knowledge to action model

to the This framework was developed in Canada by Graham et al. Kitson AL, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A: Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. The knowledge to action cycle begins with the identification of a problem (usually a gap in care provision). In ten studies, the KTA Framework was integral to the design, delivery and evaluation of the implementation activities. It was cited 470 unique times across the three databases, indicating the bibliometric impact of the source paper. (2006) proposed the knowledge-to-action (KTA) process conceptual framework that could be useful for facilitating the use of research knowledge by several stakeholders, such as practitioners, policymakers, patients, and the public. CLAHRC YH would also like to acknowledge the participation and resources of our partner organisations. Application of knowledge translation (KT) theories, models, and frameworks (TMFs) is one method for successfully incorporating evidence into clinical care. The views and opinions expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. 2013, 19: 915-24. Limitations of English language and year of publication 2006-June 2013 were set. Knowledge to action framework for home health monitoring 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. 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. The authors declare that they have no competing interests. Knowledge translation strategies can include elements such as linkage and exchange, audit and feedback, informatics and patient-mediated and organisational interventions [29]. Straus S, Graham I: Development of a mentorship strategy: a knowledge translation case study. More About Knowledge Translation at CIHRCIHR. J Rehabil Med. This study sought to identify and describe available full-spectrum KT TMFs to subsequently guide users. One hundred and forty-six studies described usage to varying degrees, ranging from referenced to integrated. 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. Perhaps more significantly, the KTA Framework is associated with the Canadian Institutes of Health Research [27]. 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. 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. The first phase explores the creation of knowledge tools or products, such as an intervention or a clinical guideline . 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. 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. 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. 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 reflects the spread of the framework across a range of settings, to different health care services and systems and larger scale and smaller projects. The databases were Scopus, Web of Science and Google Scholar. 10.1002/chp.179. Social support interventions. Knowledge Translation in Health Care: Moving from Evidence to Practice. 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). However, supplementary hypertext links could be followed up from Google Scholar to either an abstract or, optimally, to the full text. Using the knowledge to action process model to incite clinic - LWW 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. Effectiveness: The extent to which the intended effect or benefits that were achieved under optimal . 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. All ten studies reported applying the Action Cycle, describing at least five of the seven possible phases (see Table 5). 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. administrative databases) and/or active measurement (e.g. The KTA Framework is being used in practice with varying degrees of completeness. These goals are to increase (a) the use of evidence-based research and (b) the understanding and use of KT principles. 10.1177/1077558711430690. Worldviews Evid Based Nurs. Action Cycle within the KTA Model The second step involves adapting the validated knowledge to the local context. 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. 2013, 69: 2336-47. 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). BMC Med Res Methodol. This inner component of the model is broken down into 3 phases: (1) knowledge inquiry, (2) knowledge synthesis, and (3) the creation of knowledge tools and products. Others related to specific conditions, such as stroke [23],[24], children with cerebral palsy and motor difficulties [25] and osteoarthritis [26]. Jacqueline Tetroe MA, Step KTA 3.B - Center on Knowledge Translation for Technology Transfer Only 10 of 146 papers reported direct use, with examples demonstrating that the framework was integral to their study. The taxonomy enabled us to refine the inclusion criteria to identify studies that reported explicit application of the KTA Framework. Lost in knowledge Translation: time for a map? Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE: Knowledge translation of research findings. 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]. 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. II is an occupational therapist. 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. It is frequently cited, with usage ranging from simple attribution via a reference, through informing planning, to making an intellectual contribution. Eight of the ten studies were conducted in Canada, one in the Democratic Republic of Congo [17] and one in Denmark [18]. Building a conceptual model Forms of knowledge Research evidence Clinician knowledge, skills, experience Yet the albeit limited, evidence available indicates that bringing information close to the point of decision-making (such as using reminders or decision support tools) is likely to be more effective than using more traditional educational strategies (such as study, teaching or training) to try to address barriers and change practice [31],[33]. The relation between knowledge and action. The KTA Framework is composed of two distinct, but related components: (i) Knowledge Creation, and (ii) the Action Cycle. Translating Knowledge into Action to Prevent Type 2 Diabetes: Medicare 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. 