Implement Sci. Implement Sci. 2008, 3: 1-10.1186/1748-5908-3-1. Most of the theories were interdisciplinary or from nursing and were published between 1983 and 2006 [11]. 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. Terms and Conditions, 2014, 348: g1687-10.1136/bmj.g1687. Interventions can be of multiple sorts: educational (passive or active strategies), professional (reminders, audit and feedback), organizational (redesign services), and patient directed (health literacy, patient decision aids) [3]. This study also reinforces the importance of reporting standards [8],[36], such as the new TIDieR checklist [37] to facilitate more explicit reporting of implementation studies and their subsequent inclusion in systematic reviews. The framework has two components: Knowledge Creation and an Action Cycle, each of which comprises multiple phases. "The KT Library is designed to provide information to NIDRR grantees and interested members of the public about a wide spectrum of knowledge translation and evidence-based resources.". 2009, 41: 1024-1032. 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 . questionnaires). Ilott I, Gerrish K, Bray K, Laker S: Tackling the implementation challenge: bridging thegapbetweenresearchandpractice. 10.1111/jan.12091. 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). References to non-English language articles were removed. Such work may require additional funding for longer term monitoring or strategies to sustain knowledge use over time. 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. 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]. Methods: We used the Knowledge to Action framework, which was developed to map how science is translated into effective health programs, to examine how the evidencebased intervention from the 2002 Diabetes Prevention Program trial was translated into the Centers for Disease Control and Prevention's largescale National Diabetes Prevention Evaluating outcomes is an area of KT that requires more attention and involves evaluating whether application of the knowledge is actually impacting the desired outcome be it patient or practitioner behaviour, health outcomes, or system-level changes. 10.1111/j.1553-2712.2007.tb02369.x. 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 knowledge to action cycle begins with the identification of a problem (usually a gap in care provision). 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). Action phases may be carried out sequentially or simultaneously; knowledge phases may impact on the action phases. This was necessary given the limited resources available to support the review process. When the framework was integral to knowledge translation, it guided action in idiosyncratic ways and there was theory fidelity. Citation searching for the original reference by Graham and colleagues [1] optimised the sensitivity and specificity of the search strategy. 10.1097/00001786-200410000-00002. Key factors present in sustaining knowledge use can include perceived benefits and risks, relevance, leadership, policy integration, resources and politics. 2005, 58: 107-12. Important considerations for choosing a KT strategy (or strategies) include a clearly defined goal or objective for each strategy, an understanding of how the strategy overcomes one or more barriers to behaviour or attitude change, and the use of theory to inform selection and implementation. 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]. For an example of how these might be developed, check out our earlier post. The one-hour conversation between Dr. Marianne Farkas of Boston University's Center for Psychiatric Rehabilitation and Dr. Ian Graham was presented in . 10.1016/j.amepre.2012.05.024. Edited by: Straus S, Tetroe J, Graham I. 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. Lost in knowledge Translation: time for a map? Kennedy CC, Ioannidis G, Giangregorio LM, Adachi JD, Thabane L, Morin SN, Crilly RG, Marr S, Josse RG, Lohfeld L, Pickard LE, King S, van der Horst M-L, Campbell G, Stroud J, Dolovich L, Sawka AM, Jain R, Nash L, Papaioannou A: An interdisciplinary knowledge translation intervention in long-term care: study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial. 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. Med Care Res Rev. 2009, Wiley-Blackwell BMJ Books, Oxford, 94-113. Becky Field. the site home page. 2002, 38: 94-104. 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. Knowing your audience and assessing the value, usefulness and appropriateness of the particular knowledge is critical to its uptake and sustained use. Duplicates between records from the databases were identified and the most complete record was retained for the subsequent sift process. Neither did we seek out grey literature or search specific thesis/dissertation databases. Only ten studies reported and gave supportive examples of incorporating the KTA Framework in an integrated way. For example, difficulties in applying exclusion/inclusion criteria were discussed by the team and all subsequent decisions were then resolved by consensus. Adapting to local context is a critical step in the process. 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. It is one of the most frequently cited conceptual frameworks for knowledge translation. 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. 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). Rycroft-Malone J, Bucknall T: Models and Frameworks for Implementing Evidence-Based Practice. Knowledge Translation in Health Care: Moving from Evidence to Practice. It is important that KT is maximized in health care to improve patient outcomes. We chose citation searching as our preferred method to identify reports of practical applications of a model or framework [14],[15]. Furthermore, knowledge can inform each phase of the action cycle and the knowledge funnel can rotate to feed into different phases. 