Knowledge mobilization in Type 2 Diabetes Mellitus (T2DM) researchers: an approach to the Mexican national health system

ABSTRACT

The literature on transfer, mobilization, and appropriation of knowledge produced in universities and public research centers yielded results allowing a better understanding of benefits, obstacles, and determining channels of such processes. Emphasis has been on differences between agents, researchers, and institutions, instead of trying to understand epistemic practices that affect Knowledge Mobilization (KMb). Our key question is: what type of obstacles are presented in KMb generated by Mexican researchers at the National Health System of Mexico when focused on Type 2 Diabetes Mellitus (T2DM)? We analyzed obstacles in the mobilization of knowledge generated by Mexican T2DM researchers focused at the National Health System of Mexico. We critically discuss the KMb literature, evaluate its qualitative methodology, and offer a case study with researchers in T2DM from the National Health System of Mexico. Finally, we discuss the findings and approaches from the theory in a series of recommendations to address the problem.

RESUMO

A literatura sobre transferência, mobilização e apropriação de conhecimento produzida em universidades e centros públicos de pesquisa produziu resultados que permitem compreender melhor os benefícios, obstáculos e canais determinantes desses processos. A ênfase tem sido colocada nas diferenças entre agentes, pesquisadores e instituições, em vez de tentar compreender as práticas epistêmicas que afetam a Mobilização do Conhecimento (MC). Nossa questão principal é: que tipo de obstáculos são apresentados nos MC gerados por pesquisadores mexicanos com foco no Diabetes Mellitus tipo 2 (DM2) no Sistema Nacional de Saúde Mexicano? Analisamos os obstáculos na mobilização do conhecimento gerado por pesquisadores mexicanos especializados em DM2 do Sistema Nacional de Saúde Mexicano. Discutimos criticamente a literatura sobre MC, avaliamos sua metodologia qualitativa e oferecemos um estudo de caso com pesquisadores de DM2 do Sistema Nacional de Saúde Mexicano. Finalmente, discutimos as descobertas e abordagens da teoria em uma série de recomendações para resolver o problema.

RESUMEN

La literatura sobre transferencia, movilización y apropiación de conocimientos producida en universidades y centros públicos de investigación arrojó resultados que permiten comprender mejor los beneficios, obstáculos y canales determinantes de dichos procesos. Se ha puesto énfasis en las diferencias entre agentes, investigadores e instituciones, en lugar de intentar comprender las prácticas epistémicas que afectan la Movilización del Conocimiento (MC). Nuestra pregunta clave es: ¿qué tipo de obstáculos se presentan en la MC generados por investigadores mexicanos enfocan en la Diabetes Mellitus tipo 2 (DM2) del Sistema Nacional de Salud de México? Analizamos los obstáculos en la movilización del conocimiento generado por investigadores mexicanos especializados en DM2 del Sistema Nacional de Salud de México. Discutimos críticamente la literatura sobre MC, evaluamos su metodología cualitativa y ofrecemos un estudio de caso con investigadores en DM2 del Sistema Nacional de Salud de México. Finalmente, discutimos los hallazgos y enfoques de la teoría en una serie de recomendaciones para abordar el problema.

KEYWORDS:

• Knowledge mobilization
• national health systems
• Diabetes Mellitus
• researchers

PALAVRAS-CHAVE:

• Mobilização do conhecimento
• sistemas nacionais de saúde
• Diabetes Mellitus
• investigadores

PALABRAS CLAVE:

• Movilización de conocimiento
• sistemas nacionales de salud
• Diabetes Mellitus
• investigadores

1. Introduction

The abyss that exists among research evidence, generated knowledge, and its use in policy and practice has been recognized internationally for several decades (Powell et al. 2017; Estabrooks et al. 2008). The implications of avoidable harm, ineffective policies, and services, duplication, or waste of efforts and resources are documented in academia (Harvey 2013). The past twenty-five years have shown a growing and significant concern with understanding both the nature of research-derived knowledge and how the use of this knowledge in practical settings or complex organizations, such as health services, can be fostered (Bennet and Bennet-Hughes 2007). As a result, a series of terms associated with this concern have emerged in recent years, such as knowledge management, which is used to refer to a range of proactive approaches deployed to encourage research-informed knowledge creation and sharing (Freebairn et al. 2016).

Knowledge management stresses an emphasis on information that is not only transferred linearly to the professional but also proposes that teams of professionals and researchers co-create knowledge by working together (Wutzke et al. 2018). From another perspective, the concept generation of knowledge is proposed to take advantage of tacit perceptions (and often very subjective), skills, and informal practices (or “know-how”) of those involved so that they can be acted upon through local policies (Ward 2017). This approach underlines the exchange of knowledge, which is conceived as a dynamic and fluid process that incorporates different forms of knowledge from multiple sources. Sharing is specifically based on the idea that individuals or groups of individuals come together as communities to exchange ideas, evidence, and knowledge (Johnson et al. 2018). From this perspective, we can appreciate a problem, namely, about the exchange and the complexity of having an effective comprehension of knowledge. For this reason, some authors have resorted to the term knowledge translation: a series of efforts aimed at translating research, such as health research, into action. In other words, translation is the synthesis, dissemination, change, and ethical application of knowledge to improve health, health service delivery, and the health system according to Sibley et al. (2017). In recent years, the knowledge mobilization (KMb) concept has been chosen, which is understood as a process that occurs within the framework of existing social relations in research – that is, the situated social processes of interactions and learning. However, there is a great diversity of models and theoretical frameworks that aim to provide an increasingly complex vision of the mobilization and use of knowledge (Nilsen 2015; Mathenson and Malcom 2016; Bennet and Bennet-Hughes 2007). The proliferation of these frameworks results in a polysemy of terms and models that revolve around the same studied phenomenon, where there is still very little guidance on how to select the most appropriate one.

Based on the above, three questions in particular arise. First, which actors are a fundamental part of the transmission of knowledge generated in the field of health? Secondly, what obstacles underlie the interaction of the actors? Lastly, what conceptual elements can encourage an effective interaction and mobilization of knowledge generated by health researchers to other sectors? In this article, the key question we aim to answer is: what type of obstacles are presented in the mobilization of knowledge generated by Mexican researchers at the National Health System of Mexico when focused on T2DM? To answer this question we analyzed the obstacles in the mobilization of knowledge generated by Mexican researchers focused on Type 2 Diabetes Mellitus (T2DM) at the National Health System of Mexico. We critically discuss the literature related to KMb and evaluate its qualitative methodology, in addition to evaluating the case study with researchers in T2DM from the National Health System of Mexico. Finally, we discuss the findings and approaches from the theory in a series of recommendations to address the problem.

2. Knowledge mobilization and its analytical framework

As we can see, there is a great diversity of terms to address the problem of KMb generated in scientific communities. For this reason, we consider it pertinent to elucidate and stylize a concept of KMb with the aim of understanding the process, locating the actors – for example, doctors, managers, political leaders, and patients – that participate (Graham et al. 2018) and understand the obstacles that arise. Therefore, we searched, extracted, and critically analyzed publications in indexed journals referring to the KMb of research in the health sector from 2010 to 2023 (although, it was detected that since 2007 this term of KMb began to emerge) using the text mining technique¹ from Silge and Robinson 2016. The aim of this section is to critically discuss the KMb concept and offer a robust conceptual framework to answer to the research question.

