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the main menu, We focus on all things knowledge translation (KT) and patient engagement (PE), from a health research and healthcare perspective. 2014, 9: 54-10.1186/1748-5908-9-54. A total of 146 papers were identified as attributing use of the KTA Framework. Lost in knowledge Translation: time for a map? Nine were published in peer-reviewed journals with the exception being a Master of Science degree dissertation [19]. Article However, we were interested in the real-world application of the KTA Framework as a guide to implementation activities in health care and whether it was used in a way that was true to the framework. The quality of reporting was assessed using criteria adapted from Carroll and colleagues [16]. Firstly, there is a risk of bias and subsequent error given the lead author conducted most of the initial screening, all data extraction and synthesis. A notable feature of the KTA Framework is the development of knowledge tools or products as part of Knowledge Creation. A secondary concern was theory fidelity [13], which relates to how this conceptual framework was being used in practice, specifically whether the KTA Framework was articulated in a way that was true to the source paper [1]. It was cited 470 unique times across all databases. Adapted from Graham 2006 (https://pubmed.ncbi.nlm.nih.gov/16557505/) by Crockett 2017 (https://medium.com/knowledgenudge/kt-101-the-knowledge-to-action-framework-7fbe399723e8). Perhaps more significantly, the KTA Framework is associated with the Canadian Institutes of Health Research [27]. For example, the creation of websites, interactive e-learning modules, training packages and a protocol were reported as part of the Action Cycle [19],[23],[24], yet they could be knowledge tools/products. The data were extracted from the integrated studies where the KTA Framework was applied in practice. 2013, Wiley-Blackwell BMJ Books, Oxford, 2, Book 1, Lgar F: Assessing barriers and facilitators to knowledge use. J Eval Clin Pract. Each study demonstrates the particularity of implementation activities. Future research could examine the studies which we categorised as using the KTA Framework to a lesser degree, perhaps for conceptual or persuasive reasons rather than instrumentally. Menon A, Korner-Bitensky N, Kastner M, McKibbon KA, Straus S: Strategies for rehabilitation professionals to move evidencebased knowledge into practice: a systematic review. However, adaptation of guidelines also runs the risk of deviating from the original evidence base to address this, a systematic approach to guideline adoption has been developed by a Canadian collaboration called ADAPTE [4]. The knowledge to action cycle is one framework for knowledge translation that integrates policy makers throughout the research cycle. Jacqueline Tetroe MA, 2012, 7: 50-10.1186/1748-5908-7-50. Methods Monitoring the use of knowledge is critical in understanding how and to what extent the KT strategy has had an impact on outcomes (the next phase in the action cycle). Reprinted with permission from John Wiley and Sons. As Kate has described previously, knowledge synthesis (second generation knowledge) involves synthesizing results from individual research studies and interpreting them within the context of global evidence. J Behav Med. Furthermore, knowledge can inform each phase of the action cycle and the knowledge funnel can rotate to feed into different phases. The Knowledge to Action Cycle (KTA) breaks down the implementation process into 7 actionable phases starting with determining the knowledge-practice/policy gap through to sustaining the change. Moving from Evidence to Practice. 2010, 5: 92-10.1186/1748-5908-5-92. BF is a researcher at the School of Health and Related Research (ScHARR), University of Sheffield, and also an occupational therapist. The prevalence of the Action Cycle may simply reflect the cyclical nature of the change process evident in other common, quality improvement tools such as the Plan, Do, Study, Act cycle [30]. The search strategy was limited to citation searching of three databases. Citation searching for the original reference by Graham and colleagues [1] optimised the sensitivity and specificity of the search strategy. 60612, One Illini Drive Data for each phase were then synthesised across studies to help understand how the framework had been used in practice. This flexibility was intended, as Graham and colleagues [1] state the framework can also accommodate different phases being accomplished by different stakeholders and groups (working independently of each other) at different points in time (p. 18). Only ten studies reported and gave supportive examples of incorporating the KTA Framework in an integrated way. A few authors have attempted this, such as McEvoy and colleagues [43] who examined benefits reported by authors using the Normalization Process Theory. (Dignan, M.B & Carr, P.A. Box. 2012, 7: 87-10.1186/1748-5908-7-87. 