Impact of Non-Human Actors in Communicating Meaning: Towards a Knowledge Translation Framework

ObjectiveTo map what is currently known about knowledge translation (KT) in Anglo-American paramedicine. The review focuses on reported barriers and facilitators to the implementation of new knowledge, and the use...

Seventeen years. That is the often-quoted figure for approximately how long it takes to incorporate research discoveries into the practice of health-care providers.1 This lag can be much longer, if at any point from bench or animal studies to human trials, the effects are smaller when tested in larger human trials or inconsistent findings are reported when the studies are replicated.2 Despite spending billions of dollars on clinical research, quality improvement initiatives, clinical practice guideline development, training of health-care professionals and risk assessments, effective interventions and programs do not always reach the patients that could benefit from them.3 The Canadian Institute of Health Research reported that one-third of patients do not receive treatments that are proven to be effective, and one-quarter of patients receive care that is not needed or is potentially harmful.4 In a similar analysis, the CareTrack study found that adults in Australia received appropriate care (according to relevant guidelines) only 57% of the time.5 In an examination of underuse of effective medical services around the world, failure of practitioners to know about or act upon evidence for a variety of reasons contributed to suffering, disability and loss of life in both low- and high-income countries 'regardless of payment model or health system, and in clinical settings ranging from rural clinics to tertiary hospitals'.6 With the current pressures both to deliver evidence-based practice and achieve cost-effective outcomes, dietitians, like the other health-care practitioners with whom they work, are expected to identify and incorporate best evidence into their practices in a timely way and monitor this impact on health outcomes. Addressing the gap between the creation of knowledge and its uptake by stakeholders to create efficiencies in care delivery and improve the health outcomes of individuals and populations has come to be known as knowledge translation (KT). A more specific definition of KT was developed by the Canadian Institute of Health Research: Knowledge translation is 'a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products, and strengthen the health-care system'.7 In Europe, it may be referred to as implementation science and while translational research, continuing education and professional development can be part of the knowledge transfer process, they are not synonymous with it.8 Graham et al.'s Knowledge-to-Action (KTA) framework has been central to KT strategies since its publication in 2006.8 The Knowledge Creation component of the framework relates to distilling the vast amount of knowledge available in health care so that the most valid and useful is accessible to stakeholders. This knowledge is derived from high-quality primary research (knowledge inquiry), the most relevant of which is then replicated, appraised and synthesised in the form of systematic reviews or meta analyses (knowledge synthesis), which are further refined into tools such as clinical practice guidelines, decision aids, care pathways and evidence summaries (tools and products). These final tools are meant to provide clear recommendations to inform and guide the actions of the various stakeholders such as health-care providers, patients and policy-makers. Experiential knowledge can and should be incorporated, as ideally creators of knowledge (researchers) collaborate throughout the process with end-users of the knowledge (stakeholders). Grol remarked that 'evidence-based medicine should be complemented by evidence-based implementation'10 and while there are gaps in our knowledge about effective strategies for enhancing KT, there are a growing number of resources to inform KT activities. Cochrane has developed a KT framework11 to ensure their reviews are relevant and follow stringent methodological processes and utilise reviews conducted by their Effective Practice and Care Group12 and Consumer and Communications Review Group13 to ensure their KT activities are grounded in best practices for dissemination and uptake. The Appraisal of Guidelines for Research and Evaluation AGREE II Scorecard for rating the quality of clinical practice guidelines has included ranking on domains relevant to improving their uptake (KT) since 2003.14 A scoping review by Wilson et al.15 identified that the steps in KT frameworks relating to adapting knowledge to the local context, assessing barriers to knowledge use and implementing interventions to promote knowledge use (referred to as dissemination in his review) were generally underpinned by at least one of the following theories: persuasive communication, diffusion of innovations theory or social marketing. Parks et al.16 provide a detailed methodology for enhancing the dissemination and update of programs and policies to enhance diabetes-related care in local health departments using some of these frameworks. Kastner and Straus illustrate how the knowledge to action framework was used to create a clinical support tool to enhance osteoporosis disease management by primary care providers.17 Both these examples illustrate KT strategies designed to consider the local practice settings in which the knowledge or innovation will be used. Another key factor in a KT plan is the identification of barriers to knowledge uptake. Barriers can be individual such as lack of knowledge, skills, time, resistance to change or occur during the interaction between the practitioner and patient.18 This issue of Nutrition & Dietetics includes a report on a pilot study examining empathy scores of Malaysian dietitians using a validated survey tool.19 If the patient is the target for a particular KT intervention, examining the provider–patient relationship can enhance communication and improve outcomes, the ultimate goal of KT. Replacing older knowledge with new evidence is another KT challenge.20 Clinical practice guidelines that have been widely adopted into