After evaluating the geolocation of the scientific literature on KMb in the health sector published in the last decade, we found that research is concentrated in a few countries: Canada, England, and Australia. As mentioned, there are multiple visions and models of the use and application of knowledge (Asthana, Jones, and Sheaff 2020; Freebain et al. 2017); however, it can be said that there are three “hegemonic” currents in literature: the Canadian American, the English-European, and the Australian. Canadian American research focuses on the translation of knowledge generated in research agencies for the elaboration of policies and strategies to improve health services; that is, KMb is observed as a linear and unidirectional process where knowledge is transferred from producers to users. European research has focused on modeling KMb processes from the creation of knowledge derived from research to its practical use.

Despite recognizing that the production of knowledge is a collaborative process between the various agents that participate, a linear vision is still maintained where researchers generate specialized knowledge that will be applied to users in public health settings, without considering that users actively participate in the generation of said knowledge. Finally, the research in Australia shows a significant influence of the Canadian current but drawing from the notion of linkage between producers (researchers) and users (policy and practice) for the transfer and use of knowledge. Despite the hegemonic position of these three currents, a growing Latin American literature on KMb that takes up and discusses both the Canadian vision and the English vision, can be found in recent years (Natera et al. 2020; Rojas and Natera 2019; De Fuentes and Dutrénit 2012; Dutrénit, Natera, and Vera-Cruz 2019).

This literature has focused on trying to explain KMb processes in Latin America – that is, in developing countries – and thus advance conventional models of producer-user knowledge transfer that have left much to be desired in regard to the use of knowledge and its translation in public services, such as health systems in said region. Despite the heterogeneity of definitions, analysis, and study disciplines, it was found that there is a set of characteristics in which most definitions of KMb converge. Table 1 lists the twenty-five original definitions of KMb found in text mining. For the purposes of this article, the key analytical categories of each concept or definition were identified, as well as the country where the referred work was published.

Table 1. Definitions of knowledge mobilization and main analytical categories.

Reference	Country	Definition/Concept	Categories
Perrotta and Alonso (2021)	Argentina	Knowledge Mobilization then supposes a series of strategies, processes, actions that are identified in the daily work of scientists, as well as a series of recommendations that involve it in its normative nature aimed at addressing the linkage processes between producers and knowledge users.	Strategies, processes, actions, daily tasks, scientists.
Castillo et al. (2021)	Canada	Processes that involve close collaboration between researchers and community actors as co-investigators as part of a broader agenda for progressive social change. They also involve strategic communication mechanisms to mobilize knowledge beyond those directly involved in the research process.	Local needs and interests; scientists; information and scientific production.
Susinos, Saiz-Linares, and Ruiz-López (2022)	Spain	Knowledge is mobilized when it is accepted that research is a political activity that, in fact, allows certain problems to emerge, that stand out as worthy of being investigated due to the fact that they are identified by the protagonists as conflictual in their lives. Consequently, research is considered relevant when it is linked to people's needs and committed to the common good.	Flow, researchers, mediators, users, maximization of benefits, improvement of profile, impact, wealth.
Ferlie (2022)	Australia	Recent work in the social sciences has moved away from reliance on formal knowledge management systems or linear knowledge translation (KT) models to emphasize more contextual, process, and practical models of knowledge mobilization.	Context, process, practice, commercialization.
Latulippe et al. (2021)	Canada	The effectiveness of KT refers to the capacity of the different strategies used to produce results for users, actors and the health system. Research on the effectiveness of the KT strategy has been concerned primarily with individual strategies, that is, strategies that directly aim at changing the knowledge, attitudes, and behaviors of health workers. In general, these strategies are moderately effective in changing practices.	Strategies, users, practices, actors, health systems, modification of knowledge, effectiveness.
Asthana, Jones, and Sheaff (2020)	England	KMb models have begun to move from passive, linear, and instrumental conceptions that see “knowledge” as a transferable commodity to more relational approaches that involve linking and sharing to connect researchers and decision makers, with the idea that knowledge is neither fixed nor privileged.	Knowledge sharing; linkage; mobile/dynamic knowledge; knowledge gaps.
Melville-Richards et al. (2020)	England	Complex and interactive effort in which collaboration at the individual and organizational level is essential to cross multiple and diverse borders. Harnessing border objects to enable collaboration between knowledge producers and users is on the agenda to increase knowledge assimilation and thereby improve patient outcomes.	Collaboration; producers and users of knowledge; co-production; borders; knowledge assimilation.
Grooten et al. (2020)	Belgium	Dynamic and iterative process that takes place within a complex system of interactions between researchers and knowledge users, which can vary in intensity, complexity, and level of commitment depending on the nature of the research and the results, as well as the needs of the researcher. Knowledge user in particular.	Knowledge transfer; knowledge users; interaction system.
Rojas and Natera (2019)	Colombia	Reciprocal and complementary flow of knowledge based on research, circulating between researchers, knowledge agents, and users of knowledge. This circulation of knowledge is positive for those who participate and can lead to concrete benefits, the transformation of knowledge into practices. KMb occurs within the framework of asymmetric and power relations, which have cultural, political, and economic dimensions.	Knowledge flow/circulation; innovation; power relationships; asymmetry; cognitive or disciplinary distances.
Gradinger et al. (2019)	England	The knowledge mobilization model combines operational evaluation of services with a participatory approach to action-oriented research, which aims to influence the development and application of service innovations in real time.	Participation; action-oriented research; innovation.
	Spain	Knowledge mobilization could be a feasible approach to bridge the gap between research and practice, as it includes a deep understanding of decision-making and the key elements to promote adherence to evidence-based practice.	Gaps; innovation; evidence-based practice.
Kitson et al. (2018)	Australia	It is a complex network made up of five interdependent subnetworks or groups of key processes: problem identification, knowledge creation, knowledge synthesis, implementation, and evaluation; which interact dynamically in different ways at different times in one or more sectors (e.g. community, health, government education, research).	Knowledge translation; complexity; knowledge networks.
Powell, Davies, and Nutley (2017)	Scotland	Process that involves the creation and use of knowledge and that arises as a result of other relational and political processes.	Creation and use of knowledge; relational processes.
Freebairn et al. (2017)	Australia	Knowledge mobilization further highlights organizational structures and system design requirements, and more explicitly values the co-creation of knowledge. It is also the broader term to encompass all activities that involve generating, sharing, and using research.	Co-creation of knowledge; stake; share; use of knowledge.
Mathenson and Malcom (2016)	Canada	Knowledge mobilization helps make research useful to society, and it does so in such a way that the search for solutions can itself inform the research agenda.	Knowledge translation; knowledge transfer; solutions.
Eldestein (2016)	Netherlands	Knowledge mobilization processes provide the structure for collaborative research partnerships … interactions between researchers, policy makers and practitioners are integral to translating research into practice and vice versa.	Collaborative research; interactions; transfer of research; knowledge sharing
Ungar et al. (2015)	Canada	Knowledge mobilization indicates efforts that help bridge the gap between research and action.	Participation-action; community projects.
Dwan, McInnes and Mazumdar (2015)	Australia	It includes all intentional efforts to increase the influence of research evidence on policy and practice.	Knowledge producers; knowledge users; knowledge translation.
Nabyonga Orem et al. (2013)	Uganda	Dynamic and iterative process that includes the synthesis, dissemination, sharing, and ethical application of knowledge to improve health, provide more effective health services and products, and strengthen the health care system.	Knowledge transfer; ethical application of knowledge.
Fournier (2012)	Canada	Collection and mediation of knowledge from different sources and from various actors as a prior step to concerted action.	Collection and mediation of knowledge.
Cooper and Levin (2010)	Canada	It is the name for the emerging field of research that seeks to strengthen the connections between research, policy, and practice. It covers 3 fields of action: the contexts of the producers of the research, the contexts of the users of the research, and the third-party agencies that mediate between the two groups.	Research producers; research users.
Bennet and Bennet-Hughes (2007)	Canada	Process of value creation or a flow of value through the creation, assimilation, use, exchange, and application of specific knowledge to a defined community. QI goes far beyond the dissemination of knowledge from source to beneficiary, from researchers to the community.	Value creation; knowledge transfer; exchange; complexity.

