10.1097/00001786-200410000-00002. The relation between knowledge and action. Estabrooks and colleagues [28] comment that the Canadian research funding organisation had adopted the KTA Framework to guide knowledge translation, deploying specific grant mechanisms to ensure involvement of knowledge users with researchers throughout the research process (p. 2). Hua D, Carter S, Bellerive J, Allu SO, Reid D, Tremblay G, Lindsay P, Tobe SW: Bridging the gap: innovative knowledge translation and the Canadian hypertension education program. CIHR also provides a practical guide to designing a KT intervention for health researchers, with relevant examples of its application. Article Some indication of the impact of this article can be gained from constructing a normalised citation count for comparison purposes. Hamilton, ON: McMaster University. the site home page. 2010, Wiley Blackwell, Chichester, UK. The full text of the 146 papers was examined to establish the extent to which the use of the KTA Framework was attributed by the authors. The quality of reporting was assessed using criteria adapted from Carroll and colleagues [16]. This involves valuing the utility of the knowledge to the problem, setting and circumstances, as well as tailoring the knowledge to the specific situation. The KTA Framework [1] was developed in Canada by Graham and colleagues in the 2000s in response to the confusing multiplicity of terms used to describe the process of moving knowledge into action [1]. One hundred and forty-six studies described usage to varying degrees, ranging from referenced to integrated. Do they work? IL Jacqueline Tetroe MA, In the absence of formal comparisons of citation search techniques, we decided to operationalise citation searching using Google Scholar. The lead author (BF) contributed to this study while undertaking the National Institute for Health Research/Health Education England Clinical Academic Training Programme Master in Clinical Research scheme. Implementation Sci 9, 172 (2014). Each component involves several phases which overlap and can be iterative; Graham and colleagues [1] describe the phases as dynamiccan influence each other (p. 20). This reinforces the importance of theory fidelity and that authors refer to established taxonomies or reporting standards [36],[37],[40],[41] so we can understand how conceptual frameworks, theories and models are really used to guide practice or inform research. This MCHRI framework for impact has been adapted form multiple sources and from internal learnings and is underpinned by the Canadian knowledge to action process. 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]. Each study demonstrates the particularity of implementation activities. Menon A, Korner-Bitensky N, Kastner M, McKibbon KA, Straus S: Strategies for rehabilitation professionals to move evidencebased knowledge into practice: a systematic review. Privacy In ten studies, the KTA Framework was integral to the design, delivery and evaluation of the implementation activities. Straus, J. Tetroe, W. Caswell, and N. Robinson, 2006 . Perhaps more significantly, the KTA Framework is associated with the Canadian Institutes of Health Research [27]. Retrieved from http://www.nccmt.ca/registry/view/eng/70.html. Field, B., Booth, A., Ilott, I. et al. The Knowledge-to-Action Framework | by Leah Crockett | KnowledgeNudge | Medium Sign up 500 Apologies, but something went wrong on our end. All ten described using the Action Cycle and seven referred to Knowledge Creation. administrative databases) and/or active measurement (e.g. Implement Sci. This review seeks to answer two questions: Is the KTA Framework being used in practice? and If so, how is the KTA Framework being used in practice? We were interested in the real-life application of this conceptual framework to real-world implementation challenges. 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. 2009, Wiley-Blackwell BMJ Books, Oxford, 94-113. All ten studies reported using the Action Cycle. It is important that KT is maximized in health care to improve patient outcomes. BMC Med Res Methodol. 2009, 41: 1024-1032. Why use theory to guide the process of moving evidence into action? McLean R, Tucker J: Evaluation of CIHRs Knowledge Translation Funding ProgramCIHR.[http://www.cihr-irsc.gc.ca/e/47332.html#a2.1]. Rather, papers typically stated aims and objectives, which often related to closing evidence/knowledge-practice gaps. Int J Nurs Educ Scholarsh. Also, this conceptual framework may appeal because of a lack of jargon and a simple diagram depicts the knowledge translation process. The knowledge to action cycle is one framework for knowledge translation that integrates policy makers throughout the research cycle. Edited by: Straus S, Tetroe J, Graham ID. PubMed Phys Ther. Knowledge translation has been defined as a process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improvehealthprovide more effective health services and products and strengthen the health care system [2]. Tailoring knowledge was described in three studies [18],[20],[26]. 