Transforming dementia research into practice: A multiple case study of academic research utilization strategies in Dutch Alzheimer Centers

Transforming dementia research into practice: A multiple case study of academic research utilization strategies in Dutch Alzheimer Centers | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Transforming dementia research into practice: A multiple case study of academic research utilization strategies in Dutch Alzheimer Centers Eden Meng Zhu, Martina Buljac-Samardžić, Kees Ahaus, Robbert Huijsman This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4679095/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Jan, 2025 Read the published version in Health Research Policy and Systems → Version 1 posted 7 You are reading this latest preprint version Abstract Background Non-pharmacological dementia research products generated in traditional university settings, such as social and behavioral interventions, often experience challenges to impact practices that they were developed for. The Netherlands established five specialized academic health science centers, referred to as Alzheimer Centers, to structurally coordinate and facilitate the utilization of dementia research knowledge. This study leverages implementation science to systematically explore the research utilization strategies used by academic researchers from each Alzheimer Center, based on the ‘knowledge-to-action’ (KTA) framework, which includes knowledge creation, adaptation, dissemination, and implementation. Methods Individual semi-structured qualitative interviews were conducted with 29 respondents across the five Alzheimer Centers in the Netherlands, selected through purposive (snowball) sampling. Interviews were conducted in-person and virtually through Microsoft Teams, and all were audio-recorded and transcribed verbatim. Data analysis was guided by the dimensions of the KTA framework. Result There was a high variation in the strategies used across the five Alzheimer Centers to bring non-pharmacological dementia research into practice, and selected strategies in each Center were influenced by the typology of research products produced and the Centers’ organizational heritage. The knowledge creation and adaptation phases were mainly facilitated by funders’ guidance toward research impact and research product co-creation with patients and implementing organizations. Dissemination and implementation phases were often facilitated through utilizing support from university-based technology transfer offices to facilitate implementation and valorization and establishing and strategically leveraging formal infrastructure, such as public-private partnerships and professional collaborative networks. Conclusion Successful research utilization requires evolving researcher competencies to meet environmental demands and facilitating co-creation with research end-users and implementing partners. Understanding external determinants influencing research utilization in the Dutch dementia research ecosystem is crucial for capacity-building and aligning cross-sector agendas. The KTA framework appears to reveal the intricacies of research utilization, guiding future studies to explore strategies employed across various contexts. Knowledge translation Implementation science Research impact Dementia Figures Figure 1 Background Non-pharmacological dementia research knowledge products, such as eHealth interventions, psychoeducation programs, and diagnostic tools [ 56 ], are often siloed within academic settings and research domains, contributing to the 17-year research-to-practice gap that delays research use and societal impact [ 33 ]. Knowledge and pragmatic tools that guide pharmacological drug discovery and development processes, including product production, validation, valuation, and commercialization [ 5 , 35 ], are considerably more mature compared to those available to guide researchers in non-pharmacological dementia research utilization [ 56 , 57 ]. Formal research infrastructures, such as academic health science centers (AHSC), have been developed as capacity-building initiatives to strengthen the research ecosystem and enhance research impact of such academic outputs [ 14 ]. AHSCs have been characterized internationally as university institutions that have a tripartite aim of providing patient care, education and research and are structured to promote close multi-disciplinary collaboration and engagement between academic researchers and (clinical) practitioners [ 20 , 39 ]. The structure, governance, and organizational dynamics within AHSCs have been investigated [ 20 ], but previous studies have not structurally identified strategies, employed by academic researchers, to utilize research products [ 14 , 17 ]. The concept of research utilization is also referred to as ‘knowledge translation’, ‘knowledge transfer’, or ‘knowledge mobilization’ [ 22 ]. However, these terms are often inconsistently used in literature, and the explicit stages and strategies employed in the research utilization process are enigmatic in literature [ 15 , 51 ]. Implementation science theories, models and frameworks can be used to structurally explore and guide the phases of the research utilization processes, to determine specific strategies employed throughout, and to help monitor and evaluate process outcomes [ 30 , 36 , 57 ]. The complex and iterative processes involved in delivering non-pharmacological research knowledge products to the intended end-users can be explored using process models, such as the knowledge-to-action (KTA) framework, which consists of two main components: the knowledge creation funnel and the knowledge action cycle [ 18 ]. The KTA framework was originally developed by Graham et al. as a comprehensive ‘planned action model’, or ‘process model’, that guides the translation and transfer of academic research findings into real-world impact [ 22 , 42 , 52 ]. This framework was chosen to guide this study over other implementation process models, such as i-PARIHS [ 24 ], due to its adaptability and wide application across various disciplines [ 18 ]. This study is guided by a four-phase research utilization model, guided by the KTA dimensions, that includes knowledge creation, adaptation, dissemination, and implementation. The first phase, knowledge creation, encompasses the three stages within the knowledge creation funnel: knowledge inquiry, knowledge synthesis, and the development of research knowledge tools and products, such as health education programs and decision support tools [ 22 ]. In this phase, research output may be supported by a Mode 1 research production approach, which involves research directed by funders and researchers, or a Mode 2 approach, emphasizing society- and practice-focused research that encourages a participatory approach to health research [ 15 , 17 ]. Participatory approaches that include input from various stakeholders within the research ecosystem, including health practitioners in care settings and patients with lived experience, are often engaged to facilitate the process of creating equitable and feasible research knowledge products [ 13 , 27 ]. The knowledge action cycle is the second component of the KTA framework and is segmented into three phases, ‘knowledge adaptation’, ‘knowledge dissemination’, and ‘knowledge implementation’, to clearly explicate the strategies employed by researchers. The second phase in the research utilization model, knowledge adaptation, begins with a contextual needs assessment, followed by knowledge adaptation activities, such as co-designing and adapting research product components with local stakeholders and end-users to fit to the user context [ 34 , 41 , 45 ]. For fundamental (biomedical) research products, this stage can also be understood as how research findings are translated into products, such as diagnostic tools, suitable for implementation in clinics and other practice settings [ 19 ]. Knowledge adaptation should be delineated into intervention adaptation and implementation adaptation, respectively defined as adapting the intervention components to fit the user group (e.g., culturally and socially appropriate adaptation) and adapting the implementation plan to fit the contextual determinants (e.g., available resources, organizational readiness) [ 3 ]. Knowledge dissemination is an implicit stage in the KTA trajectory, characterized as an activity of ‘end-of-grant knowledge translation’ [ 22 ], but this study explicates this as a critical stage used to translate knowledge to practice and policy [ 7 ]. Knowledge dissemination is the third phase in the research utilization model and is defined here as the transfer and exchange of knowledge, beyond the boundaries of the research origin, to the intended recipients (e.g., implementation agencies, patients) [ 4 ]. Dissemination strategies can be categorized as a ‘push’ or ‘pull’ strategy, in which either the knowledge producers proactively provide knowledge to their target recipients (e.g., conducting training) or the knowledge recipients seek knowledge to support their decision-making (e.g., conducting a scoping review to inform policy) [ 21 , 29 ]. Knowledge ‘exchange’ strategies were also identified in ‘integrated knowledge translation’ (IKT) literature as facilitating active co-creation and partnership engagement to disseminate knowledge by investing in strengthening research infrastructure and health policies [ 1 ]. Notably, this stage is often facilitated prior to, or parallel to, the implementation process [ 36 ]. The last phase of the research utilization model, knowledge implementation, consists of assessing barriers and facilitators to implementation, selecting and tailoring implementation strategies, monitoring and evaluating implementation outcomes, and scaling and sustaining the intervention in the implementation setting [ 22 ]. A scoping review found 146 articles that mentioned the use of the KTA framework, but only 10 articles provided clear examples that demonstrated how the framework was used to guide implementation, all from the perspective of clinicians and healthcare practitioners [ 18 , 42 ]. Structurally exploring the activities performed to facilitate the research utilization process, from the researchers’ perspective, can inform the creation of theory-driven implementations strategies, which can explicate the knowledge utilization process to reduce implementation complexity and enhance process clarity [ 2 ]. In the Netherlands, five AHSCs with expertise in dementia research, referred to as the Alzheimer Centers, were created to strengthen the healthcare and research systems by defragmenting actors involved in research, treatment, and education. Guided by the research utilization model and the KTA dimensions, this study aims to explore the unique research knowledge utilization activities of each Alzheimer Center and determine overarching strategies employed to create, adapt, disseminate, and implement non-pharmacological dementia research to achieve research impact. The main research questions include: What strategies were used by the Alzheimer Centers to facilitate creation and adaptation of research findings into research products? What strategies were employed to disseminate research products? What strategies were used to facilitate the implementation of research products? Methods Study design This study had a multiple case study design, guided by Yin [55], to explore the respective research knowledge utilization processes present in each Alzheimer Center. This design was advantageous to identify “how” these processes occur and explore “why” certain strategies appeared in one context and were absent in others. To ensure reliability and validity, an in-depth analysis of each case was performed to identify the activities performed by each Alzheimer Center at each stage of the KTA trajectory, and patterns in the activities were identified to inductively extrapolate research utilization strategies [40]. Cross-case comparisons (i.e. cross-referencing) were used to compare strategies from each Alzheimer Center and strengthen validity of findings across varied contexts. This approach also helped determine the contextual variables within each Alzheimer Center that may influence the selection of certain strategies [55]. Results were developed based on the findings from semi-structured interviews with key informants from each Alzheimer Center. Setting In the Netherlands, there are seven university medical centers (UMCs), located in Amsterdam, Rotterdam, Nijmegen, Groningen, Maastricht, Utrecht, and Leiden, responsible for providing patient care, education, and research [11]. Between 2000 and 2019, five UMCs have embedded AHSCs, referred to as Alzheimer Centers, to centralize the creation of dementia research, education, and care (diagnostic and treatment) and to provide tertiary support in each of their respective regional catchment areas [6, 46]. Each Alzheimer Center focuses on various areas and stages of dementia research, ranging from fundamental knowledge creation to applied research implementation and sustainment. The Alzheimer Centers were purposively selected due to their unique tripartite structure as AHSC in the Netherlands, their significant research output, and their social and professional connectivity and entanglement with other stakeholders within the Dutch dementia research ecosystem, detailed in Table 1. Table 1. Description of Dutch dementia research ecosystem stakeholder groups Stakeholders Description of role and function in research ecosystem ZonMw ZorgOnderzoek Nederland (Care Research Netherlands) (ZonMw) is a government-financed research funding agency that designs programmes that facilitate the allocation of public health research funding. In addition to providing funding, ZonMw performs activities including providing research impact planning guidance (e.g., theory of change) and knowledge brokering between research teams, practice and policy. Dutch Organization for Scientific Research (NWO) NWO is a government-financed research funding agency that ensures quality and innovation in science for a wider range of basic and interdisciplinary research areas. Alzheimer Nederland Alzheimer Netherlands is a charity and patient-representative organisation for people with dementia and their caregivers, as well as a dementia research funding agency and knowledge broker. Activities performed include advocating for better patient care, raising public awareness, and facilitating informative support services, including: "Dementia dialogues”: Structured events that involve researchers and other stakeholders to discuss and share experiences, influence policies, and strengthen support networks. “Alzheimer Cafes”: Informal community support meetings organized for people with dementia, caregivers, and care and research professionals to share experiences, disseminate research, and gather real-world perspectives. National knowledge institutions National knowledge institutions (e.g., Pharos and Vilans) enhance the research ecosystem by synthesizing evidence, guiding policy, and ensuring knowledge translation to improve societal health outcomes. Researchers receive support from such institutes in knowledge brokering and translation. Health insurance agencies Health insurers may support research utilization by financing, adopting and sustaining evidence-based practices. For example, van thuis uit is an initiative from CZ insurance that promotes ageing in place (home-based care). Dutch Ministry of Health, Welfare, and Sport (VWS) VWS directs the national health research agenda and funds healthcare research, influences policy, sets standards, and promotes innovations, significantly shaping healthcare quality and public health initiatives in the Netherlands. VWS established the National Dementia Strategy 2020-2030 to stimulate research (via ZonMw and NWO) aimed at improving quality of life for people with dementia and their caregivers. VWS also stimulates research through funding the Stimuleringsregeling E-Health Thuis (SET) initiative , which promotes the adoption and implementation of e-health solutions in home care settings. Professional associations or federations Professional associations, including the Dutch Federation for Psychology and Dutch Federation for Neurologists, set professional standards, accredit educational programs, and impact research by promoting ethical guidelines and facilitating collaborations within their respective fields. Verpleegkundigen & Verzorgenden Nederland (V&VN) is a professional association for nurses, nursing assistants, and professional carers in the Netherlands and support each group through professional standards, educational resources, advocacy, networking opportunities, and promoting best practices. V&VN supports occupational groups (e.g., case managers) by providing professional development and guidance tailored to their needs within the healthcare industry. Sample and recruitment Recruited research participants include program managers and researchers employed by an Alzheimer Center, specializing in a range of disciplines (e.g., psychiatry, neuropsychology, epidemiology) that contribute to dementia research. The research team obtained permission from the leader(s) of each Alzheimer Center, prior to the study, to conduct research in their organization. Individual participants were recruited using purposive and snowball sampling, identified through each Alzheimer Center’s official website, official LinkedIn pages, and through the referral of Alzheimer Center leaders. These leaders also shared an introductory e-mail, on the research team’s behalf, to inform and invite selected staff members to participate in this ongoing research project, and staff members responded with their intention to participate. Selected participants had a wide range of years of work experience and research area expertise, including developing fundamental research, social and behavioral programs, and digital health technologies. The variety of participant backgrounds included aimed to provide a representative sample of each Alzheimer Center’s staff profiles and research portfolio. Data collection The research team, consisting of one PhD candidate and three university professors, conducted semi-structured qualitative interviews with 5-6 participants from each Alzheimer Center. On average, each interview was 60 minutes and focused on the insights of 1-2 participants. The interview guide (see Additional file 1. Table 1) was developed with guidance from the stages of the KTA framework, focusing on the (1) mode of knowledge creation, (2) knowledge adaptation activities, and (3) dissemination and implementation strategies. Each author listed in this study participated in developing the interview guide and conducting interviews. Topics and questions were pilot-tested in the first two interviews and remained the same, so there were no repeated interviews needed. Informed consent forms were provided to each respondent prior to the interviews, detailing the scope of the project and the data management plan to provide transparency to participants. There were no withdrawals during the data collection process. All authors participated in conducting interviews. Interviews were conducted in-person or through video-conferencing between March 2023 and December 2023, and audio- and visual-recordings were made to ensure data accuracy during data transcription. Interviews were conducted until data saturation was reached (i.e. responses became homogenous and repetitive). Data analysis Each interview recording was transcribed verbatim, and transcripts were sent to the respondents for final comments and