Iranian experts’ perspectives on facilitators and barriers influencing the infectious disease knowledge network:  A qualitative study

Abstract

Background

Knowledge networks, such as Communities of Practice (CoP), are essential elements of knowledge management. They play a crucial role in assimilating various knowledge domains and converting individual knowledge into collective knowledge. This study aimed to assess the concept of knowledge networks and identify facilitators and barriers influencing knowledge sharing in infectious diseases, according to Iranian experts.

Methods

This qualitative study employed content analysis and used purposive and snowball sampling. The data were collected via online or face-to-face interviews with 25 participants with diverse expertise in infectious diseases (both clinical and non-clinical), epidemiology, knowledge management, and knowledge-based business management in Iran. The thematic analysis technique was used to code the interviews, and the collected data were analyzed using MAXQDA 20 software.

Results

Thematic analysis of the interviews led to 437 codes. These codes were categorized into two groups: facilitators and barriers. The facilitators shaping the knowledge network for infectious diseases were classified into three main categories: individual factors, organizational factors, and communication mechanisms. Individual factors involved two themes: strengthening knowledge exchange between experts in infectious diseases and personal characteristics such as the criteria for network membership. Organizational factors comprised three themes: organizational and trans-organizational factors, management strategies, and interactions with non-governmental sectors. Communication mechanisms included two themes: the use of information technology and knowledge brokers. In addition, three important challenges were identified as barriers influencing the knowledge network: administration and policy-making, organizational and trans-organizational, and personal challenges.

Conclusions

Several facilitators and barriers influence the formation of an infectious disease knowledge network, which must be addressed to ensure its effectiveness, development, and long-term sustainability. Addressing these factors will enable the network to effectively integrate diverse knowledge and contribute to advancing infectious disease management.

Introduction

Knowledge networks are networks that appear in various forms, such as Communities of Practice (CoP). These networks bring together scientists from different disciplines, fostering tacit knowledge sharing and exchange between specialists in scientific fields. These networks can be created at the organizational and inter-organizational levels and even beyond organizational boundaries. They also offer opportunities to break down professional barriers, address complex systemic challenges, and support professionals. These networks are of utmost importance in the synthesis of diverse knowledge streams from various contributors in knowledge management [1,2,3,4]. These structures facilitate the fluid exchange of knowledge and expertise among individuals and groups, surpassing organizational boundaries to convert individual insights into collective comprehension. These interactive environments cultivate the generation of innovative information, enhancement of pre-existing knowledge, and efficient resolution of intricate challenges [5, 6].

Reliance on knowledge networks is significant in the constantly evolving field of healthcare [7]. Health organizations worldwide prioritize enhancing the caliber, efficacy, and productivity of their services [8]. A crucial element of this commitment involves embracing research-based and evidence-driven decision-making processes [9]. However, efficient and timely dissemination of diverse knowledge into health practice and policy-making requires a new framework for organizing and disseminating the evidence. Central to this framework is the promotion of active participation among physicians and healthcare practitioners in creating and exchanging knowledge, as well as attaining consensus on its practical application [10, 11]. For instance, Chan et al. showed that improving the quality of drug prescriptions in the geriatrics department requires effective communication and collaboration between various specialties in multidisciplinary knowledge networks [12]. Moreover, during the COVID-19 crisis in Canada, inter-organizational collaboration among experts through knowledge exchanges proved to be an effective strategy for collectively shouldering public health responsibilities [13].

However, infectious diseases still pose a threat to people’s health. This risk is exacerbated by the emergence of new pathogens, re-emergence of infections, and environmental and lifestyle-related challenges to disease control [14, 15]. The COVID-19 pandemic has been unprecedented in recent years, with the World Health Organization (WHO) reporting more than 153 million cases and 2.3 million deaths by mid-2021 [16].

Effectively combating infectious diseases requires strategic collaboration and a broad knowledge base. The scientific community, government bodies, non-governmental organizations, and health policymakers must engage in extensive cooperation. However, the lack of coordination and cooperation among all stakeholders and authorities in the control of infectious diseases is one of the most important weaknesses of the care systems in developing countries, such as Iran [15, 17] According to a study conducted in southern Nigeria, managing endemic infectious diseases is significantly hindered by the inadequate application of research findings in policy-making and practice. The creation of knowledge networks and strengthening collaboration between research producers and evidence users have been proposed as possible solutions to this problem. This finding highlights the crucial role of knowledge networks in achieving evidence-based healthcare delivery in these diseases [18].