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). Lost in knowledge Translation: time for a map? Journal of Continuing Education in the Health Professions, 30, 167-171. doi:10 Firstly, we were interested in the practical application of the KTA Framework and thus in identifying papers where the KTA Framework appeared to be a fundamental guide to the work reported. Article This presents an interpretation challenge both for those seeking to learn from such projects and systematic reviewers. The Knowledge to Action (KTA) framework is an effective approach in the implementation science literature to methodically guide the translation of evidence-based research findings into practice, putting knowledge into practical use. For an example of how these might be developed, check out our earlier post. Once a KT strategy has been delivered, the use of knowledge should be monitored which may be instrumental (behaviour), conceptual (attitude/perception), or as a persuasive tool for pushing change(knowledge as ammunition). BMJ. Only ten studies reported and gave supportive examples of incorporating the KTA Framework in an integrated way. Finding Health Statistics: Going Beyond the Literature, Learning, Leadership, and Professionalism, NExT Online Course for Public Health Nursing, Program planning for health education and promotion, Special Collections & University Archives, Nursing Experts: Translating the Evidence - Public Health Nursing, The Canadian Institute of Health Research, https://pubmed.ncbi.nlm.nih.gov/16557505/, https://medium.com/knowledgenudge/kt-101-the-knowledge-to-action-framework-7fbe399723e8, "Knowledge translation strategies to improve the use of evidence in public health decision making in local government: intervention design and implementation plan" (2013), "Knowledge translation within a population health study: how do you do it?" All results were imported and combined into an Excel spreadsheet for review by two reviewers. Taylor MJ, McNicholas C, Nicolay C, Darzi A, Bell D, Reed JE: Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. For example, Eccles et al. References to non-English language articles were removed. The Knowledge to Action Framework [1] (the KTA Framework) is a conceptual framework intended to help those concerned with knowledge translation deliver sustainable, evidence-based interventions. Carroll C, Booth A, Cooper K: A worked example of best fit framework synthesis: a systematic review of views concerning the taking of some potential chemopreventive agents. Harrison, S.E. Overview of the Knowledge to Action Cycle. Assessing the public health impact of health promotion initiatives. The views and opinions expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Helfrich CD, Damschroder LJ, Hagedorn HJ, Daggett GS, Sahay A, Ritchie M, Damush T, Guihan M, Ullrich PM, Stetler CB: A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Manage cookies/Do not sell my data we use in the preference centre. The search results are illustrated in Figure 2, the PRISMA flow chart. 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. 61656, Rockford, The Action Cycle was reported in all the integrated examples, illustrating theory fidelity in this specific subset of studies. Interestingly, a recent evaluation of the Canadian Institutes of Health Research (CIHR) Knowledge Translation Funding Program [38] presented results relating to knowledge translation products, academic outputs and capacity building together, giving the appearance, in our interpretation, that these different dimensions may be regarded as equally important. Share your thoughts in the comments section below, or by tweeting at us at @KnowledgeNudge. Moving from Evidence to Practice. The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC SY) used the KTA Framework to underpin a programme of knowledge translation work undertaken between 2008 and 2013 [12]. When using the Knowledge to Action Process model to effect an evidence-based change (e.g., in a clinical practice), one of the factors that knowledge users (e.g., clinicians) may site as an impediment is an absence of the evidence appraisal and statistical analysis skills that are required in the knowledge inquiry phase. Rycroft-Malone J, Bucknall T: Models and Frameworks for Implementing Evidence-Based Practice. Our findings support this proposal. 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. Only four studies detailed Knowledge Creation, yet existing knowledge was utilised in the other studies to identify knowledge-practice gaps, or as part of the Action Cycle. The K2A framework describes and depicts the high-level processes necessary to move from discovery into action by using translation of evidence-based programs, practices, or policiesbroadly defined to include evidence-based communications, campaigns, guidelines, and other interventions and tools. Most studies illustrate how knowledge was adapted to the local context. Prevailing wisdom encourages the use of theories, models and conceptual frameworks, yet their application is less evident in practice. Google Scholar. This illustrates the adaptability of the conceptual framework to different health care settings and topics. It may be that when people are consulted, they identify those barriers that they feel able to influence, such as knowledge or awareness, rather than organisational barriers, which could be perceived as more problematic or more distant. Worldviews Evid Based Nurs. This may explain the varying degrees to which the framework was used. 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]. 2009, 6: Paper 10-10.2202/1548-923X.1741. When the framework was integral to knowledge translation, it guided action in idiosyncratic ways and there was theory fidelity. We developed a taxonomy to categorise this variation (see Table 1). 