approval. Sensitive information was redacted upon request. Each transcript was first examined individually, and repeated concepts were systematically labelled and thematically grouped to conduct content analysis using an abductive thematic coding approach, based on Timmermans and Tavory [10, 43]. First-order codes were deductively extracted and organized along the established dimensions of the KTA framework. Following, based on similar findings across transcripts, inductive thematic second-order codes were identified, extracted, and analyzed to explicate the research utilization strategies employed at each stage. This was the most appropriate approach given the dual research aim of identifying the novel strategies identified in this research context and each strategy’s respective position in the KTA trajectory. The first author (EMZ) conducted the initial first-order coding of the raw data, and all authors were involved in developing and refining the second-order thematic codes to validate the final interpretation of themes. The final themes were used to develop research utilization strategies that informed the case description for each Alzheimer Center. The coding framework can be found in Additional file 1. Table 2. The qualitative reporting in this study was guided by the COREQ checklist (see Additional file 1. Table 3) [44]. Ethical approval Ethical approval was obtained from the Research Ethics Review Committee at Erasmus University Rotterdam (ETH2223-0473), and all participants signed informed consent forms, detailing the scope of the study and the intended use of the data provided, to ensure research transparency and protect participants’ privacy rights. Results Case descriptions Data from 29 respondents were included in this study, and the response rates for each Alzheimer Center were Center A: 5/6; Center B: 6/8; Center C: 6/9; Center D: 6/10; and Center E: 6/7. Respondents were early-career professionals [1-4 years’ experience] (8/29; 27.6%), mid-career professionals [5-10 years’ experience] (6/29; 20.7%), and senior-career professionals (10+ years’ experience) (15/29; 51.7%). Each Center facilitated collaboration between various UMC departments involved in dementia research, such as neurology, psychiatry, epidemiology, radiology and nuclear medicine, and geriatrics, and invested in different research priority areas, including risk and prevention, etiology of dementia, and dementia care services. Case descriptions for each Alzheimer Center are presented in Table 2, and details on research utilization strategies utilized in each Alzheimer Center are presented in Figure 1 and Table 3 (A-D), which serve as summary for the findings in each subsection of the Results. Table 2. Alzheimer Center case descriptions Center A Center A was established in 2013 and serves a catchment area with 3.5 million inhabitants. This Center specializes in frontotemporal dementia, heredity in dementia, culturally-adapted dementia diagnosis, and identifying risk factors for dementia. The main types of research produced by this Center include neuroimaging databases, intercultural dementia diagnostics and care, and diagnostic criteria of familial frontotemporal lobar degeneration. The team at Center A is bolstered by the collaborative efforts of the departments of Neurology, Neuroscience, Radiology and Nuclear Medicine, and Epidemiology. Center B Center B was established in 2003 and serves a catchment area with 1.5 million inhabitants, and specializes in dementia risk and prevention, biomarkers, diagnostics and disease mechanisms, psychosocial interventions and eHealth. The main type of research produced include a biobank for dementia progression analysis, Living Lab for innovative care environments, AI-based tool for dementia detection and risk reduction, and plasma biomarker development for secondary prevention in at-risk individuals. Center B involves the departments of Psychiatry and Neuropsychology, Neurology, Radiology and Nuclear Medicine, Epidemiology, and Health Services Research to advance dementia care and research. Center C Center C was established in 2000 and serves a catchment area with 2.5 million inhabitants. Center C specializes in molecular diagnostics, risk and protective factors, intervention and prevention, early diagnosis and prognosis, and neuroimaging to advance understanding, early detection, and treatment of Alzheimer’s disease and other dementias. Center C involves the departments of Neurology, Psychiatry, Radiology and Nuclear Medicine, Clinical Chemistry, Neuropsychology, Public Health, and Genetics, collaborating on dementia research and patient care to enhance diagnosis, treatment, and prevention strategies. Center D Center D was established in 2019 and serves a catchment area with 1.7 million inhabitants. This Center focuses on investigates genetic and molecular markers of brain aging and neurodegenerative diseases, a largescale multigenerational Cohort Study examining health behaviors over the life course to reduce dementia risk, and the TAP-dementia project, a national collaboration aimed at improving dementia diagnosis and incorporating patient feedback. Center D involves the departments of Elderly Medicine, Neurology, Neuropsychology, Psychiatry and Radiology. Center E Center E was established in 2010 and serves a catchment area with 2.1 million inhabitants. This Center focuses on enhancing long-term dementia care, utilizing AI for better diagnostics, developing innovative imaging technologies, and advancing clinical research on Alzheimer's mechanisms and therapies. Center E involves the departments of Geriatric Medicine, Neurology, Medical Imaging, and Primary and Community Care in its research on dementia care, AI diagnostics, advanced imaging, and clinical interventions. Strategies facilitating knowledge creation Three main strategies were used by the Alzheimer Centers to facilitate the creation of feasible research knowledge products and accelerate the societal use of research knowledge. First, respondents from all five Centers noted that research funders' clear guidelines and requirements facilitated implementation planning in the knowledge creation stage, such as by mandating the submission of a dissemination and implementation plan in grant applications. Additionally, funding agencies offered varying research impact models, aiding researchers in developing a 'theory of change' to explicate the process toward achieving research impact, beginning with knowledge product development. “They're [funders] really working on forming this learning communities, and involving all stakeholders who are also now working on an impact plan. So now we're really thinking more small in each work pack to also overall for [the consortium] using the theory of change methods from Alzheimer Nederlands, try to see on different levels, “Who are you targeting? What are you influencing? What are your bigger goals?” And really make more visual image plan for impact.” (Respondent 10) Second, respondents collaborate with diverse cross-sector partners, including government agencies, private organizations, and third-sector collaborative partners, to co-create research agendas and knowledge products. For example, Alzheimer Center researchers received insights into the societal demand for research from patients with lived experiences and healthcare professionals through connections, formed via UMC memory clinics and external events focused on dementia knowledge sharing, such as the Dementia Dialogues and Alzheimer Café. Research demand, derived from practice-based knowledge, was also obtained from government officials at the municipality level, national associations (e.g., Dutch federation for psychology), and steering committees of regional elderly care networks, consisting of nursing home teams and implementation practitioners. “What I really learned during this project also is that it's important to, like in the earlier stages of development, already have the end users involved also. So we always had this neurologist on the team who sees the patients and sees, like the real cases, as they are being discussed at the multidisciplinary meetings and that helps a lot to get this really clinically feasible [diagnostic] tool.” (Respondent 17) Last, respondents reported actively investing in research system infrastructures that strategically reduce knowledge creation fragmentation (e.g., research lifecycle discontinuation), and leverage knowledge beyond project silos. Continuity was achieved by employing research systems interventions, such as long-term public-private (consortium) research projects and learning communities. In addition, Alzheimer Centers A, D and E each hired an Alzheimer Center coordinator to facilitate the continuation of research projects, through securing subsequent rounds of funding, and to connect interdisciplinary research groups to reduce departmental knowledge silos. Alzheimer Center A, B, and C also emphasized the significance of leveraging formalized public-private partnerships (through research consortia) to reduce knowledge creation fragmentation across sectors. “We work together a lot because, for example, [name] is the coordinator for the Alzheimer Center, but also she joins the regional dementia platform. So there are links between the research and the care. For the local GPs, for example, dementia is not an interesting group, but the vulnerable elderly is an interesting group for them, and dementia is a part of this group. Yeah. So when you make a bit broader, then you have more effect what you're doing.” (Respondent 25) “In the new consortia, we're looking more into co-designing interventions with companies to be part of the application from the start and then also have to contribute in cash or in kind because it makes them more a part of this application. (…) You really have to collaborate with the industry because people are starting to see that only academia driven interventions are usually not the ones that are still used in practice in the long run.” (Respondent 11) Table 3A. Strategies identified to facilitate knowledge creation Broad strategy Main activities mentioned by respondents from each Alzheimer Center Center A Center B Center C Center D Center E (Research funders) provide clear guidelines and requirements for facilitating research impact Grant applications require dissemination Funder guides research theory impact roadmap Results intended for commercial use Funder required societal impact Funders required societal impact (Researchers) co-create research agendas and research knowledge products with external cross-sector partners Research targets local underrepresented needs Industry partners co-design products Products tested validated with partners External partners request tools Elderly care networks inform researchers Invest in research system infrastructures that strategically reduce knowledge creation fragmentation and leverage knowledge beyond individual projects Coordinator reduced fragmentation usability Structural solutions reduce fragmentation Consortia structure facilitated continuity Coordinator tracked recruitment efficiency Coordinator monitors projects networks guide Strategies facilitating research knowledge product adaptation Three main strategies were used by Alzheimer Centers to adapt research knowledge products to fit the determinants found in the implementation setting and research ecosystem. First, respondents leveraged resources from the Alzheimer Centers, such as the research, education, and healthcare infrastructure, to access patients and participants who can inform the adaption of research knowledge to feasible products. For instance, all Alzheimer Centers had access to memory clinics, situated within the UMC, and client panels, consistent of people with dementia and their informal caregivers, to seek immediate feedback and adaptation support from the relevant end-users (e.g., patient groups and clinicians) to develop culturally appropriate research knowledge products and equitable implementation plans. Alzheimer Center B, C, D and E also reported training support for researchers, such as for project management, science communication, and lobbying and advocacy. “We have a list of patients who consent to be asked for these things so we can call them, for example. But often of course we set up a specific task and a specific client panel for the project. So in our latest project where investigated feasibility of implementing digital tools from five memory clinics. We asked patients in five memory clinics to comment on the tool. (…) So we included 15 clinicians [including geriatricians] and 40 patients and their significant others.” (Respondent 13) Secondly, all Alzheimer Centers used wider ecosystem infrastructure (e.g., regional networks) and resources to adapt knowledge product delivery. For example, respondents adapted the research knowledge product into multiple language options and created simplified, multi-modal (e.g., print, website, application) versions, closely based on the original intervention components, to increase implementation feasibility and remove end-users’ barriers to use. Alzheimer Center A, D and E actively obtained feedback and insights from participants of external networks (e.g., regional elderly care networks) to advise the cultural adaptation of research knowledge product components and select implementation strategies that fit the contextual determinants. “Alzheimer Nederland is a partner in this consortium and Vilans and other partners that really try to translate the research to the public. So we in our junior training program, there are afternoons that we visit, Alzheimer Nederland or Vilans. I think part of these afternoons was how to involve the public in research design. But also if you have results, how do you try to make the impact that you are aiming for and how to spread the knowledge?” (Respondent 19) Lastly, respondents utilized the expertise and resources of cross-sector external partners to support knowledge product adaptation. For instance, national knowledge institutes (e.g., Vilans, Pharos) acted as implementation support practitioners and knowledge brokers in the dementia research ecosystem, and they have trained researchers to use theory of change models to plan research utilization and pragmatically adapt the research knowledge product to fit the infrastructure of the wider implementation ecosystem. Further, funding agencies (e.g., ZonMw, Alzheimer Nederland) have also provided technical support to researchers to adapt and communicate research knowledge with cross-sector stakeholders, such as by translating research findings into practical advice to influence policy reform and decision-making. “You know the way to organize in the Netherlands is the government provides increasingly little direct funding to the university. So there's still some, but much of the research funding goes through ZonMw [national health research funding agency] and NWO [national research funding agency]. And of course, within these distributing organizations, that's people who focus more on translating the science to policy advice. So that's their job in particular to try to obtain the results from researchers. Yeah, and they formulate advice to government policy.” (Respondent 2) Table 3B. Strategies identified to facilitate knowledge adaptation Broad strategy Selected activities each Alzheimer Center Center A Center B Center C Center D Center E Leverage Alzheimer Center resources and infrastructures to adapt knowledge products to users Memory clinics provide access Adaptation through end-user feedback Adaptation through events’ feedback Adaptation through panels feedback Specialized department for implementation science Leverage research system infrastructure and resources to adapt knowledge product delivery and enhance widespread accessibility and usability for end-users Use regional networks relevance Industry partner creates software Develop clinical guidelines fidelity Create feasible public products Adapt findings to new audience Utilize expertise and resources of external partners to support researchers in facilitating knowledge product adaptation Understand funding agencies role Engage industry partners PhD secondment National knowledge institute partner Junior researcher training site visits Support from knowledge institutes Strategies facilitating research knowledge product dissemination Five main strategies were used by Alzheimer Centers to disseminate research findings and research knowledge products to targeted end-users and relevant stakeholders. First, respondents from each Alzheimer Center actively sought out, established, and fostered cross-sector partnerships between academic institutions, government agencies, private sector (industry), and third sector (intermediaries) to overcome traditional knowledge silos. All Alzheimer Centers actively shared research findings through intermediary organization channels, such as national knowledge institutes (e.g., Pharos and Vilans) and utilized technical support and science communication training from these organizations. Alzheimer Centers A, C, D, and E have received accreditation from health associations, such as the Dutch Federation for Neurologists, to conduct training courses for healthcare professionals. This accreditation facilitates participation from healthcare professionals by offering continuing education credits. Alzheimer Center C distinguished itself through fundraising activities, merchandise sales, and coordination of charity events to disseminate research updates and solicit support from individuals and industry donors. “We need to make sure that we then send it also to all the funders. So make sure that Alzheimer Nederland has seen it, or ZonMw. (…) Often, for example, funders might say “oh, this is a really nice project. We're so happy to do it together with you, very willing to write something for your website or an interview.” (Respondent 13) “And then the wish was to have more in-service training, with credits or points. For the symposium, I also arranged to pick up points as well. Then maybe that helped with the [clinician] attendance numbers. But of course they deserve it. They learn a lot during those days. So there was a wish for more in-service training. So we did a pilot this year, and it was very well received.” (Respondent 18) Second, respondents from Alzheimer Centers A, B, E shared the importance of establishing direct connections with government agencies responsible for updating best practice guidelines to influence health policy. A range of activities were reported across each Alzheimer Center, such as presenting main research findings and important results through a ministry report to inform policy, utilizing existing connections and partnerships to optimize dissemination efforts, contributing as an advisor to the National Dementia Strategy, and communicating with influential political figures through research consortia events and funding agencies that act as knowledge brokers with government agencies. “I'm also in the Advisory Board of the National Dementia Strategy of the Ministry of Health, Welfare and Sport. So every three months we come together, also with the Minister, to talk about dementia and what are gaps, what we have to do. And so I think we have nice channels also to send our message.” (Respondent 7) Third, multi-modal formats of education were used by Alzheimer Centers to disseminate research knowledge findings across specialized and non-specialized audiences. For instance, common activities of research knowledge transfer included conducting virtual webinars and training workshops for healthcare professionals through YouTube, and sharing knowledge