Although in the field of infectious diseases, there are knowledge networks based on technological tools such as the Global Public Health Information Network (GPHIN), Global Outbreak Alert and Response Network (GOARN), Google Flu Trends, BioCaster, GET WE, and MedISys. These networks use a variety of technologies to collect, analyze, and disseminate data on infectious diseases. They focus on facilitating the exchange of information and expertise among a wide range of researchers, healthcare professionals, policymakers, and the public. However, these networks are transactional, and their members share information and resources based on need [17]. In contrast, networks such as Communities of Practice (CoPs) emphasize the strengthening of cooperation between specialists with common interests and expertise in a particular field. This leads to more stable and collaborative relationships and creates a space for members to engage in meaningful discussions, share their experiences, and develop collective knowledge and skills [1]. In other words, while researchers and other experts play a pivotal role in these efforts, a lack of communication between research findings and health policy can hinder disease control efforts despite the existence of prevention and treatment protocols. Therefore, enhanced coordination and collaboration among healthcare practitioners through the creation and implementation of interactive knowledge networks such as Communities of Practice (CoPs) are essential for overcoming these obstacles in infectious diseases [19].

In this regard, McKellar et al. also emphasized the importance of networked knowledge exchange and capacity building. They discussed the potential costs and benefits of these activities, as well as ways to maximize the benefits [20]. Communication can be improved within and across national borders by strengthening knowledge exchange and forging stronger partnerships between research institutions and healthcare organizations. In turn, this will enhance initiatives aimed at tackling infectious diseases [21].

The purpose of this research was to evaluate the factors that enable or hinder the need and significance of establishing interactive knowledge exchange networks and communities of practice (CoPs) among infectious disease specialists. Given the nature and rapid spread of infectious diseases, the sharing of information, knowledge, and experiences among experts in this field is highly valuable. As a result, the findings of this research are particularly important for infectious disease managers and policymakers, as well as for promoting a community of specialists and enhancing healthcare providers’ grasp of collective knowledge and practices.

Methods

Participants

This qualitative study employing content analysis was carried out in Iran. Semi-structured interviews were conducted with 25 experts, including infectious disease specialists (clinical and non-clinical), epidemiologists, knowledge management experts, and executives of knowledge-based firms) Like companies that produce new services such as medicine, vaccine, medical equipment, etc.). The participants were selected based on purposive and snowball sampling. They met the following criteria: willingness to engage with the research team, holding a degree in fields such as infectious diseases (e.g., a Ph.D. In Medical Virology, Medical Bacteriology, Medical Microbiology, or Epidemiology) or health knowledge management (e.g., a Ph.D. In the Medical Library of Information Sciences), and being actively involved in their respective field. The interviews were continued until data saturation. We conducted a total of 23 interviews, with one interview conducted per participant. After we reached data saturation, two more interviews were conducted to ensure that no new piece of data pertaining to the research topic would be obtained. The interviews were conducted either in person (face to face) at the specialists’ workplaces or online through social networks such as Skype, WhatsApp, and Google Meet.

Data collection

The study used a semi-structured interview guide with close-ended questions to gather information about the study’s goals and limitations (see Appendix 1). The interview guide consisted of two parts: demographic data and the knowledge network and factors affecting it. The interviews were conducted from October to December 2022 and took an average of 30 to 45 min. The participants provided informed consent before interviews after being ensured of the confidentiality of the information. They were also asked to recommend other individuals whom they believed were pertinent to the investigation. In addition, they offered consent to have their voices recorded and were assured of their ability to withdraw from the study at any time.

Data analysis

The data collected from the interviews was analyzed based on thematic analysis. At the end of each interview, we meticulously transcribed the interview in Microsoft Word 2019. Upon reviewing the transcripts multiple times, the initial themes and sub-themes were identified using MAXQDA 20. The coding into major and minor themes was done independently by MO, M, and NA, L. Discrepancies were resolved through discussion with a third reviewer (A, SH). The member check strategy [22] was used to ensure the validity and reliability of the data. Initial codes were shared with some participants to compare and verify the consistency of the ideas generated from the data with their content. Inter-coder agreement was checked to control the validity of the data. After the initial analysis, the researchers re-analyzed the interview texts and combined similar codes and subsets. In the next step, the relationships between subsets were identified and categorized into larger themes. Finally, the main themes of this study were extracted.

