Knowledge Translation Program Research Articles

Translating evidence: pain treatment in newborns, infants, and toddlers during needle-related procedures : German version

Treatment of pain in preterm, sick, and healthy newborns and infants and toddlers (up to 2years of age) is consistently reported to be inadequate, and effective strategies are poorly implemented. To present existing evidence of effective pain treatment strategies during needle-related procedures and to highlight initiatives focused on translating evidence into practice. This Clinical Update focuses on the 2022 International Association for the Study of Pain Global Year for Translating Pain Knowledge to Practice in the specific population of newborns, infants, and toddlers. Best evidence is reviewed, and existing knowledge translation strategies and programs available to implement evidence into practice are presented. Effective strategies for newborn and young infants during frequently occurring needle procedures include small volumes of sweet solutions, breastfeeding, or skin-to-skin care when feasible and culturally acceptable. In addition, strategies such as nonnutritive sucking, positioning, swaddling, gentle touch, facilitated tucking, and secure holding can be used. For toddlers, the evidence is less robust, and discerning between pain and distress is challenging. However, strategies recommended for needlerelated procedures include upright secure comfort holding by parents/caregivers, age-appropriate distraction, and topical anesthetics. Translation of effective pain management needs to involve the family, who need to be supported and empowered to comfort their child during painful procedures. Organizational, nationwide, and global initiatives aimed at improving implementation of effective pain treatments exist. There is evidence of effective pain management strategies for newborns, infants, and toddlers, and agreat deal of effort is being made to translate knowledge into action.

Reliability, Knowledge Translation, and Implementability of the Spanish Version of the Hammersmith Infant Neurological Examination

Purpose. This study aimed to: (a) translate and cross-culturally adapt the Hammersmith Infant Neurological Examination (HINE) into Spanish; (b) evaluate its intra- and inter-examiner reliability; (c) support a knowledge translation and tool implementation program in early intervention; and (d) evaluate its reliability and implementation for professionals one year after receiving training. Materials and methods. The translation followed the World Health Organization’s recommendations. Reliability was assessed in 25 infants aged between 3 and 15 months with identifiable risks of cerebral palsy (CP). The implementation was also evaluated by analyzing the reliability of professionals without previous experience of the tool by using a pre-survey and a follow-up survey one year after training. The survey covered aspects related to the use of early detection tools of CP and the use of HINE, including attitudes, opinions, and perceptions. Results. An excellent intra- and inter-examiner agreement was obtained for the total score of the HINE intra-class correlation coefficient (ICC = 0.98 in both indices). One year after training, the professionals also showed excellent reliability values (ICC = 0.99), as well as an increase in sensitization and skills in evidence-based practices for the early detection of “high risk” of CP. Conclusions. The Spanish version of HINE is a reliable measure for the neurological evaluation of “high risk” of CP and can be administered after standardized training and without costs to acquire the evaluation. This allows its accessible and widespread implementation in the clinical context.

Promoting Participation-Focused Practices in Inclusive Educational Settings: Stakeholders' Perspectives Following a Knowledge Translation Initiative.

Available participation-focused interventions (e.g., the Pathways and Resources for Engagement and Participation intervention [PREP]), are not well integrated into practice, indicating a knowledge-to-practice gap. To explore the perspectives of school-based (SB) occupational therapists and occupational therapy managers following knowledge translation (KT) programs for facilitating participation-based practices in inclusive education. This was an implementation qualitative study. After taking part in KT programs for implementing PREP, which were tailored to the needs and contexts of each stakeholder group, occupational therapists participated in focus groups, and occupational therapy managers responded to open-ended survey questions. A content analysis was done separately for each group, then integrated and organized according to the Participation-focused KT (P-KT) framework. Inclusive educational setting. Seven occupational therapists working in inclusive schools and 39 occupational therapy managers. We identified 10 themes addressing the micro, meso, and macro levels of the P-KT framework across the two groups. Five themes, common to all participants, addressed micro (e.g., setting participation-focused goals) and meso (e.g., school-PREP fit) levels. Macro-level themes were addressed by managers only (e.g., anchoring PREP to existing policy of the Israeli Ministry of Education). Targeting different stakeholders at the micro and meso levels of the educational system can initiate a shift in practice toward a focus on participation. KT intersectoral initiatives at the macro level (e.g., targeting community services and local policies), and engaging other stakeholders (e.g., students, families, and educators), are required to ensure the sustainability of participation-based practices. What This Article Adds: The authors present two knowledge translation programs that target both occupational therapists and managers in the educational system. The programs promote a shift in school-based occupational therapy services toward a focus on participation and environment.