through the Alzheimer Café events, and across regional networks, to disseminate beyond the research teams’ usual professional networks. “We have a strong connection there and we also have warm links with other Alzheimer cafes so some of them ask us every year for specific sessions to be presented there and also present an overview of new insights in Alzheimer's disease or new insights in dementia.” (Respondent 8) “We have had a webinar about this topic last week, explaining more about how to do cross cultural dementia diagnostics as a neuropsychologist, and that was also within our strategy to reach as many healthcare professionals as possible at once. So everybody can watch it. And so that's step one of the plan: reach as many people as possible.” (Respondent 1) Fourth, social and professional networking applications and commercial marketing strategies were used by the Alzheimer Centers to disseminate research knowledge. Each Alzheimer Center leveraged connections with the communications team from the UMC to share research findings through the UMC social media accounts, marketing channels, and official website and newsletter. Alzheimer Centers A, B, and C strategically used social and professional networking applications, by creating dedicated webpages on LinkedIn (LinkedIn Corp) and Twitter (X Corp), to facilitate research dissemination to specific demographics of researchers and healthcare professionals. Alzheimer Centers A and C monitored dissemination outcomes through web and social media analytics tools to incorporate engagement metrics, including total reach and post impressions, but did not use the data to select or tailor dissemination strategies. “I help with the communication activities and make sure that after every publication the students write a blog, and they share it online and they make an overview of one PowerPoint slide of what the study was about and what are the results. So we have the collection of all those slides, of all the results of the studies, and we use it in presentation.” (Respondent 16) “You have your different channels; we have our own social media channels. We have newsletters, we do a lot of public lectures. We have Alzheimer's cafes that a lot of people are involved in the region. So dissemination is something that we really love.” (Respondent 7) Lastly, formal research support structures from the Alzheimer Center and external partners, including formal public-private collaborations and regional care networks, were used to facilitate research dissemination. Alzheimer Centers D and E each hired a coordinator to manage and facilitate all dissemination activities, including sharing new research findings via social media and internal and public newsletters, creating a formal communication strategy, and actively maintaining relationships with partners (e.g., steering committees of regional networks, client panels). Alzheimer Center C provided more formalized internal structures to disseminate research knowledge, such as science communication training and meetings for researchers to share about their ongoing research projects and standardized templates used for tracking and reporting research outputs for annual reports (e.g., consortia research output tracker) and knowledge sharing through social networks (e.g., LinkedIn post template). “For example, in the [consortium], we have outlined all the different target groups that we're interested in because we also have an aim in that consortium to reach the healthcare professionals. So there we did a kind of mapping of who are the health care professionals that we want to target, and how can we reach them and in what way are we going to reach them?” (Respondent 8) Table 3C. Strategies identified to facilitate knowledge dissemination Broad strategy Selected activities each Alzheimer Center Center A Center B Center C Center D Center E Actively seek out, establish, and foster cross-sector partnerships between academic institutions, government agencies, private sector (industry), and third sector (intermediaries) to overcome traditional knowledge silos Funders as knowledge brokers Industry partner app creation Keep funders intermediaries updated Intermediary organizations support dissemination Intermediary organizations support brokering Establish direct connections with government agencies responsible for updating best practice guidelines to influence health policy Identify and advise federations/ committees Researchers on national board n/a n/a National group for Care standard Dementia disseminates Using multi-modal formats of education to disseminate research knowledge findings across diverse (specialized and non-specialized) audiences Virtual webinars for professionals Integrate research into courses Annual lectures to stakeholders University network collaborates for participation Knowledge sharing through networks Use media and market communication strategies to disseminate research knowledge Disseminate through UMC channels Dissemination through social media Alzheimer's Center targeted dissemination Dissemination through UMC channels Dissemination through UMC channels Leverage research support structures from the Alzheimer Center and external partners to facilitate dissemination Communications manager strategic dissemination Dissemination through partnerships collaborations Engage professionals with seminars Tailor dissemination to specific (niche) audiences Leverage established networks and partnerships Strategies facilitating research knowledge product implementation Four main strategies to implement, scale-up, and sustain research knowledge products across various implementation settings were reported by respondents. First, respondents from each Alzheimer Center reported the importance of nurturing cross-sector partnerships with government, industry vendors, charities, patient representative groups, funders, and collaborative networks. Respondents also reported the value of facilitating such partnerships to adopt and sustain research knowledge products within existing the infrastructure and workflow of industry and third-sector partners. For example, these partnering organizations purchased and implemented the research knowledge product, such as a training module for nurses, in their organizational platform (i.e. website) to continue providing education to end-users. Alzheimer Centers B, D, and E emphasized the importance of maintaining partnerships with industry to foster trust, ensure continuous communication, and leverage respective resources and expertise for scaling collaboration. Sustained partnerships streamline future knowledge product implementation and reduce resource waste associated with initiating new collaborations. “And then we also try to make educational materials for healthcare professionals on this topic We just made them and now available also freely available via Alzheimer Netherlands. We're working on educational models for healthcare professionals on dementia risk reduction to educate them.” (Respondent 7) Second, respondents from all Alzheimer Centers performed various activities to scale-up research knowledge products implementation as routine practices within existing organizations. Alzheimer Center A, C, and E implemented new research knowledge products (e.g., diagnostic tools) directly into the memory clinics, and peripheral clinics within the catchment area, with less resistance since these products were co-created with clinical staff members. Alzheimer Center B, D, and E implemented and scaled-up research knowledge products for use in non-clinical settings with the appropriate infrastructure, such as by adapting a diagnostic approach suitable for implementation in nursing homes. Similarly, the implementation and scale-up of research knowledge products across societal systems (e.g., education, welfare, health, environment) was also mentioned as a valuable strategy. For example, a health educational module that promotes understanding and inclusivity of people with dementia fit the pillar of an education curriculum that promoted inclusive citizenship, demonstrating how strategically aligned, cross-systems collaboration can help scale research knowledge products implementation beyond system silos to increase research impact to diverse end-user groups. Alzheimer Center B, D, and E sustained research knowledge products within organizations by providing iterative support to a local champion who employed ‘train the trainer’ strategies to facilitate scale-up within implementing organizations. “We're looking always a bit for ways to have an entrance with schools because they're so busy and often very hesitant. So you have this course about citizenship. It's obligated for primary schools to teach the children to become good citizens. So there's a project that kind of fits in like because it's good citizenship to learn about dementia and to do this.” (Respondent 10) Third, respondents from Alzheimer Centers B, C, D, and E reportedly sought out sustainable (alternative) financing from diverse channels to implement and sustain research knowledge products. Alzheimer Centers B and D actively sought additional funding instruments and opportunities to support implementation and sustainment from both public (e.g., government funders, municipality subsidies) and private (e.g. private foundations) funders. Activities from Alzheimer Centers C and E were partially funded by the revenue obtained through licensing fees and product sales, paid by adopting organizations and end-users. Respondents from Alzheimer Center B and E attempted to have new research knowledge products covered by health insurance reimbursement channels, which required the products to be (cost-) effective and produce positive health outcomes. However, the precise requirements and process to qualify a new product for reimbursement through health insurers were unclear to respondents. Only respondents from Alzheimer Center B mentioned reimbursement mechanisms from alternative (non-academic) funding sources, such as the Stimuleringsregeling E-Health Thuis (SET) , a government-funded initiative that supports the scale-up of eHealth technologies that facilitate home-based care. “We also, for example, have funding from SET. And so we have also these pilots in the region, but that's in [city], where we work together with, for example, case managers and care organizations also to implement it in those regional pilots.” (Respondent 8) In that line, there are also opportunities to embed the research knowledge product within existing health purchasing policies, such as the sustainable coalition initiative (via health insurer). “[Health insurer] said that they wanted to include this as a priority area in the strategy of ‘van thuis uit’. It's care concept in the sustainable coalition of [health insurers]. So they want to fund the intervention.” (Respondent 8) Lastly, respondents from Alzheimer Center A, B, and C reported the use of transdisciplinary knowledge valorization strategies to move research products to real-world practice settings. Alzheimer Center A, B and C reported that research knowledge was implemented and scaled-up using commercialization practices (e.g., structured processes of production, distribution, marketing, and sales) and adhering to legal and regulatory requirements, such as obtaining CE marking and ensuring GDPR compliance for eHealth products. Knowledge transfer offices, and technology transfer offices, at the central university supported the Alzheimer Centers with developing structured business plans and formal contracts that facilitate collaboration with private sector partners, managing the intellectual property rights and legal ownership of the research, and staying up-to-date on the latest regulatory guidelines throughout the product development process. “Another part is the valorization that we also worked on and that was dissemination for commercial studies. And so we also had that in mind, in commercial studies, we want to use this as an outcome measure, that would be possible, but they would need to pay a license fee for using the instrument. And using the scoring algorithm, et cetera.(…) we started out early with thinking about implementation. This could be a model in which we earn some money to sustain the academic development and the clinical implementation.” (Respondent 12) “We're also speaking to people of the Technology Transfer Office to see, once we have this model, hopefully in a year or two, what steps do we need to do either right beforehand or afterward, to get the CE marking for instance, to be able to bring to a clinical setting and to use it by other healthcare providers.” (Respondent 2) Table 3D. Strategies identified to facilitate knowledge implementation Broad strategy Main activities mentioned by respondents from each Alzheimer Center Center A Center B Center C Center D Center E Nurture cross-sector partnerships with government, industry vendors, charities, patient representative groups, funders, and collaborative networks Project-based implementation pathways infrastructure Embed training module website Validate develop algorithm partner Develop intervention with government agency Use established networks Seek opportunities to support the scale-up of an intervention as a regular service Implement research into clinics Fit intervention into curriculum Memory clinics implement instruments Change modality reduce costs Sustain products through continued interprofessional relationships Seek sustainable financing mechanisms from diverse channels n/a Seek alternative funding agencies Commercialization of algorithm fees Government funding for nursing homes Association works on financing Using transdisciplinary knowledge valorization strategies to move research products to real-world practice settings Technology transfer office supports (business plan, regulations) Technology transfer office supports (business plan, regulations) Stakeholders support projects workshops n/a n/a Discussion The results revealed that each Alzheimer Center iteratively engaged diverse stakeholders, including individuals with lived experiences, caregivers, and practitioners, in co-designing and co-creating both the research knowledge products and the dissemination and implementation processes.This identified research utilization strategy aligned with the guiding principles of integrated knowledge translation (IKT), which aim to develop research directions, through engaged scholarship between researchers and knowledge end-users in practice, and to co-design and co-create research knowledge products, often facilitated through community-based participatory research and knowledge linkage and exchange [51]. Applying the KTA dimensions to explore research utilization from the research producers’ perspective has clarified opportunities and challenges in real-world IKT. Results confirmed the value of engaging cross-sectoral stakeholders and end-users to improve research utilization outcomes, while also highlighting the need for new researcher competencies, such as effectively communicating and facilitating collaborations across multi-disciplinary teams [54]. Further, this study found that several research funders mandated the use of IKT and required research teams to engage end-users and practice agencies in the co-creation of knowledge products and the implementation plan. However, as critiqued by Holmes and Jones [23], the requirements and criteria set by research funders, guiding the nature and strength of co-creation in funded projects, were often loosely defined, and the impact of funder activities that promote co-creation and implementation remain unclear. A separate study on dissemination and implementation activities of international research funders revealed that monitoring and measuring research impact was also a prevalent challenge [47]. Further investment is needed to understand how research impact is monitored and evaluated by various funding agencies across diverse research ecosystems. The choice of research utilization strategies may also be explained by path dependence theory, which implies that strategies are selected based on each Alzheimer Center’s development trajectory, past decisions, organizational heritage, and team competencies [28]. As political and societal forces cause evolution and revolution within the external research ecosystem, Alzheimer Centers may be vulnerable to risks from path dependency, including poor responsiveness to environmental changes, such as disruptive challenges in partnerships and networks or changes in policy [14, 28]. Risks can be mitigated by enhancing team resilience, responsivity, and agility through strengthening researchers’ competencies at each stage of the research continuum through didactic activities, mentorship and expert consultation, knowledge sharing, and specialized financing instruments [26, 50]. At an organizational level, Alzheimer Centers may consider structuring annual researcher performance appraisals to include societal research impact in the assessment criteria, and impact narrative case studies can be used to highlight the societal value of research, as recommended by the national Dutch Strategy Evaluation Protocol 2021–2027 [49]. The practices of other actors within the wider dementia research ecosystem may also evolve to incentivize and support research utilization scaling, such as funding agencies developing dissemination- and implementation-focused financing instruments [47]. The selection of research dissemination and implementation strategies may also vary based on the research product’s typology. Respective positions of research products can be mapped across the translational science pipeline: T1 (conducting basic research), T2 (effectiveness in human clinical trials), T3 (implementation of clinically effective products), and T4 (conducting real-world outcome evaluations) [19]. The typology of research products developed in each Alzheimer Center is largely influenced by the Center’s research priority area. For instance, Alzheimer Center C focused mainly on conducting fundamental research (T1-T2), including biomarker discovery and (pre-) clinical trials, whereas Alzheimer Center E focused mainly on conducting applied health research (T3-T4), including the implementation of clinically effective non-pharmacological programs. Respondents from Alzheimer Center C commonly reported the importance of fostering bilateral R&D partnerships with pharmaceutical companies that relied on the Center’s research infrastructure and leveraging the advantages of integrated public-private discovery and development networks [12]. In contrast, respondents from Alzheimer Center E emphasized the value of developing and utilizing participatory knowledge infrastructure, such as social and professional collaborative networks with third-sector organizations, in the dissemination, implementation, and sustainment of research products [53]. Accordingly, depending on which stage of the translational science pipeline the research product is positioned, researchers require certain sets of competencies to overcome the unique determinants (i.e. barriers) that influence research utilization outcomes. By leveraging implementation science knowledge, the research utilization process can be explicated using impact and process models, and specific research utilization strategies can be systematically selected and tailored to address specific determinants. Pragmatic tools, such as the research impact logic model, developed by Jones and Bice [25], and such as a context-specific implementation planning instrument, developed by Prausnitz et al. [37], are needed to systematically guide research teams in implementation planning and to