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). 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]. The importance of organisational or external factors and the ability to influence them is well recognised [1],[3],[33]-[35]. 2014, 9: 2-10.1186/1748-5908-9-2. Interest in using systematic literature reviews to investigate theories, models and conceptual frameworks has increased in recent years [7],[39]. 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. The integrated studies described different ways of integrating the KTA Framework, particularly the Action Cycle. A total of 1,057 titles and abstracts were screened. 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. 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. Do they work? Copyright 2015 Wiley Periodicals, Inc., A Wiley Company Knowledge Translation in Health Care: Moving from Evidence to Practice. One can also move between the knowledge creation phase and the action cycle, in an iterative fashion. Perhaps more significantly, the KTA Framework is associated with the Canadian Institutes of Health Research [27]. 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. California Privacy Statement, 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. Two researchers (BF and II) conducted an initial assessment of the full-text articles. The KTA Framework is composed of two distinct, but related components: (i) Knowledge Creation, and (ii) the Action Cycle. Two studies reported using all phases of Knowledge Creation [20],[26] (see Table 4). 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 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]. 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. 2010, 5: 92-10.1186/1748-5908-5-92. It is frequently cited, with usage ranging from simple attribution via a reference, through informing planning, to making an intellectual contribution. The framework has two components: Knowledge Creation and an Action Cycle, each of which comprises multiple phases. looked at 10 behaviour change interventions where explicit use of theory was absent, and mapped these strategies to domains of the Theoretical Domains Framework. Ian D. Graham PhD, Ian D. Graham PhD. 10.1002/chp.20077. Canadian Journal of Speech-Language Pathology . The relation between knowledge and action. This may reflect a publication bias, between reporting process and outcomes. The citation search yielded 1,787 records. The Action Cycle focuses on the processes needed to implement knowledge in healthcare settings including identifying problems; assessing determinants of KT; selecting, tailoring, implementing, and evaluating KT interventions; and determining strategies for ensuring sustained knowledge use. 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. 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. 2010, Dissertation for Masters of Science, School of Nursing, Queens University, Ontario, Canada. 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. Google Scholar also enabled access to book chapters whereas Scopus and Web of Science only indexed peer-reviewed journal articles. We further identified a need to use taxonomies when analysing or evaluating knowledge translation strategies [33],[34]. It includes the production, synthesis and interpretation of knowledge. 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). Can J Cardiol. We acknowledge that faced with the same task, another review team might choose to include papers reporting a single knowledge translation strategy. 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. Springer Nature. 2014, 11: 26-34. Effectiveness: The extent to which the intended effect or benefits that were achieved under optimal . The papers were coded according to the taxonomy in Table 1. Lgar [32] recommends using established taxonomies developed for barriers and facilitators within knowledge translation projects. 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. This showed that the degree of usage varied from merely citing the KTA Framework to full integration into the study. We focus on all things knowledge translation (KT) and patient engagement (PE), from a health research and healthcare perspective. 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. Each study demonstrates the particularity of implementation activities. 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 ]. We recognise that assimilation and utilisation of an influential framework is a continuous process and that we have employed essentially a cross-sectional method to survey the literature. 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. 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. We acknowledge that there are multiple choices available when conducting citation searches. J Nurs Care Qual. 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. This is typically the recommended starting point for implementation and involves identifying a problem that needs attention. AB is a member of the editorial board of Implementation Science. 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. None described applying every phase of the KTA Framework. Crosby R, Noar SM: Theory development in health promotion: are we there yet?. We initially included 146 studies that reported using the KTA Framework. Quality assessment of the integrated studies proved problematic given that many papers did not report research questions, traditional research designs or recruitment and selection of participants as required by the criteria [16]. Knowledge synthesis is essential when considering an initiatives potential for widespread implementation and collates existing knowledge using rigorous methodologies. Rather, papers typically stated aims and objectives, which often related to closing evidence/knowledge-practice gaps. This involved checking whether the four elements were described. It was cited 470 unique times across all databases. Tugwell and colleagues [26] highlight this particular challenge, commenting that most outcomes in arthritis research are about pain and function. Menon A, Korner-Bitensky N, Kastner M, McKibbon KA, Straus S: Strategies for rehabilitation professionals to move evidencebased knowledge into practice: a systematic review. The knowledge to action (KTA) is a process model that helps you select implementation strategies. Knowledge to Action Framework. Knowledge creation has three phases: (1) knowledge inquiry, (2) knowledge synthesis, and (3) knowledge tools and products. Phys Ther. For example, Eccles et al. 