The REDUCED trial: a cluster randomized trial for REDucing the Utilization of CEsarean delivery for Dystocia

To reduce cesarean delivery rates in nulliparous women, guidelines for diagnosing nonprogressive labor have been developed by the National Institute of Child Health and Human Development, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. These are mainly based on data from the Consortium for Safe Labor study. The guidelines have not been tested in a clinical trial, so the efficacy and safety of this new approach is uncertain. This study aimed to assess whether adoption of new guidelines for diagnosing nonprogressing labor would reduce cesarean delivery rates. We conducted a cluster randomized controlled trial of a knowledge translation program of the guidelines in 26 Canadian hospitals (13 control sites and 13 intervention sites). The sites included all intrapartum care sites in Alberta that perform cesarean delivery and deliver at least 70 nulliparous women annually. The baseline period started on January 1, 2015. The intervention was initiated at the first intervention site in January 2017. The follow-up period began at the first intervention site in February 2017 and lasted till February 2020. The primary outcome was the rate of cesarean delivery in nulliparous women with vertex presentation in labor at term. The secondary outcomes included spontaneous vaginal birth and maternal and neonatal safety. The main data source for the primary and secondary outcomes was the Alberta Perinatal Health Program database. The cesarean delivery rates were assessed using repeated measures mixed effects logistic regression applied to individual births. The analysis was based on 45,193 deliveries at intervention sites and 43,725 deliveries at control sites. There was no evidence of a decrease in the rate of cesarean delivery in association with the intervention (baseline-adjusted odds ratio, 0.94; 95% confidence interval [0.85-1.05]; P=.259). The rate of spontaneous vaginal delivery increased slightly (baseline-adjusted odds ratio, 1.10; 95% confidence interval, [1.01-1.18]; P=.024). We did not observe any differences in adverse maternal or neonatal outcomes. Cesarean delivery rates in nulliparous women were not reduced by the application of recent guidelines for the diagnosis of nonprogressive labor. Spontaneous vaginal delivery-a secondary outcome-was increased in the intervention group. The intervention appears to be safe.

Translating evidence: pain treatment in newborns, infants, and toddlers during needle-related procedures.

Treatment of pain in preterm, sick, and healthy newborns and infants and toddlers (up to 2 years of age) is consistently reported to be inadequate, and effective strategies are poorly implemented. To present existing evidence of effective pain treatment strategies during needle-related procedures and to highlight initiatives focused on translating evidence into practice. This Clinical Update focuses on the 2022 International Association for the Study of Pain Global Year for Translating Pain Knowledge to Practice in the specific population of newborns, infants, and toddlers. Best evidence is reviewed, and existing knowledge translation strategies and programs available to implement evidence into practice are presented. Effective strategies for newborn and young infants during frequently occurring needle procedures include small volumes of sweet solutions, breastfeeding, or skin-to-skin care when feasible and culturally acceptable. In addition, strategies such as nonnutritive sucking, positioning, swaddling, gentle touch, facilitated tucking, and secure holding can be used. For toddlers, the evidence is less robust, and discerning between pain and distress is challenging. However, strategies recommended for needle-related procedures include upright secure comfort holding by parents/caregivers, age-appropriate distraction, and topical anesthetics. Translation of effective pain management needs to involve the family, who need to be supported and empowered to comfort their child during painful procedures. Organizational, nationwide, and global initiatives aimed at improving implementation of effective pain treatments exist. There is evidence of effective pain management strategies for newborns, infants, and toddlers, and a great deal of effort is being made to translate knowledge into action.

Developing a knowledge translation program for health practitioners: Allied Health Translating Research into Practice.

