Knowledge Translation In Healthcare Research Articles

Conducting clinical research and embedding person‐centred care into the hospital setting during a global pandemic: Challenges and solutions

AbstractConducting scientific research in the healthcare context is an ongoing challenge. Immediate clinical care and related tasks take priority out of necessity, often in difficult circumstances including unplanned staff absenteeism and turnover, and resource limitations. These challenges are further exacerbated in times of crisis, such as the current worldwide pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). The pandemic disproportionately affects vulnerable populations, such as people living with dementia who rely on aged and healthcare services. Concurrently research studies aiming to improve health and aged care for these people are also being negatively impacted by the pandemic. There is a need for the development of guidelines that will support researchers to implement and maintain quality studies during pandemics, to prevent unnecessary delay in the dissemination of research findings, that have the potential to improve healthcare delivery quality and outcomes.This presentation first highlights the main challenges and solutions that have emerged in a study aiming to improve healthcare for people living with dementia in hospital settings, using evidence‐based person‐centred care. In addition to evaluating health outcomes for people living with dementia and cost‐effectiveness, we are using a knowledge translation framework (Goodenough et al., 2017; Damschroder et al., 2009) to evaluate the implementation of the intervention (process and outcomes) and determine nationwide scalability for hospital ward and care services. Evidence on how to adapt research processes to enable research programs to continue throughout the pandemic will be presented, followed by a set of guidelines to support researchers to engage successfully in clinical research during a pandemic. The guidelines aim to be generalisable to all clinical research projects that have been impacted by the current SARS‐CoV‐2 pandemic, as well as projects that may face future similar crises.ReferencesDamschroder LJ, Aron DC, Keith RE, et al. 2009. Fostering implementation of health research findings into practice: A consolidated framework for advancing implementation science. Implement Sci. 4(50):15 ‐20.Goodenough B, Young M. (2017). Innovation to Implementation for Dementia (i2i4dementia): A Practical Guide to Knowledge Translation in Health Care (with examples from aged care and dementia). Dementia Collaborative Research Centres, Australia. Access: DementiaKT.com.au

Acute Health Care Provision in Rural Long-Term Care Facilities: AScoping Review of Integrated Care Models.

We aimed to map integrated care models for acute health care in rural long-term care facilities (LTCFs) for future investigation. Systematic scoping review. Residential LTCFs in rural areas worldwide. The common health-related online databases were systematically searched complemented by a manual search of gray literature. Following the 5-stage framework of Arksey and O'Malley, the extent of included literature was identified and findings were summarized using qualitative meta-summary. A total of 35 references were included for synthesis, predominantly primary research on completed and ongoing projects reporting on integrated health care services in rural LTCFs. Incorporating previous research, we extracted 5 approaches of integrated acute-health care models: (1) Availability of Specialists, (2) Networks, (3) Quality Management (QM) and Organization, (4) Telemedicine, and (5) Telehealth. This research presents the result of a literature review examining integrated care models as a way to improve acute health care in LTCFs in rural areas. Integrated care models in rural settings can help face the challenging situation and fulfil the complex health care needs of LTCF residents by reducing fragmentation and thereby improve continuity and coordination of acute health care services. These results can guide policy making in creating interventions and support adequate implementation of care models by knowledge translation in health care.

Dissemination and implementation of clinical practice guidelines: a longitudinal, mixed-methods evaluation of the Canadian Task Force on Preventive Health Care's knowledge translation efforts.

