KT Knowledge Transfer

Collection of articles on KT is available here.

Quantitative measures of health policy implementation determinants and outcomes: a systematic review
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Allen P, Pilar M, Walsh-Bailey C, Hooley C, Mazzucca S, Lewis CC, et al.
Implement Sci 2020 Jun 19;15(1):47-020-01007-w.
BACKGROUND: Public policy has tremendous impacts on population health. While policy development has been extensively studied, policy implementation research is newer and relies largely on qualitative methods. Quantitative measures are needed to disentangle differential impacts of policy implementation determinants (i.e., barriers and facilitators) and outcomes to ensure intended benefits are realized. Implementation outcomes include acceptability, adoption, appropriateness, compliance/fidelity, feasibility, penetration, sustainability, and costs. This systematic review identified quantitative measures that are used to assess health policy implementation determinants and outcomes and evaluated the quality of these measures. METHODS: Three frameworks guided the review: Implementation Outcomes Framework (Proctor et al.), Consolidated Framework for Implementation Research (Damschroder et al.), and Policy Implementation Determinants Framework (Bullock et al.). Six databases were searched: Medline, CINAHL Plus, PsycInfo, PAIS, ERIC, and Worldwide Political. Searches were limited to English language, peer-reviewed journal articles published January 1995 to April 2019. Search terms addressed four levels: health, public policy, implementation, and measurement. Empirical studies of public policies addressing physical or behavioral health with quantitative self-report or archival measures of policy implementation with at least two items assessing implementation outcomes or determinants were included. Consensus scoring of the Psychometric and Pragmatic Evidence Rating Scale assessed the quality of measures. RESULTS: Database searches yielded 8417 non-duplicate studies, with 870 (10.3%) undergoing full-text screening, yielding 66 studies. From the included studies, 70 unique measures were identified to quantitatively assess implementation outcomes and/or determinants. Acceptability, feasibility, appropriateness, and compliance were the most commonly measured implementation outcomes. Common determinants in the identified measures were organizational culture, implementation climate, and readiness for implementation, each aspects of the internal setting. Pragmatic quality ranged from adequate to good, with most measures freely available, brief, and at high school reading level. Few psychometric properties were reported. CONCLUSIONS: Well-tested quantitative measures of implementation internal settings were under-utilized in policy studies. Further development and testing of external context measures are warranted. This review is intended to stimulate measure development and high-quality assessment of health policy implementation outcomes and determinants to help practitioners and researchers spread evidence-informed policies to improve population health. REGISTRATION: Not registered.

Characteristics of knowledge translation theories, models and frameworks for health technology reassessment: expert perspectives through a qualitative exploration
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Esmail R, Clement FM, Holroyd-Leduc J, Niven DJ, Hanson HM.
BMC Health Serv Res 2021 Apr 29;21(1):401-021-06382-8.
BACKGROUND: Health Technology Reassessment (HTR) is a process that systematically assesses technologies that are currently used in the health care system. The process results in four outputs: increase use or decrease use, no change, or de-adoption of a technology. Implementation of these outputs remains a challenge. The Knowledge Translation (KT) field enables to transfer/translate knowledge into practice. KT could help with implementation of HTR outputs. This study sought to identify which characteristics of KT theories, models, and frameworks could be useful, specifically for decreased use or de-adoption of a technology. METHODS: A qualitative descriptive approach was used to ascertain the perspectives of international KT and HTR experts on the characteristics of KT theories, models, and frameworks for decreased use or de-adoption of a technology. One-to-one semi-structured interviews were conducted from September to December 2019. Interviews were audio recorded and transcribed verbatim. Themes and sub-themes were deduced from the data through framework analysis using five distinctive steps: familiarization, identifying an analytic framework, indexing, charting, mapping and interpretation. Themes and sub-themes were also mapped to existing KT theories, models, and frameworks. RESULTS: Thirteen experts from Canada, United States, United Kingdom, Australia, Germany, Spain, and Sweden participated in the study. Three themes emerged that illustrated the ideal traits: principles that were foundational for HTR, levers of change, and steps for knowledge to action. Principles included evidence-based, high usability, patient-centered, and ability to apply to the micro, meso, macro levels. Levers of change were characterized as positive, neutral, or negative influences for changing behaviour for HTR. Steps for knowledge to action included: build the case for HTR, adapt research knowledge, assess context, select interventions, and assess impact. Of the KT theories, models, and frameworks that were mapped, the Consolidated Framework for Implementation Research had most of the characteristics, except ability to apply to micro, meso, macro levels. CONCLUSIONS: Characteristics that need to be considered within a KT theory, model, and framework for implementing HTR outputs have been identified. Consideration of these characteristics may guide users to select relevant KT theories, models, and frameworks to apply to HTR projects.

