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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]. Use at a lighter level through adapting or combining with other conceptual frameworks could be considered a strength, in that the KTA Framework offers the flexibility to be combined with other frameworks, being responsive to facilitating practitioner preferences and context-specific needs. Ian D. Graham PhD, Ian D. Graham PhD. This review sought to answer two questions: 'Is the 10.1111/wvn.12016. Box. 2005, 58: 107-12. 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. It sets out the key None reported using every phase of the KTA Framework. 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. Only 10 of 146 papers reported direct use, with examples demonstrating that the framework was integral to their study. 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]. Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney SE: Publication guidelines for quality improvement studies in health care: evolution of the SQUIRE project. 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]. 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. Only studies applying the framework to implementation projects were included. Reprinted with permission from John Wiley and Sons. 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. Application of knowledge translation (KT) theories, models, and frameworks (TMFs) is one method for successfully incorporating evidence into clinical care. 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. Jacqueline Tetroe MA, 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. 10 at the Canadian Institutes for Health Research. Nilsens paper provides an overview of evaluation frameworks to guide evaluation of implementation strategies [7]. J Behav Med. 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 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. 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]. Two studies reported using all phases of Knowledge Creation [20],[26] (see Table 4). And if so, how?. 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. knowledge to action gap through research-clinical partnerships in speech-language pathology. These were the question and study design, recruitment and selection and methods of data collection and analysis. The authors declare that they have no competing interests. We recommend using the latest version of IE11, Edge, Chrome, Firefox or 2014, 9: 2-10.1186/1748-5908-9-2. Key factors present in sustaining knowledge use can include perceived benefits and risks, relevance, leadership, policy integration, resources and politics. 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. Estabrooks and colleagues [28] comment that the Canadian research funding organisation had adopted the KTA Framework to guide knowledge translation, deploying specific grant mechanisms to ensure involvement of knowledge users with researchers throughout the research process (p. 2). Petzold A, Korner-Bitensky N, Menon A: Using the knowledge to action process model to incite clinical change. Petzold, A., Korner-Bitensky, N., & Menon, A. 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). 10.1016/j.cjca.2012.03.011. The framework has two components: Knowledge Creation and an Action Cycle, each of which comprises multiple phases. The purpose of translation is to provide the best outcomes and value, and lower risks to our patient population. More About Knowledge Translation at CIHRCIHR. Eight of the ten studies were conducted in Canada, one in the Democratic Republic of Congo [17] and one in Denmark [18]. Matern Child Nutr. As knowledge moves through three stages (inquiry, synthesis, tools/products), it becomes more user-friendly. 2002, 38: 94-104. 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]. (2010). "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.". 2012, 7: 87-10.1186/1748-5908-7-87. 2013, 19: 915-24. 2011, 11: 29-10.1186/1471-2288-11-29. Knowledge to Action Framework. Selection bias is another limitation given that we aimed to identify papers reporting usage of the KTA Framework rather than considering or comparing with other conceptual frameworks. Understanding if and how these theoretical tools add value to implementation endeavours and outcomes merits further research. 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). 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. Cite this article, Conceptual frameworks are recommended as a way of applying theory to enhance implementation efforts. IL Potential benefits from applying a conceptual framework include making the process of knowledge translation more systematic, with greater likelihood of changed practice and spread of evidence [4],[6]-[9]. 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 search strategy was limited to citation searching of three databases. Google Scholar also enabled access to book chapters whereas Scopus and Web of Science only indexed peer-reviewed journal articles. 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. We further identified a need to use taxonomies when analysing or evaluating knowledge translation strategies [33],[34]. Each study demonstrates the particularity of implementation activities. Next, 911 records were excluded at the sift stage. However, none of these knowledge translation strategies, designed to target different barriers, featured in the included studies, with one exception. Estabrooks CA, Teare GF, Norton PG: Should we feed back research results in the midst of a study?. Due to overlapping categories (e.g. volume9, Articlenumber:172 (2014) Ilott I, Gerrish K, Booth A, Field B: Testing the consolidated framework for implementation research on health care innovations from South Yorkshire. 