Table 3 Representative quotations from the interview participants

CMO 1: Academic researchers have the flexibility to design programs of research (resource). When academic researchers are self-motivated to move evidence into action (context), they prioritize KT strategies (reasoning) to build a foundation for successful co-production (outcome).

“This is not, at any stretch, an official expectation at the university level that I do this. This is something that I am deeply committed with because I want to normalize these very sensitive drug areas … I want to normalize [mifepristone]. They are one more drug in the armamentarium for women and families in Canada to be able to have some control over their family size and when they want to have kids, so that’s my motivation behind this.” (030, Researcher)

“When I saw [the potential] to take the clinical research I was doing … to a place where we could help everybody in the province, it was an explosion of a pathway for me…. Millions more people will have better care because I can take what I know in this context through [a policy maker] introduction and bring my understanding and my quest to understand better to the people who will be able to use that… I’ve always felt if you are honestly bringing forward high-quality evidence in a logical solution, that’s a win–win for the person you are talking to and the person you are advocating for, that the whole team will want it to work, so perhaps I am selecting research that I am bringing forward to meet those criteria, that the decision-maker is going to want to do this because it makes sense for them to be able to do their job at, usually, a lower cost for better health outcome, for example, or better access for better health outcomes. This is what the decision-makers want to achieve.” (028, Researcher)

CMO 2: Researchers have professional relationships and reputations (resource). When the reputations and relationships with key knowledge partners have a long and positive track record (context), the knowledge partners will be predisposed to trust researchers (reasoning), giving researchers improved access to knowledge users for KT activities (outcome).

“I would say it was the very proactive relationship building that [a CART leader] did with policy makers and policy makers who preceded me and who followed me … That then allows this type of response to be quite organic and quick. Because we already knew each other, we already had a relationship of trust and respect for the work done by the CART team, so when information about the regulations for [mifepristone] were brought forward, the information exchange was very fluid.” (034, Policy maker)

“You recognize that people aren’t in there for their own personal gain and credibility and consistency of messaging, and just by association, when people who are recognized and work for the university and they have academic interests, that all helps to build that. Then if there’s a personal link, like for us to [a CART senior investigator], which reinforces the trusting relationship. Then when all the conversations become clearly that we are all very like-minded in this, then we move much more quickly.” (036, Health care professional leader)

“One reason why all these actually scientific organizations were supportive is that all researchers in the CART-GRAC group are part of these particular organizations… it helps a lot when you are really already part of the organization for a long time.” (026, Researcher)

“I think the knowledge that we were working to gather in this project with our national professional groups, I think that was credible or gave us credibility. I also think the fact we are affiliated with universities, provides some credibility, and we are generally pretty well-known….and we had no vested interest in this in the sense that, you know, we are not a pharmaceutical company. We are somewhat of an advocacy group, but I think they were fairly acknowledging of the fact that we were pretty rigorous in science, you know, grounded in scientific and science, whatever evidence there was in what we were saying.” (032, Researcher)

“[CART research] appears rigorous to us in the way that it’s done. Being in the planning meetings, we’ve seen the inner workings, but even before that, you know, there’s a lot of published papers, and it’s peer-reviewed. Getting to know the researchers over time, they’re, just seeing the ethics and personalities and the motivations of all of these researchers that we’ve been interacting with over the years in the abortion kind of realm inspires trust, for sure, and then because it also aligns with our experience of the frontline… [CART investigators are] abortion providers and healthcare practitioners themselves, so also knowing that they have a deep, intimate knowledge of the practice and who they interact with, yes, I think all of that kind of nourishes this really deep trust. The fact that they want to put their research at the service of community health in dynamic collaborations with civil society and bettering people’s health, to me, that also inspires trust, for sure. Like, there’s a real, I get a real sense that they’re committed to using their capacities as researchers to really make a difference.” (021, Advocacy group leader)

CMO 3: Researchers are strategic ‘evidence advocates’ (resource). When other key groups face challenges that make action on a public health issue difficult due to political sensitivity and/or stigma (context), they perceive researchers as strategic partners (reasoning) and participate in iKT (outcome).

“Those [competitive dynamics between NGOs] that come to play, just in terms of who is speaking out and who seems to be speaking out on the [mifepristone] front. There is always a bit of tension around who is getting the media attention and not. That is why I say that [a CART leader] has played a good role, because [she] is not associated with an organization.” (021, Advocacy group leader)

“When we get a request for an evidence brief, we typically engage four to 12 experts across disciplines and some clinician researchers, some academic researchers according to the question that we’ve been asked, and I will typically take the question from the knowledge user, draft a point form, ‘Here’s the points I am thinking of for this evidence brief to answer this question. What do you think?’ People give their responses, and they send paragraphs. Then we put it together into a one- or two-page summary and then circulate it to the team. There might be health law people as well as anthropology people and pharmaceutical sciences, whatever, all of the different components, and then everybody approves. Then it goes to the knowledge user. We’ve got a phenomenal team. They’re so responsive that we are able to turn around two drafts in 24 h and get a final product in.” (028, Researcher)

CMO 4: Health policy is defined in laws, administrative guidelines, court rulings, programs, practices, and procedures (context). When researchers understand the processes governing a particular issue (resource), they can design KT strategies that target specific policy levers and policy windows (reasoning) to support evidence-informed policy change (outcome).

