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). The uptake of EBP is a complex process that can be facilitated by the use of the Knowledge to Action Process model. Hamilton, ON: McMaster University. 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. 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. 10.2340/16501977-0451. An exception was the study by Russell and colleagues [25] who reported using a questionnaire to assess a range of potential barriers and facilitators. 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. 2014, 9: 54-10.1186/1748-5908-9-54. 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]. Primary studies, exploring the direct experience and perceptions of different stakeholders in implementation projects, which have been guided by conceptual frameworks, or theories, would add to our understanding of the utility and impact of these tools. Effectiveness: The extent to which the intended effect or benefits that were achieved under optimal . All ten studies reported applying the Action Cycle, describing at least five of the seven possible phases (see Table 5). Implement Sci. "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.. 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. Most studies created a range of products, either as part of Knowledge Creation [18],[20],[21],[26] or the Action Cycle [21],[23],[24]. For Web of Science and Scopus citations, full abstracts were identified. Cookies policy. This involved checking whether the four elements were described. Citation searching for the original reference by Graham and colleagues [1] optimised the sensitivity and specificity of the search strategy. Exploring the impact of the KTA Framework, and other conceptual frameworks, on patients and the public in terms of health improvement and outcomes would also be worthwhile, as would exploring their involvement in the application of the framework, not just as recipients of services but as key stakeholders in each phase. II is an occupational therapist. Moving from Evidence to Practice. A total of 1,057 titles and abstracts were screened. 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]. In contrast, they wanted to evaluate the impact of their intervention on peoples ability to understand their choices and make informed decisions about treatment. J Contin Educ Health Prof. 2006, 26: 13-24. In the COM-B model behavior is a result of an interaction between three components, which includes: Capability, which can be psychological (knowledge) or physical (skills); Opportunity can be social (societal influences) or physical (environment); motivation can be automatic (emotion) or reflective (beliefs, intentions) [ 16, 17 ]. Google Scholar. 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. 10.1037/a0016939. In summary, KTA is applying knowledge to real life situations. Edited by: Straus S, Tetroe J, Graham I. Implement Sci. Manage cookies/Do not sell my data we use in the preference centre. AB is a member of the editorial board of Implementation Science. 2013, Wiley-Blackwell BMJ Books, Oxford, 2, Book Questionnaires, interviews, workshops, focus groups and needs assessment were used to identify barriers to change. 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. In these studies, the KTA Framework appeared to provide a practical yet flexible guide to getting research findings into practice, allowing it to be applied in idiosyncratic ways. Using the Knowledge to Action Framework in practice: a citation analysis and systematic review, https://doi.org/10.1186/s13012-014-0172-2, http://www.rcn.org.uk/__data/assets/pdf_file/0014/512600/2013_RCN_research_W06.pdf, https://epoc.cochrane.org/sites/epoc.cochrane.org/files/uploads/EPOC%20Taxonomy%20of%20Interventions%202002.pdf, http://www.cihr-irsc.gc.ca/e/47332.html#a2.1, http://creativecommons.org/licenses/by/4.0, http://creativecommons.org/publicdomain/zero/1.0/. Tabak RG, Khoong EC, Chambers DA, Brownson RC: Bridging research and practice: models for dissemination and implementation research. Using the knowledge to action process model to incite clinical change. 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). All citations identified were screened by title and available information according to agreed criteria. Knowledge becomes more refined as it moves through these three steps. Further details can be found at www.clahrc-yh.nihr.ac.uk. 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]. School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK, School of Nursing and Midwifery, University of Sheffield, Sheffield, UK, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK, You can also search for this author in Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE: Knowledge translation of research findings. The authors declare that they have no competing interests. Stacey D, Higuchi K, Menard P: Integrating patient decision support in an undergraduate nursing curriculum: an implementation project. 10.1177/1077558711430690. Each study applied the framework in an idiosyncratic way. 10.1016/j.amepre.2012.05.024. A few authors have attempted this, such as McEvoy and colleagues [43] who examined benefits reported by authors using the Normalization Process Theory. Knowledge creation has three phases: (1) knowledge inquiry, (2) knowledge synthesis, and (3) knowledge tools and products. It may also be a reflection of the challenges for defining and reporting outcomes for knowledge translation projects. The action cycle includes a range of activities needed for knowledge implementation. Rycroft-Malone J: The PARIHS framework: a framework for guiding the implementation of evidence based practice. Tugwell PS, Santesso NA, OConnor AM, Wilson AJ: Knowledge translation for effective consumers. Only ten studies were integrated, signifying that the KTA Framework was integral to the design, delivery and evaluation of the implementation activities. These goals are to increase (a) the use of evidence-based research and (b) the understanding and use of KT principles. Knowledge producers . 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. In the absence of formal comparisons of citation search techniques, we decided to operationalise citation searching using Google Scholar. The Canadian Institute of Health Research has one of the most well-known definitions of knowledge translation. Implement Sci. 