Are we in a pickle? Rethinking the world of research and user interaction

The lion's tail and knowledge boundaries are two analogies referred to in the lead essay by Lindstrom, MacLeod and Levy. These may be helpful but require slight readjustment. Grabbing onto the lion's tail implies one reality and one intersection point, whereas the old analogy of the blind men and the elephant shows that various perspectives are required. Integrated knowledge translation refers to user involvement throughout the research process. Participatory models are one form of integrated knowledge translation, but caution is required to help maintain the knowledge boundaries. There is the real danger of one group becoming "pickled," or having unbalanced osmotic pressure from another group, resulting in destroyed "cell wall" boundaries. Neither researchers nor users should morph into each other but should, rather, fulfill unique roles within a respectful, trusted research relationship. Lessons learned at the Manitoba Centre for Health Policy teach us that collaborative health services research takes time, money, mutual understanding and respect (including respect from academic institutions for this paradigm of research). This requires a dedicated centre of core group scientists willing to devote the necessary time. Diffused networks may not be stable enough to maintain the long-term relationship building required for the intersection of researchers and decision-makers.