The greatest barrier for translating knowledge into successful interventions that have meaningful impacts on people and populations is not needs finding.  It isn’t need-finding.  It isn’t needs analysis, problem statements, or prototyping.  It isn’t evaluation, iteration, or even demonstration.  It’s the implementation–and more specifically people. 

Now it is important to specify that all those other steps are incredibly important aspects for successful innovation (the translation of knowledge into practice), but at the end of the day, when a new vaccine comes on to the market and the unvaccinated individual who does not wear his mask over his nose because he believes that it is part of a government conspiracy to make people into sheep, it isn’t the efficacy of the vaccine, the science, testing or regulation that reduces the impact of the science–its a lack of understanding, ignorance, and misinformation that can mobilize masses against what should be an obvious decision for individuals and the greater good of society.  

Much of my time I spend thinking about the principles and practices of mobilizing knowledge, of creating systems and programs that support innovation to help others advance human health.  The mantra that I have adopted and continue to perpetuate is that we must always start with the person or people we are trying to help–that we should always check our egos and verify our assumptions.  Whether we are trying to address a clear and existing need or trying to develop an innovation that people don’t yet know they need, starting with people is key to developing things that people want and use. 

But what if the people you want to help do not want your help?  What if there is a subset of people you are trying to help who, through their action or inaction are reducing the value of innovations for the greater population?  What if the buy-in you are looking for is not there?  How do you understand and work with the people who do not want to work with you–and perhaps even want to work against you? 

Policy and legislation are of little help without solid enforcement.  The other day I asked a young man to please place his mask over his face while ordering food indoors.  He was standing next to a bylaw notice clearly stating how a mask should be worn to protect the public.  He answered me with expletives and asked “Who appointed you the mask-police?”  In between further expletives, he recounted now familiar propaganda like “Its a government conspiracy for the Sheeple,” “If you think the vaccine works and are double vaccinated, why do you care if I am or how I wear my mask?” “If you call the police, I’ll be long gone before they arrive.”  Most of my following arguments were met with “Baaaa’s” or repetitions of the above tropes.  When he finally left with his food, he shouted more ignorant slurs and expletives. 

On the one hand, the exchange could have been seen as comical, on another very uncomfortable–most of the other people in line–all wearing masks said nothing.  But in a very real sense, the exchange demonstrated an age-old concern of democracy–that democracy is tied to people’s understanding of the issues, their level of education, and their commitment to the great public good over their concerns.  There is nothing new here. 

From the perspective of innovation, however, this exchange highlighted for me the upcoming battle for knowledge translation, the often underappreciated force of counter-innovation: misinformation and its relative, information literacy.  Implementation, and more specifically people are ultimately the greatest barrier to innovation diffusion.  Perhaps this understanding is as important when starting Translation as understanding there is a “real” need for what you are trying to accomplish. 

Joseph Ferenbok for TRP | November 2021