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]. Included articles were re-examined and re-coded according to this more detailed classification. Yet, this method may prove challenging, often because of limited and imprecise reporting. 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. Med Care Res Rev. 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. J Contin Educ Health Prof. 2008, 28: 117-122. As such, the process of moving evidence to action is iterative, dynamic, and complex. 10.7748/ns2002.05.16.37.38.c3201. 2014, 11: 26-34. Conceptual frameworks provide a frame of reference for organising thinking, a guide for action and interpretation. Can J Speech-Language Pathol Audiol. However, supplementary hypertext links could be followed up from Google Scholar to either an abstract or, optimally, to the full text. J Adv Nurs. Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework. 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. 2010, 5: 14-10.1186/1748-5908-5-14. statement and This study is a citation analysis and systematic review. This study sought to identify and describe available full-spectrum KT TMFs to subsequently guide users. The KTA Framework was enacted in a variety of ways, from informing to full integration, showing flexibility of use and that it can fit local circumstances and need. Am J Prev Med. Two researchers (BF and II) conducted an initial assessment of the full-text articles. PubMed 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. 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. The issues around the keywords knowledge and actionwhich constitute the title of a book by Frey, Mandl, and von Rosenstiel ()are captured by the following four main aspects, which generate corresponding questions.. 1. Skip to In addition, this suggests conceptual frameworks do not have to be mutually exclusive. BF is a researcher at the School of Health and Related Research (ScHARR), University of Sheffield, and also an occupational therapist. 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. A taxonomy categorising the continuum of usage was developed. Involvement of stakeholders, and tailoring knowledge to the needs of people who are going to use it, is crucial. Graham I, Logan J, Harrison M, Straus S, Tetroe J, Caswell W, Robinson N: Lost in knowledge translation: time for a map?. In ten studies, the KTA Framework was integral to the design, delivery and evaluation of the implementation activities. 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). 1992). Some indication of the impact of this article can be gained from constructing a normalised citation count for comparison purposes. The databases were Scopus, Web of Science and Google Scholar. Conventional views support the use of theories, models and conceptual frameworks to underpin the process of change, yet in practice, their application seems more limited [40],[43]-[45]. Worldviews Evid Based Nurs. 2002). Guideline adaptation: an approach to enhance efficiency in guideline development and improve utilisation, Validation of the theoretical domains framework for use in behaviour change and implementation research, Theoretical domains framework to assess barriers to change for planning health care quality interventions: a systematic literature review. This review is designed to address this knowledge gap. Each implementation study was very different (see Table 3). Estabrooks CA, Teare GF, Norton PG: Should we feed back research results in the midst of a study?. 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]. Knowledge Translation in Health Care: Moving from Evidence to Practice. 2012, 69: 123-157. BMC Med Res Methodol. Action includes identifying and appraising the problem and the known research, identifying barriers and successes, planning and executing, and finally monitoring, evaluating, and adjusting. The data were extracted from the integrated studies where the KTA Framework was applied in practice. J Rehabil Med. 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. We did not assess the research rigour of the individual knowledge translation projects. 2013, 23 (4): 290-298. 2010, 33: 259-263. Initial screening out by title and abstract on the basis of partial information from Google Scholar may also have excluded relevant studies. The least reported phase, or the phase carried out least often, was sustain knowledge use. 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).. to the It was cited 470 unique times across all databases. 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. They and we resorted to a simple taxonomy to describe the level and type of usage based on explicit reporting. Terms and Conditions, Between 2009 and 2013, she was a Knowledge Translation Project Lead with the NIHR CLAHRC SY. 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]. When thinking about program planning and implementation, there are several important concepts that need to be considered. As knowledge moves through three stages (inquiry, synthesis, tools/products), it becomes more user-friendly. The Journal of Continuing Education in the Health Professions 2006, 26, p. 19. Article Menon A, Korner-Bitensky N, Kastner M, McKibbon KA, Straus S: Strategies for rehabilitation professionals to move evidencebased knowledge into practice: a systematic review. McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A, Seers K: Getting evidence into practice: the meaning of context. 10.1111/j.1752-7325.2011.00223.x. Too many KT strategies use the traditional ISLAGIATT (It Seemed Like A Good Idea At The Time)* approach, and result in uninformed interventions that are often too broad and too ambitious. None described applying every phase of the KTA Framework. 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 2014, 348: g1687-10.1136/bmj.g1687. The KTA Framework is one of many frameworks, models, and theories that provides KT researchers with a practical yet systematic method of implementation. Change may occur at more than one level, and for more than one intended end-user, and may require multiple methods of monitoring knowledge use. J Eval Clin Pract. Knowledge synthesis is essential when considering an initiatives potential for widespread implementation and collates existing knowledge using rigorous methodologies. 