explicate the research utilization process to help monitor and evaluate the outcomes of their research utilization strategies. Several notable dissemination and implementation strategies were identified in this study. First, a cross-systems collaboration strategy was successfully used to implement a health education program, originally set in healthcare organizations, in a school curriculum. Bunger et al. [8] determined similar benefits of aligning and leveraging existing resources across systems to improve research product implementation feasibility, fidelity, and sustainment. Second, the use of alternative funding mechanisms was commonly reported as a strategy to financially sustain non-pharmacological research products, through adapting products to fit the reimbursement criteria of certain government-funded initiatives and health insurance channels. Findings from Van Kessel et al. [48] further validated this result and reported that, in the Netherlands, the pricing and reimbursement of non-pharmacological research products, such as digital health interventions, are determined by negotiations between care providers, health insurers, the Dutch Healthcare Authority, and the National Health Care Institute, but no explicit requirements or guidelines are available to guide researchers to design a sustainable financial reimbursement plan. Lastly, valorization strategies were employed to implement the research products, but a series of challenges impede this approach. The Code of Practice on the management of intellectual assets for knowledge valorization in the European Research Area emphasized the importance of ‘valuing all intellectual assets’ generated through research and innovation activities [16], but current practices in academic entrepreneurship and research product commercialization focus on patenting and distributing licensing rights on intellectual property and creating independent spin-offs and start-ups [9, 31]. Resultantly, academic ‘intellectual assets’ with lower commercial value are not valorized and often remain siloed within traditional academic settings. To mitigate this risk, future research can explore how an open innovation approach can be applied to dementia valorization, such as by establishing formalized living labs with contributions from cross-sector partners [32]. Best practices from this interdisciplinary method can support stakeholders in the research ecosystem to adopt systems-thinking for knowledge management and leverage alternative business models (e.g., social enterprise) and feasible implementation pathways for non-traditional research products [38]. As emphasized by Marr and Phan [31], the activities performed by technology transfer offices, embedded within universities, to facilitate the valorization of products with lower commercial value are enigmatic. Further systematic exploration of strategies used within such support teams is required to explicate the determinants surrounding the valorization of such products and create a mutually beneficial link between implementation science and research valorization. This study may have potential research design and data collection limitations. Purposive sampling was used to recruit respondents, which may introduce selection bias and limit the generalizability of the findings to other settings outside the Alzheimer Centers which were all covered. Another limitation is related to our specialized focus on research utilization and implementation science. The implementation science jargon used by the interviewers required frequent clarification for the interviewees. The need to explain specific terms and concepts might have influenced participants' answers, as they may have provided responses based on their interpretation of the clarified terminology rather than their initial understanding. This challenge may be influenced by the early stage of implementation science in dementia research in the present Dutch context. Data collection was conducted in English, but some language and cultural nuances shared by respondents, who were native Dutch speakers, may not have been adequately captured. While in-depth insights were gained, the study's conclusions should be considered within the context of these limitations. Conclusion Results from the Alzheimer Centers suggest that successful research utilization of non-pharmacological dementia research products requires academic health science centers to build research capacity and develop researcher competencies, such facilitating co-creation with end-users, establishing, and maintaining collaborations with public and private partners, and facilitating implementation, scale-up, and sustainment. Researchers must take initiative to scale their products, integrating them into existing organizations across sectors and navigating systems to secure inclusion in reimbursement schemes. Using the KTA framework from the research producer’s perspective revealed the intricacies involved in streamlining research utilization, paving the way for future implementation science studies to enhance the monitoring and evaluation of the research utilization processes, delineated between research producers and users, across various contexts. Employing a comprehensive ecosystem approach ensures the broader impact and practical application of research findings in real-world settings. Abbreviations AHSC Academic health science centers KTA Knowledge-to-Action (framework) UMC University medical center IKT Integrated knowledge translation NWO Dutch Organization for Scientific Research ZonMw ZorgOnderzoek Nederland (Care Research Netherlands) SET Stimuleringsregeling E-Health Thuis (Incentive Scheme E-Health At Home) Declarations Human Ethics and Consent to Participate This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Erasmus School of Health Policy and Management Research Ethics Review at Erasmus University Rotterdam (Application ID: ETH2223-0473). All participants signed informed consent forms, detailing the scope of the study and the intended use of the data provided, to ensure research transparency and protect participants’ privacy rights. Permission was obtained for all audio and visual recordings. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available to preserve the privacy and integrity of participants, but data may be made available from the corresponding author on reasonable request. Competing interests Not applicable. Funding No funding or grant was obtained to conduct this study. Authors' contributions All authors (EMZ, MB, KA, and RH) conceptualized the study, developed the interview guide, and each participated in co-facilitating interviews. RH recruited the Alzheimer Centers via their directors. EMZ conducted data extraction and analysis. All authors contributed to validating data extraction and synthesized results. EMZ wrote the first draft of the manuscript with assistance from RH. All authors contributed to the final manuscript revision. All authors read and approved the final manuscript. Acknowledgements We would like to acknowledge Marco Blom, head of scientific research at Alzheimer Nederland, for contributing his professional insight and overview of the (net)work of the Dutch Alzheimer Centers to our project design. We also would like to acknowledge the leaders of all five Alzheimer Centers for their continuous support in this project, as well as all participants for sharing their time and insights. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4679095","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":335711450,"identity":"0f316989-6e57-4b9b-8c54-d37761ec14ca","order_by":0,"name":"Eden Meng Zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuUlEQVRIiWNgGAWjYDACCQbGBwwMB+B8GWK0MBsga+EhRgubBGla5Gf3mFV8+HMnT7eB+Zh0BcMdwloY55wxuzmz7Vmx2QG2NMkzDM8Ia2GWyDG7zdtwOHHbAR4zyQaGw4S1sAG1FP/5A9LC/404LTxALcwMbGBb2IjTIiGRVizZ23a42Owwm7FlgwERWuRnJG/88OPP4Tyz480PbzZUHJYjqAUGEhiYQZQB0RpAWkbBKBgFo2AU4AIAEc457IGQgtAAAAAASUVORK5CYII=","orcid":"","institution":"Erasmus University Rotterdam","correspondingAuthor":true,"prefix":"","firstName":"Eden","middleName":"Meng","lastName":"Zhu","suffix":""},{"id":335711451,"identity":"5d02a1ac-2a18-4a25-bd02-8fb23894a68d","order_by":1,"name":"Martina Buljac-Samardžić","email":"","orcid":"","institution":"Erasmus University Rotterdam","correspondingAuthor":false,"prefix":"","firstName":"Martina","middleName":"","lastName":"Buljac-Samardžić","suffix":""},{"id":335711452,"identity":"73b0ea69-8ebb-49bd-b7ad-8138a30f9582","order_by":2,"name":"Kees Ahaus","email":"","orcid":"","institution":"Erasmus University Rotterdam","correspondingAuthor":false,"prefix":"","firstName":"Kees","middleName":"","lastName":"Ahaus","suffix":""},{"id":335711453,"identity":"424965bd-da21-46ae-9065-0425311ee361","order_by":3,"name":"Robbert Huijsman","email":"","orcid":"","institution":"Erasmus University Rotterdam","correspondingAuthor":false,"prefix":"","firstName":"Robbert","middleName":"","lastName":"Huijsman","suffix":""}],"badges":[],"createdAt":"2024-07-03 09:10:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4679095/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4679095/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12961-024-01266-9","type":"published","date":"2025-01-06T15:56:52+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":62215832,"identity":"07d9e90b-1dc3-4508-a716-8cdc2590ff88","added_by":"auto","created_at":"2024-08-11 11:39:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":188041,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4679095/v1/1bc3a2c85b6bfd35c157f2bc.png"},{"id":73693725,"identity":"989dc3a4-f223-4c7d-b534-7d3dec0eb965","added_by":"auto","created_at":"2025-01-13 16:02:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1307001,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4679095/v1/34f7441a-0743-41c0-b8c8-bf2ac3b5f711.pdf"},{"id":62215831,"identity":"37aa7ca6-7ff1-40bd-a35f-c5254736c297","added_by":"auto","created_at":"2024-08-11 11:39:51","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":50087,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.Interviewguidecodebookmisc.docx","url":"https://assets-eu.researchsquare.com/files/rs-4679095/v1/9c13ca5af52e9972e4c0bfca.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Transforming dementia research into practice: A multiple case study of academic research utilization strategies in Dutch Alzheimer Centers","fulltext":[{"header":"Background","content":"\u003cp\u003eNon-pharmacological dementia research knowledge products, such as eHealth interventions, psychoeducation programs, and diagnostic tools [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e], are often siloed within academic settings and research domains, contributing to the 17-year research-to-practice gap that delays research use and societal impact [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Knowledge and pragmatic tools that guide pharmacological drug discovery and development processes, including product production, validation, valuation, and commercialization [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], are considerably more mature compared to those available to guide researchers in non-pharmacological dementia research utilization [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Formal research infrastructures, such as academic health science centers (AHSC), have been developed as capacity-building initiatives to strengthen the research ecosystem and enhance research impact of such academic outputs [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. AHSCs have been characterized internationally as university institutions that have a tripartite aim of providing patient care, education and research and are structured to promote close multi-disciplinary collaboration and engagement between academic researchers and (clinical) practitioners [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. The structure, governance, and organizational dynamics within AHSCs have been investigated [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], but previous studies have not structurally identified strategies, employed by academic researchers, to utilize research products [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe concept of research utilization is also referred to as \u0026lsquo;knowledge translation\u0026rsquo;, \u0026lsquo;knowledge transfer\u0026rsquo;, or \u0026lsquo;knowledge mobilization\u0026rsquo; [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, these terms are often inconsistently used in literature, and the explicit stages and strategies employed in the research utilization process are enigmatic in literature [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Implementation science theories, models and frameworks can be used to structurally explore and guide the phases of the research utilization processes, to determine specific strategies employed throughout, and to help monitor and evaluate process outcomes [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. The complex and iterative processes involved in delivering non-pharmacological research knowledge products to the intended end-users can be explored using process models, such as the knowledge-to-action (KTA) framework, which consists of two main components: the knowledge creation funnel and the knowledge action cycle [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The KTA framework was originally developed by Graham et al. as a comprehensive \u0026lsquo;planned action model\u0026rsquo;, or \u0026lsquo;process model\u0026rsquo;, that guides the translation and transfer of academic research findings into real-world impact [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. This framework was chosen to guide this study over other implementation process models, such as i-PARIHS [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], due to its adaptability and wide application across various disciplines [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This study is guided by a four-phase research utilization model, guided by the KTA dimensions, that includes knowledge creation, adaptation, dissemination, and implementation.\u003c/p\u003e \u003cp\u003eThe first phase, knowledge creation, encompasses the three stages within the knowledge creation funnel: knowledge inquiry, knowledge synthesis, and the development of research knowledge tools and products, such as health education programs and decision support tools [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In this phase, research output may be supported by a Mode 1 research production approach, which involves research directed by funders and researchers, or a Mode 2 approach, emphasizing society- and practice-focused research that encourages a participatory approach to health research [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Participatory approaches that include input from various stakeholders within the research ecosystem, including health practitioners in care settings and patients with lived experience, are often engaged to facilitate the process of creating equitable and feasible research knowledge products [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe knowledge action cycle is the second component of the KTA framework and is segmented into three phases, \u0026lsquo;knowledge adaptation\u0026rsquo;, \u0026lsquo;knowledge dissemination\u0026rsquo;, and \u0026lsquo;knowledge implementation\u0026rsquo;, to clearly explicate the strategies employed by researchers. The second phase in the research utilization model, knowledge adaptation, begins with a contextual needs assessment, followed by knowledge adaptation activities, such as co-designing and adapting research product components with local stakeholders and end-users to fit to the user context [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. For fundamental (biomedical) research products, this stage can also be understood as how research findings are translated into products, such as diagnostic tools, suitable for implementation in clinics and other practice settings [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Knowledge adaptation should be delineated into intervention adaptation and implementation adaptation, respectively defined as adapting the intervention components to fit the user group (e.g., culturally and socially appropriate adaptation) and adapting the implementation plan to fit the contextual determinants (e.g., available resources, organizational readiness) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eKnowledge dissemination is an implicit stage in the KTA trajectory, characterized as an activity of \u0026lsquo;end-of-grant knowledge translation\u0026rsquo; [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], but this study explicates this as a critical stage used to translate knowledge to practice and policy [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Knowledge dissemination is the third phase in the research utilization model and is defined here as the transfer and exchange of knowledge, beyond the boundaries of the research origin, to the intended recipients (e.g., implementation agencies, patients) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Dissemination strategies can be categorized as a \u0026lsquo;push\u0026rsquo; or \u0026lsquo;pull\u0026rsquo; strategy, in which either the knowledge producers proactively provide knowledge to their target recipients (e.g., conducting training) or the knowledge recipients seek knowledge to support their decision-making (e.g., conducting a scoping review to inform policy) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Knowledge \u0026lsquo;exchange\u0026rsquo; strategies were also identified in \u0026lsquo;integrated knowledge translation\u0026rsquo; (IKT) literature as facilitating active co-creation and partnership engagement to disseminate knowledge by investing in strengthening research infrastructure and health policies [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Notably, this stage is often facilitated prior to, or parallel to, the implementation process [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The last phase of the research utilization model, knowledge implementation, consists of assessing barriers and facilitators to implementation, selecting and tailoring implementation strategies, monitoring and evaluating implementation outcomes, and scaling and sustaining the intervention in the implementation setting [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA scoping review found 146 articles that mentioned the use of the KTA framework, but only 10 articles provided clear examples that demonstrated how the framework was used to guide implementation, all from the perspective of clinicians and healthcare practitioners [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Structurally exploring the activities performed to facilitate the research utilization process, from the researchers\u0026rsquo; perspective, can inform the creation of theory-driven implementations strategies, which can explicate the knowledge utilization process to reduce implementation complexity and enhance process clarity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In the Netherlands, five AHSCs with expertise in dementia research, referred to as the Alzheimer Centers, were created to strengthen the healthcare and research systems by defragmenting actors involved in research, treatment, and education. Guided by the research utilization model and the KTA dimensions, this study aims to explore the unique research knowledge utilization activities of each Alzheimer Center and determine overarching strategies employed to create, adapt, disseminate, and implement non-pharmacological dementia research to achieve research impact. The main research questions include:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat strategies were used by the Alzheimer Centers to facilitate creation and adaptation of research findings into research products?