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). This is typically the recommended starting point for implementation and involves identifying a problem that needs attention. Theories and Models of Knowledge to Action. Can J Cardiol. 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. The knowledge to action cycle is one framework for knowledge translation that integrates policy makers throughout the research cycle. When the framework was integral to knowledge translation, it guided action in idiosyncratic ways and there was theory fidelity. Regardless of the approach, its critical to ensure that interventions are tailored to address the specific issue, audience and context to enhance uptake. Copyright 2015 Wiley Periodicals, Inc., A Wiley Company 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. Most studies created a range of products, either as part of Knowledge Creation [18],[20],[21],[26] or the Action Cycle [21],[23],[24]. Citation searching for the original reference by Graham and colleagues [1] optimised the sensitivity and specificity of the search strategy. Seven described using both the Knowledge Creation and the Action Cycle components [18],[20]-[24],[27]. 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. We chose citation searching as our preferred method to identify reports of practical applications of a model or framework [14],[15]. In contrast, they wanted to evaluate the impact of their intervention on peoples ability to understand their choices and make informed decisions about treatment. This showed that the degree of usage varied from merely citing the KTA Framework to full integration into the study. Search for more papers by this author. 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]. Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework. School of Nursing, University of Ottawa, Ottawa, ON, Canada. It may also be a reflection of the challenges for defining and reporting outcomes for knowledge translation projects. 61656, Rockford, We initially included 146 studies that reported using the KTA Framework. 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. J Contin Educ Health Prof. 2006, 26: 13-24. Between 2009 and 2013, she was a Knowledge Translation Project Lead with the NIHR CLAHRC SY. Today well highlight one of the most highly cited conceptual frameworks in Canada the Knowledge-to-Action (KTA) Framework. This review is designed to address this knowledge gap. However, the target audiences were primarily patients, the public and the nursing and allied health professions. However, adaptation of guidelines also runs the risk of deviating from the original evidence base to address this, a systematic approach to guideline adoption has been developed by a Canadian collaboration called ADAPTE [4]. Those excluded at this stage included literature reviews and conceptual, descriptive or commentary papers, papers describing a single knowledge translation strategy or not topically relevant. Implement Sci. Nine were published in peer-reviewed journals with the exception being a Master of Science degree dissertation [19]. Finfgeld-Connett D, Johnson ED: Literature search strategies for conducting knowledge-building and theory-generating qualitative systematic reviews. It was cited 470 unique times across the three databases, indicating the bibliometric impact of the source paper. 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. CIHR also provides a practical guide to designing a KT intervention for health researchers, with relevant examples of its application. 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. Action is the deeds or decisions made based on knowledge and information. 10.1177/1077558711430690. AB is a member of the editorial board of Implementation Science. They and we resorted to a simple taxonomy to describe the level and type of usage based on explicit reporting. Any differences were discussed and resolved by consensus. 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. 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. Knowledge Translation in Health Care: Moving from Evidence to Practice. On this basis, all ten studies were judged as having described their projects clearly. 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 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. 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. 2012, 7: 48-10.1186/1748-5908-7-48. 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. IL Health Psychol. Most of the theories were interdisciplinary or from nursing and were published between 1983 and 2006 [11]. 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 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. 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. The least reported phase, or the phase carried out least often, was sustain knowledge use. This framework was developed in Canada by Graham et al. 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. 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. looked at 10 behaviour change interventions where explicit use of theory was absent, and mapped these strategies to domains of the Theoretical Domains Framework. Similarly, we acknowledge that some readers may be interested in precise reasons for exclusions. 