61107, 102 Medical Sciences Building, 506 S. Mathews, Urbana, From Graham I, Logan J, Harrison M, Strauss S, Tetroe J, Caswell W, Robinson N: Lost in knowledge translation: time for a map? It is focused on ensuring research findings are implemented in practice and aims to reduce the knowledge to action gap i.e. All ten described using the Action Cycle and seven referred to Knowledge Creation. When thinking about program planning and implementation, there are several important concepts that need to be considered. Worldviews Evid Based Nurs. Rather, papers typically stated aims and objectives, which often related to closing evidence/knowledge-practice gaps. Molfenter and colleagues [23] describe a strategy to assist clinicians with patient selection which could be interpreted as seeking to influence organisational barriers such as competing priorities, as well as addressing knowledge-related barriers. As such, the process of moving evidence to action is iterative, dynamic, and complex. 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]. Five studies applied one or more phases [18],[20],[22],[24],[26]. However, the target audiences were primarily patients, the public and the nursing and allied health professions. Using the Knowledge to Action Framework in practice: a citation Action is the deeds or decisions made based on knowledge and information. 2009, Wiley-Blackwell BMJ Books, Chichester, UK, 83-93. We thank Jennifer Read who provided BF with academic supervision for her MSc dissertation. Importantly, these integrated studies included examples to illustrate how the KTA Framework had been used as a guide. 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. Papers could be scrutinised according to how their aims and objectives had been operationalised. It includes the production, synthesis and interpretation of knowledge. 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. The KTA process has two components: Knowledge Creation and Action. Methods BMJ. 2009, 338: a3152-10.1136/bmj.a3152. This was necessary given the limited resources available to support the review process. Measuring this practice gap can include the use of administrative data, questionnaires, or conducting chart audits, to name a few. Prevailing wisdom encourages the use of theories, models and conceptual frameworks, yet their application is less evident in practice. Citation searches were limited to the period from 2006 (the date of publication of the source paper) to July 2013. The KTA Framework was enacted in different health care and academic settings with projects targeted at patients, the public, and nursing and allied health professionals. 2012, 8: 174-84. It is possible some potentially relevant studies were excluded during the initial sift stage. Safari. 1, Lgar F: Assessing barriers and facilitators to knowledge use. 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. Bartholomew LK, Mullen PD: Five roles for using theory and evidence in the design and testing of behaviour change interventions. Education was the most frequently employed strategy albeit in a variety of forms. Only studies applying the framework to implementation projects were included. A few free articles for further reading Chicago, The citation search yielded 1,787 records. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. 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. For example, difficulties in applying exclusion/inclusion criteria were discussed by the team and all subsequent decisions were then resolved by consensus. Finally, knowledge tools and products, considered third generation knowledge, are the most refined form of knowledge, based on earlier stages of the funnel. All undertook the first phase of identifying the problem. Action model learning - Wikipedia A few authors have attempted this, such as McEvoy and colleagues [43] who examined benefits reported by authors using the Normalization Process Theory. These include things like clinical practice guidelines, decision aids and videos. Only ten studies reported and gave supportive examples of incorporating the KTA Framework in an integrated way. The quality of reporting was assessed using criteria adapted from Carroll and colleagues [16]. PO Box 1649, Peoria, Wensing M, Bosch M, Grol R: Selecting, tailoring, and implementing knowledge translation interventions. Regardless of the approach, its critical to ensure that interventions are tailored to address the specific issue, audience and context to enhance uptake. II provided BF with clinical supervision for her MSc dissertation. 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). 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. Initial screening out by title and abstract on the basis of partial information from Google Scholar may also have excluded relevant studies. Most studies (8/10) were conducted in Canada where the KTA Framework originated. The "Knowledge to Action" Cycle: A Conversation with Dr. Ian Graham Knowledge Translation in Health Care: Moving from Evidence to Practice. There are a number of factors that can hinder or enhance the uptake of knowledge, including issues relating to the knowledge itself, factors relating to those who will be using the knowledge, and the context where the knowledge is to be used. Knowledge to Action Model. The Knowledge-to-Action Framework | by Leah Crockett - Medium 2010, 33: 259-263. 10.1016/j.jclinepi.2004.09.002. We developed a taxonomy to categorise this variation (see Table 1). 2002, 38: 94-104. The knowledge to action (KTA) is a process model that helps you select implementation strategies. Skip to Provided by the Springer Nature SharedIt content-sharing initiative. 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. Implent Sci. Tailoring knowledge was described in three studies [18],[20],[26]. Reprinted with permission from John Wiley and Sons. 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 . 2012, 7: 50-10.1186/1748-5908-7-50. 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. 2014, 9: 2-10.1186/1748-5908-9-2. The data were extracted from the integrated studies where the KTA Framework was applied in practice. J Nurs Care Qual. Bjrk IT, Lomborg K, Nielsen CM, Brynildsen G, Frederiksen A-MS, Larsen K, Reierson I, Sommer I, Stenholt B: From theoretical model to practical use: an example of knowledge translation. 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. 