Front-line health practitioners lack confidence in knowledge translation, yet they are often required to undertake projects to bridge the knowledge-practice gap. There are few initiatives focused on building the capacity of the health practitioner workforce to undertake knowledge translation, with most programs focusing on developing the skills of researchers. This paper reports the development and evaluation of a knowledge translation capacity building program for allied health practitioners located over geographically dispersed locations in Queensland, Australia. Allied Health Translating Research into Practice (AH-TRIP) was developed over five years with consideration of theory, research evidence and local needs assessment. AH-TRIP includes five components: training and education; support and networks (including champions and mentoring); showcase and recognition; TRIP projects and implementation; evaluation. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation Maintenance) guided the evaluation plan, with this paper reporting on the reach (number, discipline, geographical location), adoption by health services, and participant satisfaction between 2019 and 2021. A total of 986 allied health practitioners participated in at least one component of AH-TRIP, with a quarter of participants located in regional areas of Queensland. Online training materials received an average of 944 unique page views each month. A total of 148 allied health practitioners have received mentoring to undertake their project, including a range of allied health disciplines and clinical areas. Very high satisfaction was reported by those receiving mentoring and attending the annual showcase event. Nine of sixteen public hospital and health service districts have adopted AH-TRIP. AH-TRIP is a low-cost knowledge translation capacity building initiative which can be delivered at scale to support allied health practitioners across geographically dispersed locations. Higher adoption in metropolitan areas suggests that further investment and targeted strategies are needed to reach health practitioners working in regional areas. Future evaluation should focus on exploring the impact on individual participants and the health service.

Awareness of lipid guideline recommendations for high-risk patients amongst primary care physicians in Canada

Abstract Background Lipid guidelines for cardiovascular (CV) risk reduction have evolved in recent years, particularly since the introduction of PCSK9 inhibitors. In many jurisdictions, CV risk management is provided by primary care physicians (PCPs). We surveyed Canadian PCPs regarding their awareness and implementation of the 2021 Canadian Cardiovascular Society (CCS) lipid guideline recommendations for patients following an acute coronary syndrome (ACS) or for those with diabetes but without CV disease. Methods and results From a national database of PCPs with interest and/or experience in CV medicine, we invited PCPs to complete a survey regarding lipid management in high-risk patients. A committee of PCPs and specialists with lipid expertise including several co-authors of the 2021 CCS lipid guidelines had designed the survey to probe awareness and practice patterns. A total of 203 PCPs from across Canada completed the survey between January and March 2022. 23.6% of respondents had previously prescribed a PCSK9 inhibitor. Almost all (96.5%) PCPs concurred that a post-ACS patient should be seen by their PCP within 4 weeks of hospital discharge (79.3% within 2 weeks). Almost half (45.3%) responded that discharge summaries provided inadequate information relevant for PCPs, and 43% felt that lipid management post-ACS was the primary responsibility of specialists. More than half (56%) articulated challenges when seeing a post-ACS patient, related to inadequate discharge information, complexities of polypharmacy and duration of therapies, and managing perceived or real statin intolerance. 62% correctly identified the LDL-C intensification threshold of 1.8 mmol/L in post-ACS patients, while 79% considered that PCSK9 inhibitors were indicated only for those patients who were already receiving statins plus ezetimibe or had substantially elevated LDL-C levels. 55.2% were able to correctly identify clinical features associated with greatest absolute benefit of PCSK9 inhibitors in post-ACS patients. For patients with diabetes but without ASCVD, 80% of PCPs incorrectly believed that PCSK9 inhibitors were indicated for LDL-C levels above threshold despite statin therapy, and only 42% correctly identified the LDL-C threshold for treatment intensification of 2.0 mmol/L. Conclusion While PCPs are aware of the urgency regarding lipid management in post-ACS patients, many encounter challenges after hospital discharge, frequently deferring lipid management to specialists. Thus, almost one year following publication of the 2021 CCS lipid guidelines, substantial knowledge gaps remain regarding intensification thresholds and treatment options for patients post-ACS or for those with diabetes. Innovative and effective knowledge translation programs are urgently required. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Amgen Canada

AWARENESS OF LIPID GUIDELINE RECOMMENDATIONS FOR HIGH-RISK PATIENTS AMONGST PRIMARY CARE PHYSICIANS IN CANADA

AWARENESS OF LIPID GUIDELINE RECOMMENDATIONS FOR HIGH-RISK PATIENTS AMONGST PRIMARY CARE PHYSICIANS IN CANADA

Using a knowledge translation program to facilitate guideline-and evidence-based patient management: thePAH-QuERI Extension Program.