“Internally, even at the political level, even in the previous government, it was very much, ‘You need to make sure that you’re making sound scientific and technical decisions.’ It really didn’t change, and I know that might be hard to kind of believe, but in terms of the decision-making, it didn’t change. I think what the politicians may do around promoting that or using that to kind of further engage people or find support, I think that’s something that’s separate, but on the actual pure decision-making, it was always grounded in what we will do as a regulator, safety, efficacy, quality, looking at international experience, and making decisions that were really grounded in the Canadian health system.” (007/038, Regulator)

“We weren't worried about that [anti-choice voice] because the level of their discourse wouldn't sway [the regulator], who was just looking at the evidence. The degree of so-called evidence that the anti-choice have, for example, that [mifepristone] is ‘dangerous’ is inaccurate or out-dated.” (022, Advocacy group leader)

“I think we were concerned about the [initial physician-only dispensing] requirements, but I think what subsequently happened when we started digging around, we found that, in fact, it wasn’t going to work anyway. I think that that was part of the homework that we did. I don’t think this would have arisen as quickly if we hadn’t been digging around in our own jurisdictions for what the implication was for this requirement. For instance, in Ontario, I remember having the discussion with [the health professional regulator] about this. ‘This is the issue about physician dispensing, ordering and dispensing,’ and he said, ‘We do not encourage our members to do that, but it’s not completely against the regulations and the requirements. There’s some fairly onerous requirements about record keeping and stuff like that that we would expect physicians to do,’ so it became clear that this was going to be a real hurdle, but there was no absolute prohibition for it. That was not the case I think it was BC where they said, ‘We think this is a real problem. Actually, our physicians aren’t allowed to [dispense]’.” (026, Researcher)

“I think with a lot of files, especially with files that involve regulation but then also provision, the federal and provincial becomes very difficult to navigate. The medical community on this one got it right. I think it’s often rare for people to understand the complexities of that, but it’s very impressive how everybody mobilised and understood the different levers and who can do what and what the limitations were of certain roles. It was quite impressive to see a medical community that had organized itself well and that understood the process of governing when it comes to regulatory process.” (009, Policy maker)

“Just give you a perspective on how the office works, is that you do a media review every single morning. There are entire teams dedicated to media management, so from my perspective, media is incredibly effective in this country at raising issues. It would have affected at least our temperature on the situation. I think that when things are published and they show up in The Globe and Mail or their front pages, you do start to pay attention to that because you know that other people are going to be asking questions about it, so it definitely changed our interest in the topic.” (009, Policy maker)

“Part of the key to getting the introduction [with Health Canada] came with presenting research in the media and being widely cited across a broad range of print and TV media as Canada’s expert showing gaps in government policy. The Canadian Minister of Health, we were writing to [them] at the same time, but not being able to establish a relationship, but once we went in the media, the Minister’s staff reached out to us for invited evidence briefs.” (028, Researcher)

“So we were able to work with [CART] on a couple of questions when we wanted to get specific answers on issues, and we had access to that…it was very useful in terms of having that real-world experience at that sort of level of detail and granularity and independent data and information not influenced by the [pharmaceutical] company.” (038, Regulator)

CMO 5: Health policy is developed with input from key groups selected to align with the mandate of the decision maker (context). When researchers convene an iKT coalition and involve key groups to co-produce evidence (resource), the decision maker has an increased understanding of and confidence in the evidence (reasoning) supporting policy change (outcome).

“We have been, basically, amplifying [CART] voices, making sure it gets out there on social media, encouraging our supporters and members to write letter to [the regulator], or just spreading the word.” (022, Advocacy group leader)

“I feel like it was a very dynamic, kind of fluid process where all of our demands were shaped by the work that is done by CART, by their commentary, by the information they supply us with, of course with our own analysis because we run a frontline service” (034, Advocacy group leader)

“We tend to be more out there in the media or something or criticizing, you know, groups and making demands and things like that. Whereas, I think a group like CART-GRAC or [an international abortion advocacy organization], they actually work to establish a relationship, for example, with Health Canada and have meetings with them, sit down and work out the problems that way. That is just the difference between working within the system to improve policy or being a political advocate and fighting for a cause, I guess.” (022, Advocacy group leader)

“I think the fact that we were a team from so many provinces with a very experienced group and the support of [key organizations], you know, the whole group together, it gave confidence to [the regulator], I think, to make these changes and being secure with these changes.” (026, Researcher)

“If there was some sense that [the regulator] thought that it was a good idea to have a new kind of wording for this, then we could help relay that information maybe from our perspective, advise the company about the kind of wording that, in fact, we thought was maybe appropriate or would be more helpful or whatever, so I think that being sort of a conduit or maybe a connecter between regulatory people and [industry] and maybe even the colleges as well, you know, sort of flowing information back and forth between them. I think probably CART did that but packaged the information in a way that really made the case for the changes and in a clear and cogent way.” (031, Researcher)

“There was actually a distinction between the work of CART and the [pharmaceutical] company. I know that was sort of separate, but at least outside of CART but through organizations, there was a relationship with the company as well, so I think that worked well in that the research part of it was kept, there was a level sort of structural integrity that was kept independent from the company, but there were still kind of links from whether it was a researcher or from other stakeholders to the company, so I think that worked well because, again, there was a degree of separation, but it wasn’t a complete disconnect from the company.” (007, Policy maker)