Source: Authors’ elaboration based on the cited references.

From the characterization of the definitions, we can see that KMb is understood as a process. Furthermore, this process of “moving” knowledge implies the existence of mobilizing agents. The theory agrees on at least two major agents or groups, the producers and users of knowledge derived from research (Melville-Richards et al. 2020; Mathenson and Malcom 2016; Edelstein 2016). Between 2005–2010, thought was focused on the transfer of knowledge between a producer and the user; that is, universities and research centers that provide goods and services to society (Asthana, Jones, and Sheaff 2020; Haynes et al. 2020). Subsequently, people began to talk about the translation of knowledge, as well as an exchange of knowledge. The last concept of knowledge exchange is interesting for authors for two reasons; it subtly abandons the existing linearity in the two previous concepts of transfer and translation; and a plurality appears in the term knowledge – that is, there is talk of more than one type of knowledge. This has certainly meant an evolution in some of the new approaches, since it abandons the ideas of producers who transfer or translate knowledge (which they generate in research tests) to users who are seen as patients that acquire and use such knowledge passively (Asthana, Jones, and Sheaff 2020; Haynes et al. 2020).

In this aspect, we observe the existence of two approaches based on the positioning of the role played by the user in the mobilization process (from the creation of knowledge to its practical application), the implications of how the knowledge flows, and how knowledge directionality is carried out. The two identified positions or approaches identified are:

Table

Transfer or linear translation

Dynamic multilateral knowledge flow

As a receiver that uses knowledge to cover a need. In this body of literature, mobilization is understood as the transfer or translation of knowledge in a linear and unilateral manner, that is, the mobilization phases follow a sequential logic of creation-transfer-application/use; where it is the producers who create and transfer or translate (their) knowledge to users (Dick et al. 2018; Ward 2017; Mathenson and Malcom 2016; Gainforth et al. 2015).

As an agent that participates in the creation of knowledge, in the definition of the research objectives (what, why, and for what); who also uses this knowledge to adapt it to its environment and propose new solutions (e.g. doctors who use the results of medical tests to implement new treatments in specific areas). Therefore, in this vision, the movement or flows of knowledge are carried out in a multilateral, dynamic, and participatory way (Asthana, Jones, and Sheaff 2020; Rojas and Natera 2019; Freebaim et al. 2017; Bennet and Bennet-Hughes 2007).

Source: Own elaboration.

It is evident that in recent years the flow of dynamic multilateral knowledge has given rise to collaboration and co-creation of knowledge (categories that barely appear in the two definitions), where the user actively participates (Freebain et al. 2017; Asthana, Jones, and Sheaff 2020). The agents or groups that participate in this process have different types of knowledge that they exchange and use for a common purpose. This purpose is the application of knowledge in practice – that is, to put into action the results generated during the investigation and make them tangible in terms of public policies, actions, goods, and/or new or improved services that add value to society, giving solution to local or national problems and needs (Freebairn et al. 2017; Bennet and Bennet 2015).

Therefore, KMb is also a process that implies innovation in policy and practice, which emerges as a result of the interactions intrinsic to said process, being an end/result, and a necessary input in this process (Gradinger et al. 2019; Blanco-Mavillard et al. 2018; Natera et al. 2020). As can be seen from the foregoing, KMb theory is under development and still presents a certain superficiality in its definitions as well as a visible lack of consensus regarding what is understood both by mobilization (transfer, exchange, and perhaps translation) and knowledge (in some cases, research is treated as synonymous with knowledge) (Bennett and Bennet-Hughes 2007). Likewise, knowledge is approached by some as a one-dimensional and singular concept (Dick et al. 2018; Ward 2017), and by others as multi-dimensional and plural (Asthana, Jones, and Sheaff 2020; Bennet and Bennet-Hughes 2007).

This is not trivial. The consequences are enormous in terms of the approach of national strategies that promote KMb as a mechanism for transforming scientific knowledge into actions and interventions that generate social value while strengthening national systems of research – specifically in the health sector. To develop these strategies, we need clarity about the nature of the actors involved, the knowledge that each one possesses, the intentions of the results that are sought, and how these results will be achieved (linear and one-dimensional logic, or dynamic-participatory logic). To summarize, we conceptually represent the process of KMb using Figure 1.

Figure 1. Knowledge Mobilization process in health. Source: Authors’ elaboration.

The KMb approach is inserted, in a certain way, within the framework of innovation systems since it seeks the application of developments and knowledge to the solution of social problems. That is, innovation can be the result of a complex process of mobilizing research-based knowledge (e.g. a new medical technology or a policy package for national telemedicine adoption) (Asthana, Jones, and Sheaff 2020; Freebairn et al. 2017). However, the very process of consciously mobilizing diverse knowledge and capacities of actors towards a common goal can be seen in itself as an innovative process (Gradinger et al. 2019; Blanco-Mavillard et al. 2018).

In the representation, we want to emphasize that the process of KMb is dynamic and interactive – that is, it involves various phases (reciprocal and complementary) in which different types of knowledge are investigated, created, exchanged, transferred, translated, and used at different moments in time (Rojas and Natera 2019; Bennet and Bennet-Hughes 2007). Knowledge is neither fixed nor privileged (Asthana, Jones, and Sheaff 2020). In this aspect, KMb is oriented to action and above all to the use of knowledge based on research to provide solutions to social problems (Natera et al. 2020; Bennet and Bennet 2015; Ward 2017). Knowledge agents and users are fundamental here: in general, the literature emphasizes two groups of actors: knowledge producers or agents (groups of specialist scientists and/or researchers) and knowledge users (other scientists, policy makers, public or private organizations, and society in general).