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat strategies were employed to disseminate research products?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat strategies were used to facilitate the implementation of research products?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy design\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study had a multiple case study design, guided by Yin [55],\u0026nbsp;to explore the respective research knowledge utilization processes present in each Alzheimer Center. This design was advantageous to identify “how” these processes occur and explore “why” certain strategies appeared in one context and were absent in others. To ensure reliability and validity, an in-depth analysis of each case was performed to identify the activities performed by each Alzheimer Center at each stage of the KTA trajectory, and patterns in the activities were identified to inductively extrapolate research utilization strategies [40]. Cross-case comparisons (i.e. cross-referencing) were used to compare strategies from each Alzheimer Center and strengthen validity of findings across varied contexts. This approach also helped determine the contextual variables within each Alzheimer Center that may influence the selection of certain strategies\u0026nbsp;[55]. Results were developed based on the findings from semi-structured interviews with key informants from each Alzheimer Center.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSetting\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn the Netherlands, there are seven university medical centers (UMCs), located in Amsterdam, Rotterdam, Nijmegen, Groningen, Maastricht, Utrecht, and Leiden, responsible for providing patient care, education, and research [11]. Between 2000 and 2019, five UMCs have embedded AHSCs, referred to as Alzheimer Centers, to centralize the creation of dementia research, education, and care (diagnostic and treatment) and to provide tertiary support in each of their respective regional catchment areas\u0026nbsp;[6, 46]. Each Alzheimer Center focuses on various areas and stages of dementia research, ranging from fundamental knowledge creation to applied research implementation and sustainment. The Alzheimer Centers were purposively selected due to their unique tripartite structure as AHSC in the Netherlands, their significant research output, and their social and professional connectivity and entanglement with other stakeholders within the Dutch dementia research ecosystem, detailed in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1. Description of Dutch dementia research ecosystem stakeholder groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.26923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStakeholders\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescription of role and function in research ecosystem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.26923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eZonMw\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eZorgOnderzoek Nederland (Care Research Netherlands) (ZonMw) is a government-financed research funding agency that designs programmes that facilitate the allocation of public health research funding. In addition to providing funding, ZonMw performs activities including providing research impact planning guidance (e.g., theory of change) and knowledge brokering between research teams, practice and policy.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.26923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eDutch Organization for Scientific Research (NWO)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eNWO is a government-financed research funding agency that ensures quality and innovation in science for a wider range of basic and interdisciplinary research areas.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.26923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eAlzheimer Nederland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eAlzheimer Netherlands is a charity and patient-representative organisation for people with dementia and their caregivers, as well as a dementia research funding agency and knowledge broker. Activities performed include advocating for better patient care, raising public awareness, and facilitating informative support services, including:\u0026nbsp;\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\"Dementia dialogues”: Structured events that involve researchers and other stakeholders to discuss and share experiences, influence policies, and strengthen support networks.\u003c/li\u003e\n \u003cli\u003e“Alzheimer Cafes”: Informal community support meetings organized for people with dementia, caregivers, and care and research professionals to share experiences, disseminate research, and gather real-world perspectives.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.26923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eNational knowledge institutions\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eNational knowledge institutions (e.g., Pharos and Vilans) enhance the research ecosystem by synthesizing evidence, guiding policy, and ensuring knowledge translation to improve societal health outcomes. Researchers receive support from such institutes in knowledge brokering and translation.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.26923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eHealth insurance agencies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eHealth insurers may support research utilization by financing, adopting and sustaining evidence-based practices. For example, \u003cem\u003evan thuis uit\u003c/em\u003e is an initiative from CZ insurance that promotes ageing in place (home-based care).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.26923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eDutch Ministry of Health, Welfare, and Sport (VWS)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eVWS directs the national health research agenda and funds healthcare research, influences policy, sets standards, and promotes innovations, significantly shaping healthcare quality and public health initiatives in the Netherlands. VWS established the National Dementia Strategy 2020-2030 to stimulate research (via ZonMw and NWO) aimed at improving quality of life for people with dementia and their caregivers. VWS also stimulates research through funding the \u003cem\u003eStimuleringsregeling E-Health Thuis\u003c/em\u003e (SET) initiative\u003cem\u003e,\u0026nbsp;\u003c/em\u003ewhich promotes the adoption and implementation of e-health solutions in home care settings.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.26923076923077%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eProfessional associations or federations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eProfessional associations, including the Dutch Federation for Psychology and Dutch Federation for Neurologists, set professional standards, accredit educational programs, and impact research by promoting ethical guidelines and facilitating collaborations within their respective fields.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eVerpleegkundigen \u0026amp; Verzorgenden Nederland (V\u0026amp;VN) is a professional association for nurses, nursing assistants, and professional carers in the Netherlands and support each group through professional standards, educational resources, advocacy, networking opportunities, and promoting best practices. V\u0026amp;VN supports occupational groups (e.g., case managers) by providing professional development and guidance tailored to their needs within the healthcare industry.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSample and recruitment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eRecruited research participants include program managers and researchers employed by an Alzheimer Center, specializing in a range of disciplines (e.g., psychiatry, neuropsychology, epidemiology) that contribute to dementia research. The research team obtained permission from the leader(s) of each Alzheimer Center, prior to the study, to conduct research in their organization. Individual participants were recruited using purposive and snowball sampling, identified through each Alzheimer Center’s official website, official LinkedIn pages, and through the referral of Alzheimer Center leaders. These leaders also shared an introductory e-mail, on the research team’s behalf, to inform and invite selected staff members to participate in this ongoing research project, and staff members responded with their intention to participate. Selected participants had a wide range of years of work experience and research area expertise, including developing fundamental research, social and behavioral programs, and digital health technologies. The variety of participant backgrounds included aimed to provide a representative sample of each Alzheimer Center’s staff profiles and research portfolio.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData collection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe research team, consisting of one PhD candidate and three university professors, conducted semi-structured qualitative interviews with 5-6 participants from each Alzheimer Center. On average, each interview was 60 minutes and focused on the insights of 1-2 participants. The interview guide (see Additional file 1. Table 1) was developed with guidance from the stages of the KTA framework, focusing on the (1) mode of knowledge creation, (2) knowledge adaptation activities, and (3) dissemination and implementation strategies. Each author listed in this study participated in developing the interview guide and conducting interviews. Topics and questions were pilot-tested in the first two interviews and remained the same, so there were no repeated interviews needed. Informed consent forms were provided to each respondent prior to the interviews, detailing the scope of the project and the data management plan to provide transparency to participants. There were no withdrawals during the data collection process. All authors participated in conducting interviews. Interviews were conducted in-person or through video-conferencing between March 2023 and December 2023, and audio- and visual-recordings were made to ensure data accuracy during data transcription. Interviews were conducted until data saturation was reached (i.e. responses became homogenous and repetitive).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEach interview recording was transcribed verbatim, and transcripts were sent to the respondents for final comments and approval. Sensitive information was redacted upon request. Each transcript was first examined individually, and repeated concepts were systematically labelled and thematically grouped to conduct content analysis using an abductive thematic coding approach, based on Timmermans and Tavory [10, 43]. First-order codes were deductively extracted and organized along the established dimensions of the KTA framework. Following, based on similar findings across transcripts, inductive thematic second-order codes were identified, extracted, and analyzed to explicate the research utilization strategies employed at each stage. This was the most appropriate approach given the dual research aim of identifying the novel strategies identified in this research context and each strategy’s respective position in the KTA trajectory. The first author (EMZ) conducted the initial first-order coding of the raw data, and all authors were involved in developing and refining the second-order thematic codes to validate the final interpretation of themes. The final themes were used to develop research utilization strategies that informed the case description for each Alzheimer Center. The coding framework can be found in Additional file 1. Table 2. The qualitative reporting in this study was guided by the COREQ checklist (see Additional file 1. Table 3) [44].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthical approval\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Research Ethics Review Committee at Erasmus University Rotterdam (ETH2223-0473), and all participants signed informed consent forms, detailing the scope of the study and the intended use of the data provided, to ensure research transparency and protect participants’ privacy rights.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCase descriptions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData from 29 respondents were included in this study, and the response rates for each Alzheimer Center were Center A: 5/6; Center B: 6/8; Center C: 6/9; Center D: 6/10; and Center E: 6/7. Respondents were early-career professionals [1-4 years\u0026rsquo; experience] (8/29; 27.6%), mid-career professionals [5-10 years\u0026rsquo; experience] (6/29; 20.7%), and senior-career professionals (10+ years\u0026rsquo; experience) (15/29; 51.7%). Each Center facilitated collaboration between various UMC departments involved in dementia research, such as neurology, psychiatry, epidemiology, radiology and nuclear medicine, and geriatrics, and invested in different research priority areas, including risk and prevention, etiology of dementia, and dementia care services. Case descriptions for each Alzheimer Center are presented in Table 2, and details on research utilization strategies utilized in each Alzheimer Center are presented in Figure 1 and Table 3 (A-D), which serve as summary for the findings in each subsection of the Results.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2. Alzheimer Center case descriptions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eCenter A\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCenter A was established in 2013 and serves a catchment area with 3.5 million inhabitants. This Center specializes in frontotemporal dementia, heredity in dementia, culturally-adapted dementia diagnosis, and identifying risk factors for dementia. The main types of research produced by this Center include neuroimaging databases, intercultural dementia diagnostics and care, and diagnostic criteria of familial frontotemporal lobar degeneration. The team at Center A is bolstered by the collaborative efforts of the departments of Neurology, Neuroscience, Radiology and Nuclear Medicine, and Epidemiology.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eCenter B\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCenter B was established in 2003 and serves a catchment area with 1.5 million inhabitants, and specializes in dementia risk and prevention, biomarkers, diagnostics and disease mechanisms, psychosocial interventions and eHealth. The main type of research produced include a biobank for dementia progression analysis, Living Lab for innovative care environments, AI-based tool for dementia detection and risk reduction, and plasma biomarker development for secondary prevention in at-risk individuals. Center B involves the departments of Psychiatry and Neuropsychology, Neurology, Radiology and Nuclear Medicine, Epidemiology, and Health Services Research to advance dementia care and research.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eCenter C\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCenter C was established in 2000 and serves a catchment area with 2.5 million inhabitants. Center C specializes in molecular diagnostics, risk and protective factors, intervention and prevention, early diagnosis and prognosis, and neuroimaging to advance understanding, early detection, and treatment of Alzheimer\u0026rsquo;s disease and other dementias. Center C involves the departments of Neurology, Psychiatry, Radiology and Nuclear Medicine, Clinical Chemistry, Neuropsychology, Public Health, and Genetics, collaborating on dementia research and patient care to enhance diagnosis, treatment, and prevention strategies.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eCenter D\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCenter D was established in 2019 and serves a catchment area with 1.7 million inhabitants. This Center focuses on investigates genetic and molecular markers of brain aging and neurodegenerative diseases, a largescale multigenerational Cohort Study examining health behaviors over the life course to reduce dementia risk, and the TAP-dementia project, a national collaboration aimed at improving dementia diagnosis and incorporating patient feedback. Center D involves the departments of Elderly Medicine, Neurology, Neuropsychology, Psychiatry and Radiology.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eCenter E\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCenter E was established in 2010 and serves a catchment area with 2.1 million inhabitants. This Center focuses on enhancing long-term dementia care, utilizing AI for better diagnostics, developing innovative imaging technologies, and advancing clinical research on Alzheimer\u0026apos;s mechanisms and therapies. Center E involves the departments of Geriatric Medicine, Neurology, Medical Imaging, and Primary and Community Care in its research on dementia care, AI diagnostics, advanced imaging, and clinical interventions.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u003cem\u003eStrategies facilitating knowledge creation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThree main strategies were used by the Alzheimer Centers to facilitate the creation of feasible research knowledge products and accelerate the societal use of research knowledge. First, respondents from all five Centers noted that research funders\u0026apos; clear guidelines and requirements facilitated implementation planning in the knowledge creation stage, such as by mandating the submission of a dissemination and implementation plan in grant applications. Additionally, funding agencies offered varying research impact models, aiding researchers in developing a \u0026apos;theory of change\u0026apos; to explicate the process toward achieving research impact, beginning with knowledge product development.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;They\u0026apos;re [funders] really working on forming this learning communities, and involving all stakeholders who are also now working on an impact plan. So now we\u0026apos;re really thinking more small in each work pack to also overall for [the consortium] using the theory of change methods from Alzheimer Nederlands, try to see on different levels, \u0026ldquo;Who are you targeting? What are you influencing? What are your bigger goals?\u0026rdquo; And really make more visual image plan for impact.\u0026rdquo; (Respondent 10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSecond, respondents collaborate with diverse cross-sector partners, including government agencies, private organizations, and third-sector collaborative partners, to co-create research agendas and knowledge products. For example, Alzheimer Center researchers received insights into the societal demand for research from patients with lived experiences and healthcare professionals through connections, formed via UMC memory clinics and external events focused on dementia knowledge sharing, such as the Dementia Dialogues and Alzheimer Caf\u0026eacute;. Research demand, derived from practice-based knowledge, was also obtained from government officials at the municipality level, national associations (e.g., Dutch federation for psychology), and steering committees of regional elderly care networks, consisting of nursing home teams and implementation practitioners.