The Pulmonary Arterial Hypertension‐Quality Enhancement Research Initiative Extension Program was designed to support physicians’ adherence to pulmonary arterial hypertension (PAH) guidelines. Guidelines were followed in >95% of patients with functional class (FC) II/III, but for only 28.6% of FC IV patients (Month 36). Low adherence was driven by FC IV patients’ preference to avoid parenteral treatment.

Online Knowledge Translation Program Involving Video Games and University Student-Led Tutorials About Cannabis and Psychosis for Black Youth: Mixed Method Feasibility Study.

BackgroundWe have piloted a new online knowledge translation (KT) program created to educate youth about cannabis effects, which uniquely focuses on mental health risks for Black youth. Youth are generally unaware of the research linking underage usage and the risk of psychosis. Youth from some Black racialized communities in Ontario may be disproportionately affected and in need of this knowledge.ObjectiveBecause very little is known about the acceptability and feasibility of programs educating Black youth about cannabis and psychosis risk, we evaluated this KT program, which consists of tutorials facilitated by university students and video games.MethodsThis mixed methods pilot study evaluates the transfer of knowledge about cannabis and psychosis risk before and after the online KT program and, at the same time, explores participant satisfaction with the program and views about underage use. Eligible participants were youth 16-19 years of age of Black African or Caribbean descent. Trained undergraduate students from McMaster University administered a quiz (psychosis and cannabis test; PCT) to evaluate knowledge before and after the KT program. After playing the psychoeducational video games, participants attended two tutorial group sessions led by undergraduate students. The undergraduate students facilitated the online tutorials about cannabis and psychosis. The tutorials augmented the educational content embedded within the gameplay: participants discussed what they learned from the video games and their understanding of psychosis and the effects of cannabis. In addition, undergraduate students qualitatively analyzed the tutorial discussions for themes, and the prequiz and postquiz scores were analyzed for significant differences in scores.ResultsA total of 9 Black youth were recruited and completed this pilot study. The mean PCT scores were 5.67 (SD 1.7) and 7.78 (SD 1.8) before and after the KT program, respectively. There was a significant improvement in scores (P<.05) post-KT program. Thematic analysis of the facilitated tutorials revealed three major themes: video game satisfaction, marijuana and psychosis literacy, and help-seeking awareness. Overall, participants showed an increased awareness and understanding of the subject matter after the gameplay and tutorial intervention.ConclusionsWhen supplemented with tutorial sessions, the Back to Reality Series shows promise for addressing the gap in knowledge about cannabis and psychosis, and the results provide preliminary evidence that the games appeal to Black youth.

Effectiveness of a Knowledge Translation Program on Use of Outcome Measures in Community-based Physical Therapy

Effectiveness of a Knowledge Translation Program on Use of Outcome Measures in Community-based Physical Therapy

Evaluation of the partners in research course: a patient and researcher co-created course to build capacity in patient-oriented research

BackgroundIn the past decade, patient-oriented research (POR) has been at the forefront of healthcare research in Canada because it has the potential to make research more meaningful and relevant to patient needs. Despite this growing emphasis on and expectation to conduct POR, there is limited guidance about how to apply POR in practice. To address this capacity building need, the Knowledge Translation (KT) Program and patient partners co-designed, delivered, and evaluated Partners in Research (PiR), a 2-month online course for patients and researchers to collectively learn how to conduct and engage in POR.MethodsPiR was delivered to 4 cohorts of patients and researchers between 2017 and 2018. For each cohort, we evaluated the impact of the course on participants’ knowledge, self-efficacy, intentions, and use of POR using surveys at 3 time points: baseline, post-course and 6-months post-course. We also monitored the process of course design and delivery by assessing implementation quality of the PiR course. Participants were asked to rate their satisfaction with course format, course materials, quality of delivery and their level of engagement via a 7-point Likert scale in the post-course survey.ResultsA total of 151 participants enrolled in the PiR course throughout the 4 cohorts. Of these, 49 patients and 33 researchers (n = 82 participants) consented to participate in the course evaluation. Process and outcome evaluations collected over a 9-month period indicated that participation in the PiR course increased knowledge of POR concepts for patients (p < .001) and for researchers (p < .001) from pre-course to post-course timepoints. Likewise, self-efficacy to engage in POR increased from baseline to post-course for both patients (p < .001) and researchers (p < .001). Moreover, participants reported high levels of satisfaction with content, delivery and interactive components of the course.ConclusionsThe PiR course increased capacity in POR for both researchers and patients. This work enhances our understanding of how to design useful and engaging education opportunities to increase patient and researcher capacity in POR.

