knowledge to action model

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. The KTA process has two components: Knowledge Creation and Action. Overview of the Knowledge to Action Cycle. Inevitably, decisions about including or excluding studies were reliant on subjective judgements about whether the KTA Framework had been reported in an integrated way, or not. Studies were published between 2007 and 2013. 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]. Leah Crockett is a doctoral student in the Department of Community Health Sciences at the University of Manitoba. These were the question and study design, recruitment and selection and methods of data collection and analysis. Petzold A, Korner-Bitensky N, Menon A: Using the knowledge to action process model to incite clinical change. Worldviews Evid Based Nurs. Damschroder LJ, Aron DC, Keith , Rosalind E, Kirsh SR, Alexander JA, Lowery JC: Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. 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. 2012, 7: 48-10.1186/1748-5908-7-48. 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. As knowledge moves through the funnel, it is refined and summarized to be more useful for end-users. One hundred and forty-six studies described usage to varying degrees, ranging from referenced to integrated. 2004, 19: 297-304. Crosby R, Noar SM: Theory development in health promotion: are we there yet?. Data collection Four of the ten studies [17],[19],[21],[23] reported gaining ethical approval, suggesting that these had been independently characterised as research. In ten studies, the KTA Framework was integral to the design, delivery and evaluation of the implementation activities. This frequency of use in Canada could be explained by the influence of national Canadian networks and dissemination activities. 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). 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. The importance of organisational or external factors and the ability to influence them is well recognised [1],[3],[33]-[35]. The Knowledge to Action KTF The Knowledge to Action (KTA)4 is an overarching framework that includes both knowledge creation and implementation. Davies and colleagues [40] note that less than 6% of 235 studies, albeit published before 1998, explicitly used theories of behaviour or behaviour change. BMJ Qual Saf. Springer Nature. A taxonomy categorising the continuum of usage was developed. Two researchers (BF and II) conducted an initial assessment of the full-text articles. A few free articles for further reading Chicago, California Privacy Statement, Petzold, A., Korner-Bitensky, N., & Menon, A. Most studies illustrate how knowledge was adapted to the local context. Data were extracted and mapped against each phase of the framework for studies where it was integral to the implementation project. Implement Sci. 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. School of Nursing, University of Ottawa, Ottawa, ON, Canada. Knowledge synthesis is essential when considering an initiatives potential for widespread implementation and collates existing knowledge using rigorous methodologies. 2010, 33: 259-263. For example, difficulties in applying exclusion/inclusion criteria were discussed by the team and all subsequent decisions were then resolved by consensus. BF is a researcher at the School of Health and Related Research (ScHARR), University of Sheffield, and also an occupational therapist. Adapting to local context is a critical step in the process. Share your thoughts in the comments section below, or by tweeting at us at @KnowledgeNudge. Implement Sci. This review sought to answer two questions: Is the KTA Framework used in practice? 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]. Implementation researchers and health professionals can learn from this flexibility. IL 2010, 29: 1-8. (Dignan, M.B & Carr, P.A. Molfenter S, Ammoury A, Yeates E, Steele C: Decreasing the knowledge to action gap through research-clinical partnerships in speech-language pathology. Claude and colleagues [17] stated that these phases were beyond the scope of their project. 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. 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. Education was the most frequently employed strategy albeit in a variety of forms. It may also be a reflection of the challenges for defining and reporting outcomes for knowledge translation projects. However, because KT interventions are usually tailored to local contexts, and mapped to specific barriers/facilitators, effectiveness in one context does not guarantee success in another. Lost in knowledge Translation: time for a map? Finally, knowledge tools and products, considered third generation knowledge, are the most refined form of knowledge, based on earlier stages of the funnel. Edited by: Straus S, Tetroe J, Graham ID. Straus S, Graham I: Development of a mentorship strategy: a knowledge translation case study. For example, Eccles et al. Tugwell and colleagues [26] highlight this particular challenge, commenting that most outcomes in arthritis research are about pain and function. J Rehabil Med. PubMed Implement Sci. Unfortunately, an implemented change is not usually self-sustaining and requires ongoing monitoring and effort. CIHR also provides a practical guide to designing a KT intervention for health researchers, with relevant examples of its application. 2008, 3: 1-10.1186/1748-5908-3-1. 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]. 