Results

The study involved interviews with 25 participants, 20 of whom were male. All the participants were subject specialists. They were actively working as professors and researchers at Iranian universities of medical sciences, and two were managers of knowledge-based companies in the field of health systems. Table 1 lists the participants’ demographics. Initially, 871 codes were examined and then refined to 564 unique codes by eliminating repetitions and consolidating similar codes. Subsequently, through expert assessment, these codes were further narrowed to 437 definitive codes. These codes were categorized into two groups: influential facilitators and barriers (Table 2).

Table 1 Participants’ demographic data

Table 2 Facilitators and barriers influencing the knowledge network of infectious diseases

Based on the data gathered from interviews, the facilitators shaping the knowledge network for infectious diseases were classified into three main categories: individual factors, organizational factors, and communication mechanisms. In total, these categories encompassed seven key themes.

Individual factors involved two themes: “strengthening knowledge exchange between experts in infectious diseases” and “personal characteristics” such as the criteria for network membership.

Organizational factors encompassed factors related to the organization and involve three themes: “organizational and trans-organizational factors”, “management strategies”, and “interactions with non-governmental sectors”. Communication mechanisms involved two themes: the use of “information technology” and “knowledge brokers”. In addition, three important challenges were identified as barriers to the knowledge network: “administration and policy-making challenges”, “organizational and trans-organizational challenges”, and “individual challenges”. Detailed descriptions of these influential facilitators and barriers are provided to offer a comprehensive understanding of their role in shaping the knowledge network for infectious diseases.

Facilitators related to the knowledge network of infectious diseases

Individual factors

Theme 1: Strengthening knowledge exchange between experts in infectious diseases

A primary concern impacting all types of knowledge networks the knowledge network of infectious diseases is the need to improve connections between specialists. According to many interviewees, building and maintaining a knowledge network in this field depends on establishing a robust scientific framework strong scientific platform for specialists to communicate and share knowledge while recognizing different viewpoints, areas of expertise, and skills. By promoting collaboration and interdisciplinary communication, knowledge networks can benefit from diverse perspectives and expertise. This approach allows for a more comprehensive understanding of infectious diseases as specialists can share unique insights and contribute to developing innovative solutions. One participant highlighted the significance of taking immediate action based on the exchange of knowledge among specialists:

“A scientific platform that caters to the elite is highly beneficial. It allows for the scientific communication and acceptance of diverse tastes and specialties, such as microbiology, laboratory sciences, and academic professors of traditional medicine from prestigious universities. This applies to all areas and activities within the platform, ensuring a specific and valid focus.” (P5).

Theme 2: Personal characteristics (Criteria for membership)

The second theme of individual factors among facilitators of the knowledge network of infectious diseases is personal characteristics, e.g., personality, beliefs, behaviors, and attitudes shaping interactions and knowledge sharing within infectious diseases knowledge networks. By recognizing and utilizing these factors, we can enhance knowledge flow, support collaboration, and effectively combat the complexities of infectious diseases.

“It is important to acknowledge the importance of individual agents in every discipline. Despite our perceived abilities and knowledge, it’s crucial to acknowledge the boundaries of our understanding. The desire for group interaction and involvement can significantly affect motivation. Thus, when choosing members, it is crucial to carefully consider individual factors.” (P5).

Organizational factors

Theme 1: Organizational and trans-organizational factors

One of the main facilitators of establishing knowledge networks for infectious diseases is the influence of organizational and trans-organizational factors. These factors encompass the processes, structures, and mechanisms directly impacting the formation and enhancement of knowledge networks. These factors are critical to developing successful knowledge networks that can effectively respond to outbreaks, conduct research, and inform public health policy. As stated by the contributors, these factors are essential for shaping successful knowledge networks. Infectious disease stakeholders can collaborate more effectively to address current challenges and prepare for future threats by recognizing and addressing these factors.

“…Organizational factors are the same as hierarchy and definition of processes, which are very much needed in such teamwork…” (P3).