Building capacity for implementation\u2014the KT Challenge

BackgroundThe KT Challenge program supports health care professionals to effectively implement evidence-based practices. Unlike other knowledge translation (KT) programs, this program is grounded in capacity building, focuses on health care professionals (HCPs), and uses a multi-component intervention. This study presents the evaluation of the KT Challenge program to assess the impact on uptake, KT capacity, and practice change.MethodsThe evaluation used a mixed-methods retrospective pre-post design involving surveys and review of documents such as teams’ final reports. Online surveys collecting both quantitative and qualitative data were deployed at four time points (after both workshops, 6 months into implementation, and at the end of the 2-year funded projects) to measure KT capacity (knowledge, skills, and confidence) and impact on practice change. Qualitative data was analyzed using a general inductive approach and quantitative data was analyzed using non-parametric statistics.ResultsParticipants reported statistically significant increases in knowledge and confidence across both workshops, at the 6-month mark of their projects, and at the end of their projects. In addition, at the 6-month check-in, practitioners reported statistically significant improvements in their ability to implement practice changes. In the first cohort of the program, of the teams who were able to complete their projects, half were able to show demonstrable practice changes.ConclusionsThe KT Challenge was successful in improving the capacity of HCPs to implement evidence-based practice changes and has begun to show demonstrable improvements in a number of practice areas. The program is relevant to a variety of HCPs working in diverse practice settings and is relatively inexpensive to implement. Like all practice improvement programs in health care settings, a number of challenges emerged stemming from the high turnover of staff and the limited capacity of some practitioners to take on anything beyond direct patient care. Efforts to address these challenges have been added to subsequent cohorts of the program and ongoing evaluation will examine if they are successful. The KT Challenge program has continued to garner great interest among practitioners, even in the midst of dealing with the COVID-19 pandemic, and shows promise for organizations looking for better ways to mobilize knowledge to improve patient care and empower staff. This study contributes to the implementation science literature by providing a description and evaluation of a new model for embedding KT practice skills in health care settings.

A Tripartite Knowledge Translation Program: Innovative Patient-Centered Approach to Clinical Research Participation for Individuals with Multiple Sclerosis.

Background Knowledge translation (KT) models that represent an individual's perspective are a sign of effective KT. Some common challenges in KT include participant engagement, organization of the team, and time demands of the participants. We implemented a unique tripartite KT program to (1) share current research, (2) inform persons living with multiple sclerosis (pwMS) about the clinical research process, and (3) invite pwMS to immediately participate in clinical research. The primary aim was to determine participants' perspectives on the value and acceptability of an experiential research program offered at a patient and family educational conference. Methods A team of researchers identified factors that would impact the logistics of hosting an experiential research program at a conference and designed a unique tripartite KT program. The local multiple sclerosis (MS) society was engaged to select an appropriate location and invite stakeholders to the conference. A survey to determine participants' perspectives on the value and acceptability of the experiential research program was developed and analyzed. Results 65 pwMS attended the conference, and 44 (67.7%) participated in the on-site experiential research program. 72.7% of the participants completed the survey, of which 93.8% stated that they strongly agree or agree with the following statements: “Did you feel like participating in research today was a valuable experience to you?” and “Did you feel like you were contributing to MS research?” 100% of the participants agreed or strongly agreed when asked “would you like to see more research activities taking place at these kinds of events?” Conclusions This paper describes the logistics and challenges of conducting an experiential KT program, which proved to be rewarding for pwMS. The majority of pwMS attending the conference agreed to participate in the on-site experiential research program and an overwhelming majority of participants felt the experience was valuable.