It is important to underline that in the interaction between these actors, social relations are presented as mobilization channels. KMb takes place within a complex system of interactions, with relations between the actors involved as the medium or channel through which knowledge is mobilized (Grooten et al. 2020). In addition, the creation of value and capabilities has been widely discussed: “the circulation of knowledge is positive for those who participate in the process and can lead to concrete benefits and the transformation of knowledge into practices” (Rojas and Natera 2019, 20). The idea that knowledge is plural, that is, there is not only one type of (scientific) knowledge, but rather there are multiple types of knowledge and capacities that each actor has, is incorporated. Therefore, there is a plurality of knowledge(s) that is mobilized in multiple directions and creates an incremental and common knowledge among the related actors (Freebairn et al. 2017; Rojas and Natera 2019). Futhermore, KMb requires views from different disciplines to achieve continuous and effective flows of knowledge in research and, of course, to be able to put the results generated into practice and implement actions (Harper and Dickson 2019; Asthana, Jones, and Sheaff 2020; Natera et al. 2020). Following Pérez and Setién (2008), “the transdisciplinary is intended to overcome the fragmentation of knowledge, beyond the enrichment of disciplines with different knowledge (multidisciplinary) and the epistemological exchange and scientific methods of knowledge (interdisciplinary).”

Based on these features, we characterize KMb as a dynamic and interactive process that is oriented to action in relation to the practical application of the generated scientific knowledge, and creates value and capabilities in the user population. This process, which goes from the creation of knowledge to its practical application (through new goods and services, research agendas, and public policies), uses social relations as channels for the mobilization of said knowledge, while recognizing that power relations exist, and that the translation of knowledge can be slow and “sticky” at certain times. Additionally, knowledge agents (e.g. researchers) and knowledge users (e.g. doctors and patients) participate to achieve the ultimate goal of applying the knowledge created. More than one type of actor is required for this goal and, therefore, the prior and generated knowledge must be multi, inter, and/or transdisciplinary. As a result, knowledge is plural, which is why, we will refer to the mobilization of knowledge(s) in health.

3. Methodology

From the discussion on the importance of characterizing Knowledge(s) Mobilization in health from documentary research, we consider it essential to focus on the particularities of KMb generated and produced by Mexican researchers focused on Type 2 Diabetes Mellitus (T2DM). We used qualitative methodology to address our guiding question: for this research the use of a qualitative methodology was determined for the type of question that guides the work. What type of obstacles are presented in the mobilization of knowledge generated by Mexican researchers focused on Type 2 Diabetes Mellitus (T2DM) working in the National Health System of Mexico? The qualitative approach “studies the structural and situational contexts, trying to identify the deep nature of realities, their system of relationships, their dynamic structure” (Domínguez 2007, 7), and allows us to gather descriptive data.

Specifically, we will use the case study during the collection of information. According to Yin (1989), the case study is an “empirical investigation that investigates a contemporary phenomenon in its real context, where the limits between the phenomenon and the context are not shown precisely, and in it, that multiple sources of evidence are used” (Yin 1989, cited by Jiménez 2012, 142). This allows us to analyze the phenomenon in a real context, asking when, ‘how, and why’ questions (Yin 1994, 2).² Specifically, our research obtains data from interviews with 10 researchers to learn and analyze their perspective on obstacles that arise in KMb generated and produced by Mexican researchers focused on Type 2 Diabetes Mellitus working in the National Health System in Mexico.

This is complemented with an investigation of the National System of Investigators database that brings together Mexican researchers on various research topics. In the second instance, we use a grounded theory approach to process the evidence and findings, and use the ATLAS.ti software for the organization and elaboration of categories that allow us to understand and explain the findings and answer the research question. Finally, we conducted a discussion of the results and answered the research question posed in this investigation. Below we present a brief overview of the problem and the chosen case study.

3.1 Context of the problem: Type 2 Diabetes Mellitus in Mexico

Since the seventies, Type 2 Diabetes Mellitus in Mexico has had a constant increase. According to the Latin American Diabetes Association, “the term Diabetes Mellitus (DM) describes a metabolic disorder of multiple etiologies, characterized by chronic hyperglycemia with disturbances in the metabolism of carbohydrates, fats, and proteins, resulting from defects in secretion and/or in the action of insulin” (Asociación Latinoamericana de Diabetes 2019, 11). That is, “it is the elevation of glucose or sugar in the blood (…) because the pancreas does not produce enough insulin, or (…) that the body's cells are not able to use glucose properly because the insulin produced does not work as it should (resistance).”³ T2DM “is the result of the inability of the body’s cells to fully respond to insulin, which is known as ‘insulin resistance’” (FID 2019, 14). The hormone is unable to fulfill its function, generating an inadequate production of insulin (Barrio 2004, 33). In Mexico, the high prevalence of T2DM causes complications for treatment by national health agencies. According to the National Institute of Statistics and Geography (INEGI), in 2022, a preliminary 439,878 deaths were registered, of which 59,996 were due to DM, placing this disease as the second cause of death in Mexico (see Table 2).

Table 2. Main causes of death in Mexico.

Diseases	Men	Women	Total
Heart disease	57, 075	48,780	105,855
Diabetes Mellitus	30, 118	29,877	59, 995
Malignant tumors	21, 399	23,132	44,531

Source: Elaborated based on information from press release no. INEGI 29/23.

To mitigate this problem, federal agencies have defined strategies to slow down the rates of T2DM, including the National Health Program 2007–2012: for a healthy Mexico: building alliances for better health (during the government of Felipe Calderón Hinojosa) and the National Strategy for the Prevention and Control of Overweight, Obesity and Diabetes (effective from 2012 to 2018, in the presidential term of Enrique Peña Nieto). These strategies together with the publication of the Standard Official Mexican NOM-015-SSA2-2010 for the prevention, treatment, and control of Diabetes Mellitus in November 2010, encouraged agencies such as the Mexican Institute of Social Security (IMSS) and the Institute of Security and Social Services for Workers of the State (ISSSTE) to develop actions against T2DM (some of which continue to this day). These actions include Manejo Integral por Etapas (MIDE), Programa Educativo AMARTE VA, programas NutrIMSS, and Yo Puedo, CHKT, among others. In addition to the above, during the current presidential six-year term, a modification was carried out to the General Labeling Specifications for prepackaged food and nonalcoholic beverages. Commercial and health information were modified (published on March 27, 2020), with the purpose of providing information to the population about the contents of the food they consume and propitiate informed decisions.

However, the problem persists and we are surely on the cusp of an even bigger problem as a result of the imbrications of T2DM and the SARS-CoV-2 pandemic. For this reason, we consider it essential to understand Knowledge(s) Mobilization of Type 2 Diabetes Research.

3.2 Data collection: interaction with health researchers

We first did a documentary search to obtain the profile of the researchers who are working on T2DM. Our base was the database of the National System of Researchers of Mexico for 2021. Of the 35,180 researchers belonging to the SNI, Medicine and Health included 3,933 researchers. However, the figure decreases a lot with a more refined search regarding the problem of T2DM, where we located only 48 researchers investigating the problem or a connected topic such as obesity, immunity, genomics, pharmacogenetics, nutrition, and hypertension in Diabetes, as we can see in Figure 2.⁴

Figure 2. Data on the National System of Researchers. Source: National System of Researchers, 2021. Authors’ elaboration.