The Canadian Task Force on Preventive Health Care (task force) develops evidence-based preventive health care guidelines and knowledge translation (KT) tools to facilitate guideline dissemination and implementation. We aimed to determine practitioners' awareness of task force guidelines and KT tools and explore barriers and facilitators to their use. The task force's KT team completed annual evaluations using surveys and interviews with primary care providers in Canada from 2014 to 2020, to assess practitioners' awareness and determinants of use of task force guidelines and tools. We transcribed interviews verbatim and double-coded them using a framework analysis approach. A total of 1284 primary care practitioners completed surveys and 183 participated in interviews. On average, 79.9% of participants were aware of the task force's 7 cancer screening guidelines, 36.2% were aware of the other 6 screening guidelines and 18.6% were aware of the 3 lifestyle or prevention guidelines. Participants identified 13 barriers and 7 facilitators to guideline and KT tool implementation; these were consistent over time. Participants identified strategies at the public and patient, provider and health systems levels to improve uptake of guidelines. Canadian primary care practitioners were more aware of task force cancer screening guidelines than its other preventive health guidelines. Over the 6-year period, participants consistently reported barriers to guideline uptake, including misalignment with patient preferences and other provincial or specialty guideline organizations. Further evaluations will assess tailored strategies to address the barriers identified.

Potential social marketing applications for knowledge translation in healthcare: a scoping review protocol

IntroductionKnowledge translation has emerged as a practice and a science to bridge the gap between evidence and practice in healthcare. While the field has appropriately borrowed from other related fields...

The unintended negative consequences of knowledge translation in healthcare: A systematic scoping review

ABSTRACT Knowledge translation represents an avenue to address the oft-cited chasm between what should and what does happen in healthcare. Knowledge translation encompasses myriad processes through which different knowledges coalesce to inform practice. However, some reports suggest that experiences with knowledge translation are less than favourable. To better understand these experiences, a systematic scoping review of academic literature was conducted to unveil the unintended negative consequences of knowledge translation and how they were addressed. After screening 9,598 publications, six reported evidence of unintended negative consequences. The most prevalent was emotional labour – negative emotional or psychological sequelae, depression, anxiety, powerlessness, and frustration. These consequences were experienced by knowledge translation brokers, knowledge translation recipients, and knowledge translation producers. All but one publication offered some discussion of strategies to manage or mitigate these unintended negative consequences, including co-design, collaboration, and supported dialogue. These findings suggest there is limited research that explicates the unintended negative consequences of knowledge translation. Given the importance of knowledge translation, this review indicates there is considerable opportunity to advance it, in a better-informed way. Only by considering the unintended negative consequences of knowledge translation can they be identified, addressed, and potentially moderated, if not averted.

Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-Country Analysis.

Context is recognized as important to successful knowledge translation (KT) in health settings. What is meant by context, however, is poorly understood. The purpose of the current study was to elicit tacit knowledge about what is perceived to constitute context by conducting interviews with a variety of health system stakeholders internationally so as to compile a comprehensive list of contextual attributes and their features relevant to KT in healthcare. A descriptive qualitative study design was used. Semi-structured interviews were conducted with health system stakeholders (change agents/KT specialists and KT researchers) in four countries: Australia, Canada, the United Kingdom, and the United States. Interview transcripts were analyzed using inductive thematic content analysis in four steps: (1) selection of utterances describing context, (2) coding of features of context, (3) categorizing of features into attributes of context, (4) comparison of attributes and features by: country, KT experience, and role. A total of 39 interviews were conducted. We identified 66 unique features of context, categorized into 16 attributes. One attribute, Facility Characteristics, was not represented in previously published KT frameworks. We found instances of all 16 attributes in the interviews irrespective of country, level of experience with KT, and primary role (change agent/KT specialist vs. KT researcher), revealing robustness and transferability of the attributes identified. We also identified 30 new context features (across 13 of the 16 attributes). The findings from this study represent an important advancement in the KT field; we provide much needed conceptual clarity in context, which is essential to the development of common assessment tools to measure context to determine which context attributes and features are more or less important in different contexts for improving KT success.

Epistemic Influences on Knowledge Translation in Healthcare: The Mediating Role of Social Networks

Previous work has highlighted the direct effect of epistemic differences between groups on knowledge translation work. In this paper, we ask whether such differences in the 'ways of knowing' amongs...

