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. Implement Sci. 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]. Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney SE: Publication guidelines for quality improvement studies in health care: evolution of the SQUIRE project. Several strategies were used to counter this risk. 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. 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. The data were extracted from the integrated studies where the KTA Framework was applied in practice. Knowledge Translation in Health Care: Moving from Evidence to Practice. Implement Sci. Action model learning (sometimes abbreviated action learning) is an area of machine learning concerned with creation and modification of software agent 's knowledge about effects and preconditions of the actions that can be executed within its environment. Journal of Continuing Education in the Health Professions, 30, 167-171. doi:10 Safari. A few free articles for further reading Chicago, Graham ID, Tetroe J: Some theoretical underpinnings of knowledge translation. Nine were published in peer-reviewed journals with the exception being a Master of Science degree dissertation [19]. 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. PubMed Generally, it was difficult to ascertain whether the methods used captured, and indeed subsequently addressed, the full range of barriers. 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. 2012, 28: 258-61. 2011, 71 (Suppl 1): S20-S33. Action phases may be carried out sequentially or simultaneously; knowledge phases may impact on the action phases. 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. Although there may be some small variation in the actual sets of references retrieved by different citation searches, we have no reason to believe that we have systematically under- or over-represented particular types of studies in our sample. The target audience included the public and patients, the families of older adults, health professionals, occupational therapists, speech and language therapists, physiotherapists and educationalists/academics within universities. 61801, 2016 The Board of Trustees of the University of Illinois. 2013, 23 (4): 290-298. The importance of organisational or external factors and the ability to influence them is well recognised [1],[3],[33]-[35]. 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. J Nurs Care Qual. This was necessary given the limited resources available to support the review process. It may also be a reflection of the challenges for defining and reporting outcomes for knowledge translation projects. All results were imported and combined into an Excel spreadsheet for review by two reviewers. As demonstrated here, the Knowledge to Action Process model provides an excellent guide for clinicians, managers, and researchers who wish to incite change in patient care. Knowledge producers . As knowledge moves through the funnel, it is refined and summarized to be more useful for end-users. 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. Claude KM, Juvenal KL, Hawkes M: Applying a knowledge-to-action framework for primary prevention of spina bifida in tropical Africa. Rycroft-Malone J, Bucknall T: Models and Frameworks for Implementing Evidence-Based Practice. The KTA Framework was adapted to different health service settings and resources, indicating a good fit for the diversity of real-world health care. Action Cycle within the KTA Model The second step involves adapting the validated knowledge to the local context. 2011, 11: 29-10.1186/1471-2288-11-29. The Knowledge-to-Action Framework | by Leah Crockett | KnowledgeNudge | Medium Sign up 500 Apologies, but something went wrong on our end. Overview of the Knowledge to Action Cycle. Sixty two of the 146 papers (43%) were classified as referenced, meaning that the framework was cited with little, if any, further explanation (see Table 2). This study sought to identify and describe available full-spectrum KT TMFs to subsequently guide users. The findings informed their conceptual framework, which was intended to address the need for conceptual clarity in the KTA field and to offer a framework to help elucidate what we believe to be the key elements of the KTA process [1] (p. 14). Copyright 2015 Wiley Periodicals, Inc., A Wiley Company In addition, this suggests conceptual frameworks do not have to be mutually exclusive. Two researchers (BF and II) conducted an initial assessment of the full-text articles. Implement Sci. Menon A, Korner-Bitensky N, Kastner M, McKibbon KA, Straus S: Strategies for rehabilitation professionals to move evidencebased knowledge into practice: a systematic review. Regardless of the approach, its critical to ensure that interventions are tailored to address the specific issue, audience and context to enhance uptake. They and we resorted to a simple taxonomy to describe the level and type of usage based on explicit reporting. Am J Prev Med. II provided BF with clinical supervision for her MSc dissertation. Guide to Evidence Based Practice and Knowledge Translation for Public Health Nursing. 10.1046/j.1365-2648.2002.02150.x. 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. IL A continuum of usage, ranging from referenced to integrated, was developed to aid this process. 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. Nilsens paper provides an overview of evaluation frameworks to guide evaluation of implementation strategies [7]. 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. The Knowledge to Action KTF The Knowledge to Action (KTA)4 is an overarching framework that includes both knowledge creation and implementation. 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). Although the terms conceptual frameworks, theories and models are often used interchangeably, conceptual frameworks are broad and descriptive, whereas theories and models are more specific and amenable to hypothesis testing [6]. It was cited 470 unique times across all databases. Two were concerned with public health or health promotion [17],[20]; three focused on clinical academic or nurse education [18],[21],[22]. They reviewed 31 planned action theories about the process of change. Adapting to local context is a critical step in the process. A further eighteen (12%) were categorised as directed because the KTA Framework influenced the project design or helped to plan, structure or conceptualise what was done, but with no examples given. 