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. Springer Nature. Implementation Science We did not follow up references (including book chapters) or contact authors of included or excluded studies. 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. Given the incomplete abstracts obtained via Google Scholar, a rule-out strategy was employed. The Knowledge-to-Action Framework | by Leah Crockett | KnowledgeNudge | Medium Sign up 500 Apologies, but something went wrong on our end. 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. 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. A continuum of usage, ranging from referenced to integrated, was developed to aid this process. This scheme may be useful for similar studies examining theory use. 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. PRISMA flow diagram of citation analysis and systematic literature review. 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]. II provided BF with clinical supervision for her MSc dissertation. AB is Reader in Evidence Based Information Practice at the School of Health and Related Research (ScHARR), University of Sheffield, where he leads on systematic review and evidence synthesis 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. 10.1046/j.1365-2648.2002.02150.x. 2013, 69: 194-204. Straus S, Graham I: Development of a mentorship strategy: a knowledge translation case study. The KTA Framework consists of two components: (1) Knowledge Creation Knowledge creation is represented by the funnel in the centre of the image above. Knowledge to Action Model. Safari. Perhaps more significantly, the KTA Framework is associated with the Canadian Institutes of Health Research [27]. The quality of reporting was assessed using criteria adapted from Carroll and colleagues [16]. Provided by the Springer Nature SharedIt content-sharing initiative. 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?" This presents an interpretation challenge both for those seeking to learn from such projects and systematic reviewers. Citation searching seeks to optimise sensitivity and specificity when seeking to identify reports of practical applications of a model or framework. For example, Eccles et al. It is important to note that Graham and colleagues have continued to publish on applications of the framework and the multiple factors to be considered [29]. Lgar [32] recommends using established taxonomies developed for barriers and facilitators within knowledge translation projects. This is typically the recommended starting point for implementation and involves identifying a problem that needs attention. 2011, 71 (Suppl 1): S20-S33. It is one of the most frequently cited conceptual frameworks for knowledge translation. Can J Cardiol. Data extraction and presenting results according to the phases were also challenging, given that the framework is dynamic, and can be non-sequential with overlap between phases [1]. 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. Implement Sci. 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. For example, if a strategy has the goal of improving social networking, and the barrier is weak ties between end-users, the social support theory [8] may be used to design an intervention that involves the use of change agents to transfer information [2]. 2009, 33: 82-88. Only studies applying the framework to implementation projects were included. Box. The knowledge to action cycle is one framework for knowledge translation that integrates policy makers throughout the research cycle. BMJ. Rather, papers typically stated aims and objectives, which often related to closing evidence/knowledge-practice gaps. Seventeen studies (12%) were noted as adapted or combined where the KTA Framework had either been modified or blended with another conceptual framework. contextualize the Evidence Based Review of Stroke Rehabilitation and Rehabilitation Knowledge to Action Project within the KTA model and (2) show how this process led . This article is published under license to BioMed Central Ltd. Michie S, Prestwich A: Are interventions theory-based? 2009, Wiley-Blackwell BMJ Books, Oxford, 94-113. The relation between knowledge and action. The importance of organisational or external factors and the ability to influence them is well recognised [1],[3],[33]-[35]. 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]. Several strategies were used to counter this risk. administrative databases) and/or active measurement (e.g. 2012, 43: 337-50. 2007, 14: 936-941. This frequency of use in Canada could be explained by the influence of national Canadian networks and dissemination activities. The KTA Framework [1] is being used in practice with varying degrees of completeness and theory fidelity when the conceptual framework is integrated into the implementation project. CDC Knowledge to Action Framework [PDF - 33 KB] An Organizing Framework for Translation in Public Health: The Knowledge to Action Framework Applying the Knowledge to Action (K2A) Framework: Questions to Guide Planning Tool [PDF - 3.57 MB] Glossary of Terms [DOC -17 KB] Page last reviewed: April 28, 2021 Knowledge translation strategies can include elements such as linkage and exchange, audit and feedback, informatics and patient-mediated and organisational interventions [29]. Data for each phase were then synthesised across studies to help understand how the framework had been used in practice. 10.1111/wvn.12016. As weve discussed in a previous post, there are many theories, models and frameworks used in the field of knowledge translation (KT). 10.1002/chp.20077. 61801, 2016 The Board of Trustees of the University of Illinois. This framework was developed in Canada by Graham et al. 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). (2010). The study was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for South Yorkshire and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Yorkshire and Humber. 2012, 7: 48-10.1186/1748-5908-7-48. From 2008 to 2013, she led the Translating Knowledge into Action theme of NIHR CLAHRC SY. The framework has two components: Knowledge Creation and an Action Cycle, each of which comprises multiple phases. The first component of the model is the knowledge creation funnel, which represents the production and synthesis of knowledge. Google Scholar. Part of 2010, 5: 92-10.1186/1748-5908-5-92. 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.
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