Implementation Science and Nursing Leadership: Improving the Adoption and Sustainability of Evidence-Based Practice
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Nelson-Brantley HV, Chipps E.
J Nurs Adm 2021 May 1;51(5):237-239.
Increasingly, nurse executives are embracing evidence-based practice (EBP). Yet, it takes 17 years to move only 14% of research evidence into practice. Implementation science (IS) aims to reduce this gap through the study of factors that influence dissemination, adoption, implementation, and sustainability of evidence-based interventions. Nurse leaders aiming for EBP must be well equipped to support IS. This article introduces IS, leadership competencies essential for supporting implementation research and practice, and preparing an IS-ready workforce.

Beliefs and implementation of evidence-based practice among nurses in the nursing homes of a Swiss canton: An observational cross-sectional study
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Perruchoud E, Fernandes S, Verloo H, Pereira F.
J Clin Nurs 2021 May 7.
AIMS AND OBJECTIVES: Examine beliefs about EBP and its level of implementation among nurses working in nursing homes in a bilingual canton of Switzerland and explore associations between these aspects and nurses’ sociodemographic and professional characteristics. BACKGROUND: Although evidence-based practice (EBP) is recognised as an effective strategy for improving the quality and safety of care, little is known about its use in nursing homes. Nurses’ beliefs about EBP and their implementation of it in Switzerland’s nursing homes have never been explored. DESIGN: An observational cross-sectional study. METHODS: Beliefs about and implementation of EBP were evaluated using validated French- and German-language versions of the EBP Beliefs Scale and the EBP Implementation Scale, developed by Melnyk and Fineout-Overholt (Melnyk, Fineout-Overholt, & Mays, 2008, Worldviews on Evidence-Based Nursing, 5, 208). The STROBE checklist for cross-sectional studies was used in reporting this study. RESULTS: The participation rate was 40.6% (N = 194). Most participants stated that they had some knowledge of EBP and held favourable beliefs about it. Nevertheless, 37.1% of participants found the concept complicated and 36.1% found it time-consuming. Participants were more likely to implement stages in the EBP process linked to direct clinical practice rather than those which required scientific knowledge and skills. CONCLUSION: Most participants had favourable beliefs about EBP, but the level of implementation of EBP among nurses in their daily clinical practice was sub-optimal. RELEVANCE TO CLINICAL PRACTICE: A greater emphasis should be put on fostering the use of EBP among nurses working in nursing homes. This could be achieved via training and the development of individual, institutional and contextual strategies promoting the integration of EBP in clinical settings.

Assessment of an integrated knowledge translation intervention to improve nutrition intakes among patients undergoing elective bowel surgery: a mixed-method process evaluation
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Rattray M, Marshall AP, Desbrow B, von Papen M, Roberts S.
BMC Health Serv Res 2021 May 27;21(1):514-021-06493-2.
BACKGROUND: A large evidence-practice gap exists regarding provision of nutrition to patients following surgery. The aim of this study was to evaluate the processes supporting the implementation of an intervention designed to improve the timing and adequacy of nutrition following bowel surgery. METHODS: A mixed-method pilot study, using an integrated knowledge translation (iKT) approach, was undertaken at a tertiary teaching hospital in Australia. A tailored, multifaceted intervention including ten strategies targeted at staff or patients were co-developed with knowledge users at the hospital and implemented in practice. Process evaluation outcomes included reach, intervention delivery and staffs’ responses to the intervention. Quantitative data, including patient demographics and surgical characteristics, intervention reach, and intervention delivery were collected via chart review and direct observation. Qualitative data (responses to the intervention) were sequentially collected from staff during one-on-one, semi-structured interviews. Quantitative data were summarized using median (IQR), mean (SD) or frequency(%), while qualitative data were analysed using content analysis. RESULTS: The intervention reached 34 patients. Eighty-four percent of nursing staff received an awareness and education session, while 0% of medical staff received a formal orientation or awareness and education session, despite the original intention to deliver these sessions. Several strategies targeted at patients had high fidelity, including delivery of nutrition education (92%); and prescription of oral nutrition supplements (100%) and free fluids immediately post-surgery (79%). Prescription of a high energy high protein diet on postoperative day one (0%) and oral nutrition supplements on postoperative day zero (62%); and delivery of preoperative nutrition handout (74%) and meal ordering education (50%) were not as well implemented. Interview data indicated that staff regard nutrition-related messages as important, however, their acceptance, awareness and perceptions of the intervention were mixed. CONCLUSIONS: Approximately half the patient-related strategies were implemented well, which is likely attributed to the medical and nursing staff involved in intervention design championing these strategies. However, some strategies had low delivery, which was likely due to the varied awareness and acceptance of the intervention among staff on the ward. These findings suggest the importance of having buy-in from all staff when using an iKT approach to design and implement interventions.

