Knowledge Translation Principles Research Articles

Development, Acceptability, and Usability of a Virtual Intervention for Vertebral Fractures.

This project aimed to develop a virtual intervention for vertebral fractures (VIVA) to implement the international recommendations for the nonpharmacological management of osteoporotic vertebral fractures and to test its acceptability and usability. VIVA was developed in accordance with integrated knowledge translation principles and was informed by the Behavioral Change Wheel, the Theoretical Domains Framework, and the affordability, practicability, effectiveness and cost-effectiveness, acceptability, side effects/safety, and equity (APEASE) criteria. The development of the prototype of VIVA involved 3 steps: understanding target behaviors, identifying intervention options, and identifying content and implementation options. The VIVA prototype was delivered to 9 participants to assess its acceptability and usability. VIVA includes 7 1-on-1 virtual sessions delivered by a physical therapist over 5weeks. Each session lasts 45minutes and is divided in 3 parts: education, training, and behavioral support/goal setting. Four main themes emerged from the acceptability evaluation: perceived improvements in pain, increased self-confidence, satisfaction with 1-on-1 sessions and resources, and ease of use. All of the participants believed that VIVA was very useful and were very satisfied with the 1-on-1 sessions. Four participants found the information received very easy to practice, 4 found it easy to practice, and 1 found it somewhat difficult to practice. Five participants were satisfied with the supporting resources, and 4 were very satisfied. Potential for statistically significant improvements was observed in participants' ability to make concrete plans about when, how, where, and how often to exercise. VIVA was acceptable and usable to the participants, who perceived improvements in pain and self-confidence. The virtual implementation of the recommendations for the nonpharmacological management of vertebral fractures showed high acceptability and usability. Future trials will implement the recommendations on a larger scale to evaluate their effectiveness.

Leveraging knowledge translation and implementation science in the pursuit of evidence informed health professions education.

Evidence informed approaches to health professions education can ensure accountability to learners and society in providing meaningful and effective education and helping resource strained systems via streamlined and cost-efficient practices. Knowledge translation and implementation science are two areas of study originally developed in clinical medicine in response to concerns that health care practices were incongruent with the scientific evidence. Two decades of research have led to important advances in our understanding of the nature and magnitude of research-practice gaps, the factors that support or impede adoption of evidence in clinical decision-making, and in the design and evaluation of theory driven interventions to reduce gaps. This paper borrows concepts from knowledge translation and implementation science to further our thinking about how health professions education can 'truly' be evidence informed. The article is organised in four sections: a discussion of the impetus for the evidence informed health professions education movement; a description of the origins of knowledge translation and implementation science; a discussion on how knowledge translation and implementation science can be leveraged to advance the evidence informed health professions education agenda; and suggestions for future discussion and research. An example is used to illustrate the application of the underpinning principles of knowledge translation and implementation science. The authors suggest a theory driven, staged and systematic approach that integrates knowledge translation principles and processes and involves key stakeholders interested in promoting the application of educational research of evidence.

Implementation of shared decision-making in healthcare policy and practice: a complex adaptive systems perspective

Background:Despite the suggested benefits of shared decision-making (SDM), its implementation in policy and practice has been slow and inconsistent. Use of complex adaptive systems (CAS) theory may provide understanding of how healthcare system factors influence implementation of SDM. Methods:Using the example of choice of mode of birth after a previous caesarean section, in-depth, semi-structured interviews were conducted with patients, providers, and decision makers in British Columbia, Canada, to explore the system characteristics and processes that influence implementation of SDM. Implementation and knowledge translation principles guided study design, and constructionist grounded theory informed iterative data collection and analysis. Findings:Analysis of interviews (n=58) revealed that patients formed early preferences for mode of delivery (after the primary caesarean) through careful deliberation of social risks and benefits. Physicians acted as information providers of clinical risks and benefits, while decision makers revealed concerns related to liability and patient safety. These concerns stemmed from perceptions of limited access to surgical resources, which had resulted from budget constraints. Discussion and conclusions:To facilitate the effective implementation of SDM in policy and practice it may be critical to initiate SDM once patients become aware of their healthcare options, assist patients to address the social risks that influence their preferences, manage perceptions of risk related to patient safety and litigation among physicians, and enhance access to healthcare resources.