We then approached 20 researchers of the 48 identified in the National Research System database. We contacted them via email, website, phone calls, meetings, or academic events such as the National Diabetes Congress in its editions in CDMX 2021 and Guadalajara 2022. Finally, we established contact with researchers from institutes and universities located in Mexico City, Guadalajara, and Monterrey based on the high percentage of researchers existing in these federal entities. Throughout this process, confirmation was obtained from ten researchers who agreed to participate in the study anonymously and dedicate at least three sessions to answer the questions worked on in the conceptual matrix.

For this study, we used a semi-structured interviews⁵ (Kvale 2011) technique as part of the case study because it offers the possibility of obtaining direct information from the actors, allowing the researcher some flexibility to identify how each one perceives their environment. The profile of the researchers can be found in the following table, respecting their confidentiality and anonymity (Table 3).

Table 3. Profile of the researchers.

Researcher/Gender	Institution	Formation	Research Topics
Researcher 1/ Male	Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ)	Surgeon from the Faculty of Medicine at UNAM, specialist in Internal Medicine and endocrinology from the INCMNSZ.	Epidemiology of metabolic diseases, pathophysiology of type 2 diabetes and primary dyslipidemias.
Researcher 2/ Male	Centro de Investigación en Salud Poblacional, de la Secretaría de Salud.	Surgeon and Master of Science in Occupational Health from the Autonomous Metropolitan University and Doctor of Epidemiology from the University of Texas at Houston.	Hepatitis, COVID-19, and obesity and diabetes in Mexico.
Researcher 3/ Female	Instituto Politécnico Nacional (IPN)	Master’s and PhD in Sciences with a specialty in Pharmacology from the Center for Research and Advanced Studies (CINVESTAV, for its acronym in Spanish).	Septic Shock, Oxidative Stress, Diabetes and Photoacoustic Spectroscopy.
Researcher 4/ Female	Escuela Nacional de Medicina del Instituto Politécnico Nacional	Master and PhD in Pharmacology from the Center for Research and Advanced Studies (CINVESTAV, for its acronym in Spanish).	Pathophysiology of Gestational Diabetes and Pre-eclampsia and Medical Education.
Researcher 5/ Male	Instituto Politécnico Nacional (IPN)	PhD in Research and Medicine. Member of the American Society for Nutrition, of the European Society For Clinical Nutrition and Metabolism.	Diagnosis, prevention, and treatment of obesity, metabolic syndrome Diabetes and its complications.
Researcher 6/ Female	Universidad Jesuita de Guadalajara (ITESO)	PhD in Public Health Sciences. Teaching coordinator of the Degree in Nutrition and Food Sciences and Treasurer of the Mexican College of Nutritionists.	Effect on health of the consumption of sugary drinks, food labeling, environmental factors associated with obesity from public health.
Researcher 7/ Male	Centro de atención para Niños y Adolescentes con Diabetes tipo 1, Guadalajara Jalisco	Medical Director Center for Education and Care for Children and Adolescents with Diabetes (D1A Center) in Guadalajara, Jalisco	Diabetes, obesity and diabetes education.
Researcher 8/ Male	Departamento de Medicina Interna/ Facultad de Medicina y Hospital Universitario “Dr. José E. González” Universidad Autónoma de Nuevo León	Surgeon, graduated from the Faculty of Medicine of the Autonomous University of Nuevo León (UANL). PhD in Medicine from the UANL School of Medicine.	Insulin Resistance, Metabolic Syndrome, Adrenal Insufficiency, Pharmaceutical Clinical Research.
Researcher 9/ Male	Instituto Jalisciense de Investigación en Diabetes y Obesidad S. C.	Doctor from the Faculty of Medicine at UNAM, Specialty in Endocrinology from the INCMNSZ, Master's Degree in Medical Sciences from the University of Guadalajara and Diploma in Evidence-Based Medicine from the University of Oxford.	Diabetes, Obesity, Dyslipidemia, Hypertension, Cardiovascular safety of new drugs for diabetes and endocrinological problems.
Researcher 10/ Male	IMSS-Universidad de Monterrey (UDEM) México.	Professor and researcher IMSS-UDEM Mexico, Physician specialized in Pediatrics, has a Master's and Doctorate in Microbiology.	Obesity, Diabetes, Tuberculosis, Immigration health problems.

Source: Authors’ elaboration.

To obtain extensive information on the perspectives of the ten researchers, the interviews were structured into four sections: the first on general aspects of T2DM in Mexico, the second on Innovation and generation of knowledge in health, the third on KMb, and the last part focused on the Agenda and Public Policies in Health in Mexico. The following matrix shows some examples of the questions asked (Table 4).

Table 4. Structure of the interview for this study.

SECTIONS	CHARACTERISTICS
First section. General aspects of T2DM in Mexico	This section begins with the first general questions to the interviewees related to the problem of T2DM in Mexico: What impact and consequences does T2DM have on the Mexican population? What relationship and consequences has T2DM presented as a result of the SARS-CoV-2 virus? What role does diet play in T2DM? What is the outlook for T2DM in Mexico and globally?
Second section. Innovation and generation of knowledge in Health	This section focused on obtaining the perspective of researchers about innovation in health through the following questions: What kind of knowledge and research do you develop to address the problem of T2DM? What aspects are relevant to encourage the generation of knowledge in health from your perspective? What results based on the production of knowledge have you developed? Have you developed any artifact or device to deal with the problem of T2DM?
Third section. Knowledge Mobilization	This section of the interview focused on obtaining data on the mobilization of knowledge between researchers and institutions of the National Health System in Mexico based on the following questions: -How do you communicate the results of your research? Do you share the information and knowledge generated with other colleagues? Do you consider it relevant to share, exchange the knowledge generated with other scientific communities? What obstacles do you have to mobilize knowledge with your colleagues? Do you consider that the knowledge it generates reaches other types of actors such as specialists, decision makers or users? What channels or media do you use to communicate knowledge? What obstacles do you see in mobilizing the knowledge generated?
Fourth section. Agenda and Public Health Policies	The last part was meant to provide a space for researchers to communicate information on aspects related to the public health agenda and policies based on the following questions: Do you consider it relevant that the knowledge generated by you be known by a broader public? Do you know of any action or policy that collaborates in the mitigation of T2DM? Would you be willing to participate in the development of a series of actions that contribute to putting the problem of T2DM on the agenda? What aspects do you consider relevant to establish a public policy of great depth to mitigate the problem of T2DM?

Source: Authors’ elaboration.

The structure of the interview allowed us to explore the concepts of innovation in health, generation of knowledge in health, Knowledge Mobilization, channels of interaction, obstacles in Knowledge Mobilization, agenda, and public health policies.

3.3 Data processing

Once we transcribed our interviews, we used the qualitative data analysis software ATLAS.ti to process these textual sources (Friese, 2014). This tool served as an integral support when coding and categorizing the information from interviews, which we later analyzed and interpreted following a grounded methodology approach.⁶

Figure 3 shows the general steps involved in using the ATLAS.ti as a research tool.

Figure 3. Sequence of steps used in the ATLAS.ti program.