practice and reinforced by institutional care protocols can become resistant to newer evidence, and peer groups whose standards are inconsistent with best practices can make adoption of new knowledge or evidence challenging at an individual level.18 Mathews et al.21 explore these phenomena in their examination of dietitians' opinions regarding the prevalence, diagnosis and effective monitoring of refeeding syndrome in 11 countries. Their findings of variability in dietitians' assessment of prevalence of refeeding syndrome and differences in the role dietitians play in diagnosing and monitoring this condition lead them to recommend that updated, international, evidence-based clinical practice guidelines are needed. Barriers can also arise from organisational, institutional or even environmental factors. Organisational barriers can result from staff turnover and a loss of momentum, lack of institutional support for evidence-based practices, incentives that do not support best practice and a disconnect between multidisciplinary team members or the researcher/educator and the end user of the knowledge or intervention. Young et al.22 described a quality improvement initiative designed to improve nutritional and functional outcomes in older patients with or at risk of malnutrition. Using a participatory research approach to engage the multidisciplinary care providers and patients, they conducted a feasibility study to examine local processes related to discharge planning and follow up. Informed by this experience and enhanced by extensive consultations with stakeholders in the hospital and community environments, they then designed and implemented a dietitian-led discharge planning and follow-up program. While the improvements in nutritional or functional outcomes were modest, the improved communication, collaboration and discharge processes likely contributed to a shorter length of stay. The introduction of the National Disability Insurance Scheme in Australia is an example of an environmental shift that has implications for dietetic practice, training and workforce planning. Butler et al.23 surveyed course contacts from accredited dietetics programs to gain insight into how disability-related topics were addressed during dietitian undergraduate and postgraduate master's training. The development of policy documents such as role statements and core standards along with online learning modules can be key KT tools to ensure evidence-based practices are taught and practiced by those entering this emerging area of dietetic practice. While much of the KT literature seeks to address the lag between knowledge generation and actual uptake into practice, Balas and Chapman outline several factors that contribute to situations where overzealous KT and implementation has also lead to harm.20 Describing it as impulsive adoption they refer the 2001 clinical trial that concluded that intensive insulin therapy could reduce morbidity and mortality in patients in intensive care units (ICUs).24 The practice was quickly and widely recommended, and its uptake enhanced in USA as some jurisdictions tied reimbursement to protocols advocating for tight control of serum glucose levels. Eight years later, a much larger trial found that intensive glucose control actually increased mortality in patients in the ICU.25 Thousands of unnecessary deaths have been attributed to the overly quick adoption without adequate replication studies confirming the intervention was safe in the diverse patient population seen in the ICU. Misguided announcements20 are particularly problematic in today's social media landscape where unscientific advice, often amplified by celebrity endorsements, can lead to products and interventions being widely adopted or alternatively shunned irrespective of evidence. Information overload20 resulting from so many new studies being published and making headlines, makes it difficult for practitioners to quickly assess the really important ones and implement them in a timely manner. Studies with small sample sizes, large numbers of observational studies being published which are then refuted in subsequent observational studies or randomised control trials can also ultimately discourage the uptake of valuable research by consumers and create mistrust of credible nutrition guidelines.26 Finally, there is a new phenomenon in the KT arena. FOAM or Free Open Access Medical education was named by an international group of emergency physicians and refers to any free online medical education including blogs, podcasts, videos, tweet threads, chats etc.27 While these reduce the time for research to reach practitioners, others worry that this rapid dissemination may avoid the replication step and lead to harm; that adequate critical appraisal, peer review or editorial oversight may be omitted, or that active, charismatic online practitioners may over-influence the adoption of knowledge, research or innovations into clinical practice.28 FOAM proponents suggest that those concerns can be mitigated by ensuring that clinicians have adequate critical thinking skills and tools to evaluate these online knowledge offerings. They encourage educators and communications experts to work with scientists to utilise these online platforms as rapid dissemination vehicles and engagement platforms. Dietitians around the world are active in social media and online platforms and are increasingly using them to inform their practice and to share their knowledge with others. Chan et al.28 provide a toolkit for interested practitioners to explore how this once 'disruptive' form of knowledge exchange can be used effectively alongside other more traditional KT strategies to enhance the uptake and exchange of knowledge and support evidence-based practice. Dietitians are both recipients and disseminators of research knowledge. Utilising effective and relevant KT strategies that are tailored to the local circumstances and the target audience can enhance the delivery of care and programs offered by dietitians and improve the health outcomes of those they serve. The author received no funding to write this Editorial. The author is Director of PEN: Practice-based Evidence in Nutrition. JT is the sole author of this manuscript.