Knowledge Translation in a Community-Based Study of the Relations Among Violence Exposure, Post-traumatic Stress and Alcohol Misuse in Mi’kmaq Youth

In 2004, our research group was invited to continue a research partnership with a Nova Scotian Mi’kmaq community that was concerned about the causes of and interventions for adolescent alcohol misuse in their community. While our previous collaborative research focused on reducing adolescent alcohol misuse by targeting motivations for drinking that were personality specific (see Mushquash, Comeau, & Stweart, 2007), the more recent collaboration sought to investigate the possible relationship between exposure to violence, post-traumatic stress, and alcohol misuse. The present paper outlines the steps involved in gaining community consent, the plan for results sharing, the tangible benefits to the community that have been documented, and future directions and lessons learned. The paper will demonstrate how the principles of Knowledge Translation (CIHR, 2006) provide a framework for this process.

Translation into Practice: Dextrose Gel Treatment for Neonatal Hypoglycemia to Reduce NICU Admissions and Increase Breastfeeding Exclusivity.

Oral dextrose gel is an evidence-based treatment that has been shown to reduce NICU admissions and support exclusive breastfeeding. We summarize a knowledge translation project to introduce dextrose 40 percent oral gel to treat hypoglycemia or hyperglycemia. Implementation took place during the months of May, June, and July 2017. Through chart audit, rates for NICU admissions and exclusive breastfeeding were measured for a three-month period before implementation and the three-month period after implementation.There were 234 doses indicated, 128 doses given, 93 doses missed, and 13 doses declined by parents in the first three months of implementation. Admission rates to the NICU for the groups audited were 13 percent in 2016 and 6 percent in 2017.Principles of knowledge translation were used to successfully introduce this change. Centers providing maternal newborn care should consider similar projects to enable introduction.

Evaluation for learning and improvement at the right time: an example from the field.

Evaluation expertise to assist with identifying improvements, sourcing relevant literature and facilitating learning from project implementation is not routinely available or accessible to not-for-profit organisations. The right information, at the right time and in an appropriate format, is not routinely available to program managers. Program management team members who were implementing The Fred Hollows Foundation's Indigenous Australia Program's Trachoma Elimination Program required information about what was working well and what required improvement. This article describes a way of working where the program management team and an external evaluation consultancy collaboratively designed and implemented an utilisation-focused evaluation, informed by a developmental evaluation approach. Additionally, principles of knowledge translation were embedded in this process, thereby supporting the evaluation to translate knowledge into practice. The lessons learned were that combining external information and practice-based knowledge with local knowledge and experience is invaluable; it is useful to incorporate evaluative information from inception and for the duration of a program; a collaborative working relationship can result in higher quality information being produced and it is important to communicate findings to different audiences in different formats.

Making space for Indigenous knowledge translation activities in Canadian health librarianship

Abstract
 Introduction: In 2015, the Truth and Reconciliation Commission’s Call to Action 22 called upon “those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices” 1. Given that research has shown that health librarians have this ability to help affect change in the healthcare system, how does the health library literature reflect shifting professional practice that make space for Indigenous peoples and knowledge?
 Methods: In this literature review, we searched for keywords and controlled terms, or subject headings, on Indigenous topics within three key North American health library journals: the Journal of the Canadian Health Libraries Association (JCHLA) (indexed in CINAHL); the Journal of the Medical Library Association (JMLA) (Ovid MEDLINE); and Medical Reference Services Quarterly (MSRQ) (Ovid MEDLINE). A modified version of Smylie et al’s2 model of critical self-reflection guided by Indigenous knowledge translation principles was then used to analyse the papers and suggest potential avenues for future research.
 Results: Our initial search retrieved 8 articles from JMLA, 2 from MRSQ, and 14 from JCHLA which our exclusion criteria reduced to 5 articles that were then qualitatively analyzed. Of these only two articles reflected a more substantial engagement with Indigenous knowledge translation practices.
 Discussion: Most of the articles did not explicitly engage in self-reflection about how their personal, professional or systemic privileges and biases impact their work with Indigenous health topics.