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. Unfortunately, an implemented change is not usually self-sustaining and requires ongoing monitoring and effort. 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. Assessment of barriers can be done quantitatively and qualitatively using a variety of conceptual models and instruments. Effectiveness: The extent to which the intended effect or benefits that were achieved under optimal . Graham I, Logan J, Harrison M, Straus S, Tetroe J, Caswell W, Robinson N: Lost in knowledge translation: time for a map?. 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. 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. 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 ]. The KTA Framework consists of two components: (1) Knowledge Creation Knowledge creation is represented by the funnel in the centre of the image above. the main menu, efforts. Knowledge creation has three phases: (1) knowledge inquiry, (2) knowledge synthesis, and (3) knowledge tools and products. Knowledge-related barriers [32] were the most common, indicating the appropriateness of using educational strategies to address such barriers. Terms and Conditions, questionnaires). (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. Implement Sci. Becky Field. 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 KTA Framework was enacted in different health care and academic settings with projects targeted at patients, the public, and nursing and allied health professionals. Five studies applied one or more phases [18],[20],[22],[24],[26]. 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. A taxonomy categorising the continuum of usage was developed. They reviewed 31 planned action theories about the process of change. The result set was reduced to 1,057 records following removal of duplicate and non-English language records. . Nine of the studies reported assessing barriers to change [17]-[19],[21]-[26]. Keyser SE: The Implementation of a Delirium Knowledge Translation Project for Families of the Elderly. Davies and colleagues [40] note that less than 6% of 235 studies, albeit published before 1998, explicitly used theories of behaviour or behaviour change. Adapting to local context is a critical step in the process. 2014, 9: 54-10.1186/1748-5908-9-54. None described applying every phase of the KTA Framework. 10.2340/16501977-0451. A continuum of usage, ranging from referenced to integrated, was developed to aid this process. The action cycle is iterative and includes the deliberate application of knowledge to cause change in behaviours and/or attitudes. Armstrong R, Waters E, Dobbins M, Anderson L, Moore L, Petticrew M, Clark R, Pettman TL, Burns C, Moodie M, Conning R, Swinburn B. Kitson A, Powell K, Hoon E, Newbury J, Wilson A, Beilby J. LaRocca R, Yost J, Dobbins M, Ciliska D, Butt M. Kothari AR, Bickford JJ, Edwards N, Dobbins MJ, Meyer M. National Collaborating Centre for Methods and Tools (2010). Med Care Res Rev. 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. Implement Sci. 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]. Only ten studies were integrated, signifying that the KTA Framework was integral to the design, delivery and evaluation of the implementation activities. 2013, 23 (4): 290-298. Upper Saddle River, NJ: Prentice Hall. 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. This review sought to answer two questions: Is the KTA Framework used in practice? Philadelphia: Lea & Febiger. 2010, Wiley Blackwell, Chichester, UK. Booth A, Harris J, Croot E, Springett J, Campbell F, Wilkins E: Towards a methodology for cluster searching to provide conceptual and contextual richness for systematic reviews of complex interventions: case study (CLUSTER). The importance of organisational or external factors and the ability to influence them is well recognised [1],[3],[33]-[35]. Provided by the Springer Nature SharedIt content-sharing initiative. 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. 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. Google Scholar. 10.1016/j.amepre.2012.05.024. It is possible some potentially relevant studies were excluded during the initial sift stage. Offering up to 36-month product lifecycle support and 6-month end-of-life notice to allow . Implementation Sci 9, 172 (2014). Rather, papers typically stated aims and objectives, which often related to closing evidence/knowledge-practice gaps. J Contin Educ Health Prof. 2008, 28: 117-122. 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 Others argue that the effectiveness and generalisability of implementation studies are hindered by weak theoretical underpinnings [40],[43],[44]. 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]. For an overview of other determinant frameworks that are useful in this phase, see the determinant frameworks section of Nilsens paper [7]. Data collection 10.1111/j.1553-2712.2007.tb02369.x. Implement Sci. Their findings suggested that the more domains that were targeted, the less effective the intervention was [9]. The taxonomy enabled us to refine the inclusion criteria to identify studies that reported explicit application of the KTA Framework. Powell BJ, McMillen C, Proctor E, Carpenter CR, Griffley RT, Bunger AC, Glass JE, York JL: A compilation of strategies for implementing clinical innovations in health and mental health. 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. All citations identified were screened by title and available information according to agreed criteria.