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?" Privacy PubMed Google Scholar. Further information about how the different studies applied the phases within the Action Cycle are shown in Table 6. Two were concerned with public health or health promotion [17],[20]; three focused on clinical academic or nurse education [18],[21],[22]. The final list of integrated studies was agreed by two authors (BF and II), and the synthesis was discussed in detail by the team. 2010, Wiley Blackwell, Chichester, UK. Assessment of barriers can be done quantitatively and qualitatively using a variety of conceptual models and instruments. 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. Unfortunately, an implemented change is not usually self-sustaining and requires ongoing monitoring and effort. The least reported phase, or the phase carried out least often, was sustain knowledge use. Most studies illustrate how knowledge was adapted to the local context. 2014, 348: g1687-10.1136/bmj.g1687. BMJ Qual Saf. What is Knowledge Translation? | School of Physical & Occupational Overlaying the Consolidated Framework for Implementation Research (CFIR) on the KTA framework offers a comprehensive methodology to identify barriers and facilitators and evaluation of the project. The first component of the model is the knowledge creation funnel, which represents the production and synthesis 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). Stacey D, Higuchi K, Menard P: Integrating patient decision support in an undergraduate nursing curriculum: an implementation project. Non-English language studies were excluded, reducing access to examples of applying the KTA Framework published in other languages. Knowledge producers . Duplicates between records from the databases were identified and the most complete record was retained for the subsequent sift process. The framework has two components: Knowledge Creation and an Action Cycle, each of which comprises multiple phases. 2009, 33: 82-88. 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. 10.1016/j.amepre.2012.05.024. 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. 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. Work Group on Translation Tools | CDC IL 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. From the perspective of the psychology of knowledge (e.g., Strube & Wender, 1993), knowledge is a competence for action, a . Graham ID, Tetroe J: Some theoretical underpinnings of knowledge translation. One can also move between the knowledge creation phase and the action cycle, in an iterative fashion. 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. A continuum of usage, ranging from referenced to integrated, was developed to aid this process. 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]. Musk was a co-founder of OpenAI before leaving its board in 2018, and has complained recently of the company's move from a nonprofit model to a highly valuable business influenced by Microsoft. Further details can be found at www.clahrc-yh.nihr.ac.uk. 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). Knowledge Translation Portfolio, Canadian Institutes of Health Research, Ottawa, ON, Canada. The Canadian Institute of Health Research has one of the most well-known definitions of knowledge translation. https://doi.org/10.1186/s13012-014-0172-2, DOI: https://doi.org/10.1186/s13012-014-0172-2. 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. Applying the Knowledge-to-Action Framework to Engage - PubMed We acknowledge that faced with the same task, another review team might choose to include papers reporting a single knowledge translation strategy. Knowledge to Action Framework - Monash Centre for Health Research and By using this website, you agree to our 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. 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. The impact of a strategy should be assessed using explicit, rigorous qualitative and quantitative methods, beginning with formulation of a defined question of interest. How have you used the KTA Framework in your own work? Yet, this method may prove challenging, often because of limited and imprecise reporting. 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 Knowledge-to-Action (KTA) framework provides a logical structure and process to plan IS projects. The KTA model lines up with KTDRR's goals. 2013, 69: 194-204. Secondly, multifaceted strategies are more likely to be successful than a single strategy [27],[46],[47], as they target different barriers [40], which reflects our interest in the real-world use of the KTA Framework, where it is probably impossible to control and isolate one strategy [48]. Notably, the KTA Framework assumes a systems perspective and situates knowledge producers and users within a system of knowledge that is responsive, adaptive, and unpredictable. Making sense of implementation theories, models and frameworks. Next, 911 records were excluded at the sift stage. However, our review focused primarily on examining how a conceptual framework had been used in practice. Four of the ten studies [17],[19],[21],[23] reported gaining ethical approval, suggesting that these had been independently characterised as research. As knowledge moves through three stages (inquiry, synthesis, tools/products), it becomes more user-friendly. 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. Michie S, Prestwich A: Are interventions theory-based? 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]. Due to overlapping categories (e.g. 2nd ed. Using the Knowledge to Action Framework in practice: a citation Implement Sci. The following analysis focuses on results relating to these ten integrated studies. Understanding if and how these theoretical tools add value to implementation endeavours and outcomes merits further research. This presents an interpretation challenge both for those seeking to learn from such projects and systematic reviewers. J Clin Epidemiol. Philadelphia: Lea & Febiger. Ullrich PM, Sahay A, Stetler CB: Use of implementation theory: a focus on PARIHS. Moving from Evidence to Practice. Implement Sci. Assessing the public health impact of health promotion initiatives. 10.1111/j.1553-2712.2007.tb02369.x. Knowledge becomes more refined as it moves through these three steps. Rycroft-Malone J: Implementing evidence-based practice in the reality of clinical practice. 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. 10.1097/00001786-200410000-00002. Data collection Studies were published between 2007 and 2013. Rycroft-Malone J, Bucknall T: Models and Frameworks for Implementing Evidence-Based Practice. For example, Eccles et al. 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.