What can organisational theory offer knowledge translation in healthcare? A thematic and lexical analysis

BackgroundDespite the relative abundance of frameworks and models to guide implementation science, the explicit use of theory is limited. Bringing together two seemingly disparate fields of research, this article asks, what can organisational theory offer implementation science? This is examined by applying a theoretical lens that incorporates agency, institutional, and situated change theories to understand the implementation of healthcare knowledge into practice.MethodsInterviews were conducted with 20 general practitioners (GPs) before and after using a resource to facilitate evidence-based sexual healthcare. Research material was analysed using two approaches – researcher-driven thematic coding and lexical analysis, which was relatively less researcher-driven.ResultsThe theoretical lens elucidated the complex pathways of knowledge translation. More specifically, agency theory revealed tensions between the GP as agent and their organisations and patients as principals. Institutional theory highlighted the importance of GP-embeddedness within their chosen specialty of general practice; their medical profession; and the practice in which they worked. Situated change theory exposed the role of localised adaptations over time – a metamorphosis.ConclusionsThis study has theoretical, methodological, and practical implications. Theoretically, it is the first to examine knowledge translation using a lens premised on agency, institutional, and situated change theories. Methodologically, the study highlights the complementary value of researcher-driven and researcher-guided analysis of qualitative research material. Practically, this study signposts opportunities to facilitate knowledge translation – more specifically, it suggests that efforts to shape clinician practices should accommodate the interrelated influence of the agent and the institution, and recognise that change can be ever so subtle.

The Paradox of Intervening in Complex Adaptive Systems Comment on "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation".

This commentary addresses two points raised by Kitson and colleagues’ article. First, increasing interest in applying the Complexity Theory lens in healthcare needs further systematic work to create some commonality between concepts used. Second, our need to adopt a better understanding of how these systems organise so we can change the systems overall behaviour, creates a paradox. We seek to manipulate systems that self-organise and follow their own internal rules. Although, our actions may impact and indeed meet some of our objectives, system behaviour will always emerge with unpredictable consequences. Likewise, outcomes at the aggregated level of the system never reaches an optimal point as defined by the ‘external controller.’ Kitson and colleagues’ theoretical model may struggle to resolve the paradox of gaining control over the multiple knowledge translation (KT) systems covered by the model, because theoretically these systems retain control under the principle of self-organisation. That is not to suggest that individual agents cannot influence system dynamics just that the desired outcome cannot be guaranteed. Indeed, for systems to change they will need strong incentives.

From Linear to Complicated to Complex Comment on "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation".

Attention to collaborative approaches to encouraging evidence use in healthcare practice are gaining traction. The inherent complexities in collaborative and networked approaches to knowledge translation (KT) have been embraced by Kitson and colleagues in their complexity network model. In this commentary, the potential of complexity as presented by Kitson et al within their model is considered. The utility of such a model will be contingent upon how easy users find it to understand and apply to their challenge, and doing so in a way that is useful to not only help with explanation, but also with prediction.

Using Complexity to Simplify Knowledge Translation Comment on "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation".

Putting health theories, research and knowledge into practice is a challenge referred to as the knowledge-toaction gap. Knowledge translation (KT), and its related concepts of knowledge mobilization, implementation science and research impact, emerged to mitigate this gap. While the social interaction view of KT has gained currency, scholars have not easily made a link between KT and the concept of complexity. Kitson and colleagues suggest we ought to examine the role of complexity in KT processes using defined theories and concepts borrowed from network and complex adaptive systems theory. They further argue that better KT outcomes might be achieved using this new lens. There remain, however, several critical considerations for this sort of theory application to work in the real-world. Complexity and network theory offer explanatory power about the KT problem, but these theories are less helpful for understanding solutions.

Applying KT Network Complexity to a Highly-Partnered Knowledge Transfer Effort Comment on "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation".

The re-conceptualization of knowledge translation (KT) in Kitson and colleagues’ manuscript "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation" is an advancement in how one can incorporate implementation into the KT process. Kitson notes that "the challenge is to explain how it might help in the healthcare policy, practice, and research communities." We propose that these concepts are well presented when considering highly-partnered research that includes all sectors. In this manuscript we provide an example of highly-partnered KT effort framed within the KT Complexity Network Theory. This effort is described by identifying the activities and sectors involved.