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. Due to overlapping categories (e.g. We found that the framework is being used in practice, to varying degrees of completeness, and with theory fidelity when reported as integral to the implementation effort. We recommend using the latest version of IE11, Edge, Chrome, Firefox or The source paper was cited four times more frequently than the next highest cited article from the same journal published in the same year. 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. 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. For Web of Science and Scopus citations, full abstracts were identified. 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. The first phase explores the creation of knowledge tools or products, such as an intervention or a clinical guideline . Two were concerned with public health or health promotion [17],[20]; three focused on clinical academic or nurse education [18],[21],[22]. Guide to Evidence Based Practice and Knowledge Translation for Public Health Nursing. 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]. Straus S, Tetroe J, Graham ID: Knowledge Translation in Health Care. Making sense of implementation theories, models and frameworks. 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]. 2004, 19: 297-304. J Adv Nurs. It is focused on ensuring research findings are implemented in practice and aims to reduce the knowledge to action gap i.e. In addition, this suggests conceptual frameworks do not have to be mutually exclusive. More About Knowledge Translation at CIHRCIHR. 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]. Studies were published between 2007 and 2013. 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. PubMed Central PRISMA flow diagram of citation analysis and systematic literature review. 2010, 33: 259-263. Can J Speech-Language Pathol Audiol. Article 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. 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. Search for more papers by this author. However, citation figures do not reflect how this conceptual framework has actually been applied in practice. So-called action (or planned action) models are process models that facilitate implementation by offering practical guidance in the planning and execution of implementation endeavours and/or implementation strategies. 10.2340/16501977-0451. 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]. School of Nursing, University of Ottawa, Ottawa, ON, Canada. 10.1016/j.cjca.2012.03.011. 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. We thank Jennifer Read who provided BF with academic supervision for her MSc dissertation. 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 uptake of EBP is a complex process that can be facilitated by the use of the Knowledge to Action Process model. 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. 10.1111/j.1365-2648.2012.06037.x. Steps involved in Translating the Evidence into Practice: 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. Thomas A, Menon A, Boruff J, Rodriguez AM, Ahmed S: Applications of social constructivist learning theories in knowledge translation for healthcare professionals: a scoping review. 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. Included articles were re-examined and re-coded according to this more detailed classification. Health Psychol. 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]. The final list of integrated studies was agreed by two authors (BF and II), and the synthesis was discussed in detail by the team. Straus S, Graham I: Development of a mentorship strategy: a knowledge translation case study. Data collection However, supplementary hypertext links could be followed up from Google Scholar to either an abstract or, optimally, to the full text. The least reported phase, or the phase carried out least often, was sustain knowledge use. Finfgeld-Connett D, Johnson ED: Literature search strategies for conducting knowledge-building and theory-generating qualitative systematic reviews. In the context of healthcare, the Theoretical Domains Framework (which we break down in another post) is one example of a comprehensive, validated, and integrative model for assessing barriers to change that can be used to inform the development of strategies for changing attitudes and behaviours [5, 6]. The KTA process has two components: Knowledge Creation and Action. A few free articles for further reading Chicago, Nurs Stand. Google Scholar. Action is the deeds or decisions made based on knowledge and information. 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. Article 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. Moving from Evidence to Practice. 2012, 9: 1-10.1111/j.1741-6787.2011.00240.x. 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 Share your thoughts in the comments section below, or by tweeting at us at @KnowledgeNudge. 2012, 28: 258-61. 2010, Wiley Blackwell, Chichester, UK. The KTA model lines up with KTDRR's goals. The KTA process has two components: Knowledge Creation and Action. A total of 146 papers were identified as attributing use of the KTA Framework. Petzold A, Korner-Bitensky N, Menon A: Using the knowledge to action process model to incite clinical change. 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).
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