The interviews include the concepts of primary documents, quotes, codes, and notes or memos (Friese 2014, 14). They were grouped into a certain component, the Hermeneutical Unit (HU).⁷ The HU, in its function as a project container, provides the necessary structure for the visualization and organization of the data and information that are obtained throughout the analysis of the interviews. The first of these elements, the primary documents, represents the basis of the analysis. Generally, in textual format, this primary database is also divided into what Friese (2014, 15–16) calls primary document families or data attributes. In this project, we entered primary interviews with 10 different researchers.

3.3.3 Ordering of the information with the generation of textual citations

The ordering of the information began with the classification of the data through citations and codes that were derived from the first readings of the interviews. The citations, understood as fragments of information, came from the primary documentary source of the interviews. Subsequently, we segmented the interviews with the help of the Auto-Coding tool. With this component, key concepts for the investigation were located and text fragments were separated, also assigning them a code for their subsequent identification and analysis. A first general coding was carried out, which can be understood as the first approach or diagnosis of the primary documents or interviews.⁸ Subsequently, an initial code list was created from the investigation prior to the one carried out to obtain the primary document; an inductive coding was obtained directly from the data, resulting in a more flexible process, and an a priori coding scheme was developed but keeping open the possibility of modifying it according to the data obtained a posteriori. In this phase, we rely on what Lofland (1971) and Bogdan and Biklen (1992) have called code division concerning acts, activities, meanings, participation, relationships, context, environment, the definition of the situation, perspectives, ways of thinking, process, events, and methods. Generation of codes and concepts that allude to citations.

The purpose of coding is to reduce the data (Fernández Núñez 2006, 6) and to mark texts, that is, to assign codes both for identification (labels) and for analysis (values) (Ryan and Bernard 2003). The reduction of themes in the second delimited coding was carried out under the condition of merging repetitive themes with other themes related to their actions. Another condition was to generate topics that are related to the research objective. Starting from the delimitation of the themes and the generation of the citations, we constitute the semantic set of meanings. Its constitution is based on three types of codes:

• descriptive (where some distinctive element or characteristic is attributed to a part of the text),

• interpretative (they require a deeper knowledge of the subject to be able to analyze it),

• inferential (which “usually refers to patterns, themes, causal links or leitmotifs”), which can be constructed by classifying ideas from acts and relationships to context and perspectives.

In the following graph, we can see the Semantic Set of Meanings that was constituted with the number of citations obtained from the coding of the transcripts. The result of this more stylized coding yielded 59 topics and 549 citations (Graph 1).

Graph 1. Categories.

In the first instance, we divided the analysis units a posteriori through abstract constructs that emerged from the interviews. These codes can be identified before, during, or after the analysis of the primary document. At this stage, we built code books or systems, which served as organized lists of codes that we ranked according to the objectives of the project. It is important to mention that on many occasions the criteria for generating the evidence were found in concepts expressed by the specialists themselves, concepts that due to their relevance and reiteration were fundamental to understanding any quote.⁹ Coding, by assigning keywords to fragments of the documentary source, “reduces and structures large interview texts into a few tables and figures.”¹⁰ From the synthesis, semantic closeness and relevance in the interviews, we created five axes that respond to the research question.

3.3.4 Creation of five thematic axes from the themes and codes

The semantic set of meanings makes it possible to develop a categorization of thematic elements. However, on many occasions, categorization is wrongly used as a synonym for coding in the analysis of texts in social sciences (Kvale 2011, 138–140). In this research we understand categorization as an organization established in a more particular and delimited way than the creation of codes, this is because our own categories depend on the objective of the project, the evidence of the interviews, and our own interpretation. Therefore, for the creation of the thematic axes we brought together a series of themes that, due to their semantic proximity and, above all, their close relationship, can become a relevant concept for research.¹¹

It is important to mention that in this phase, the categories created also correspond to the families that we elaborated on ATLAS.ti, according to their gradual classification. In this case, we grouped five families considering the links and objectives of the project:

1. Actors

2. Public health policies

3. Public Agenda

4. Healthcare Innovation

5. Knowledges mobilization

Each theme represents a concept that groups different themes and codes. Its constitution allowed us to filter, organize, and facilitate the selection of items reviewed in the interviews.¹² At this point, it is important to observe how the themes were constituted to observe their relationship and above all to show that the prevalence of themes generates codes that constitute findings to elucidate the problem that we have raised in this research. The next step was to establish the thematic axes – facilitated by the software – that served as a prelude to the establishment of visible relationships capable of being exposed in graphic representations, such as models or diagrammatic sets (Muñoz Justicia and Sahagún Padilla 2017, 8).

4. Interpretation and discussion of results

Here we describe the actors who participate in Knowledge(s) Mobilization in health research. The concept of actor has been widely used in the social sciences. From an empirical perspective, the primary concern revolves around the objectives and intentions of the actor, among which we can find “naive theories of action,” those that conceive of states and institutions as actors (Beyme 1994, 318–346). Dye (1987) and Subirats (1990–1991) consider that the analysis of public policies recovers the concern for the actors to the detriment of the structures. This is true even in those approaches such as networks, advocacy coalitions or the focus on “political communities” (policy community). Ultimately, advocacy coalitions, networks or political communities are nothing but ensembles – more or less articulated – of actors (García-Cruz et al. 2021, 200). Following authors, Figure 4 shows the network of actors that are fundamental to the mobilization of knowledge of the Mexican National Health System. In the network, we can see all the actors mentioned by the interviewees, and not a single topic or actor is incorporated that was not mentioned throughout the interviews. The first distinction that we can locate in the network is that referring to individual actors and collective actors. The identification of individual actors does not usually present major difficulties. However, in the case of collective actors, it is totally different. In this research, the individual actors are researchers and clinicians, especially the so-called knowledge producers. In terms of collective actors, we can generally locate institutions or agencies that are in charge of public and private health in our country, as we can see in the descriptive network (Figure 4).

Figure 4. Actor-network. Source: Authors’ elaboration based on the coding with ATLAS.ti.

Identifying the actors allowed us to understand the participants of Knowledges Mobilization regarding diabetes research, but above all to identify some obstacles that arise when KMb is generated by researchers, as we can read in the following excerpt from an interview with one researcher:

One of the problems in communicating the results to other colleagues or authorities is the little interaction, I think basically because we only see each other at conferences and events with colleagues we already know. It is difficult because we do not have spaces for interaction to share our results, a program or plan to share our knowledge would be a good start.

What was mentioned by the interviewee is consistent with a lack of a joint public policy to address the problem of communication comprehensively. For another researcher, it is essential to address the problem in an intensive intersectoral manner that gives due importance to health in all policies, as we can see in the following excerpt from the interview:

A set of public policies is needed, a comprehensive, multi-stakeholder and multilevel comprehensive vision, and this, let's say, is the conceptual principle of mobilizing knowledge to generate a long-term public health policy, independent of the six-year presidential and political positions. A public health policy that prioritizes the problem and has as its main objective that the Mexican population can modify their health based on the knowledge generated by our investigations.

Thus, knowledge mobilization of diabetes is part of the great challenge of public health policies in Mexico.