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;What I really learned during this project also is that it\u0026apos;s important to, like in the earlier stages of development, already have the end users involved also. So we always had this neurologist on the team who sees the patients and sees, like the real cases, as they are being discussed at the multidisciplinary meetings and that helps a lot to get this really clinically feasible [diagnostic] tool.\u0026rdquo; (Respondent 17)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eLast, respondents reported actively investing in research system infrastructures that strategically reduce knowledge creation fragmentation (e.g., research lifecycle discontinuation), and leverage knowledge beyond project silos. Continuity was achieved by employing research systems interventions, such as long-term public-private (consortium) research projects and learning communities. In addition, Alzheimer Centers A, D and E each hired an Alzheimer Center coordinator to facilitate the continuation of research projects, through securing subsequent rounds of funding, and to connect interdisciplinary research groups to reduce departmental knowledge silos. Alzheimer Center A, B, and C also emphasized the significance of leveraging formalized public-private partnerships (through research consortia) to reduce knowledge creation fragmentation across sectors.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We work together a lot because, for example, [name] is the coordinator for the Alzheimer Center, but also she joins the regional dementia platform. So there are links between the research and the care. For the local GPs, for example, dementia is not an interesting group, but the vulnerable elderly is an interesting group for them, and dementia is a part of this group. Yeah. So when you make a bit broader, then you have more effect what you\u0026apos;re doing.\u0026rdquo; (Respondent 25)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In the new consortia, we\u0026apos;re looking more into co-designing interventions with companies to be part of the application from the start and then also have to contribute in cash or in kind because it makes them more a part of this application. (\u0026hellip;) You really have to collaborate with the industry because people are starting to see that only academia driven interventions are usually not the ones that are still used in practice in the long run.\u0026rdquo; (Respondent 11)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3A. Strategies identified to facilitate knowledge creation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.232323232323232%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBroad strategy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"76.76767676767676%\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eMain activities mentioned by respondents from each Alzheimer Center\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.324324324324323%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.972972972972972%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter C\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.216216216216218%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter D\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.56756756756757%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter E\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003e(Research funders) provide clear guidelines and requirements for facilitating research impact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003eGrant applications require dissemination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\"\u003e\n \u003cp\u003eFunder guides research theory impact roadmap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003eResults intended for commercial use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003eFunder required societal impact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\"\u003e\n \u003cp\u003eFunders required societal impact\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003e(Researchers) co-create research agendas and research knowledge products with external cross-sector partners\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003eResearch targets local underrepresented needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\"\u003e\n \u003cp\u003eIndustry partners co-design products\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003eProducts tested validated with partners\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003eExternal partners request tools\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\"\u003e\n \u003cp\u003eElderly care networks inform researchers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003eInvest in research system infrastructures that strategically reduce knowledge creation fragmentation and leverage knowledge beyond individual projects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003eCoordinator reduced fragmentation usability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\"\u003e\n \u003cp\u003eStructural solutions reduce fragmentation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003eConsortia structure facilitated continuity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003eCoordinator tracked recruitment efficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\"\u003e\n \u003cp\u003eCoordinator monitors projects networks guide\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStrategies facilitating research knowledge product adaptation\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThree main strategies were used by Alzheimer Centers to adapt research knowledge products to fit the determinants found in the implementation setting and research ecosystem. First, respondents leveraged resources from the Alzheimer Centers, such as the research, education, and healthcare infrastructure, to access patients and participants who can inform the adaption of research knowledge to feasible products. For instance, all Alzheimer Centers had access to memory clinics, situated within the UMC, and client panels, consistent of people with dementia and their informal caregivers, to seek immediate feedback and adaptation support from the relevant end-users (e.g., patient groups and clinicians) to develop culturally appropriate research knowledge products and equitable implementation plans. Alzheimer Center B, C, D and E also reported training support for researchers, such as for project management, science communication, and lobbying and advocacy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We have a list of patients who consent to be asked for these things so we can call them, for example. But often of course we set up a specific task and a specific client panel for the project. So in our latest project where investigated feasibility of implementing digital tools from five memory clinics. We asked patients in five memory clinics to comment on the tool. (\u0026hellip;) So we included 15 clinicians [including geriatricians] and 40 patients and their significant others.\u0026rdquo; (Respondent 13)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSecondly, all Alzheimer Centers used wider ecosystem infrastructure (e.g., regional networks) and resources to adapt knowledge product delivery. For example, respondents adapted the research knowledge product into multiple language options and created simplified, multi-modal (e.g., print, website, application) versions, closely based on the original intervention components, to increase implementation feasibility and remove end-users\u0026rsquo; barriers to use. Alzheimer Center A, D and E actively obtained feedback and insights from participants of external networks (e.g., regional elderly care networks) to advise the cultural adaptation of research knowledge product components and select implementation strategies that fit the contextual determinants.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cbr\u003e\u0026nbsp;\u0026ldquo;Alzheimer Nederland is a partner in this consortium and Vilans and other partners that really try to translate the research to the public. So we in our junior training program, there are afternoons that we visit, Alzheimer Nederland or Vilans. I think part of these afternoons was how to involve the public in research design. But also if you have results, how do you try to make the impact that you are aiming for and how to spread the knowledge?\u0026rdquo; (Respondent 19)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eLastly, respondents utilized the expertise and resources of cross-sector external partners to support knowledge product adaptation. For instance, national knowledge institutes (e.g., Vilans, Pharos) acted as implementation support practitioners and knowledge brokers in the dementia research ecosystem, and they have trained researchers to use theory of change models to plan research utilization and pragmatically adapt the research knowledge product to fit the infrastructure of the wider implementation ecosystem. Further, funding agencies (e.g., ZonMw, Alzheimer Nederland) have also provided technical support to researchers to adapt and communicate research knowledge with cross-sector stakeholders, such as by translating research findings into practical advice to influence policy reform and decision-making.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;You know the way to organize in the Netherlands is the government provides increasingly little direct funding to the university. So there\u0026apos;s still some, but much of the research funding goes through ZonMw [national health research funding agency] and NWO [national research funding agency]. And of course, within these distributing organizations, that\u0026apos;s people who focus more on translating the science to policy advice. So that\u0026apos;s their job in particular to try to obtain the results from researchers. Yeah, and they formulate advice to government policy.\u0026rdquo; (Respondent 2)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3B. Strategies identified to facilitate knowledge adaptation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.31313131313131%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBroad strategy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"68.68686868686869%\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelected activities each Alzheimer Center\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.91044776119403%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.402985074626866%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.91044776119403%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter C\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.895522388059703%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter D\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.880597014925375%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter E\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.632653061224488%\"\u003e\n \u003cp\u003eLeverage Alzheimer Center resources and infrastructures to adapt knowledge products to users\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\"\u003e\n \u003cp\u003eMemory clinics provide access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\"\u003e\n \u003cp\u003eAdaptation through end-user feedback\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\"\u003e\n \u003cp\u003eAdaptation through events\u0026rsquo; feedback\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003eAdaptation through panels feedback\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eSpecialized department for implementation science\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.632653061224488%\"\u003e\n \u003cp\u003eLeverage research system infrastructure and resources to adapt knowledge product delivery and enhance widespread accessibility and usability for end-users\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\"\u003e\n \u003cp\u003eUse regional networks relevance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\"\u003e\n \u003cp\u003eIndustry partner creates software\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\"\u003e\n \u003cp\u003eDevelop clinical guidelines fidelity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003eCreate feasible public products\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eAdapt findings to new audience\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.632653061224488%\"\u003e\n \u003cp\u003eUtilize expertise and resources of external partners to support researchers in facilitating knowledge product adaptation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\"\u003e\n \u003cp\u003eUnderstand funding agencies role\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\"\u003e\n \u003cp\u003eEngage industry partners PhD secondment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\"\u003e\n \u003cp\u003eNational knowledge institute partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003eJunior researcher training site visits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eSupport from knowledge institutes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStrategies facilitating research knowledge product dissemination\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFive main strategies were used by Alzheimer Centers to disseminate research findings and research knowledge products to targeted end-users and relevant stakeholders. First, respondents from each Alzheimer Center actively sought out, established, and fostered cross-sector partnerships between academic institutions, government agencies, private sector (industry), and third sector (intermediaries) to overcome traditional knowledge silos. All Alzheimer Centers actively shared research findings through intermediary organization channels, such as national knowledge institutes (e.g., Pharos and Vilans) and utilized technical support and science communication training from these organizations. Alzheimer Centers A, C, D, and E have received accreditation from health associations, such as the Dutch Federation for Neurologists, to conduct training courses for healthcare professionals. This accreditation facilitates participation from healthcare professionals by offering continuing education credits. Alzheimer Center C distinguished itself through fundraising activities, merchandise sales, and coordination of charity events to disseminate research updates and solicit support from individuals and industry donors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We need to make sure that we then send it also to all the funders. So make sure that Alzheimer Nederland has seen it, or ZonMw. (\u0026hellip;) Often, for example, funders might say \u0026ldquo;oh, this is a really nice project. We\u0026apos;re so happy to do it together with you, very willing to write something for your website or an interview.\u0026rdquo; (Respondent 13)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;And then the wish was to have more in-service training, with credits or points. For the symposium, I also arranged to pick up points as well. Then maybe that helped with the [clinician] attendance numbers. But of course they deserve it. They learn a lot during those days. So there was a wish for more in-service training. So we did a pilot this year, and it was very well received.\u0026rdquo; (Respondent 18)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSecond, respondents from Alzheimer Centers A, B, E shared the importance of establishing direct connections with government agencies responsible for updating best practice guidelines to influence health policy. A range of activities were reported across each Alzheimer Center, such as presenting main research findings and important results through a ministry report to inform policy, utilizing existing connections and partnerships to optimize dissemination efforts, contributing as an advisor to the National Dementia Strategy, and communicating with influential political figures through research consortia events and funding agencies that act as knowledge brokers with government agencies.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026apos;m also in the Advisory Board of the National Dementia Strategy of the Ministry of Health, Welfare and Sport. So every three months we come together, also with the Minister, to talk about dementia and what are gaps, what we have to do. And so I think we have nice channels also to send our message.\u0026rdquo; (Respondent 7)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThird, multi-modal formats of education were used by Alzheimer Centers to disseminate research knowledge findings across specialized and non-specialized audiences. For instance, common activities of research knowledge transfer included conducting virtual webinars and training workshops for healthcare professionals through YouTube, and sharing knowledge through the Alzheimer Caf\u0026eacute; events, and across regional networks, to disseminate beyond the research teams\u0026rsquo; usual professional networks.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We have a strong connection there and we also have warm links with other Alzheimer cafes so some of them ask us every year for specific sessions to be presented there and also present an overview of new insights in Alzheimer\u0026apos;s disease or new insights in dementia.\u0026rdquo; (Respondent 8)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We have had a webinar about this topic last week, explaining more about how to do cross cultural dementia diagnostics as a neuropsychologist, and that was also within our strategy to reach as many healthcare professionals as possible at once. So everybody can watch it. And so that\u0026apos;s step one of the plan: reach as many people as possible.\u0026rdquo; (Respondent 1)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFourth, social and professional networking applications and commercial marketing strategies were used by the Alzheimer Centers to disseminate research knowledge. Each Alzheimer Center leveraged connections with the communications team from the UMC to share research findings through the UMC social media accounts, marketing channels, and official website and newsletter. Alzheimer Centers A, B, and C strategically used social and professional networking applications, by creating dedicated webpages on LinkedIn (LinkedIn Corp) and Twitter (X Corp), to facilitate research dissemination to specific demographics of researchers and healthcare professionals. Alzheimer Centers A and C monitored dissemination outcomes through web and social media analytics tools to incorporate engagement metrics, including total reach and post impressions, but did not use the data to select or tailor dissemination strategies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I help with the communication activities and make sure that after every publication the students write a blog, and they share it online and they make an overview of one PowerPoint slide of what the study was about and what are the results. So we have the collection of all those slides, of all the results of the studies, and we use it in presentation.\u0026rdquo; (Respondent 16)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;You have your different channels; we have our own social media channels. We have newsletters, we do a lot of public lectures. We have Alzheimer\u0026apos;s cafes that a lot of people are involved in the region. So dissemination is something that we really love.