“To ensure the legal approval of these networks, it is necessary to establish clear organizational frameworks. These frameworks should outline permissible exchanges within each area, ensuring the usefulness of the network for all parties involved. It is crucial to identify and clarify the specific points relevant to individuals and their associated institutions.” (P14).

Theme 2: Management strategies

Effective management strategies can direct the network path, determine the input and output of processes, and regulate them. A key aspect of effective management strategies is clearly defining the tasks and roles of individuals within an organization. This can significantly impact the outcomes of knowledge networks. By assigning specific responsibilities to individuals based on their skills, expertise, and knowledge, managers can ensure that each member effectively contributes to the network’s goals. This can foster a sense of ownership, accountability, and collaboration among team members, thereby improving coordination and communication within the network. Participants P2 and P5 stated the following:

“Effective management policies are crucial for success. Without targeted guidance, leadership, and excellent management, nothing would come to fruition. Conflicts are inevitable when different views and experiences collide.” (P2).

“The management must know how to manage, divide the tasks, hold multiple meetings… interact with them more… If the network management is strong and capable, it can lead the affairs, and, most importantly, the support of top managers from Take these processes “. (P11)

Theme 3: Strengthening interactions with non-governmental sectors

An important factor for the successful formation of knowledge networks is establishing a stronger relationship with non-governmental sectors. Input from those interviewed shows that the non-profit sector can provide several advantages: More efficient and effective research in healthcare can be achieved by working collaboratively with the non-governmental sector, thus facilitating the creation of new products and the provision of high-quality healthcare. This collaboration allows for the transformation of research knowledge into tangible actions and policies that serve to benefit society at large. Moreover, the partnership between knowledge institutions and non-governmental organizations encourages the development of innovative and comprehensive approaches to problem-solving. This partnership empowers societies by driving positive change and promoting inclusiveness. Participant P12 specifically emphasized these advantages:

“The exchange of knowledge between non-governmental companies and academic professionals is currently limited. While there is some exchange on face-to-face platforms, it is mostly through trial and error in the production of products. However, external interactions with companies can greatly impact the effectiveness of research results and the achievement of the knowledge network’s main goals, ultimately promoting network performance.” (P12).

Communication mechanisms

Theme 1: Use of information technology

The use of information technology significantly influences knowledge networks in infectious diseases. The participants emphasized that information technologies help the knowledge network by facilitating the acquisition, assimilation, sharing, and dissemination of knowledge, particularly in generating new knowledge. Information technology has revolutionized research by facil.itating collaboration and knowledge sharing among researchers globally. Online platforms and databases allow researchers to access and contribute to a vast repository of data on infectious diseases, accelerating the spread of fresh research and treatment advancements. They also stated that technological tools supporting a knowledge network should offer a robust infrastructure for managing a comprehensive knowledge base and creating collaborative workspaces. This viewpoint was shared by P10 and P22.

“Technological infrastructure is a significant factor shaping the growth of networks. It is essential for the formation of networks and is widely used in today’s world.” (P 10).

“Specialists rely on this infrastructure to effectively apply technology and build a comprehensive knowledge base through collaborative efforts.” (P 22).

Theme 2: Use of knowledge brokers

Knowledge brokers facilitate and enhance the transmission and communication of knowledge among individuals. Their presence in networks can lead to better communication between members and teams, resulting in successful cooperation. Librarians, as experts in connecting people and information, have a vital role in the knowledge ecosystem of infectious diseases. They facilitate communication and understanding among researchers, healthcare practitioners, policymakers, and the wider community. As intermediaries, librarians facilitate communication and knowledge exchange, ensuring that diverse perspectives and expertise are considered in understanding and addressing infectious disease challenges. For instance, Participants P8 and P1 stated the following:

“The profession of librarianship plays a crucial role in using technology to effectively mediate networks. Librarians can use these resources to form networks and play a significant role in their development.” (P8).

“Unfortunately, our librarians were introduced mostly as book repositories… while as a good source of knowledge, they can be facilitators for these scientific networks… Informants can help in informing and publishing.” (P17).