10.1046/j.1365-2648.2002.02150.x. 2014, 11: 26-34. Citation searching seeks to optimise sensitivity and specificity when seeking to identify reports of practical applications of a model or framework. The purpose of translation is to provide the best outcomes and value, and lower risks to our patient population. For example, in the context of clinical practice guidelines (CPGs), adapting existing national guidelines (which may lack applicability and how organizations need to change to adopt guidelines) to fit local circumstances serves not only to increase the relevance and applicability of guidelines, but also gives end-users a sense of ownership to help promote implementation. Within KTA, knowledge creation - or the production of knowledge - is composed of three phases: knowledge inquiry (first-generation knowledge), knowledge synthesis (second-generation knowledge), and creation of knowledge tools and/or products (third-generation knowledge). However, as shown by our study, citation searching in isolation from citation analysisthe detailed examination of full-textis unable to discriminate between where a model is simply mentioned in passing or even for cosmetic reasons and where it represents an explicit intellectual and conceptual contribution. Manage cookies/Do not sell my data we use in the preference centre. In ten studies, the KTA Framework was integral to the design, delivery and evaluation of the implementation activities. Citation searches were limited to the period from 2006 (the date of publication of the source paper) to July 2013. Two studies reported using all phases of Knowledge Creation [20],[26] (see Table 4). Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, Lamb SE, Dixon-Woods M, McCulloch P, Wyatt JC, Chan A-W, Michie S: Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Field, B., Booth, A., Ilott, I. et al. 2004, 19: 297-304. All authors read and approved the final manuscript. 2002). Michie S, Prestwich A: Are interventions theory-based? It may be useful for them to consider the extent to which they wish to follow or be guided by a conceptual framework before embarking on a knowledge translation project, especially regarding outcome measures because .the focus of knowledge into action is ultimately to enhance health status [1 p. 18]. Provided by the Springer Nature SharedIt content-sharing initiative. Knowledge Translation Portfolio, Canadian Institutes of Health Research, Ottawa, ON, Canada. So in terms of doing theory-informed KT, as the saying goes if you dont have time to do it right, when will you have time to do it over?, *ISLAGIATT: Attributed to Dr. Martin P. Eccles. 10.1002/chp.47. Ullrich PM, Sahay A, Stetler CB: Use of implementation theory: a focus on PARIHS. Upper Saddle River, NJ: Prentice Hall. Others argue that the effectiveness and generalisability of implementation studies are hindered by weak theoretical underpinnings [40],[43],[44]. All these described the Action Cycle and seven referred to Knowledge Creation, articulating the KTA Framework in a way that was true to the source paper [1]. The knowledge to action (KTA) process proposed by Graham et al (2006) is a framework to facilitate the development and application of research evidence into clinical practice. 2011, 71 (Suppl 1): S20-S33. Privacy Part of 61656, Rockford, The uptake of EBP is a complex process that can be facilitated by the use of the Knowledge to Action Process model. Knowledge Translation in Health Care: Moving from Evidence to Practice. Most studies illustrate how knowledge was adapted to the local context. We sought to identify all reported citations of a particular reference irrespective of the context within which that reference had been used. Article Over time, barriers to knowledge use may change from those initially identified, so sustaining knowledge use includes an ongoing feedback loop that cycles back through the action phases. On this basis, all ten studies were judged as having described their projects clearly. The inclusion criteria were based on an affirmative answer to two questions Does the paper describe a KT project? and Is the KTA Framework a fundamental guide to this project? The initial sift phase was carried out by one researcher (BF), with another researcher coding a proportion of these (II). Citation searching can circumvent the problems of variation in terminology (a retrieval problem) or uninformative abstracts (a reporting problem) typically encountered in topic-based searches of bibliographic databases. The framework has two components: Knowledge Creation and an Action Cycle, each of which comprises multiple phases. 2012, 8: 174-84. (2010). The KTA model lines up with KTDRR's goals. Most studies created a range of products, either as part of Knowledge Creation [18],[20],[21],[26] or the Action Cycle [21],[23],[24]. Bartholomew LK, Mullen PD: Five roles for using theory and evidence in the design and testing of behaviour change interventions. These goals are to increase (a) the use of evidence-based research and (b) the understanding and use of KT principles. Duplicates between records from the databases were identified and the most complete record was retained for the subsequent sift process. Our study had several limitations. Cite this article, Conceptual frameworks are recommended as a way of applying theory to enhance implementation efforts. The relation between knowledge and action. Tugwell and colleagues [26] highlight this particular challenge, commenting that most outcomes in arthritis research are about pain and function. IL Implementation Science A citation search of three databases tracking the source paper Lost in knowledge translation: time for a map? identified 1,787 records between 2006 and July 2013. Kitson AL, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A: Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. The Knowledge-to-Action (KTA) framework provides a logical structure and process to plan IS projects. Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework. A coding scheme, with 19 categories for theory use for behaviour change interventions, ranging from mentioned but not demonstrated, right through to theory refinement, has been developed [41]. Child Health, Health Equity, Integrated Knowledge Translation, Canadian Institutes of Health Research (CIHR, https://www.ncbi.nlm.nih.gov/pubmed/16557505, practical guide to designing a KT intervention. Stacey D, Higuchi K, Menard P: Integrating patient decision support in an undergraduate nursing curriculum: an implementation project. Single studies at this stage are not ready to be translated into practice on a broad scale, but are necessary to inform future research and feed into the larger evidence base. This illustrates the adaptability of the conceptual framework to different health care settings and topics. Article 2012, 69: 123-157. (2006) proposed the knowledge-to-action (KTA) process conceptual framework that could be useful for facilitating the use of research knowledge by several stakeholders, such as practitioners, policymakers, patients, and the public. 61107, 102 Medical Sciences Building, 506 S. Mathews, Urbana, Secondly, multifaceted strategies are more likely to be successful than a single strategy [27],[46],[47], as they target different barriers [40], which reflects our interest in the real-world use of the KTA Framework, where it is probably impossible to control and isolate one strategy [48]. This article presents independent research by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Yorkshire and Humber (NIHR CLAHRC YH). PubMed Central 10.1177/1077558711430690. The taxonomy enabled us to refine the inclusion criteria to identify studies that reported explicit application of the KTA Framework. BMJ Qual Saf. Implementation researchers and health professionals can learn from this flexibility. 2009, 33: 82-88. https://doi.org/10.1186/s13012-014-0172-2, DOI: https://doi.org/10.1186/s13012-014-0172-2. How have you used the KTA Framework in your own work? All ten studies reported applying the Action Cycle, describing at least five of the seven possible phases (see Table 5). 10.1002/chp.179. Knowing your audience and assessing the value, usefulness and appropriateness of the particular knowledge is critical to its uptake and sustained use. Harrison, S.E. The index citation for the source paper for the KTA Framework Lost in knowledge translation: time for a map? by Graham and colleagues [1] was identified on each of three databases that offered functionality for citation searching. Yet the albeit limited, evidence available indicates that bringing information close to the point of decision-making (such as using reminders or decision support tools) is likely to be more effective than using more traditional educational strategies (such as study, teaching or training) to try to address barriers and change practice [31],[33]. The KTA Framework was adapted to different health service settings and resources, indicating a good fit for the diversity of real-world health care. Google Scholar. The Knowledge-to-Action Process The Coordinated Implementation Model The Stetler Model of Research Utilization Conner's conceptual model for research-utilization evaluation Publication Date: August 2007 Copyright 2007 The Board of Regents of The University of Wisconsin System. Implement Sci. Implement Sci. 10.1007/s10865-010-9260-1. Molfenter and colleagues [23] describe a strategy to assist clinicians with patient selection which could be interpreted as seeking to influence organisational barriers such as competing priorities, as well as addressing knowledge-related barriers. Crosby R, Noar SM: Theory development in health promotion: are we there yet?. Knowledge Translation in Health Care: Moving from Evidence to Practice. Translation - Moving the best evidence into professional practice. Google Scholar references often included an incomplete text fragment rather than a more traditional abstract. Two researchers (BF and II) conducted an initial assessment of the full-text articles. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 2012, 28: 258-61. Claude and colleagues [17] stated that these phases were beyond the scope of their project. Most studies (8/10) were conducted in Canada where the KTA Framework originated. Our findings support this proposal. We did not assess the research rigour of the individual knowledge translation projects. Rather, papers typically stated aims and objectives, which often related to closing evidence/knowledge-practice gaps. Measuring this practice gap can include the use of administrative data, questionnaires, or conducting chart audits, to name a few. Based on knowledge to action, there were 3 phases to the study implementation: problem identification (lack of routine checklist use in Cameroonian hospitals), multifaceted implementation strategy (3-day multidisciplinary training course, coaching, facilitated leadership engagement, and support networks), and outcome evaluation 4 months Several strategies were used to counter this risk. It also involves comparing what is known about a problem and what current practice is and whether there is a gap that needs to be addressed. Google Scholar also enabled access to book chapters whereas Scopus and Web of Science only indexed peer-reviewed journal articles. Involvement of stakeholders, and tailoring knowledge to the needs of people who are going to use it, is crucial. Finally, knowledge tools and products, considered third generation knowledge, are the most refined form of knowledge, based on earlier stages of the funnel. Knowledge creation has three phases: (1) knowledge inquiry, (2) knowledge synthesis, and (3) knowledge tools and products. We have chosen to report the aggregate number of excluded papers on the PRISMA flow diagram (Figure 2). Matern Child Nutr. Rather, we focused on the application of, and theory fidelity to, the KTA Framework. In practice, the implications of this decision were minimal as many Google Scholar records