Background: In the rehabilitation sciences field, including physical therapy and manual therapy, there is a gap between scientific evidence and its application in clinical practice. Transferring scientific evidence to clinicians and translating this knowledge into practice have been identified as a challenge in the healthcare field. The processes of knowledge exchange and knowledge translation in the physical therapy and manual therapy fields are very challenging and several barriers can be pointed out. These barriers are contributors to the gap between scientific evidence and its application in clinical practice. By identifying the existing barriers and applying strategies to improve knowledge exchange and knowledge translation, it will be possible to improve both scientific use and evidence-based practice.Objectives: To highlight the barriers interfering in the processes of knowledge exchange and translation in physical therapy and manual therapy fields, and to point out specific barriers that may affect the effectiveness of knowledge exchange and knowledge translation in the manual therapy field.Major findings: Various barriers in the knowledge exchange and translation processes were described, in the literature. These include issues with scientific publications such as lack of detailed description of the intervention used, confusing language, differences between dissemination/capture channels by interpretation issues. Enhancing the relationship between researchers and clinicians by using simple language is the most frequent strategy suggested to reduce the barriers of knowledge exchange and translation in the physical therapy and manual therapy fields.

How does new knowledge ‘flow’ within an organisation? In this paper we report upon a case study in which ethnography is employed to render visible the ‘knowledge transfer’ (strategically redefined as ‘knowledge translation’) occurring between a PhD researcher and the members of the organisation in which he is ‘embedded’. In this case the PhD student is located within an architectural firm and an industry context that is not accustomed to housing researchers in its midst. The path of knowledge flow, or rather its translation, is not found to be smooth. Knowledge ‘flow’ happens only in leaks and trickles through the organisation. We discuss the implications of this case for how ethnographic research in a business context might be communicated to an audience who do not necessarily value scrutiny of this nature.

One of the key areas of delivery of the 'Action Plan for Health Research 2019-2029', for the Health Service Executive (HSE) in Ireland, is adding value and using data and knowledge, including health-related quality of life (HRQoL), for improved health care, service delivery and better population health and wellbeing. The development of governance, management and support framework and mechanisms will provide a structure for ensuring research is relevant to the organisation's service plan, well designed, has a clear plan for dissemination and translation of knowledge, and minimises research waste. Developing a process for the translation, dissemination and impact of research is part of the approach to improving translation of research into practice and aligning it with knowledge gaps. A project was undertaken to develop a clear, unified, universally applicable approach for the translation, dissemination, and impact of research undertaken by HSE staff and commissioned, sponsored, or hosted by the organisation. This included the development of guidance, training, and information for researchers. Through an iterative process, an interdisciplinary working group of experts in knowledge translation (KT), implementation science, quality improvement and research management, identified KT frameworks and tools to form a KT, dissemination, and impact process for the HSE. This involved a literature review, screening of 247 KT theories, models, and frameworks (TMFs), review of 18 TMFs selected as usable and applicable to the HSE, selection of 11 for further review, and final review of 6 TMFs in a consensus workshop. An anonymous online survey of HSE researchers, consisting of a mixture of multiple choice and free text questions, was undertaken to inform the development of the guidance and training. A pilot of the KT process and guidance, involving HSE researchers testing its use at various stages of their research, demonstrated the need to guide researchers through planning, stakeholder engagement, and disseminating research knowledge, and provide information that could easily be understood by novice as well as more experienced researchers. A survey of all active researchers across the organisation identified their support and knowledge requirements and led to the development of accompanying guidance to support researchers in the use of the process. Researchers of all levels reported that they struggled to engage with stakeholders, including evidence users and policy makers, to optimise the impact of their research. They wanted tools that would support better engagement and maximise the value of KT. As a result of the project a range of information, guidance, and training resources have been developed. KT is a complex area and researchers need support to ensure they maximise the value of their research. The KT process outlined enables the distilling of a clear message, provides a process to engage with stakeholders, create a plan to incorporate local and political context, and can show a means to evaluate how much the findings are applied in practice. This is a beneficial application of KT in the field of patient reported outcomes. In implementing this work, we have reinforced the message that stakeholder engagement is crucial from the start of the research study and increases engagement in, and ownership of, the research knowledge.