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. Most studies focused on improving knowledge or awareness, supporting what we know about the preponderance of professional or educational knowledge translation strategies within interventions aiming to promote the uptake of evidence [31]. Implementation researchers and health professionals can learn from this flexibility. Straus S, Graham I: Development of a mentorship strategy: a knowledge translation case study. Petzold A, Korner-Bitensky N, Menon A: Using the knowledge to action process model to incite clinical change. This is a limitation of using Google Scholar for citation searches. Only ten studies were integrated, signifying that the KTA Framework was integral to the design, delivery and evaluation of the implementation activities. It includes the production, synthesis and interpretation of knowledge. Bartholomew and Mullen [42] suggest that the prevailing wisdom in the field of health-related behaviour change is that well-designed and effective interventions are guided by theory (p. S20). Google Scholar. Booth A, Harris J, Croot E, Springett J, Campbell F, Wilkins E: Towards a methodology for cluster searching to provide conceptual and contextual richness for systematic reviews of complex interventions: case study (CLUSTER). Most studies created a range of products, either as part of Knowledge Creation [18],[20],[21],[26] or the Action Cycle [21],[23],[24]. J Eval Clin Pract. 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. The Action Cycle was reported in all the integrated examples, illustrating theory fidelity in this specific subset of studies. All ten studies reported applying the Action Cycle, describing at least five of the seven possible phases (see Table 5). Correspondence to Nine of the studies reported assessing barriers to change [17]-[19],[21]-[26]. Neither did we seek out grey literature or search specific thesis/dissertation databases. Data for each phase were then synthesised across studies to help understand how the framework had been used in practice. Hamilton, ON: McMaster University. Judging between informed and directed was difficult, suggesting further refinement of the categories is required. Building a conceptual model Forms of knowledge Research evidence Clinician knowledge, skills, experience the main menu, 10.1007/s10865-010-9260-1. This scheme may be useful for similar studies examining theory use. 10.1177/1077558711430690. Only ten studies reported and gave supportive examples of incorporating the KTA Framework in an integrated way. Once an understanding of the potential barriers and facilitators to adoption has been achieved, the next phase involves planning and carrying out interventions to bring about the intended change. On this basis, all ten studies were judged as having described their projects clearly. Three studies illustrated each phase of the Action Cycle or explained their reasons for not doing so [18],[23],[25]. 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]. It would be interesting to review the conceptual papers we excluded to explore how they were influenced by the framework and informed the development of conceptual frameworks more generally. We chose citation searching as our preferred method to identify reports of practical applications of a model or framework [14],[15]. 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. The KTA process has two components: Knowledge Creation and Action. Eight of the ten studies were conducted in Canada, one in the Democratic Republic of Congo [17] and one in Denmark [18]. 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. However, there are multiple KT TMFs and little guidance on which to select. 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. J Contin Educ Health Prof. 2006, 26: 13-24. The Journal of Continuing Education in the Health Professions 2006, 26, p. 19. However, citation figures do not reflect how this conceptual framework has actually been applied in practice. 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. A taxonomy categorising the continuum of usage was developed. Applying the Knowledge-to-Action Framework to Engage Stakeholders and Solve Shared Challenges with Person-Centered Advance Care Planning in Long-Term Care Homes Authors George A Heckman 1 2 , Veronique Boscart 1 3 , Patrick Quail 4 , Heather Keller 1 5 , Clare Ramsey 6 , Vanessa Vucea 2 , Seema King 7 , Ikdip Bains 2 , Nora Choi 6 , Allan Garland 6 Tailoring knowledge was described in three studies [18],[20],[26]. A strategy informed by theory is also much more likely to be effective in changing behaviours and attitudes. Implement Sci. Claude and colleagues [17] stated that these phases were beyond the scope of their project. BMJ. 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. Cite this article, Conceptual frameworks are recommended as a way of applying theory to enhance implementation efforts. Five studies applied one or more phases [18],[20],[22],[24],[26]. Most studies illustrate how knowledge was adapted to the local context. This frequency of use in Canada could be explained by the influence of national Canadian networks and dissemination activities. The final list of integrated studies was agreed by two authors (BF and II), and the synthesis was discussed in detail by the team. In ten studies, the KTA Framework was integral to the design, delivery and evaluation of the implementation activities. Consequently, we recommend that the phase select, tailor, implement intervention be amended to include define and select outcomes and knowledge use measures, as a prompt to those using the KTA Framework to specify such outcomes when selecting which knowledge translation strategies to use. CLAHRC YH would also like to acknowledge the participation and resources of our partner organisations. https://doi.org/10.1186/s13012-014-0172-2, DOI: https://doi.org/10.1186/s13012-014-0172-2. Refresh the page, check Medium 's site status, or find. 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. (Dignan, M.B & Carr, P.A. Data collection Nurs Stand. All authors read and approved the final manuscript. "Knowledge translation is defined as a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.. All citations identified were screened by title and available information according to agreed criteria. 