5. Conclusions

We proposed a Knowledges Mobilization (KMb) model that implies a dynamic process oriented toward action, one that fosters values and capabilities in the users of such knowledge. This process goes from the generation of knowledge to its practical application (offering of new goods and services, and promoting research agendas, and public policies); it uses social relations as mobilization channels for such knowledge, acknowledging existing power relations and recognizing that translation can be slow and “sticky” at certain times. Agents of mobilization (for example, researchers) and knowledge users (for example, practitioners and/or patients), participate in this process. In addition, to accomplish the final goal of knowledge application, the participation of more than one actor is required. Figure 1 illustrates the different parts of the model proposed: innovation, mobilizing agents, channels of mobilization, public policies, and an agenda. Several mediating factors occur within these components and for that reason, we need to take into account the different phenomena of each one to better understand the process.

The Horizontal Model of Knowledge(s) Mobilization, KMb, is part of innovation systems because one of its objectives is the application of knowledge for the solution of social issues. This innovation can be the result of a complex process to mobilize knowledge based on research, e.g. a new medical technology or a policy plan for telemedicine at a national level (Freebairn et al. 2017).

Within this component, several mediating factors are considered:

• Knowledge generation: Scientific knowledge is often produced by researchers in their own environment, a university, lab, or research facilities, among others (Westwood et al. 2021; Castillo et al. 2021). They are used to their traditional modes of knowledge production more academically oriented (Mode 1), but also changing to a more socially distributed mode of knowledge production (Mode 2) (Ferlie 2022). This pluralism can generate new, actionable knowledge production, closer to the user and its mobilization (Harvey et al. 2021).

• Researcher perspectives: Researchers have a posture predetermined by their training, cultural and academic background, and their intentions with the knowledge they are generating (Sales, Estivalis, and Escobedo-Peiro 2021). These elements of perspective can determine the relationship between the knowledge produced and the intended user, and divisions between experts and non-experts can determine or hinder the translation of discoveries and devices to a general audience (Alonso, Perrotta, and Riccono 2022). Also, the work of researchers can be determined by their production context (stimuli, prestige, networks) and be susceptible to power asymmetries in knowledge production (Perrotta and Alonso 2021). Researchers must take intended users of the knowledge generated into account (Susinos, Saiz-Linares, and Ruiz-López 2022).

• Practice: The activity of professionals demands the production of new techniques and knowledge based on evidence (Latulippe et al. 2021). Within these practices, continuous learning, social innovation, adaptation, and evaluation are key activities that foster the search for new knowledge and the expansion of the field through knowledge mobilization to other environments and actors (Cooper, MacGregor, and Shewchuk 2020). Practice is an iterative process that in certain environments can lead to information search that can become a key in KMb (Hartling et al. 2021).

Mobilizing agents: The mobilization of knowledge and capabilities among actors of different backgrounds, oriented towards a common goal, itself can be an innovating process (Gradinger et al. 2019; Blanco-Mavillard et al. 2018). KMb is a dynamic and interactive process; it implies different phases – reciprocal and complementary – where different knowledges are researched, created, exchanged, translated, and used in different time settings (Rojas and Natera 2019; Bennet and Bennet-Hughes 2007). This knowledge is not fixed or privileged (Asthana, Jones, and Sheaff 2020). To mediate the mobilizing agents there is evidence of:

• Engagement and re-use of knowledge: There is a relationship and complex interplay between user engagement and re-use of knowledge. The design and planning of programs promoting engagement can contribute to an evolution of knowledge and the use of practices in public policy and decision-making (Harvey et al. 2021). This is a planned strategy from a public program that can be taken by the users, such as policy briefs or press releases, and taken by an audience and transformed in their own language and context to keep the knowledge circulating.

• Knowledge brokers: Knowledge brokers are professionals that can build a bridge between scientific knowledge and user needs or demands. These actors can come from different domains, such as industry, that can bring new treatments or techniques to possible users or buyers (Cooper, MacGregor, and Shewchuk 2020) or professionals that communicate academic concepts to a general audience (Merga 2021).

Mobilization channels: KMb resides within a complex system of interactions, where the relations between involved actors are the medium where knowledge is mobilized (Grooten, et al. 2020). In addition, the creation of values and capabilities has been broadly discussed: “circulation of knowledge is positive for those who participate in the process and can lead to concrete benefits and the transformation of knowledge into practices” (Rojas and Natera 2019, 20). The mediating evidence of this component can be categorized as:

• Cooperation: Research and knowledge is not produced by individual entities; researchers collaborate with others to generate scientific products. When cooperation and an asymmetry of power exist, researchers tend to look for the privileged group to be included and often neglect their peers or the users in their context (Perrotta and Alonso 2021). Nonetheless, sometimes the environment and settings of research can lead to considering the needs and interests of the inhabitants of their research environment and start developing joint activities that can even transform or impact the research agenda (Castillo et al. 2021).

• Engagement: Researchers affirm engaging their activity to interested parties and include a multiplicity of voices in the research process and knowledge exchange; all knowledge comes from some engagement with the previous one (Alonso, Perrotta, and Riccono 2022). The social structures of knowledge production must be engaged for it to be useful and pertinent to different actors to reach wider audiences and address the studied phenomena more accurately (Sales, Estivalis, and Escobedo-Peiro 2021). Also, engagement must consider the public for knowledge to be accessible, acquired, and transformed (Charide, Stallwood, and Munan 2023). In the end, the experience of users can lead to a more productive, reliable, and pertinent knowledge application (Hartling et al. 2021).

• Use: KMb implies that knowledge ends up in use by people to mitigate a social problem or in intended activities that may differ from the ones originally proposed by research or public policy, users can develop their own strategies derived from research to more effective ones through use (Harvey et al. 2021). This factor is crucial as a mobilizing channel because it leads to an improvement in planning and data usage and creates a relation of trust and the development of capabilities derived from scientific research (Cooper, MacGregor, and Shewchuk 2020).

Agenda: KMb incorporates different views from different disciplines to accomplish continuous and effective flows of knowledge in research, and of course to achieve a practice derived from general results and implement actions (Harper and Dickson 2019; Asthana, Jones, and Sheaff 2020; Natera et al. 2020). Agendas are mediated by:

• Co-development of public policy: The development of public policy in KMb is a process where no single actor must have a privileged position on the actions to attend to a social problem or develop an action. Hierarchies and classical public policy models (top-down) must become horizontal and include researchers and users as stakeholders with a decision capacity on the use of knowledge and its course (Sales, Estivalis, and Escobedo-Peiro 2021). Also, recommendations in the evaluation of the actions and programs developed from knowledge must have the participation of the users to be pertinent and more viable (Charide, Stallwood, and Munan 2023). Programs must be nuanced by a general audience and their voice to be active in the process of developing public policy (Harvey et al. 2021). This can lead to transforming actors from consumers to prosumers, in specific not just to passively participate or act in the planning or receiving phase of a strategy but to be involved in the whole process (Susinos, Saiz-Linares, and Ruiz-López 2022).