\u0026rdquo; (Respondent 7)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eLastly, formal research support structures from the Alzheimer Center and external partners, including formal public-private collaborations and regional care networks, were used to facilitate research dissemination. Alzheimer Centers D and E each hired a coordinator to manage and facilitate all dissemination activities, including sharing new research findings via social media and internal and public newsletters, creating a formal communication strategy, and actively maintaining relationships with partners (e.g., steering committees of regional networks, client panels). Alzheimer Center C provided more formalized internal structures to disseminate research knowledge, such as science communication training and meetings for researchers to share about their ongoing research projects and standardized templates used for tracking and reporting research outputs for annual reports (e.g., consortia research output tracker) and knowledge sharing through social networks (e.g., LinkedIn post template).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;For example, in the [consortium], we have outlined all the different target groups that we\u0026apos;re interested in because we also have an aim in that consortium to reach the healthcare professionals. So there we did a kind of mapping of who are the health care professionals that we want to target, and how can we reach them and in what way are we going to reach them?\u0026rdquo; (Respondent 8)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3C. Strategies identified to facilitate knowledge dissemination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.262626262626263%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBroad strategy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"73.73737373737374%\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelected activities each Alzheimer Center\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter C\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter D\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter E\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.083333333333332%\"\u003e\n \u003cp\u003eActively seek out, establish, and foster cross-sector partnerships between academic institutions, government agencies, private sector (industry), and third sector (intermediaries) to overcome traditional knowledge silos\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eFunders as knowledge brokers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eIndustry partner app creation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eKeep funders intermediaries updated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eIntermediary organizations support dissemination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eIntermediary organizations support brokering\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.083333333333332%\"\u003e\n \u003cp\u003eEstablish direct connections with government agencies responsible for updating best practice guidelines to influence health policy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eIdentify and advise federations/ committees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eResearchers on national board\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNational group for Care standard Dementia disseminates\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.083333333333332%\"\u003e\n \u003cp\u003eUsing multi-modal formats of education to disseminate research knowledge findings across diverse (specialized and non-specialized) audiences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eVirtual webinars for professionals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eIntegrate research into courses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eAnnual lectures to stakeholders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eUniversity network collaborates for participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eKnowledge sharing through networks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.083333333333332%\"\u003e\n \u003cp\u003eUse media and market communication strategies to disseminate research knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eDisseminate through UMC channels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eDissemination through social media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eAlzheimer\u0026apos;s Center targeted dissemination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eDissemination through UMC channels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eDissemination through UMC channels\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.083333333333332%\"\u003e\n \u003cp\u003eLeverage research support structures from the Alzheimer Center and external partners to facilitate dissemination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eCommunications manager strategic dissemination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eDissemination through partnerships collaborations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eEngage professionals with seminars\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eTailor dissemination to specific (niche) audiences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eLeverage established networks and partnerships\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStrategies facilitating research knowledge product implementation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFour main strategies to implement, scale-up, and sustain research knowledge products across various implementation settings were reported by respondents. First, respondents from each Alzheimer Center reported the importance of nurturing cross-sector partnerships with government, industry vendors, charities, patient representative groups, funders, and collaborative networks. Respondents also reported the value of facilitating such partnerships to adopt and sustain research knowledge products within existing the infrastructure and workflow of industry and third-sector partners. For example, these partnering organizations purchased and implemented the research knowledge product, such as a training module for nurses, in their organizational platform (i.e. website) to continue providing education to end-users. Alzheimer Centers B, D, and E emphasized the importance of maintaining partnerships with industry to foster trust, ensure continuous communication, and leverage respective resources and expertise for scaling collaboration. Sustained partnerships streamline future knowledge product implementation and reduce resource waste associated with initiating new collaborations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;And then we also try to make educational materials for healthcare professionals on this topic We just made them and now available also freely available via Alzheimer Netherlands. We\u0026apos;re working on educational models for healthcare professionals on dementia risk reduction to educate them.\u0026rdquo; (Respondent 7)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSecond, respondents from all Alzheimer Centers performed various activities to scale-up research knowledge products implementation as routine practices within existing organizations. Alzheimer Center A, C, and E implemented new research knowledge products (e.g., diagnostic tools) directly into the memory clinics, and peripheral clinics within the catchment area, with less resistance since these products were co-created with clinical staff members. Alzheimer Center B, D, and E implemented and scaled-up research knowledge products for use in non-clinical settings with the appropriate infrastructure, such as by adapting a diagnostic approach suitable for implementation in nursing homes. Similarly, the implementation and scale-up of research knowledge products across societal systems (e.g., education, welfare, health, environment) was also mentioned as a valuable strategy. For example, a health educational module that promotes understanding and inclusivity of people with dementia fit the pillar of an education curriculum that promoted inclusive citizenship, demonstrating how strategically aligned, cross-systems collaboration can help scale research knowledge products implementation beyond system silos to increase research impact to diverse end-user groups. Alzheimer Center B, D, and E sustained research knowledge products within organizations by providing iterative support to a local champion who employed \u0026lsquo;train the trainer\u0026rsquo; strategies to facilitate scale-up within implementing organizations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We\u0026apos;re looking always a bit for ways to have an entrance with schools because they\u0026apos;re so busy and often very hesitant. So you have this course about citizenship. It\u0026apos;s obligated for primary schools to teach the children to become good citizens. So there\u0026apos;s a project that kind of fits in like because it\u0026apos;s good citizenship to learn about dementia and to do this.\u0026rdquo; (Respondent 10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThird, respondents from Alzheimer Centers B, C, D, and E reportedly sought out sustainable (alternative) financing from diverse channels to implement and sustain research knowledge products. Alzheimer Centers B and D actively sought additional funding instruments and opportunities to support implementation and sustainment from both public (e.g., government funders, municipality subsidies) and private (e.g. private foundations) funders. Activities from Alzheimer Centers C and E were partially funded by the revenue obtained through licensing fees and product sales, paid by adopting organizations and end-users. Respondents from Alzheimer Center B and E attempted to have new research knowledge products covered by health insurance reimbursement channels, which required the products to be (cost-) effective and produce positive health outcomes. However, the precise requirements and process to qualify a new product for reimbursement through health insurers were unclear to respondents. Only respondents from Alzheimer Center B mentioned reimbursement mechanisms from alternative (non-academic) funding sources, such as the \u003cem\u003eStimuleringsregeling E-Health Thuis (SET)\u003c/em\u003e, a government-funded initiative that supports the scale-up of eHealth technologies that facilitate home-based care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We also, for example, have funding from SET. And so we have also these pilots in the region, but that\u0026apos;s in [city], where we work together with, for example, case managers and care organizations also to implement it in those regional pilots.\u0026rdquo; (Respondent 8)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn that line, there are also opportunities to embed the research knowledge product within existing health purchasing policies, such as the sustainable coalition initiative (via health insurer).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;[Health insurer] said that they wanted to include this as a priority area in the strategy of \u0026lsquo;van thuis uit\u0026rsquo;. It\u0026apos;s care concept in the sustainable coalition of [health insurers]. So they want to fund the intervention.\u0026rdquo; (Respondent 8)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eLastly, respondents from Alzheimer Center A, B, and C reported the use of transdisciplinary knowledge valorization strategies to move research products to real-world practice settings. Alzheimer Center A, B and C reported that research knowledge was implemented and scaled-up using commercialization practices (e.g., structured processes of production, distribution, marketing, and sales) and adhering to legal and regulatory requirements, such as obtaining CE marking and ensuring GDPR compliance for eHealth products. Knowledge transfer offices, and technology transfer offices, at the central university supported the Alzheimer Centers with developing structured business plans and formal contracts that facilitate collaboration with private sector partners, managing the intellectual property rights and legal ownership of the research, and staying up-to-date on the latest regulatory guidelines throughout the product development process.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Another part is the valorization that we also worked on and that was dissemination for commercial studies. And so we also had that in mind, in commercial studies, we want to use this as an outcome measure, that would be possible, but they would need to pay a license fee for using the instrument. And using the scoring algorithm, et cetera.(\u0026hellip;) we started out early with thinking about implementation. This could be a model in which we earn some money to sustain the academic development and the clinical implementation.\u0026rdquo; (Respondent 12)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We\u0026apos;re also speaking to people of the Technology Transfer Office to see, once we have this model, hopefully in a year or two, what steps do we need to do either right beforehand or afterward, to get the CE marking for instance, to be able to bring to a clinical setting and to use it by other healthcare providers.\u0026rdquo; (Respondent 2)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3D. Strategies identified to facilitate knowledge implementation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.153846153846153%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBroad strategy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78.84615384615384%\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eMain activities mentioned by respondents from each Alzheimer Center\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.91869918699187%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.69918699186992%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78048780487805%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter C\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.463414634146343%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter D\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.13821138211382%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCenter E\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.153846153846153%\" valign=\"top\"\u003e\n \u003cp\u003eNurture cross-sector partnerships with government, industry vendors, charities, patient representative groups, funders, and collaborative networks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.705128205128204%\" valign=\"top\"\u003e\n \u003cp\u003eProject-based implementation pathways infrastructure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.743589743589743%\" valign=\"top\"\u003e\n \u003cp\u003eEmbed training module website\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.75%\" valign=\"top\"\u003e\n \u003cp\u003eValidate develop algorithm partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.98076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eDevelop intervention with government agency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eUse established networks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.153846153846153%\" valign=\"top\"\u003e\n \u003cp\u003eSeek opportunities to support the scale-up of an intervention as a regular service\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.705128205128204%\" valign=\"top\"\u003e\n \u003cp\u003eImplement research into clinics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.743589743589743%\" valign=\"top\"\u003e\n \u003cp\u003eFit intervention into curriculum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.75%\" valign=\"top\"\u003e\n \u003cp\u003eMemory clinics implement instruments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.98076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eChange modality reduce costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eSustain products through continued interprofessional relationships\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.153846153846153%\" valign=\"top\"\u003e\n \u003cp\u003eSeek sustainable financing mechanisms from diverse channels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.705128205128204%\" valign=\"top\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.743589743589743%\" valign=\"top\"\u003e\n \u003cp\u003eSeek alternative funding agencies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.75%\" valign=\"top\"\u003e\n \u003cp\u003eCommercialization of algorithm fees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.98076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eGovernment funding for nursing homes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eAssociation works on financing\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.153846153846153%\" valign=\"top\"\u003e\n \u003cp\u003eUsing transdisciplinary knowledge valorization strategies to move research products to real-world practice settings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.705128205128204%\" valign=\"top\"\u003e\n \u003cp\u003eTechnology transfer office supports (business plan, regulations)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.743589743589743%\" valign=\"top\"\u003e\n \u003cp\u003eTechnology transfer office supports (business plan, regulations)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.75%\" valign=\"top\"\u003e\n \u003cp\u003eStakeholders support projects workshops\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.98076923076923%\" valign=\"top\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Discussion ","content":"\u003cp\u003eThe results revealed that each Alzheimer Center iteratively engaged diverse stakeholders, including individuals with lived experiences, caregivers, and practitioners, in co-designing and co-creating both the research knowledge products and the dissemination and implementation processes.This identified research utilization strategy aligned with the guiding principles of integrated knowledge translation (IKT), which aim to develop research directions, through engaged scholarship between researchers and knowledge end-users in practice, and to co-design and co-create research knowledge products, often facilitated through community-based participatory research and knowledge linkage and exchange [51]. Applying the KTA dimensions to explore research utilization from the research producers’ perspective has clarified opportunities and challenges in real-world IKT. Results confirmed the value of engaging cross-sectoral stakeholders and end-users to improve research utilization outcomes, while also highlighting the need for new researcher competencies, such as effectively communicating and facilitating collaborations across multi-disciplinary teams [54].\u003c/p\u003e\n\u003cp\u003eFurther, this study found that several research funders mandated the use of IKT and required research teams to engage end-users and practice agencies in the co-creation of knowledge products and the implementation plan. However, as critiqued by Holmes and Jones\u0026nbsp;[23], the requirements and criteria set by research funders, guiding the nature and strength of co-creation in funded projects, were often loosely defined, and the impact of funder activities that promote co-creation and implementation remain unclear. A separate study on dissemination and implementation activities of international research funders revealed that monitoring and measuring research impact was also a prevalent challenge\u0026nbsp;[47]. Further investment is needed to understand how research impact is monitored and evaluated by various funding agencies across diverse research ecosystems.