Understanding the uptake of a clinical innovation for osteoarthritis in primary care: a qualitative study of knowledge mobilisation using the i-PARIHS framework
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Swaithes L, Dziedzic K, Finney A, Cottrell E, Jinks C, Mallen C, et al.
Implement Sci 2020 Oct 28;15(1):95-020-01055-2.
BACKGROUND: Osteoarthritis is a leading cause of pain and disability worldwide. Despite research supporting best practice, evidence-based guidelines are often not followed. Little is known about the implementation of non-surgical models of care in routine primary care practice. From a knowledge mobilisation perspective, the aim of this study was to understand the uptake of a clinical innovation for osteoarthritis and explore the journey from a clinical trial to implementation. METHODS: This study used two methods: secondary analysis of focus groups undertaken with general practice staff from the Managing OSteoArthritis in ConsultationS research trial, which investigated the effectiveness of an enhanced osteoarthritis consultation, and interviews with stakeholders from an implementation project which started post-trial following demand from general practices. Data from three focus groups with 21 multi-disciplinary clinical professionals (5-8 participants per group), and 13 interviews with clinical and non-clinical stakeholders, were thematically analysed utilising the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, in a theoretically informative approach. Public contributors were involved in topic guide design and interpretation of results. RESULTS: In operationalising implementation of an innovation for osteoarthritis following a trial, the importance of a whole practice approach, including the opportunity for reflection and planning, were identified. The end of a clinical trial provided opportune timing for facilitating implementation planning. In the context of osteoarthritis in primary care, facilitation by an inter-disciplinary knowledge brokering service, nested within an academic institution, was instrumental in supporting ongoing implementation by providing facilitation, infrastructure and resource to support the workload burden. ‘Instinctive facilitation’ may involve individuals who do not adopt formal brokering roles or fully recognise their role in mobilising knowledge for implementation. Public contributors and lay communities were not only recipients of healthcare innovations but also potential powerful facilitators of implementation. CONCLUSION: This theoretically informed knowledge mobilisation study into the uptake of a clinical innovation for osteoarthritis in primary care has enabled further characterisation of the facilitation and recipient constructs of i-PARIHS by describing optimum timing for facilitation and roles and characteristics of facilitators.

Systematic review and policy dialogue to determine challenges in evidence-informed health policy-making: findings of the SASHA study
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Yazdizadeh B, Sajadi HS, Mohtasham F, Mohseni M, Majdzadeh R.
Health Res Policy Syst 2021 May 4;19(1):73-021-00717-x.
BACKGROUND: Various interventions have been undertaken in Iran to promote evidence-informed health policy-making (EIHP). Identifying the challenges in EIHP is the first step toward strengthening EIHP in each country through the design of tailored interventions. Therefore, the current study was conducted to synthesize the results of earlier studies and to finalize the list of barriers to EIHP in Iran. METHODS: To identify the barriers to EIHP in Iran, two steps were taken: a systematic review and policy dialogue. To conduct the systematic review, three Iranian databases and PubMed, Health Systems Evidence (HSE), Embase, and Scopus were searched. The reference lists of included papers and documentation from some local organizations were hand-searched. Upon conducting the systematic review, given the significance of stakeholders in clarifying the problem of EIHP, policy dialogue was used to complete the list previously extracted and to do advocacy. Selection criteria for the stakeholders included influential and informed individuals from knowledge-producing, knowledge-utilizing, and knowledge-brokering organizations. Semi-structured interviews were held with three important absent stakeholders. RESULTS: Challenges specific to Iran that were identified included the lack of integration of the health ministry and the medical universities, lack of ties between health knowledge utilization organizations, failure to establish long-term research plans, neglect of national research needs at the time of recruiting human resources in knowledge-producing organizations, and duplication and lack of coordination in routine data obtained from surveillance systems, disease registration systems, and censuses. It seems that some challenges are common across countries, including neglecting the importance of inter- and intra-disciplinary studies, the capacity of policy-makers and managers to utilize evidence, the criteria for evaluating the performance of policy-makers, managers, and academic members, the absence of long-term programmes in knowledge-utilizing organizations, the rapid replacement of policy-makers and managers, and lack of use of evaluation studies. CONCLUSIONS: In this study, we tried to identify the challenges regarding EIHP in Iran using a systematic review and policy dialogue approach. This is the first step toward determining the best interventions to improve evidence-informed policy-making in each country, because these challenges are contextual and need to be investigated contextually.