Sarah received her PhD (2016) in Interdisciplinary Studies at the University of British Columbia. Her work involved integrated knowledge translation with stakeholders on women’s decision-making related to C-sections. The dissertation featured a chapter on knowledge translation as well as a policy brief, which was taken up by health authorities.

Birth After Caesarean: An Investigation of Decision-Making for Mode of Delivery

Non-traditional content: policy brief in a public health dissertation. 

Mentors/collaborators: patients, health providers, and policy makers in BC.

Could you describe your dissertation topic to us? In what ways was your dissertation non-traditional/innovative in your field?

In spite of best practice guidelines, caesarean section rates have been steadily rising in Canada since the 1990s. I was interested to explore why this phenomenon was happening and what strategies might support patients and care providers to choose non-surgical birth options. I partnered with patients, providers, and policy makers throughout my dissertation process to create a feedback loop – as I generated evidence about the topic, partners would apply it to policy and practice, and in turn provide me insight into how to refine my research questions and methods. Together we co-wrote a policy brief, which formed one chapter of my dissertation. Partnering with health system decision makers and co-authoring a policy brief together was innovative and non-traditional, but this “integrated knowledge translation” reflects the increased demand for researchers to create evidence that is meaningful and useful for the public good.

As you conceived to follow this path, what was the reaction of the key actors in your university (such as your supervisor, committee, department, other)? Did you receive any resistance?

When applying to graduate schools, I sought out programs that would support me to conduct an “integrated knowledge translation” dissertation. My supervisors and committee members all conducted applied health services research, and my Interdisciplinary Studies Graduate Program had a long history of encouraging non-traditional dissertations, particularly in the health sciences. Rather than expressing any resistance, my committee and graduate program encouraged me to pursue a novel approach, build relationships with policy makers, gain a shared sense of the problem, and collaborate on a policy brief that would have impact with decision makers.

How do you think your non-traditional dissertation helped you develop professional competencies and prepared you for academic/non-academic career prospects? 

Through my dissertation, and now my postdoctoral fellowship, I have worked in a liminal space between academic and non-academic environments. Knowledge translation and implementation science involve complex, overlapping contexts and my dissertation helped me to develop skills for working between these environments – facilitation, communicating for different audiences. In a typical day working on my dissertation, for instance, I might conduct a one-on-one interview with a physician, co-present to a health authority committee with my nurse educator collaborator, meet by videoconference with my patient advisory group, and code qualitative data with my supervisor. A great deal of the preparation for my career was in building the language and situated knowledge for collaborating with different stakeholders. Our relationships are the most valuable product of my dissertation.

Did you face any challenges regarding the evaluation of your dissertation (such as from the external examiner)?

My examining committee, like my supervisors, consisted of individuals who had experience with conducting applied health services research. They adjudicated my dissertation (including the policy brief), according to rigorous methodological standards. To ensure that my study design choices were defendable, my supervisory committee had encouraged me to write two methods chapters – one on my traditional qualitative design and one on my integrated knowledge translation methods. My examination was intense, but it was the highlight of my PhD. I could not be prouder of the work that my committee, stakeholder partners, and I put into this project. My external examiner reflected that our integrated knowledge translation approach was “a novel (and commendable) approach for a doctoral thesis and is likely to have an impact not only on the discipline but also, and perhaps more importantly, on practices within the study setting.”

What would you have done differently if you could do it all over again? What advice do you have for doctoral students who would like to produce a non-traditional dissertation?

The one thing I wish I could have done differently is to make more time with my policy maker partners, earlier in my degree. Face-to-face meetings, shadowing, and ethnographic observation are different strategies I might have used. These in-person interactions are where knowledge is co-created, and researchers can gain an understand of how evidence will be used in different contexts. Put simply, these partners are also my co-workers. We talk about our families, our career aspirations – the things that are part of any work culture. Having time together in-person helps to forge meaningful relationships and make our collaborations that much more enjoyable. This is something I have had the time and capacity to do more of during my postdoctoral fellowship. For doctoral students that wish to produce a non-traditional dissertation, the greatest lesson came from my supervisors: work with the right people. Interview your potential supervisors and committee members to see if your idea is feasible and a “good fit.” Are they willing to support your novel approach? Will it be an appendix to your dissertation or a central component? Will it be something you conduct off the side of your desk or part of your daily doctoral work? What additional skills or coursework will you need? And importantly, will you enjoy collaborating on this together? At the same time, listen to their expertise. My supervisors helped guide me to complete a defendable, publishable dissertation on time and within budget. The ideas that were not feasible to pursue in my dissertation did not go away, instead they became part of my research plan and the foundation for the next phase of my career.