Barriers to the knowledge network for infectious diseases

Theme 1: Administration and policy-making challenges

According to the participants, a significant barrier to developing a successful infectious knowledge network is the limited understanding of infectious diseases, management difficulties, and policy-making. They emphasized that without a solid understanding of infectious diseases, it becomes challenging to effectively manage and make informed policy decisions. They noted that health organizations struggle to manage and create policies in the field of infectious diseases because managers and policymakers often overlook the shortcomings of these areas. Considering these challenges, the participants suggested that focusing on elements, such as policy and management frameworks, can lead to successful outcomes. For instance, two participants said,

“We have identified a weakness in knowledge transfer within our organization. Therefore, organizations must prioritize both organizational and managerial policies in addressing this issue” (P 15).

“The role of management is important here, and it is better to choose managers who have a lot of general expertise, are impartial, and can invite different people from different disciplines to interactions. The result is empathy and effectiveness of interactions to control and find solutions to challenges for patients and the health system…, something that we do not see in our health system at the moment…” (P10).

Theme 2: Organizational and trans-organizational challenges

Organizational and trans-organizational challenges are the second obstacle to the knowledge network of infectious diseases. Many participants identified structural problems, weak organizational culture, and inadequate infrastructure as major obstacles to forming societies and knowledge exchange networks in infectious diseases. A comprehensive strategy is needed to improve collaboration, communication, and efficiency in knowledge sharing within an infectious disease knowledge network. This includes promoting a culture that values collaboration across different organizations, establishing better ways to communicate and share information, simplifying administrative procedures to facilitate knowledge sharing, and providing enough funding and resources to support the network’s activities. By overcoming these challenges, the network can improve its knowledge-sharing capabilities, resulting in more effective prevention and management of infectious diseases. For example, two participants stated the following:

“We have structural problems and no culture of information exchange and sharing within our organization… Important individuals with knowledge and experience are not given proper attention.” (P 21).

“When we talk about the knowledge network, the infrastructure must be provided first because it strengthens the knowledge in the system. Lack of infrastructure, culture, process, and support from organizational managers for these processes are challenges. If these issues are resolved, it can lead to the flourishing of networks and increased interactions, and we can witness its positive effects on society in the field of infectious disease control and treatment…” (P9).

Theme 3: Individual challenges

One of the main barriers to developing knowledge networks in infectious diseases is individual challenges. The participants identified several problems related to these challenges that hinder the formation of knowledge networks, such as the heavy workload, a lack of a clear definition of knowledge networks for individuals, and social factors. Overcoming these obstacles will foster a collaborative and innovative atmosphere. This environment will enhance our abilities to prevent, identify, and manage infectious diseases effectively.

“Most people don’t want to participate in activities like knowledge networks due to a lack of time… Time limitations can explain why people don’t participate and prefer to do things that are their main responsibility. …“(P4).

“… In my view, this matter remains incompletely comprehended, and what I have failed to grasp is that while many individuals may possess familiarity with the discourse from a scientific perspective, they may lack any practical insights on the subject matter…. They have no background regarding the issue. Now, how can this network be implemented?” (P8).

“Social factors are also important… People’s expectations can affect the quality and amount of knowledge exchange.” (P19).

Discussion

This qualitative study evaluated knowledge networks and identified facilitators and barriers influencing knowledge sharing in infectious diseases. Since infectious diseases are important not only in Iran, but also worldwide, it is crucial to strengthen the scientific foundation of specialists and promote their participation in sharing information and knowledge. The results showed that facilitating collaboration among individuals with diverse expertise promotes knowledge exchange, learning, and innovation. This, in turn, enhances therapeutic approaches and facilitates forming a professional knowledge network and innovation to enhance therapeutic approaches.

The findings demonstrated a pressing problem in healthcare regarding the consistent and effective application of research findings in practice, a dilemma that has persisted for many years [23]. A deficiency in translating research into clinical practice has detrimental impacts, compromising clinical outcomes and the overall quality of healthcare services. Additionally, it leads to the squandering of resources and perpetuates an inefficient and unproductive health system. Deploying effective strategies is crucial to bridging this gap in knowledge applications. Facilitating the exchange of knowledge by creating wide networks with different goals, such as control, prevention, and the development of new treatment methods that include different organizations, professions, and people, is vital to addressing these challenges in infectious diseases [24,25,26].

Personal attributes are another critical factor influencing the development of knowledge networks in infectious diseases. Individual characteristics that vary and influence engagement in a knowledge network have been evaluated in several studies for their impact on knowledge sharing and exchange (27–28).