Connections, Communication and Collaboration in Healthcare's Complex Adaptive Systems Comment on "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation".

A more sophisticated understanding of the unpredictable, disorderly and unstable aspects of healthcare organisations is developing in the knowledge translation (KT) literature. In an article published in this journal, Kitson et al introduced a new model for KT in healthcare based on complexity theory. The Knowledge Translation Complexity Network Model (KTCNM) provides a fresh perspective by making the complexity inherent in complex systems overt. The model encourages a whole system view and focuses on the interdependent relationships between actions, interactions and actors. Taking a systems approach assists our understanding of the connections, communication and collaboration necessary to promote knowledge mobilisation and facilitate the adoption of change. With further development, this could enable the targeting of more effective strategies across the various stakeholders and levels of service, fostering redesign and innovation.

Classification schemes for knowledge translation interventions: a practical resource for researchers

BackgroundAs implementation science advances, the number of interventions to promote the translation of evidence into healthcare, health systems, or health policy is growing. Accordingly, classification schemes for these knowledge translation (KT) interventions have emerged. A recent scoping review identified 51 classification schemes of KT interventions to integrate evidence into healthcare practice; however, the review did not evaluate the quality of the classification schemes or provide detailed information to assist researchers in selecting a scheme for their context and purpose. This study aimed to further examine and assess the quality of these classification schemes of KT interventions, and provide information to aid researchers when selecting a classification scheme.MethodsWe abstracted the following information from each of the original 51 classification scheme articles: authors’ objectives; purpose of the scheme and field of application; socioecologic level (individual, organizational, community, system); adaptability (broad versus specific); target group (patients, providers, policy-makers), intent (policy, education, practice), and purpose (dissemination versus implementation). Two reviewers independently evaluated the methodological quality of the development of each classification scheme using an adapted version of the AGREE II tool. Based on these assessments, two independent reviewers reached consensus about whether to recommend each scheme for researcher use, or not.ResultsOf the 51 original classification schemes, we excluded seven that were not specific classification schemes, not accessible or duplicates. Of the remaining 44 classification schemes, nine were not recommended. Of the 35 recommended classification schemes, ten focused on behaviour change and six focused on population health. Many schemes (n = 29) addressed practice considerations. Fewer schemes addressed educational or policy objectives. Twenty-five classification schemes had broad applicability, six were specific, and four had elements of both. Twenty-three schemes targeted health providers, nine targeted both patients and providers and one targeted policy-makers. Most classification schemes were intended for implementation rather than dissemination.ConclusionsThirty-five classification schemes of KT interventions were developed and reported with sufficient rigour to be recommended for use by researchers interested in KT in healthcare. Our additional categorization and quality analysis will aid in selecting suitable classification schemes for research initiatives in the field of implementation science.

Knowledge Translation in Healthcare - Towards Understanding its True Complexities Comment on "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation".

This commentary argues that to fully appreciate the complexities of knowledge transfer one firstly has to distinguish between the notions of "data, information, knowledge and wisdom," and that the latter two are highly context sensitive. In particular one has to understand knowledge as being personal rather than objective, and hence there is no form of knowledge that a-priori is more authoritative than another. Secondly, knowledge transfer in organisations can only be successful if the organisation is organised and managed as a "complex adaptive organisation" – its key characteristics arising from it’s a-priori defined common "purpose, goals and values." Knowledge transfer, seen as "whole of system/organisation learning," is highly context sensitive; while the principles may apply to many organisations, knowledge as such is not transferable from one context to another, it always will be a unique learning exercise at this particular point in time in this particular organisation.

Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation.