• Institutional Structure: The institution’s background where knowledge is produced must be transformed in order to surpass asymmetries of power (Perrotta and Alonso 2021) and create more flexible standards closer to an audience (Merga 2021) for knowledge to be accessed and exchanged. Most researchers can take their knowledge to the public and negotiate a research agenda and test their strategies with the user taking into account their interests and needs (Castillo et al. 2021). The adaptation of administrative procedures can be a decisive factor for users or patients to participate in healthcare interventions and programs (Latulippe et al. 2021). Finally, some incentives on academic production can cripple KMb by creating a closed environment of research groups away from the intended user (Alonso, Perrotta, and Riccono 2022).

• Funding: Resources are a critical issue for knowledge production but also for the audience and users to reach the ultimate goal to make research a common practice. Funding must be part of the agenda, to facilitate users to approach new treatments or techniques in healthcare (Hartling et al. 2021). The assignment of resources is dependent on strategic roles and even in a political environment this must change to a strategic role for a better and more effective agenda on health care (Cooper, MacGregor, and Shewchuk 2020). All actors of KMb must be included in the funding strategy to provide financial and administrative support.

• Governance: KMb fosters cooperative practice and may cause some underlying tensions. Soft features like values, aligned expectations, and high trust are important in making collaboration happen and creating an environment where action and networking practice are linked to the foster of capabilities (Ferlie 2022).

In synthesis, innovation in healthcare from knowledge mobilization is an iterative process with a complex network of mediating factors all interacting with each other, through different agents and channels (see Figure 5). The process of innovation is not static and, as it develops, all factors are interconnected. Because one part of the model can alter another part unintentionally, all different components must be taken into account, and knowledge mobilization must depend on the prudential judgment of the people involved in it, in order to achieve better and more effective practices.

Figure 5. Horizontal Model of Knowledge(s) Mobilization. Source: Own elaboration.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work has been financed by the National Council of Humanities, Science and Technology CONAHCYT), through the project 428201, Ciencia de Frontera 2019.

Notes on contributors

Juan Carlos García-Cruz

Juan Carlos García Cruz Ph.D. in Philosophy of Science. Researcher for Mexico in the CONACYT program. Member of the National System of Researchers. Professor in the Department of Economic Production at UAM-X. His main research interests are innovation, knowledge mobilization, national health systems, and social appropriation of knowledge.

J. Alexandre Oliveira Vera-Cruz

Alexandre Oliveira Vera-Cruz Researcher at the Autonomous Metropolitan University (Xochimilco Unit). Member of the National System of Researchers in the Area of Social Sciences, and regular member of the Mexican Academy of Sciences. He currently coordinates the collective research project, funded by the CONACYT: “Transfer of Knowledge oriented toward national health problems: The case of Diabetes”

Notes

1 The search process for the construction of the set of documents analyzed (articles, book chapters, and books) began with the exploration of keywords contained in their titles. The exploration was carried out through the Web of Science platform, where the NEAR Boolean operator was used to restrict the search for articles whose titles had the words "mobilization" and “knowledge” (in English and Spanish). Subsequently, once the summary was analyzed, the documents and studies that referred to the health sector were selected. The need for this operator was due to the fact that the first searches carried out on the platform without it returned a large number of unreliable results (around 500 articles), which showed a universe of article titles that contained the words in question, but they did not make explicit reference to a discussion on the subject and the health sector.

2 The benefits of applying a case study are the use of techniques such as participant observation and interviews, which favor the obtaining of particular data, life experiences, perspectives focused on the profile of the interviewees, positions, and personal reflections. The above feeds each of the phases that are the foundation of the research design.

3 The classification of DM can be established based on its origin and characteristics, among which are type 1 and type 2 diabetes, these being the most common. Type 1 DM was previously recognized as juvenile diabetes because it can commonly present during childhood and adolescence, “it is defined as an autoimmune disease with progressive destruction of β cells, resulting in a physiologic dependence on exogenous insulin” (Chiang et al. 2014, 2034).

4 Data obtained from the CONACYT official website database. Elaboration on Excel and Power BI.

5 The interview “is a method of unique sensitivity and power to capture the lived experiences and meanings of the everyday world of the subjects” (Kvale 2011, 34). Thus, this resource builds a dialogue to understand and interpret the way in which an actor is part of a context, how he lives it and how he interacts with other actors.

6 Glaser and Strauss defined Grounded Theory as an “inductive approach in which immersion in data serves as a starting point for the development of a theory about a phenomenon” (Guillemette 2006). It tends “to generalize in the direction of theoretical ideas, emphasizing the development of theories more than the proof of a theory” (Hunt and Ropo 1995, cited by Páramo Morales 2015). Grounded theory requires identifying theoretical categories that are derived from data by using a constant comparative method (Glaser and Strauss 1967; Hammersley 1989), resorting to the theoretical sensitivity of the researcher. This requires the researcher to compare the contents of various interview or observation episodes with the emerging theoretical concepts of the effort to identify the fundamental themes (Wells 1995; Barnes 1996, cited by Páramo Morales 2015).

7 The HU is subdivided, in turn, into various tools, which are the main components of the program, and that categorize the data according to the researcher’s needs. This subdivision follows an organic development derived from a component of the previous one, it also follows the codification and subsequent analysis of the key elements of the investigation, ranging from "isolated" concepts to complex families.

8 The types of citations that can be used in ATLAS.ti, this according to the six primary document formats that the software supports (since, as mentioned before, the textual format is the most used, and the one of particular interest in this case, but it is not the only one that can be used). Thus, citations can be: Textual: the only ones that offer enough “syntactic clues” to make a frequency search possible within the data. Graphics: corresponds to “a rectangular region within a primary graphic document.” PDF: they can be textual and graphic, and have a special encoding. Audiovisuals: selected from a timeline, their duration may not last more than a few milliseconds. GE: citations corresponding to georeferences obtained from GoogleEarth.

9 Categories can be developed in advance or derived ad hoc during the analysis; they can be taken from theory or vernacular knowledge, as well as from the interviewees’ own language. Categorizing research interviews can provide an overview of large numbers of transcripts and facilitate comparisons and hypothesis testing (Kvale 2011, 139).

10 The use of codes in advance of the creation of the researcher’s own categories is due to the very nature of the code: the capture of a particular but not exclusive meaning that can also serve – in a rather technical sense – to facilitate the search for the citations classified within the code in the event that the information contained – in turn – in said citations is not easy to locate using basic search techniques within a text (Friese 2014, 18).

11 Kvale explains that categorization, by providing a systematization of key concepts, is more likely to be quantified with greater meaning, unlike coding. In addition to grouping the codes related to a particular research question, hypothesis, construct or theme, and facilitating their location within the text, the display of information through categorization begins to lay the foundations for the consequent drawing of conclusions or representation of results (Fernández Núñez 2006, 4).

12 Depending on their composition, the families can be of primary documents, codes, and even notes that have been made during the analysis (Muñoz Justicia and Sahagún Padilla 2017, 55–56). While the codes and annotations can be classified according to their characteristics or even the section in which they are found (in the case of notes), the families of primary documents can be grouped according to the methodology used, the tools or techniques used, the particular case, and even the type of primary document.