Recent literature shows that adopting an accounting information system (AIS) can lead to better decision-making, planning, efficiency and on-time management control, and organisational functionality. However, the impact of AIS implementation on role creation in the organisation is unclear. With the digital transformation of AIS and daily advances in machine learning and other innovative technologies, it is also unclear how these changes interact with human roles in organisations and which AIS components are considered essential. This paper addresses the above issues by applying the actor-network theory to examine the impact of deep machine learning modules in predicting the human actor roles in accounting information systems in organisations. We targeted 120 human actors and examined the influence of deep machine learning modules in predicting 11 personnel and professional features of human actors, based on multivariate statistical analysis. Our findings show that two human factors (familiarity with accounting information and time spent on becoming familiar with it) are the most influential elements that can predict the human actor roles in accounting information systems in organisations. So, human and non-human actors are both essential parts of an integrated AIS that must be considered. The current literature has focused on the AIS structure with less on the interaction between human and non-human actors. One of the main contributions of this study is providing evidence that AIS heavily relies on its human and non-human actors to form a coherent and united AIS network to promote AIS management strategies. The practical implication of the results is that investing in either technology or human resources alone is not enough to achieve the best productivity and performance in organisations. Instead, there must be a balance between human and non-human actors.

BackgroundHealth 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.MethodsA 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.ResultsThirteen 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.ConclusionsCharacteristics 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.

The importance to bridge the gap between research and policy making has been widely recognised. Also, in the field of Burden of Disease, this gap exists. There are various terms used to define the dynamic process of synthesising, exchanging and applying generated knowledge into policy making. These are among other interchangeably used terms: knowledge translation, research utilization, implementation science, knowledge transfer or knowledge exchange, here referred to as knowledge translation (KT). The driver behind the systematic effort of KT is to bridge the gap between the generation of that knowledge and its application such as to improve public health. Among communication strategies to achieve KT include the engagement with policy and decision-makers for effective use of the findings into potential benefits for the health and wellbeing of the population. Other strategies, include the development of patient-public-involvement partnerships to communicate the findings with the public and create an open dialogue for further use of research results into practice. The focus of KT by researchers to date has mainly been on the ‘translation' of biomedical research, including findings from clinical trials, evidence from clinical practice guidelines, mixed-methods data on the development of implementation tools and other. However, similar findings on the translation of such evidence from burden of disease studies (BoD) have been non-existent. Potential reasons for this may have been challenges such as creating effective engagement strategies with appropriate stakeholders for the use of BoD findings, establishing a common methodological framework, difficulties in interpreting the findings for health-policy purposes, or miscommunication practices on the value and impact of BoD. Further, BoD methodological tools require specialist knowledge and interpretation of results into practice, hence, making KT even more challenging. Therefore, the prospect of developing a KT framework specifically for BoD remains an opportunity but also a pressing challenge.

ObjectiveHealth technology reassessment (HTR) is a field focused on managing a technology throughout its life cycle for optimal use. The process results in one of four possible recommendations: increase use,...

Waterpipe tobacco smoking (WTS) rates in the Eastern Mediterranean Region (EMR) are the highest worldwide, particularly among young people. Although fiscal policies to curb tobacco use have been recommended by the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), implementation has been suboptimal. The Eastern Mediterranean Consortium on the Economics of Waterpipe Tobacco Smoking (ECON-WTS) was formed in response to this need to produce knowledge on the economics of WTS in the EMR and apply a comprehensive Knowledge translation (KT) framework. The KT framework comprised priority setting, evidence synthesis, knowledge translation, and knowledge uptake. In this article, we discuss the approaches followed in applying the KT framework to WTS control, providing examples and noting challenges and lessons learned where possible.

IntroductionAcademic–government partnerships are important to advance timely, responsive and relevant evidence for decision-making (policy, guideline, law and regulation) deliberations. Deliberate and strategic integrated knowledge translation (KT) approaches within such partnerships...