10.1111/j.1752-7325.2011.00223.x. This was necessary given the limited resources available to support the review process. PubMed Central Google Scholar. Knowledge Translation Portfolio, Canadian Institutes of Health Research, Ottawa, ON, Canada. Our review, and similar studies [39],[40],[43]-[45], consistently comments on the limited, haphazard use of theory, even though theories can be applied in many different ways [41]. For example, difficulties in applying exclusion/inclusion criteria were discussed by the team and all subsequent decisions were then resolved by consensus. Rycroft-Malone J: Implementing evidence-based practice in the reality of clinical practice. California Privacy Statement, 2012, 7: 48-10.1186/1748-5908-7-48. There was substantial variation in the setting and target audience for each documented change, the methods used to apply the KTA Framework and the terminology employed to report the phases within Knowledge Creation and the Action Cycle. Selection bias is another limitation given that we aimed to identify papers reporting usage of the KTA Framework rather than considering or comparing with other conceptual frameworks. The index citation for the original paper was identified on three databasesWeb of Science, Scopus and Google Scholarwith the facility for citation searching. 2009, Wiley-Blackwell BMJ Books, Chichester, UK, 83-93. The benefits of theory-informed KT practice are not limited to providing a deliberate map for interventions, but also allow for increased validity and rigor and more seamless integration of KT-related evidence into the ever-growing body of implementation literature. knowledge to action gap through research-clinical partnerships in speech-language pathology. From Graham I, Logan J, Harrison M, Strauss S, Tetroe J, Caswell W, Robinson N: Lost in knowledge translation: time for a map? 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. Springer Nature. 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). Data extracted were mapped to each phase of Knowledge Creation and the Action Cycle (see Figure 1) by one researcher (BF) and then discussed with the whole team. II is an occupational therapist. It is one of the most frequently cited conceptual frameworks for knowledge translation. efforts. As the process of KT is iterative, not only can (i) inform (ii), but components of the action cycle also feed back to inform knowledge creation [2, 3]. Developed by Ian Graham and colleagues [1], the KTA Framework is based on the commonalities of over 30 planned-action theories (which make up the action cycle) with the addition of a knowledge creation component. Action includes identifying and appraising the problem and the known research, identifying barriers and successes, planning and executing, and finally monitoring, evaluating, and adjusting. Understanding the barriers to knowledge uptake and implementation strategies, as well as facilitators of change, are critical to effective knowledge translation activities. Full-text articles were obtained for any article coded for inclusion and for any articles that appeared relevant but where it was unclear whether the KTA Framework had been actually used in practice. PubMed The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. One can also move between the knowledge creation phase and the action cycle, in an iterative fashion. review papers, conceptual or descriptive papers and those describing a single knowledge translation strategy or not topically relevant), we excluded against a single criterion, even when multiple criteria applied, as practical considerations rendered it unnecessary to exhaustively document all possible reasons for exclusion for each paper. Using the framework itself as a device through which to examine how it had been used seemed an appropriate and pragmatic approach for our purposes. Implement Sci. This review is designed to address this knowledge gap. Health Psychol. Disconnect between Knowledge and Action Gap between what we know and what we do Under-use of effective treatments -5-50 years to change practice . Citation searches were limited to the period from 2006 (the date of publication of the source paper) to July 2013. Ilott I, Gerrish K, Booth A, Field B: Testing the consolidated framework for implementation research on health care innovations from South Yorkshire. Estabrooks CA, Teare GF, Norton PG: Should we feed back research results in the midst of a study?. Between 2009 and 2013, she was a Knowledge Translation Project Lead with the NIHR CLAHRC SY. Finfgeld-Connett D, Johnson ED: Literature search strategies for conducting knowledge-building and theory-generating qualitative systematic reviews. Closer examination revealed that usage varied considerably, ranging from simple attribution via a reference through to being integral to most aspects of the implementation work. A strategy informed by theory is also much more likely to be effective in changing behaviours and attitudes. -[http://www.cihr-irsc.gc.ca/e/39033.html]. Keyser SE: The Implementation of a Delirium Knowledge Translation Project for Families of the Elderly. Potential benefits from applying a conceptual framework include making the process of knowledge translation more systematic, with greater likelihood of changed practice and spread of evidence [4],[6]-[9]. 