either duplicated full bibliographic records already identified from Web of Science or Scopus or contained at least sufficient detail in the title or in the limited text displayed (text fragment), to indicate whether the paper merited further consideration. An exception was the study by Russell and colleagues [25] who reported using a questionnaire to assess a range of potential barriers and facilitators. Estabrooks CA, Teare GF, Norton PG: Should we feed back research results in the midst of a study?. Theories and Models of Knowledge to Action. This article is published under license to BioMed Central Ltd. Studies were published between 2007 and 2013. Health professionals across the globe share the challenges of translating the best available evidence into actual health interventions in a timely way to provide the most effective care and service. The Journal of Continuing Education in the Health Professions 2006, 26, p. 19. Nine of the studies reported assessing barriers to change [17]-[19],[21]-[26]. In real-world practices of the Data-Information-Knowledge-Action model, data are collected surrounding a problem to be addressed, then the data are interpreted to identify competing explanations for the problem, as well as uncertainties of the explanations. administrative databases) and/or active measurement (e.g. Thirty nine (27%) were categorised as informed because the KTA Framework had influenced the project in a non-specified way without citing examples of how it had been applied. Given the incomplete abstracts obtained via Google Scholar, a rule-out strategy was employed. Refresh the page, check Medium 's site status, or find. (2013), "The effectiveness of knowledge translation strategies used in public health: a systematic review" (2012), "Uncovering Tacit Knowledge: A Pilot Study to Broaden the Concept of Knowledge in Knowledge Translation" (2011), "Assessing the public health impact of health promotion initiatives" (2010), Agency for Healthcare Research and Quality (AHRQ) - Translating Research into Practice, Canadian Institute for Health Research (CIHR) - Knowledge Translation & Commercialization, Center on Knowledge Translation for Disability and Rehabilitation Reseach (KTDRR) - KT Library, Cochrane Public Health Group - Knowledge Translation, McMaster University - Collaborations for Health (CfH) - Knowledge Translation, National Collaborating Centre for Methods and Tools - Knowledge Translation Methods and Tools for Public Health, University of Alberta - Knowledge Utilization Studies Program, Develop a PLAN - determine key stakeholders, expertise & support, Measure/collect data - baseline, process, outcomes, expenses, Implement - DO - pilot roll-out, educate, support, navigate, Manage & Adjust - ACT - Adapt, Adopt or Abandon based on evidence, Sustain & Grow - Share the results, get feedback, embed in standards or policies, spread more broadly. 2009, 41: 1024-1032. II provided BF with clinical supervision for her MSc dissertation. We initially included 146 studies that reported using the KTA Framework. Unfortunately, an implemented change is not usually self-sustaining and requires ongoing monitoring and effort. This produced a subset of studies that contained examples of using the KTA Framework in an integral way. Authors identified many barriers relating to environmental factors [32] such as lack of time and/or resources. The final list of integrated studies was agreed by two authors (BF and II), and the synthesis was discussed in detail by the team. The KTA process has two components: Knowledge Creation and Action. Worldviews Evid Based Nurs. . Knowledge-related barriers [32] were the most common, indicating the appropriateness of using educational strategies to address such barriers. 2002, 38: 94-104. This may be an artefact of reporting: few studies justify or explain their theoretical stance; even fewer do so using the appropriate constructs or with theory fidelity. The papers were coded according to the taxonomy in Table 1. They reviewed 31 planned action theories about the process of change. Graham, J. Logan, M.B. Discovery: The original biomedical, behavioral, or epidemiologic factor that stimulated development of an intervention (1).. Efficacy: The extent to which the intended effect or benefits were achieved under optimal conditions (2).. knowledge to action gap through research-clinical partnerships in speech-language pathology. Armstrong R, Waters E, Dobbins M, Anderson L, Moore L, Petticrew M, Clark R, Pettman TL, Burns C, Moodie M, Conning R, Swinburn B. Kitson A, Powell K, Hoon E, Newbury J, Wilson A, Beilby J. LaRocca R, Yost J, Dobbins M, Ciliska D, Butt M. Kothari AR, Bickford JJ, Edwards N, Dobbins MJ, Meyer M. National Collaborating Centre for Methods and Tools (2010). Throughout each of these stages, researchers can take an integrated approach, tailoring their activities (be they developing research questions, messages or dissemination strategies) to that of the end-users. J Adv Nurs. Initial screening out by title and abstract on the basis of partial information from Google Scholar may also have excluded relevant studies. Collaboration for Leadership in Applied Health Research and Care for South Yorkshire, Collaboration for Leadership in Applied Health Research and Care for Yorkshire and Humber. Papers were excluded if they were not empirical real-life applications of the KTA Framework; if they were literature reviews; if they were only conceptual or descriptive papers (including discussion, commentaries or protocols); if they described a single knowledge translation strategy, such as a clinical practice guideline; or if they were not topically relevant.