The findings revealed that organizational and trans-organizational factors are among the most important aspects influencing the development of knowledge networks in infectious diseases. Findings from earlier studies align with this, showcasing that characteristics within organizations significantly influence the distribution and exchange of knowledge between organizations [29,30,31]. This study demonstrates that management strategies and practices play a crucial role in fostering the development and enhancement of interconnected knowledge-sharing networks within an organization. The effective implementation of these processes can significantly enhance the flow of knowledge within the network, making it a crucial factor for the successful launch of knowledge networks [32]. This study highlights the significant role of management practices in driving the effectiveness of knowledge networks. Similar findings have been observed in multiple previous studies [33,34,35].

A recent study suggests that the network of information in infectious diseases can aid a reflective and inclusive approach to improving primary healthcare. It can also provide a platform for discussions, support the transmission process, and facilitate knowledge exchange [13]. The network should include representatives from public and non-public sectors, requiring a mixed resource allocation model involving all stakeholders. Partnering with the non-public sector can provide valuable features, such as skill effectiveness, innovation, technology, motivation, financing, and risk sharing. Public-private partnership is a sustainable financial mechanism for health development initiatives and improves the quality of public services [36]. Hernandez and Zaragoza’s investigation corroborates the desirability of public and non-public collaboration in mitigating healthcare challenges and advancing service provision [37].

The analysis revealed that using information technology, specifically tools that enable streamlined communication and information sharing, holds considerable sway over the knowledge exchange network in the field of infectious diseases. These technologies are pivotal for promoting knowledge sharing, forging connections between individuals and various organizational departments, and mediating knowledge transfer across disparate entities. Therefore, access to these technologies is imperative for the efficiency of knowledge networks, providing the necessary infrastructure to expedite knowledge sharing and transfer within a network [38, 39]. Although information technologies can present risks or threats, such as diminishing in-person interactions and potentially undermining trust and collaboration, their benefits are much more significant [40]. Goh’s research emphasizes the substantial role that information systems and informatics play in enabling expertise sharing and dissemination among professionals [41].

This study suggests that using brokers such as librarians and medical informants can enhance the effectiveness of a knowledge network. These intermediaries act as bridges between scientists, leaders, and policymakers, making communication and comprehension easier. As a result, there is more teamwork, and knowledge is shared more widely. The study recommends that knowledge networks use these mediators more frequently to enhance their overall effectiveness [42]. Several studies have indicated that knowledge brokers facilitate social interactions and participatory processes by focusing on tasks such as identifying, appraising, and translating evidence. These professionals identify emerging problems that can be resolved using the knowledge contained in evidence and documentation [43,44,45].

Regarding the barriers to the formation of the infectious disease knowledge network, the findings from this study suggest that the health system must implement management policies and open scientific frameworks to enhance knowledge sharing and exchange among specialists. Misaligned management strategies or a lack of coherence with organizational goals can be primary factors in the failure of networks and knowledge communities to fulfill their knowledge-sharing and professional expertise goals. Elements such as the provision of organizational facilities, the overarching environment, and the prevailing culture exert significant influence on the efficacy of the knowledge network’s operational capabilities [46,47,48]. Furthermore, this study suggests that specific personal traits can make it harder to build knowledge networks and share knowledge with others. This decreased knowledge sharing can harm collaborative efforts. This presents a significant challenge, as has been highlighted in previous studies.

Limitation

This study encompasses a limited segment of the health research community. Consequently, future studies should meticulously assess and scrutinize diverse dimensions of research in this domain while also considering the perspectives of a wider array of individuals and specialties. Policies governing the use of this network and crucial elements contributing to its advancement should be established based on these evaluations.

Conclusions

The findings underscore the importance of expanding scientific evidence and research in the field of infectious disease. A strong network linking different departments, specialties, and experts from various disciplines is critical for rapid response. Creating such a network requires strategic partnerships with healthcare institutions and non-governmental sector entities while maintaining consistent communication through direct and digital interactions. This study identifies the facilitators and barriers to implementing a knowledge network specifically for infectious diseases. By carefully evaluating the effectiveness and practical applications of each aspect, we can significantly enhance the likelihood of successfully establishing, growing, and maintaining a network. It is essential to recognize and successfully navigate challenges that arise to guarantee a network’s successful establishment and ongoing functionality.