Table 1. Comparison of integration of three types of knowledge in six initiatives.

Initiative, country, study period	General details	Integration
		Systems knowledge	Target knowledge	Transformation knowledge
One Health initiatives
West Nile Virus surveillance, Italy, from 201343	Inter-institutional working groups of local and regional authorities in human, animal and environmental health, covering Emilia-Romagna, Lombardy and Piedmont. Implementation of integrated surveillance of birds, horses, humans and mosquitos, including sampling protocols, technical procedures, data-sharing agreements and public information campaigns.	Comprehensive conceptual framework, multispecies sampling protocols, data sharing and linking of information in interdisciplinary groups allowed for integration of systems knowledge. Dissemination to the general public promoted via seminars and educational activities.	Shared leadership fostered integration of target knowledge. Objectives and targets, for overall initiative and individual expert teams, were well defined. Lack of funding for specific targets demonstrated the incomplete alignment of objectives between central and local levels. Institutional set-up lacked flexibility for adaptation.	Strong institutional backing and complex and competent actor network facilitated legitimacy, implementation and resilience. Joint field activities created a team spirit and fostered communication. Annual plenary meetings improved effectiveness. However, public involvement and accessibility of transformation knowledge were considered limited.
Opisthorchiasis control in Lawa province, Thailand, from 200544	Longstanding research track at local university complemented with community-based integrated surveillance, parasite sampling in fish, human screening, medical treatment and education campaigns targeted at public and schools. Linked to international helminth control programme.	Research on opisthorchiasis endemicity and human prevalence. Collaboration with community members for data collection and dissemination fostered integration of local systems knowledge. The need for a more integrated surveillance approach, to understand transmission dynamics, was recognized.	An iterative approach, to facilitate mutual learning in local communities, resulted in an increasingly broad scope and comprehensive objectives. High level of local commitment and collaboration indicated a strong alignment of target knowledge between initiative and all local actors and stakeholders.	Transformation knowledge integrated via collaboration with, and capacity building in, local hospitals. Education strategies for communities and schools aimed to foster transformation knowledge among general public. Production of manuals should allow replication of approach.
Strategic plan for implementing One Health, Kenya, from 201145	Establishment of interministerial committees and task forces in charge of programme development, e.g. a national influenza task force, a zoonosis technical working group, One Health zoonotic disease units at central and peripheral levels and a One Health task force covering central and eastern Africa. Establishment of One Health offices within disease units and a national One Health secretariat.	Joint situation analyses of zoonotic diseases and the adoption of a One Health approach in routine and/or emergency activities fostered a shared understanding of systems knowledge.	Development of a One Health strategy/action plan strengthened common vision and direction at operational/institutional level. Inadequate funding for coordinated activities and lack of political will indicated insufficient alignment of objectives between initiative and high-level decision-makers.	A lack of institutional arrangements for coordination and collaboration between the line agencies and operational departments indicated that networks for collective action needed to be strengthened.
Other initiativesa
Review of complex intersectoral services for child protection, the United Kingdom, 2010–201146	Analysis of entire child-protection system to review and improve service provision at national level. Collaborative integration of evidence with stakeholders across entire chain of interests and responsibilities: affected individuals, charities, family proceedings courts, local institutions, national department of education and professionals.	Authorities and stakeholders jointly defined 60 relevant variables, and provided evidence on their relations, interactions and feedback loops. There was integration of systems knowledge through personal interactions, facilitated by joint building and analysis of system dynamics models. Group understanding developed in joint model analysis and validation.	Target knowledge was integrated via analysis of actor targets, as determinants of system behaviour.	Integration of transformation knowledge supported by joint definition and analysis of scenarios for transforming the activities and structures of the child-protection sector. Trust, networks and collaborative capacities for implementation were strengthened across hierarchies and sectors.
One Health surveillance and control, Canada, 2010–201247	Analysis of integrated Lyme disease surveillance and control strategies to support decision-making and programme direction of public health authorities in Quebec. Collaboration with five national and regional authorities in agriculture, environment and public health. Actor perspectives on 11 strategic option’s effects on 16 target criteria were analysed under emerging and epidemic outbreak scenarios.	Focus groups, expert interviews and literature review facilitated integration of systems knowledge by joint problem definition and performance assessment of strategic options.	Target knowledge was integrated by defining targets in dialogue, discussion and reflection, by the elicitation and systematic analysis of stakeholder institution’s perspectives on target weights for animal, environmental and public, health, economic, operational, social and strategic impacts and surveillance, and by joint reflection on, and validation of the resulting multicriteria assessments.	Supported integrated transformation knowledge through joint elaboration of strategic options and target criteria, indicators and scales that were relevant to pertinent authorities. Participation in research, analysis and data analysis built collaborative capacities, networks for implementation and trust.
Intercultural collaboration for integrated health, Guatemala, 2012–201548	Analysis of impacts, of a facilitated transdisciplinary approach, on trust, networks and mutual learning among biomedical doctors and traditional Maya healers. All in a country where structural violence hampers the development of integrative health systems. Collaborative referral designed to integrate different health systems in patients’ health-seeking pathways.	Integration of systems knowledge facilitated among practitioners via joint design and validation of empirical research on barriers to integrative health services. Group understanding was developed through workshop techniques and the changes in perspective that occurred during joint fieldwork.	Integration of target knowledge was supported through increased understanding of the perspectives of other participating actors and via negotiation of the characteristics and objectives of the transdisciplinary approach.	Integration of transformation knowledge was supported by strengthening collaborative capacities, by an improved understanding of viewpoints of other actors which in many other projects remain hidden because of the segregation of institutions and sectors, and by the joint development, implementation, and assessment of pilot models for institutional and operational transformation.

^a Initiatives that applied specific knowledge integration approaches in fields of relevance to One Health.