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. 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]. 10.7748/ns2002.05.16.37.38.c3201. efforts. 2012, 7: 50-10.1186/1748-5908-7-50. Authors identified many barriers relating to environmental factors [32] such as lack of time and/or resources. Reprinted with permission from John Wiley and Sons. Knowledge becomes more refined as it moves through these three steps. 2010, 5: 82-10.1186/1748-5908-5-82. None reported using every phase of the KTA Framework. Such work may require additional funding for longer term monitoring or strategies to sustain knowledge use over time. Becky Field. From the perspective of the psychology of knowledge (e.g., Strube & Wender, 1993), knowledge is a competence for action, a . Edited by: Straus S, Tetroe J, Graham I. 2012, 69: 123-157. 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. Knowledge Translation in Health Care: Moving from Evidence to Practice. Translation - Moving the best evidence into professional practice. Program implementation involves the activities of putting the program into place, from gaining acceptance for the program to making revisions when the program is not working as planned - (Ervin, N. Advanced community health nursing practice: Population focused care. Implement Sci. The one-hour conversation between Dr. Marianne Farkas of Boston University's Center for Psychiatric Rehabilitation and Dr. Ian Graham was presented in . Skip to All ten described using the Action Cycle and seven referred to Knowledge Creation. Graham I, Logan J, Harrison M, Straus S, Tetroe J, Caswell W, Robinson N: Lost in knowledge translation: time for a map?. 10.2340/16501977-0451. 1, Lgar F: Assessing barriers and facilitators to knowledge use. Graham et al. This presents an interpretation challenge both for those seeking to learn from such projects and systematic reviewers. Share your thoughts in the comments section below, or by tweeting at us at @KnowledgeNudge. 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. 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. 60607, Chicago, Between 2009 and 2013, she was a Knowledge Translation Project Lead with the NIHR CLAHRC SY. Action is the deeds or decisions made based on knowledge and information. Implementation Sci 9, 172 (2014). The Knowledge to Action (KTA) Framework was developed in Canada by Graham and colleagues in the 2000s, following a review of 31 planned action theories. 2010, Wiley Blackwell, Chichester, UK. The monitoring, outcomes or sustaining phases of the Action Cycle were less often described, although three noted their plans for doing so [18],[24],[26]. 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).. We sought to identify all reported citations of a particular reference irrespective of the context within which that reference had been used. Acad Emerg Med. Further, the time frame of the citation searches only captures work up to a certain point (from the date of publication of the source paper to July 2013). Manage cookies/Do not sell my data we use in the preference centre. Harrison, S.E. Duplicates between records from the databases were identified and the most complete record was retained for the subsequent sift process. The KTA Framework comprises two distinct but related components: (i) Knowledge Creation (represented by the funnel) surrounded by (ii) the Action Cycle (Figure 1). Key factors present in sustaining knowledge use can include perceived benefits and risks, relevance, leadership, policy integration, resources and politics. The first phase explores the creation of knowledge tools or products, such as an intervention or a clinical guideline . Google Scholar. Rycroft-Malone J: Implementing evidence-based practice in the reality of clinical practice. J Adv Nurs. This showed that the degree of usage varied from merely citing the KTA Framework to full integration into the study. Ilott I, Gerrish K, Booth A, Field B: Testing the consolidated framework for implementation research on health care innovations from South Yorkshire. 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. Addressing sustainability also involves planning for both the spread and scaling up of knowledge use, and concerns whether an innovation continues to be used beyond the initial implementation. We did not follow up references (including book chapters) or contact authors of included or excluded studies. Also, this conceptual framework may appeal because of a lack of jargon and a simple diagram depicts the knowledge translation process. For Web of Science and Scopus citations, full abstracts were identified. 10.1016/j.amepre.2012.05.024. Graham, J. Logan, M.B. 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. 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. 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]. PO Box 1649, Peoria, Questionnaires, interviews, workshops, focus groups and needs assessment were used to identify barriers to change. 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. Conceptual frameworks are recommended as a way of preparing for the multiple, dynamic and interactive factors that influence the uptake of evidence in practice [3]-[5]. McEvoy R, Ballini L, Maltoni S, O Donnell CA, Mair FS, Macfarlane A: A qualitative systematic review of studies using the normalization process theory to research implementation processes. Due to overlapping categories (e.g. -[http://www.cihr-irsc.gc.ca/e/39033.html]. 10.1111/jan.12091. J Contin Educ Health Prof. 2010, 30: 167-71. However, the target audiences were primarily patients, the public and the nursing and allied health professions. 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). The integrated studies described different ways of integrating the KTA Framework, particularly the Action Cycle. We have chosen to report the aggregate number of excluded papers on the PRISMA flow diagram (Figure 2). The production of knowledge tools and products uses synthesized knowledge to present evidence in concise and user-friendly formats tailored to meet end-user informational needs. The impact of a strategy should be assessed using explicit, rigorous qualitative and quantitative methods, beginning with formulation of a defined question of interest.
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