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. 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. Citation searching for the original reference by Graham and colleagues [1] optimised the sensitivity and specificity of the search strategy. 10.1016/j.jclinepi.2004.09.002. However, the method is replicable and could be repeated to update the review in future. When thinking about program planning and implementation, there are several important concepts that need to be considered. PO Box 1649, Peoria, Theories and Models of Knowledge to Action. The KTA process has two components: Knowledge Creation and Action. 2012, 43: 337-50. 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 KTA Framework is a framework for guiding the process of KT, adopted by the Canadian Institutes of Health Research (CIHR) and other organizations worldwide. Regardless of the approach, its critical to ensure that interventions are tailored to address the specific issue, audience and context to enhance uptake. The MCHRI framework includes 6 Key Steps summarised below: Steps 1 & 2 - Formative Research: engage stakeholders to identify problem from all perspectives, to scope and prioritise . The purpose of translation is to provide the best outcomes and value, and lower risks to our patient population. Davies P, Walker AE, Grimshaw JM: A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. Only one study [26] reported using decision support tools as a knowledge translation strategy, although it is possible others did not report all the details of strategies they used to promote the adoption of their interventions. The citation search yielded 1,787 records. Knowledge-related barriers [32] were the most common, indicating the appropriateness of using educational strategies to address such barriers. It focuses on two main areas of activity: knowledge creation and knowledge tailoring . Four of the ten studies [17],[19],[21],[23] reported gaining ethical approval, suggesting that these had been independently characterised as research. Understanding effects in reviews of implementation interventions using the Theoretical Domains 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. A continuum of usage, ranging from referenced to integrated, was developed to aid this process. Seven described using both the Knowledge Creation and the Action Cycle components [18],[20]-[24],[27]. Several conceptual frameworks are pertinent for implementation scientists, including Promoting Action on Research Implementation in Health Services (PARIHS) [5],[10] the Consolidated Framework for Implementation Research (CFIR) [3] as well as the KTA Framework [1]. 2010, 33: 259-263. All authors read and approved the final manuscript. The importance of organisational or external factors and the ability to influence them is well recognised [1],[3],[33]-[35]. None described applying every phase of the KTA Framework. Selecting an intervention has been described as both an art and a science, and ideally should be based on evidence of its effectiveness [2]. Implementation Science Citation searching was further indicated in this review given that our scoping search, using the databases MEDLINE and CINAHL, had previously identified few abstracts reporting explicitly the use of the KTA Framework in practice. Crosby R, Noar SM: Theory development in health promotion: are we there yet?. BF, II and AB conceived the review; AB designed the study; AB undertook the searches; BF and II screened and extracted the data; BF wrote the review; and BF, II, AB and KG made comments and edited the review drafts. The Knowledge to Action (KTA) Framework is used for facilitating the use of research knowledge by several stakeholders, such as practitioners, policymakers, patients and the public. 2010, 5: 92-10.1186/1748-5908-5-92. Reprinted with permission from John Wiley and Sons. However, there are multiple KT TMFs and little guidance on which to select. Each study applied the framework in an idiosyncratic way. We did not include the many papers about clinical practice guidelines for two interrelated reasons. Am J Prev Med. Straus S, Graham I: Development of a mentorship strategy: a knowledge translation case study. Russell DJ, Rivard LM, Walter SD, Rosenbaum PL, Roxborough L, Cameron D, Darrah J, Bartlett DJ, Hanna SE, Avery LM: Using knowledge brokers to facilitate the uptake of pediatric measurement tools into clinical practice: a before-after intervention study. In other cases, we made an initial judgement, based on the abstract or a Google text fragment, that the paper was not about an empirical, real-life, knowledge translation or implementation project. Several strategies were used to counter this risk. Rycroft-Malone J: The PARIHS framework: a framework for guiding the implementation of evidence based practice. Only ten studies were integrated, signifying that the KTA Framework was integral to the design, delivery and evaluation of the implementation activities. Can J Cardiol. 10.1002/chp.179. Copyright 2015 Wiley Periodicals, Inc., A Wiley Company 2012, 8: 174-84. volume9, Articlenumber:172 (2014) This reflected our focus on whether the KTA Framework is used in practice and, if so, how it is applied. The Canadian Institute of Health Research has one of the most well-known definitions of knowledge translation.
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