Many representations of the movement of healthcare knowledge through society exist, and multiple models for the translation of evidence into policy and practice have been articulated. Most are linear or cyclical and very few come close to reflecting the dense and intricate relationships, systems and politics of organizations and the processes required to enact sustainable improvements. We illustrate how using complexity and network concepts can better inform knowledge translation (KT) and argue that changing the way we think and talk about KT could enhance the creation and movement of knowledge throughout those systems needing to develop and utilise it. From our theoretical refinement, we propose that KT is a complex network composed of five interdependent sub-networks, or clusters, of key processes (problem identification [PI], knowledge creation [KC], knowledge synthesis [KS], implementation [I], and evaluation [E]) that interact dynamically in different ways at different times across one or more sectors (community; health; government; education; research for example). We call this the KT Complexity Network, defined as a network that optimises the effective, appropriate and timely creation and movement of knowledge to those who need it in order to improve what they do. Activation within and throughout any one of these processes and systems depends upon the agents promoting the change, successfully working across and between multiple systems and clusters. The case is presented for moving to a way of thinking about KT using complexity and network concepts. This extends the thinking that is developing around integrated KT approaches. There are a number of policy and practice implications that need to be considered in light of this shift in thinking.

Increasing Fruit and Vegetable Consumption Through a Healthy Eating Blog: A Feasibility Study.

BackgroundDespite efforts made by public health organizations to improve consumption of fruits and vegetables, populations in developed countries usually eat less than the minimum recommended. Social media, such as blogs, represent a unique opportunity for improving knowledge translation in health care because they facilitate interactive communication between the public and health professionals. However, no studies have yet evaluated the effect of blogs to promote dietary behavior changes.ObjectiveOur study aims to conduct a preliminary assessment before undertaking a full randomized controlled trial (RCT) of the feasibility of using an evidence-based healthy eating blog promoting the consumption of fruits and vegetables among adult women.MethodsA total of 80 women aged 18 years and older (mean 42, SD 13 years) eating less than five servings per day of fruit and vegetables (mean 2.75, SD 1.84 servings) were recruited. Participants were randomized to the healthy eating blog group (n=40), which included a weekly blog post over a 6-month period, or to a control group (n=40) that had no exposure to the healthy eating blog. Blog posts were written by a registered dietitian and focused on the improvement of fruit and vegetable consumption. We targeted four main determinants of the behavior that were identified as the best predictors for fruit and vegetable intake by two systematic reviews: (1) knowledge, (2) attitude, (3) self-efficacy, and (4) motivation. The intervention was considered feasible if (1) more than 70% of questionnaires were completed, (2) attendance rate was more than 90% for in-person appointments with the research coordinator, (3) participants accessed at least 75% of the blog posts, and (4) the attrition rate was less than 25%. Blog access was assessed by collecting the blog browsing history data for each participant.ResultsDuring the intervention, 26 posts were published on the blog. Pre- (baseline) and postintervention (6 months) questionnaires were completed by mean 97% (SD 3%) of participants. All participants attended their in-person appointments. Women accessed mean 87% (SD 7%) of the posts published during the intervention. Only 3% (2/80) of participants dropped out of the study. Between the healthy eating blog and control groups, a difference of 1.0 servings of fruits and vegetables (P<.001) indicated moderate effects of the intervention (Cohen d=0.54).ConclusionsThese results suggest that an intervention using a healthy eating blog meets preestablished feasibility criteria. A larger-scale RCT using the same methodology will be conducted to assess the impact of a healthy eating blog on the dietary habits of women.

Positive emotion in knowledge creation

PurposeDespite the importance of evidence-based practice, the translation of knowledge into quality healthcare continues to be stymied by an array of micro, meso and macro factors. The purpose of this paper is to suggest a need to consider different – if not unconventional approaches – like the role of positive emotion, and how it might be used to promote and sustain knowledge translation (KT).Design/methodology/approachBy reviewing and coalescing two distinct theories – the broaden-and-build theory of positive emotions and the organisational knowledge creation theory – this paper presents a case for the role of positive emotion in KT.FindingsTheories pertaining to positive emotion and organisational knowledge creation have much to offer KT in healthcare. Three conceptual “entry points” might be particularly helpful to integrate the two domains – namely, understanding the relationship between knowledge and positive emotions; positive emotions related to Nonaka’s concept of knowledge creation; and the mutual enrichment contained in the parallel “upward spiralling” of both theories.Research limitations/implicationsThis is a conceptual paper and as such is limited in its applicability and scope. Future work should empirically explore these conceptual findings, delving into positive emotion and KT.Originality/valueThis is the first paper to bring together two seemingly disparate theories to address an intractable issue – the translation of knowledge into quality healthcare. This represents an important point of departure from current KT discourse, much of which continues to superimpose artefacts like clinical practice guidelines onto complex healthcare context.