BackgroundApplication of knowledge translation (KT) theories, models, and frameworks (TMFs) is one method for successfully incorporating evidence into clinical care. However, there are multiple KT TMFs and little guidance on which to select. This study sought to identify and describe available full-spectrum KT TMFs to subsequently guide users.MethodsA scoping review was completed. Articles were identified through searches within electronic databases, previous reviews, grey literature, and consultation with KT experts. Search terms included combinations of KT terms and theory-related terms. Included citations had to describe full-spectrum KT TMFs that had been applied or tested. Titles/abstracts and full-text articles were screened independently by two investigators. Each KT TMF was described by its characteristics including name, context, key components, how it was used, primary target audience, levels of use, and study outcomes. Each KT TMF was also categorized into theoretical approaches as process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks. Within each category, KT TMFs were compared and contrasted to identify similarities and unique characteristics.ResultsElectronic searches yielded 7160 citations. Additional citations were identified from previous reviews (n = 41) and bibliographies of included full-text articles (n = 6). Thirty-six citations describing 36 full-spectrum were identified. In 24 KT TMFs, the primary target audience was multi-level including patients/public, professionals, organizational, and financial/regulatory. The majority of the KT TMFs were used within public health, followed by research (organizational, translation, health), or in multiple contexts. Twenty-six could be used at the individual, organization, or policy levels, five at the individual/organization levels, three at the individual level only, and two at the organizational/policy level. Categorization of the KT TMFs resulted in 18 process models, eight classic theories, three determinant frameworks, three evaluation frameworks, and four that fit more than one category. There were no KT TMFs that fit the implementation theory category. Within each category, similarities and unique characteristics emerged through comparison.ConclusionsA systematic compilation of existing full-spectrum KT TMFs, categorization into different approaches, and comparison has been provided in a user-friendly way. This list provides options for users to select from when designing KT projects and interventions.Trial registrationA protocol outlining the methodology of this scoping review was developed and registered with PROSPERO (CRD42018088564).

Knowledge translation (KT) is a set of activities or processes for synthesising, disseminating, and applying research evidence in decision-making for the benefit of society. For KT to be successful, it is paramount for researchers to play an active role in encouraging evidence uptake and use in decision-making. We carried out a mapping exercise and interviews with research cluster heads at Cochrane South Africa (CSA) of the KT activities and processes being implemented (or are planned for implementation). We organized the mapping and interview results according to the KT themes described in the Cochrane KT framework. The KT framework comprises six themes, namely, (i) prioritization and co-production of research evidence; (ii) building a sustainable infrastructure for knowledge translation; (iii) engaging with audiences for knowledge exchange or dialogue; (iv) packaging, communication and dissemination which entails disseminating research to users; (v) building audience capacity to use evidence or training activities; and (vi) advocacy or improving the culture of using evidence. Through the mapping exercise and interviews, we learned that CSA researchers excelled in implementing activities and processes linked to most of the KT themes, including producing different types of systematic reviews and providing reliable evidence for health decision-making. Cochrane South Africa (CSA) researchers are also involved in mentoring and training postgraduate students and various health decision-makers (e.g., health professionals, guideline panels and policy-makers). While they excel in the above-mentioned activities, “packaging, communication, and dissemination of research evidence” (theme iv) was identified as an area of improvement.

BackgroundMuch of the research and theorising in the knowledge translation (KT) field has focused on clinical settings, providing little guidance to those working in community settings. In this study, we build on previous research in community-based KT by detailing the theory driven and empirically-informed CollaboraKTion framework.MethodsA case study design and ethnographic methods were utilised to gain an in-depth understanding of the processes for conducting a community-based KT study as a means to distilling the CollaboraKTion framework. Drawing on extensive field notes describing fieldwork observations and interactions as well as evidence from the participatory research and KT literature, we detail the processes and steps undertaken in this community-based KT study as well as their rationale and the challenges encountered. In an effort to build upon existing knowledge, Kitson and colleagues’ co-KT framework, which provides guidance for conducting KT aimed at addressing population-level health, was applied as a coding structure to inform the current analysis. This approach was selected because it (1) supported the application of an existing community-based KT framework to empirical data and (2) provided an opportunity to contribute to the theory and practice gaps in the community-based KT literature through an inductively derived empirical example.ResultsAnalysis revealed that community-based KT is an iterative process that can be viewed as comprising five overarching processes: (1) contacting and connecting; (2) deepening understandings; (3) adapting and applying the knowledge base; (4) supporting and evaluating continued action; and (5) transitioning and embedding as well as several key elements within each of these processes (e.g. building on existing knowledge, establishing partnerships). These empirically informed theory advancements in KT and participatory research traditions are summarised in the CollaboraKTion framework. We suggest that community-based KT researchers place less emphasis on enhancing uptake of specific interventions and focus on collaboratively identifying and creating changes to the contextual factors that influence health outcomes.ConclusionsThe CollaboraKTion framework can be used to guide the development, implementation and evaluation of contextually relevant, evidence-informed initiatives aimed at improving population health, amid providing a foundation to leverage future research and practice in this emergent KT area.

Development of a clinical decision support tool and order set for stillbirth and second-trimester fetal death using knowledge translation principles