Parent engagement in co-design of clinical trials: the PARENT trial

Evidence generated from partnering with parents to design and conduct research together may be used to refine, adjust, and modify future research approaches. This study aimed to describe the initial approaches to parent engagement in the design of the PARENT trial as well as understand parent perspectives on the acceptability and relevance of the PARENT trial and potential barriers and facilitators to participation.Parents participating in the TARGet Kids! cohort were invited to participate in a focus group, called the PARENT panel, to co-design the PARENT trial. This focus group was conducted to capture diverse individual and collective parents’ experiences. Overall methodological approaches for the PARENT panel were informed by the CIHR Strategy for Patient Oriented Research (SPOR) guiding principles (mutual respect, co-building, inclusiveness, and support) for patient engagement in research, and facilitated through the Knowledge Translation Program in the Li Ka Shing Knowledge Institute at Unity Health Toronto. Using a Nominal Group Technique, the PARENT panel provided feedback on the feasibility, relevance, and acceptability of the proposed intervention. Findings from this work will be used to further refine, adjust, and modify the next iteration of the PARENT trial, which will also serve as an opportunity to discuss the efforts made by researchers to incorporate parent suggestions and what additional steps are required for improved patient engagement.

Benefits of a Recovery-Oriented Knowledge Translation Program for Mental Health Community Support Teams: A Qualitative Study

In most developed countries, health systems are attempting to compensate for underuse scientific evidence and its integration into healthcare services and practices. This qualitative study aimed to identify perceived benefits of a knowledge translation program implemented within mental health community services ((At your fingertips, Quebec, 2016-2018)). Results suggests that the production of a collaborative platform composed of a variety of activities and techno-educational tools, derived from integrated knowledge, facilitates the uptake by professionals in a context of reflective practices. Dissemination of these tools through technology of information and communication provides access to best recovery-oriented practices at your fingertips.

On-farm food safety knowledge, attitudes and self-reported practices of layer hen farmers

PurposeThe purpose of this paper is to assess the knowledge, attitudes and practices (KAP) of farmers regarding the on-farm food safety measures in the commercial layer farms in Thailand prior the implementation of the mandatory Good Agricultural Practices (GAP) standard.Design/methodology/approachThe cross-sectional study was conducted through the face-to-face interview with a questionnaire in 143 GAP certified and 59 non-GAP certified farms. The levels of safety and quality measures implemented in farms were evaluated using a self-reported approach. Scoring system was applied to investigate the relationship between level of practices and its determining factors using the correlation test.FindingsThe layer hen farmers appeared to have an adequate level of knowledge on safety and quality measures; however, some misconception on recommended practices was still observed. The significant differences (p<0.001) in the regularity of practices adopted in farms were noticed between GAP and non-GAP groups. The GAP farmers have higher level of knowledge, and positive attitudes toward implementation. Only the weak positive relationships were found between all KAP variables which implied that there are other factors influencing the translation of knowledge and favorable attitudes into practices.Originality/valueNone of the on-farm food safety KAP report has been published in Thailand. This study highlights the gaps in the practices and issues needed to be focused by standard promoters for developing the knowledge translation programs aimed at enhancing the standard of layer farming.

MIFEPRISTONE READY: UPTAKE OF MIFEPRISTONE MEDICAL ABORTION TRAINING IN CANADA

Objectives In 2012, only 60 doctors provided medical abortion in Canada. Mifepristone-based medical abortion is a gold standard that has now been available in Canada since 2016. While no longer mandatory, the Health Canada/SOGC/CFPC/CPhA Medical Abortion Training Program is the only comprehensive training program in the country, and this program meets the Health Canada definition of appropriate training. We will provide the current data on training across Canada. Methods This is a descriptive study of the participants in the SOGC Medical Abortion Training Program. Data is classified by province/territory of practice, as well as membership/practice type. Updated information to May 31, 2019 will be provided at the time of presentation. Results As of September 2018, there were 1324 prescribers (physicians and nurse practitioners) as well as 2273 pharmacists trained to prescribe and dispense mifepristone. There were prescribers in every province and territory, including PEI, where there were, until recently, no surgical abortion services. Only Nunavut does not have a pharmacist trained in medical abortion. In comparison to the number of OB/GYNs in Canada, approximately 11.7% of Obstetrician/Gynaecologists were trained in Canada within the first 18 months of availability of mifepristone. Conclusions There has been an over 2200% increase in the number of possible medical abortion providers in Canada since the approval of combination mifepristone-misoprostol. This is reflective of a successful launch of the Medical Abortion Training Program, as well as a coordinated integrated Knowledge Translation (iKT) program and community of practice.