10.2340/16501977-0451. Only ten studies were integrated, signifying that the KTA Framework was integral to the design, delivery and evaluation of the implementation activities. In addition, this suggests conceptual frameworks do not have to be mutually exclusive. Most of the theories were interdisciplinary or from nursing and were published between 1983 and 2006 [11]. Google Scholar. Citation searching seeks to optimise sensitivity and specificity when seeking to identify reports of practical applications of a model or framework. Others related to specific conditions, such as stroke [23],[24], children with cerebral palsy and motor difficulties [25] and osteoarthritis [26]. Involvement of stakeholders, and tailoring knowledge to the needs of people who are going to use it, is crucial. Between 2009 and 2013, she was a Knowledge Translation Project Lead with the NIHR CLAHRC SY. However, citation figures do not reflect how this conceptual framework has actually been applied in practice. 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 Adv Nurs. IL Rycroft-Malone J, Bucknall T: Models and Frameworks for Implementing Evidence-Based Practice. The integrated studies described different ways of integrating the KTA Framework, particularly the Action Cycle. Their findings suggested that the more domains that were targeted, the less effective the intervention was [9]. 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. 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. 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]. Our study had several limitations. Moving from Evidence to Practice. 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/. Seventeen studies (12%) were noted as adapted or combined where the KTA Framework had either been modified or blended with another conceptual framework. 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). 2010, 5: 14-10.1186/1748-5908-5-14. -[http://www.cihr-irsc.gc.ca/e/39033.html]. BMC Med Res Methodol. Ian D. Graham PhD, Ian D. Graham PhD. 2014, 348: g1687-10.1136/bmj.g1687. 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. Our experience certainly confirms that this search method circumvents the problems of variation in terminology typically encountered in topic-based searches of bibliographic databases. The source paper was cited four times more frequently than the next highest cited article from the same journal published in the same year. 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. Initial screening out by title and abstract on the basis of partial information from Google Scholar may also have excluded relevant studies. 2009, 41: 1024-1032. [http://www.rcn.org.uk/__data/assets/pdf_file/0014/512600/2013_RCN_research_W06.pdf]. Action is the deeds or decisions made based on knowledge and information. Rather, papers typically stated aims and objectives, which often related to closing evidence/knowledge-practice gaps. This review is designed to address this knowledge gap. This is typically the recommended starting point for implementation and involves identifying a problem that needs attention. 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). 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. Refresh the page, check Medium 's site status, or find. 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]. A total of 1,057 titles and abstracts were screened. It is one of the most frequently cited conceptual frameworks for knowledge translation. Int J Nurs Educ Scholarsh. 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. 2010, Wiley Blackwell, Chichester, UK. The KTA Framework consists of two components: (1) Knowledge Creation Knowledge creation is represented by the funnel in the centre of the image above. 10.1177/1077558711430690. BMJ. Building a conceptual model Forms of knowledge Research evidence Clinician knowledge, skills, experience Ilott I, Gerrish K, Booth A, Field B: Testing the consolidated framework for implementation research on health care innovations from South Yorkshire. Ullrich PM, Sahay A, Stetler CB: Use of implementation theory: a focus on PARIHS. We did not follow up references (including book chapters) or contact authors of included or excluded studies. 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. The final list of integrated studies was agreed by two authors (BF and II), and the synthesis was discussed in detail by the team. 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. PubMed Central Implement Sci. Citation searches were limited to the period from 2006 (the date of publication of the source paper) to July 2013. 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]. Knowledge Translation in Health Care: Moving from Evidence to Practice. 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 quality of reporting was assessed using criteria adapted from Carroll and colleagues [16]. 1992). the site home page. Citations were excluded where there was insufficient information to make a judgment about inclusion/exclusion criteria. Understanding the barriers to knowledge uptake and implementation strategies, as well as facilitators of change, are critical to effective knowledge translation activities. 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]. 2011, 11: 29-10.1186/1471-2288-11-29. McLean R, Tucker J: Evaluation of CIHRs Knowledge Translation Funding ProgramCIHR.[http://www.cihr-irsc.gc.ca/e/47332.html#a2.1]. The papers were coded according to the taxonomy in Table 1. Two studies reported using all phases of Knowledge Creation [20],[26] (see Table 4). 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]. 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. 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. How have you used the KTA Framework in your own work? Celebrate the work you have accomplished. Phys Ther. 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. 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. Knowledge Translation in Health Care: Moving from Evidence to Practice. 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. knowledge to action gap through research-clinical partnerships in speech-language pathology. Conceptual frameworks provide a frame of reference for organising thinking, a guide for action and interpretation. Others argue that the effectiveness and generalisability of implementation studies are hindered by weak theoretical underpinnings [40],[43],[44]. 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. J Contin Educ Health Prof. 2006, 26: 13-24. Google Scholar. 