\u003c/p\u003e\n\u003cp\u003eThe choice of research utilization strategies may also be explained by path dependence theory, which implies that strategies are selected based on each Alzheimer Center’s development trajectory, past decisions, organizational heritage, and team competencies [28]. As political and societal forces cause evolution and revolution within the external research ecosystem, Alzheimer Centers may be vulnerable to risks from path dependency, including poor responsiveness to environmental changes, such as disruptive challenges in partnerships and networks or changes in policy [14, 28]. Risks can be mitigated\u0026nbsp;by enhancing team resilience, responsivity, and agility\u0026nbsp;through strengthening researchers’ competencies at each stage of the research continuum through didactic activities, mentorship and expert consultation, knowledge sharing, and specialized financing instruments [26, 50]. At an organizational level,\u0026nbsp;Alzheimer Centers may consider structuring annual researcher performance appraisals to include societal research impact in the assessment criteria, and impact narrative case studies can be used to highlight the societal value of research, as recommended by the national Dutch Strategy Evaluation Protocol 2021–2027 [49]. The practices of other actors within the wider dementia research ecosystem may also evolve to incentivize and support research utilization scaling, such as funding agencies developing dissemination- and implementation-focused financing instruments [47].\u003c/p\u003e\n\u003cp\u003eThe selection of research dissemination and implementation strategies may also vary based on the research product’s typology. Respective positions of research products can be mapped across the translational science pipeline: T1 (conducting basic research), T2 (effectiveness in human clinical trials), T3 (implementation of clinically effective products), and T4 (conducting real-world outcome evaluations) [19]. The typology of research products developed in each Alzheimer Center is largely influenced by the Center’s research priority area. For instance, Alzheimer Center C focused mainly on conducting fundamental research (T1-T2), including biomarker discovery and (pre-) clinical trials, whereas Alzheimer Center E focused mainly on conducting applied health research (T3-T4), including the implementation of clinically effective non-pharmacological programs. Respondents from Alzheimer Center C commonly reported the importance of fostering bilateral R\u0026amp;D partnerships with pharmaceutical companies that relied on the Center’s research infrastructure and leveraging the advantages of integrated public-private discovery and development networks\u0026nbsp;[12]. In contrast, respondents from Alzheimer Center E emphasized the value of developing and utilizing participatory knowledge infrastructure, such as social and professional collaborative networks with third-sector organizations, in the dissemination, implementation, and sustainment of research products [53].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccordingly, depending on which stage of the translational science pipeline the research product is positioned, researchers require certain sets of competencies to overcome the unique determinants (i.e. barriers) that influence research utilization outcomes. By leveraging implementation science knowledge, the research utilization process can be explicated using impact and process models, and specific research utilization strategies can be systematically selected and tailored to address specific determinants. Pragmatic tools, such as the research impact logic model, developed by Jones and Bice [25], and such as a context-specific implementation planning instrument, developed by Prausnitz et al. [37], are needed to systematically guide research teams in implementation planning and to explicate the research utilization process to help monitor and evaluate the outcomes of their research utilization strategies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeveral notable dissemination and implementation strategies were identified in this study. First, a cross-systems collaboration strategy was successfully used to implement a health education program, originally set in healthcare organizations, in a school curriculum. Bunger et al. [8] determined similar benefits of aligning and leveraging existing resources across systems to improve research product implementation feasibility, fidelity, and sustainment. Second, the use of alternative funding mechanisms was commonly reported as a strategy to financially sustain non-pharmacological research products, through adapting products to fit the reimbursement criteria of certain government-funded initiatives and health insurance channels. Findings from Van Kessel et al. [48] further validated this result and reported that, in the Netherlands, the pricing and reimbursement of non-pharmacological research products, such as digital health interventions, are determined by negotiations between care providers, health insurers, the Dutch Healthcare Authority, and the National Health Care Institute, but no explicit requirements or guidelines are available to guide researchers to design a sustainable financial reimbursement plan. Lastly, valorization strategies were employed to implement the research products, but a series of challenges impede this approach. The \u003cem\u003eCode of Practice on the management of intellectual assets for knowledge valorization in the European Research Area\u003c/em\u003e emphasized the importance of ‘valuing all intellectual assets’ generated through research and innovation activities [16], but current practices in academic entrepreneurship and research product commercialization focus on patenting and distributing licensing rights on intellectual property and creating independent spin-offs and start-ups [9, 31]. Resultantly, academic ‘intellectual assets’ with lower commercial value are not valorized and often remain siloed within traditional academic settings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo mitigate this risk, future research can explore how an open innovation approach can be applied to dementia valorization, such as by establishing formalized living labs with contributions from cross-sector partners [32]. Best practices from this interdisciplinary method can support stakeholders in the research ecosystem to adopt systems-thinking for knowledge management and leverage alternative business models (e.g., social enterprise) and feasible implementation pathways for non-traditional research products [38]. As emphasized by Marr and Phan [31], the activities performed by technology transfer offices, embedded within universities, to facilitate the valorization of products with lower commercial value are enigmatic. Further systematic exploration of strategies used within such support teams is required to explicate the determinants surrounding the valorization of such products and create a mutually beneficial link between implementation science and research valorization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study may have potential research design and data collection limitations. Purposive sampling was used to recruit respondents, which may introduce selection bias and limit the generalizability of the findings to other settings outside the Alzheimer Centers which were all covered. Another limitation is related to our specialized focus on research utilization and implementation science. The implementation science jargon used by the interviewers required frequent clarification for the interviewees. The need to explain specific terms and concepts might have influenced participants' answers, as they may have provided responses based on their interpretation of the clarified terminology rather than their initial understanding. This challenge may be influenced by the early stage of implementation science in dementia research in the present Dutch context. Data collection was conducted in English, but some language and cultural nuances shared by respondents, who were native Dutch speakers, may not have been adequately captured. While in-depth insights were gained, the study's conclusions should be considered within the context of these limitations.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eResults from the Alzheimer Centers suggest that successful research utilization of non-pharmacological dementia research products requires academic health science centers to build research capacity and develop researcher competencies, such facilitating co-creation with end-users, establishing, and maintaining collaborations with public and private partners, and facilitating implementation, scale-up, and sustainment. Researchers must take initiative to scale their products, integrating them into existing organizations across sectors and navigating systems to secure inclusion in reimbursement schemes. Using the KTA framework from the research producer\u0026rsquo;s perspective revealed the intricacies involved in streamlining research utilization, paving the way for future implementation science studies to enhance the monitoring and evaluation of the research utilization processes, delineated between research producers and users, across various contexts. Employing a comprehensive ecosystem approach ensures the broader impact and practical application of research findings in real-world settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAHSC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcademic health science centers\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKTA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKnowledge-to-Action (framework)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUMC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUniversity medical center\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIKT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntegrated knowledge translation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNWO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDutch Organization for Scientific Research\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eZonMw\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eZorgOnderzoek Nederland (Care Research Netherlands)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSET\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStimuleringsregeling E-Health Thuis (Incentive Scheme E-Health At Home)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eHuman Ethics and Consent to Participate\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Erasmus School of Health Policy and Management Research Ethics Review at Erasmus University Rotterdam (Application ID: ETH2223-0473). All participants signed informed consent forms, detailing the scope of the study and the intended use of the data provided, to ensure research transparency and protect participants’ privacy rights. Permission was obtained for all audio and visual recordings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available to preserve the privacy and integrity of participants, but data may be made available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo funding or grant was obtained to conduct this study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors' contributions\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll authors (EMZ, MB, KA, and RH) conceptualized the study, developed the interview guide, and each participated in co-facilitating interviews. RH recruited the Alzheimer Centers via their directors. EMZ conducted data extraction and analysis. All authors contributed to validating data extraction and synthesized results. EMZ wrote the first draft of the manuscript with assistance from RH. All authors contributed to the final manuscript revision. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge Marco Blom, head of scientific research at Alzheimer Nederland, for contributing his professional insight and overview of the (net)work of the Dutch Alzheimer Centers to our project design. We also would like to acknowledge the leaders of all five Alzheimer Centers for their continuous support in this project, as well as all participants for sharing their time and insights.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAffret A, Prigent O, Porcherie M, Aromatario O, Cambon L. Development of a knowledge translation taxonomy in the field of health prevention: a participative study between researchers, decision-makers, and field professionals. Health Research Policy and Systems. 2020;18:1-91.\u003c/li\u003e\n\u003cli\u003eBauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychology. 2015;3:32.\u003c/li\u003e\n\u003cli\u003eBaumann AA, Stirman SW, Cabassa LJ. Adaptation in Dissemination and Implementation Science. In: Dissemination and Implementation Research in Health. 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Learning Health Systems. 2023;7:e10359.\u003c/li\u003e\n\u003cli\u003eProctor EK, Toker E, Tabak R, McKay VR, Hooley C, Evanoff B. Market viability: a neglected concept in implementation science. Implementation Science. 2021;16:98.\u003c/li\u003e\n\u003cli\u003eRobinson T, Skouteris H, Burns P, Melder A, Bailey C, Croft C, Spyridonidis D, Teede H. Flipping the paradigm: a qualitative exploration of research translation centres in the United Kingdom and Australia. Health Research Policy and Systems. 2020;18:1-111.\u003c/li\u003e\n\u003cli\u003eSarah Crowe, Kathrin Cresswell, Ann Robertson, Guro Huby, Anthony Avery, Aziz Sheikh. The case study approach. BMC Medical Research Methodology. 2011;11:100.\u003c/li\u003e\n\u003cli\u003eScheuer JD. Translating evidence-based knowledge objects into practice. Frontiers in Health Services. 2023;3:1107096.\u003c/li\u003e\n\u003cli\u003eSharon E. Straus, Jacqueline Tetroe, Ian D. Graham. Knowledge Translation in Health Care. 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Embedding implementation science in the research pipeline. Transl Behav Med. 2024 Feb;14(2):73-79.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"health-research-policy-and-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hrps","sideBox":"Learn more about [Health Research Policy and Systems](http://health-policy-systems.biomedcentral.com/)","snPcode":"12961","submissionUrl":"https://submission.nature.com/new-submission/12961/3","title":"Health Research Policy and Systems","twitterHandle":"@HarpsJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Knowledge translation, Implementation science, Research impact, Dementia","lastPublishedDoi":"10.21203/rs.3.rs-4679095/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4679095/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNon-pharmacological dementia research products generated in traditional university settings, such as social and behavioral interventions, often experience challenges to impact practices that they were developed for. The Netherlands established five specialized academic health science centers, referred to as Alzheimer Centers, to structurally coordinate and facilitate the utilization of dementia research knowledge. This study leverages implementation science to systematically explore the research utilization strategies used by academic researchers from each Alzheimer Center, based on the \u0026lsquo;knowledge-to-action\u0026rsquo; (KTA) framework, which includes knowledge creation, adaptation, dissemination, and implementation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIndividual semi-structured qualitative interviews were conducted with 29 respondents across the five Alzheimer Centers in the Netherlands, selected through purposive (snowball) sampling. Interviews were conducted in-person and virtually through Microsoft Teams, and all were audio-recorded and transcribed verbatim. Data analysis was guided by the dimensions of the KTA framework.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eThere was a high variation in the strategies used across the five Alzheimer Centers to bring non-pharmacological dementia research into practice, and selected strategies in each Center were influenced by the typology of research products produced and the Centers\u0026rsquo; organizational heritage. The knowledge creation and adaptation phases were mainly facilitated by funders\u0026rsquo; guidance toward research impact and research product co-creation with patients and implementing organizations. Dissemination and implementation phases were often facilitated through utilizing support from university-based technology transfer offices to facilitate implementation and valorization and establishing and strategically leveraging formal infrastructure, such as public-private partnerships and professional collaborative networks.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSuccessful research utilization requires evolving researcher competencies to meet environmental demands and facilitating co-creation with research end-users and implementing partners. Understanding external determinants influencing research utilization in the Dutch dementia research ecosystem is crucial for capacity-building and aligning cross-sector agendas. The KTA framework appears to reveal the intricacies of research utilization, guiding future studies to explore strategies employed across various contexts.\u003c/p\u003e","manuscriptTitle":"Transforming dementia research into practice: A multiple case study of academic research utilization strategies in Dutch Alzheimer Centers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-11 11:39:47","doi":"10.21203/rs.3.rs-4679095/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-10T20:50:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-20T12:12:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"313313549761660225211749911950826956090","date":"2024-07-24T20:52:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-22T03:49:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-11T06:33:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-11T06:33:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"Health Research Policy and Systems","date":"2024-07-03T09:09:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"health-research-policy-and-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hrps","sideBox":"Learn more about [Health Research Policy and Systems](http://health-policy-systems.biomedcentral.com/)","snPcode":"12961","submissionUrl":"https://submission.nature.com/new-submission/12961/3","title":"Health Research Policy and Systems","twitterHandle":"@HarpsJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3264d02d-34ad-4c0d-9031-c4c0487dc4db","owner":[],"postedDate":"August 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-13T15:58:21+00:00","versionOfRecord":{"articleIdentity":"rs-4679095","link":"https://doi.org/10.1186/s12961-024-01266-9","journal":{"identity":"health-research-policy-and-systems","isVorOnly":false,"title":"Health Research Policy and Systems"},"publishedOn":"2025-01-06 15:56:52","publishedOnDateReadable":"January 6th, 2025"},"versionCreatedAt":"2024-08-11 11:39:47","video":"","vorDoi":"10.1186/s12961-024-01266-9","vorDoiUrl":"https://doi.org/10.1186/s12961-024-01266-9","workflowStages":[]},"version":"v1","identity":"rs-4679095","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4679095","identity":"rs-4679095","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}