Exploring women's beliefs and perceptions about healthy eating blogs: a qualitative study.

BackgroundChronic diseases are the leading cause of death (63%) worldwide. A key behavioral risk factor is unhealthy eating. New strategies must be identified and evaluated to improve dietary habits. Social media, such as blogs, represent a unique opportunity for improving knowledge translation in health care through interactive communication between health consumers and health professionals. Despite the proliferation of food and lifestyle blogs, no research has been devoted to understanding potential blog readers’ perceptions of healthy eating blogs written by dietitians.ObjectiveTo identify women’s salient beliefs and perceptions regarding the use of healthy eating blogs written by dietitians promoting the improvement of their dietary habits.MethodsWe conducted a qualitative study with female Internet users living in the Quebec City, QC, area with suboptimal dietary habits. First, the women explored 4 existing healthy eating blogs written in French by qualified dietitians. At a focus group 2-4 weeks later, they were asked to discuss their experience and perceptions. Focus group participants were grouped by age (18-34, 35-54, and 55-75 years) and by their use of social media (users/nonusers). Using a questionnaire based on the Theory of Planned Behavior, participants were asked to identify salient beliefs underlying their attitudes (advantages/disadvantages), subjective norms (what people important to them would think), and perceptions of control (facilitators/barriers) regarding the use of a healthy eating blog written by a dietitian to improve dietary habits. Discussion groups were audiotaped, transcribed verbatim, coded, and a deductive content analysis was performed independently by 2 individuals using the NVivo software (version 10).ResultsAll participants (N=33) were Caucasian women aged between 22 to 73 year. Main advantages perceived of using healthy eating blogs written by a dietitian were that they provided useful recipe ideas, improved lifestyle, were a credible source of information, and allowed interaction with a dietitian. Disadvantages included increased time spent on the Internet and guilt if recommendations were not followed. Important people who would approve were family, colleagues, and friends. Important people who could disapprove were family and doctors. Main facilitators were visually attractive blogs, receiving an email notification about new posts, and finding new information on the blog. Main barriers were too much text, advertising on the blog, and lack of time.ConclusionsThe women in this study valued the credibility of healthy eating blogs written by dietitians and the contact with dietitians they provided. Identifying salient beliefs underlying women’s perceptions of using such blogs provides an empirically supported basis for the design of knowledge translation interventions to help prevent chronic diseases.

A scoping review of classification schemes of interventions to promote and integrate evidence into practice in healthcare.

BackgroundMany models and frameworks are currently used to classify or describe knowledge translation interventions to promote and integrate evidence into practice in healthcare.MethodsWe performed a scoping review of intervention classifications in public health, clinical medicine, nursing, policy, behaviour science, improvement science and psychology research published to May 2013 by searching MEDLINE, PsycINFO, CINAHL and the grey literature. We used five stages to map the literature: identifying the research question; identifying relevant literature; study selection; charting the data; collating, summarizing, and reporting results.ResultsWe identified 51 diverse classification schemes, including 23 taxonomies, 15 frameworks, 8 intervention lists, 3 models and 2 other formats. Most documents were public health based, 55% included a literature or document review, and 33% were theory based.ConclusionsThis scoping review provides an overview of schemes used to classify interventions which can be used for evaluation, comparison and validation of existing and emerging models. The collated taxonomies can guide authors in describing interventions; adequate descriptions of interventions will advance the science of knowledge translation in healthcare.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0220-6) contains supplementary material, which is available to authorized users.