Overview of a Knowledge Translation (KT) Project to improve the vaccination experience at school: The CARD™ System.

BackgroundStudents experience fear, pain, and fainting during vaccinations at school. While evidence-based interventions exist, no Knowledge Translation (KT) interventions have been developed to mitigate these symptoms. A multidisciplinary team—the Pain Pain Go Away Team—was assembled to address this knowledge-to-care gap. This manuscript provides an overview of the methodology, knowledge products, and impact of an evidence-based KT program developed and implemented to improve the vaccination experience at school.MethodsWe adapted knowledge and assessed the barriers to knowledge use via focus group interviews with key stakeholder groups involved in school-based vaccinations: students, nurses, school staff, and parents. Next, we developed project-specific goals and data collection tools and collected baseline data. We then created a multifaceted KT intervention called The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract) to provide a framework for planning and delivering vaccinations using a student-centred approach. Selected KT tools from this framework were reviewed in additional focus groups held in all stakeholder groups. The multifaceted KT intervention was then finalized and implemented in stages in two projects including grade 7 students undergoing school vaccinations and impact on student outcomes (e.g., symptoms of fear, pain, dizziness) and process outcomes (e.g., utilization of interventions that reduce student symptoms, vaccination rate) were assessed.ResultsParticipants reported that improving the vaccination experience is important. Based on participant feedback, an evidence-based multifaceted KT intervention called The CARD™ System was developed that addresses user needs and preferences. Selected KT tools of this intervention were demonstrated to be acceptable and to improve knowledge and attitudes about vaccination in the stakeholder groups. In two separate implementation projects, CARD™ helped grade 7 students prepare for vaccinations and positively impacted on their vaccination experiences. CARD™ improved vaccination experiences for other stakeholder groups as well. There was no evidence of an impact on school vaccination rates.ConclusionWe developed and implemented a promising multifaceted KT intervention called The CARD™ System to address vaccination-associated pain, fear, and fainting. Future research is recommended to determine impact in students of different ages and in different geographical regions and clinical contexts.

Moving knowledge into practice: Evaluating cross-cultural applicability of the Promoting Action on Research Implementation in Health Service framework

Clinical practice guidelines are developed worldwide, at an ever increasing rate (Sandstrom et al., 2015) and accessed internationally without a full understanding as to whether they are applicable in cross cultural settings. Informed by a review of the literature which identified a range of theories, frameworks and models to guide knowledge translation, the Promoting Action on Research Implementation in Health Services (PARIHS) framework (Kitson et al., 1998b), was selected as a suitable framework to explore evidence based clinical guideline development work in a cross cultural context. This research study was an exploration of the appropriateness and utility of the PARIHS framework, in the cultural translation and adaptation of an evidence based clinical practice guideline into clinical practice in the healthcare system in Malta. It also aimed to identify challenges and barriers to successful cultural translation and implementation to inform future cross cultural knowledge translation programs. A case study using an embedded single case was used. Data collection consisted of two focus groups with multidisciplinary healthcare professionals (n=11 and n=5), eighteen semi structured interviews (n=9 pre and n=9 post) and non-participant observation of two guideline development groups. Data was analysed both inductively and deductively using Framework Analysis. Findings of the study indicate that the components of the PARIHS framework of evidence, context and facilitation are useful to guide the cultural translation and adaptation of an evidence based clinical practice guideline. In addition, a number of challenges and barriers to successful translation and potential implementation were identified; the influence of politics, culture and context, stakeholder involvement including patient involvement, and resources, both human and financial. Overall the PARIHS framework is a useful tool to guide the cultural translation and adaptation of an evidence based clinical practice guideline. The study identified important additions to the PARIHS framework to improve its utility: expanding the use of culture in the PARIHS framework to include macro, meso and micro dimensions; the need for a definition of what context means within the PARIHS framework; the inclusion of politics as a sub element of context; the importance of resources, and acknowledging the role of the patient within the framework.