaches that goes beyond the sociology of translation. The commentary claims that this epistemic shift hinges upon a shift in the narrative framing of KT, and that we need to consider the broader narrative and historical ideology of knowledge dissemination behind KT, and that a failure to do so, leaves us with KT seen as a linear transmission of “true” knowledge to peoples and places lacking such knowledge.

Knowledge translation was created in response to the knowledge-do gap. With the growing number of research projects, utilization of research knowledge roused interest. One of its defects, which are seen more in developing countries, is the scarcity of recognized practical knowledge translation applications. The actions taken to strengthen knowledge translation can be classified into three categories of ‘push, pull and exchange’. In Iran, some of the interventions effective in knowledge translation, may not have primarily taken place with this aim, but can however be effective in it. Some of the measures taken specifically in Iran’s research system are: capacity building of human resources for knowledge translation, better utilization of research by the Ministry of Health and Medical Education, creating necessary incentives among medical universities, identification of barriers and proposing interventions. Pilots of knowledge translation interventions are concerned with ‘push’ activities whose main focus is to support knowledge translation activities and promote active strategies (or increase interaction between researchers and decision makers during research and utilization of results). Long-plan programs such as ‘Iran’s Health Innovation and Science Development plan have also been designed for the future. These include formation of centers for reducing the knowledge-do gap in the form of knowledge and health technology translation centers.

Putting health theories, research and knowledge into practice is a challenge referred to as the knowledge-to-action gap. Knowledge translation (KT), and its related concepts of knowledge mobilization, implementation science and research impact, emerged to mitigate this gap. While the social interaction view of KT has gained currency, scholars have not easily made a link between KT and the concept of complexity. Kitson and colleagues suggest we ought to examine the role of complexity in KT processes using defined theories and concepts borrowed from network and complex adaptive systems theory. They further argue that better KT outcomes might be achieved using this new lens. There remain, however, several critical considerations for this sort of theory application to work in the real-world. Complexity and network theory offer explanatory power about the KT problem, but these theories are less helpful for understanding solutions.

In a recent Editorial for this journal, El-Jardali and Fadlallah proposed a new framework for Knowledge Translation (KT) in healthcare. Many such frameworks already exist; thus, new entrants to the field must be scrutinized in regard to their unique contributions to advancing understanding and practice. The El-Jardali and Fadlallah framework focuses on policy-level discussions, a relatively under-studied issue to date. Their framework usefully incorporates both priority setting questions at the front-end (which KT efforts get undertaken and which do not) as well as evaluation questions at the back-end (how do we show that more evidence-informed decisions are actually better ones?). Their framework also emphasizes capacity building among both decision-makers and researchers. This is an area worthy of additional attention, particularly because it is likely to be far more challenging than El-Jardali and Fadlallah allow.

The critical interpretive synthesis by Borst and colleagues offered a new perspective on knowledge translation (KT) sustainability from the perspective of Science and Technology Studies. From our applied health services perspective, we found several interesting ideas to bring forward. First, the idea that KT sustainability includes the ongoing activation of networks led to several future research questions. Second, while not entirely a new concept, understanding how KT actors work strategically and continuously with institutional rules and regulations to sustain KT practice was noteworthy. We add to the discussion by emphasizing the importance of non-researcher voices (clinicians, administrators, policy-makers, patients, carers, public) in sustaining KT practice. We also remind readers that the health ecosystem is dynamic and interdependent, where one system level influences and is influenced by another, and that these constant adaptations suggest that understanding KT practices cannot be a one-off event but represent repeated moments for transformative learning.