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. This citation analysis and systematic review investigated the practical application of a well-established conceptual frameworkthe KTA Framework [1]. The Knowledge to Action Framework. Note that action steps may not be sequential, and one can start at any phase of the cycle. Implementation Sci 9, 172 (2014). (2010). Knowledge to Action Framework. II provided BF with clinical supervision for her MSc dissertation. An exception was the study by Russell and colleagues [25] who reported using a questionnaire to assess a range of potential barriers and facilitators. Harrison, S.E. These goals are to increase (a) the use of evidence-based research and (b) the understanding and use of KT principles. Tabak RG, Khoong EC, Chambers DA, Brownson RC: Bridging research and practice: models for dissemination and implementation research. AB is a member of the editorial board of Implementation Science. Tugwell PS, Santesso NA, OConnor AM, Wilson AJ: Knowledge translation for effective consumers. 2013, 69: 194-204. Selecting an intervention has been described as both an art and a science, and ideally should be based on evidence of its effectiveness [2]. 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. 2010, 5: 92-10.1186/1748-5908-5-92. 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. Knowledge syntheses take the form of studies that fall into the categories of systematic reviews, scoping reviews, and meta-analyses, just to name a few. Google Scholar. The taxonomy enabled us to refine the inclusion criteria to identify studies that reported explicit application of the KTA Framework. More About Knowledge Translation at CIHRCIHR. 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. 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]. 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. This can be achieved through observation (e.g. Social support interventions. Using the knowledge to action process model to incite clinical change. 2012, 28: 258-61. 2009, 4: Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N: Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. (2013), "The effectiveness of knowledge translation strategies used in public health: a systematic review" (2012), "Uncovering Tacit Knowledge: A Pilot Study to Broaden the Concept of Knowledge in Knowledge Translation" (2011), "Assessing the public health impact of health promotion initiatives" (2010), Agency for Healthcare Research and Quality (AHRQ) - Translating Research into Practice, Canadian Institute for Health Research (CIHR) - Knowledge Translation & Commercialization, Center on Knowledge Translation for Disability and Rehabilitation Reseach (KTDRR) - KT Library, Cochrane Public Health Group - Knowledge Translation, McMaster University - Collaborations for Health (CfH) - Knowledge Translation, National Collaborating Centre for Methods and Tools - Knowledge Translation Methods and Tools for Public Health, University of Alberta - Knowledge Utilization Studies Program, Develop a PLAN - determine key stakeholders, expertise & support, Measure/collect data - baseline, process, outcomes, expenses, Implement - DO - pilot roll-out, educate, support, navigate, Manage & Adjust - ACT - Adapt, Adopt or Abandon based on evidence, Sustain & Grow - Share the results, get feedback, embed in standards or policies, spread more broadly. Bartholomew LK, Mullen PD: Five roles for using theory and evidence in the design and testing of behaviour change interventions. Five studies applied one or more phases [18],[20],[22],[24],[26]. Nurs Stand. 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]. Knowledge becomes more refined as it moves through these three steps. 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. Translation - Moving the best evidence into professional practice. 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. Data for each phase were then synthesised across studies to help understand how the framework had been used in practice. IL 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. Safari. It is possible some potentially relevant studies were excluded during the initial sift stage. Action phases may be carried out sequentially or simultaneously; knowledge phases may impact on the action phases. research findings not being translated. Med Care Res Rev. The Knowledge-to-Action (KTA) framework provides a logical structure and process to plan IS projects. Effectiveness: The extent to which the intended effect or benefits that were achieved under optimal . 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]. The framework has two components: Knowledge Creation and an Action Cycle, each of which comprises multiple phases. 10.1007/s10865-010-9260-1. The first component of the model is the knowledge creation funnel, which represents the production and synthesis of knowledge. The citation search for the original source paper [1] yielded 1,787 records. 2011, 71 (Suppl 1): S20-S33. It was cited 470 unique times across the three databases, indicating the bibliometric impact of the source paper. J Contin Educ Health Prof. 2008, 28: 117-122. Questionnaires, interviews, workshops, focus groups and needs assessment were used to identify barriers to change. 2002, 38: 94-104. This presents an interpretation challenge both for those seeking to learn from such projects and systematic reviewers. 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]. 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 This flexibility was intended, as Graham and colleagues [1] state the framework can also accommodate different phases being accomplished by different stakeholders and groups (working independently of each other) at different points in time (p. 18). J Adv Nurs. From the perspective of the psychology of knowledge (e.g., Strube & Wender, 1993), knowledge is a competence for action, a . Google Scholar. 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. Google Scholar.
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