From knowledge translation theory to practice: developing an evidence to care hub in a pediatric rehabilitation setting

Purpose: Ensuring evidence-informed care happens systematically and consistently is not easy in complex health facilities. This paper describes the evolution of knowledge translation infrastructure (Evidence to Care) within a pediatric rehabilitation hospital to address barriers to evidence-informed decision-making and accelerate research uptake to influence clinical care.Methods: Development of Evidence to Care involved a series of steps integrating knowledge translation principles, best evidence and stakeholder needs. Key aspects included: recognizing health system drivers and organizational enablers; establishing organizational structures and processes; building and operationalizing a strategic vision through activities and demonstration projects; and evaluating impact.Results: By way of a fully realized working model, two large-scale demonstration projects aligned with the Knowledge-to-Action Cycle have been completed. Audit findings demonstrate tangible examples of improving healthcare quality through investment in knowledge translation resources, processes and tailored evidence products. Critical enablers of this infrastructure include strong leadership commitment and ongoing direction, a dedicated expert team, alignment with strategic priorities and situated within organizational structures to link research, clinical care and education.Conclusions: With a replicable model, Evidence to Care addresses established health system barriers related to time, resources, skill and knowledge through dedicated knowledge translation specialists and knowledge brokers to facilitate knowledge translation practice.Implications for rehabilitationDeveloping dedicated knowledge translation infrastructure is both novel and relatively new in healthcare.Sharing step by step processes helps other organizations learn from field-tested experiences of what works and what doesn’t in a particular setting.Involving stakeholders at all levels of an organization is key to valuing knowledge translation and fostering an evidence-friendly culture.Co-creating tailored knowledge products and planning for dissemination and uptake fosters inter-disciplinary collaboration and joint problem-solving among clients, families and providers.

Knowledge Translation of the PERC Rule for Suspected Pulmonary Embolism: A Blueprint for Reducing the Number of CT Pulmonary Angiograms.

IntroductionComputerized decision support decreases the number of computed tomography pulmonary angiograms (CTPA) for pulmonary embolism (PE) ordered in emergency departments, but it is not always well accepted by emergency physicians. We studied a department-endorsed, evidence-based clinical protocol that included the PE rule-out criteria (PERC) rule, multi-modal education using principles of knowledge translation (KT), and clinical decision support embedded in our order entry system, to decrease the number of unnecessary CTPA ordered.MethodsWe performed a historically controlled observational before-after study for one year pre- and post-implementation of a departmentally-endorsed protocol. We included patients > 18 in whom providers suspected PE and who did not have a contraindication to CTPA. Providers entered clinical information into a diagnostic pathway via computerized order entry. Prior to protocol implementation, we provided education to ordering providers. The primary outcome measure was the number of CTPA ordered per 1,000 visits one year before vs. after implementation.ResultsCTPA declined from 1,033 scans for 98,028 annual visits (10.53 per 1,000 patient visits (95% CI [9.9–11.2]) to 892 scans for 101,172 annual visits (8.81 per 1,000 patient visits (95% CI [8.3–9.4]) p<0.001. The absolute reduction in PACT ordered was 1.72 per 1,000 visits (a 16% reduction). Patient characteristics were similar for both periods.ConclusionKnowledge translation clinical decision support using the PERC rule significantly reduced the number of CTPA ordered.

Evaluating an Indigenous health curriculum for diabetes prevention: engaging the community through talking circles and knowledge translation of results.

Kahnawà:ke is a Kanien'kehá:ka (Mohawk) community in Quebec, Canada. In 1997, the community-controlled Kateri Memorial Hospital Centre in partnership with the Kahnawake Education Center, and the Kahnawake Schools Diabetes Prevention Project (KSDPP) developed an elementary school diabetes prevention health education program, aimed to increase knowledge of Type 2 diabetes, healthy eating and active lifestyles. Long-term goals for KSDPP community and school interventions are to decrease obesity and diabetes. To evaluate the Kateri Memorial Hospital Centre Health Education Program for Diabetes Prevention (HEP) and use key principles of knowledge translation to promote understanding of results to upgrade HEP content and improve delivery. A KSDPP community-based participatory research team used mixed methods for evaluation, combining a cross-sectional survey for 23 teachers with interviews of two elementary school principals and three culturally appropriate Indigenous talking circles with HEP authors, teachers and parents. Questionnaire results were presented as descriptive statistics. The thematic textual analysis identified emerging themes from talking circles and interviews. Facilitators of HEP delivery were an acknowledgement of its importance; appreciation of prepared lesson plans for teachers; and KSDPP's strong community presence. Barriers included reduced administrative support and instructional time due to competing academic demands; the need for increased Kanien'kehá:ka cultural content; and outdated resource materials. Recommendations included increasing teacher training, Kanien'kehá:ka cultural content and administrative support. Community researchers undertook detailed knowledge translation activities of facilitators, barriers and recommendations with hospital and education centre administrators and Kahnawà:ke community to maximize uptake of findings before external dissemination of results.

The MOVIN’ project (Mobilisation Of Ventilated Intensive care patients at Nepean): A quality improvement project based on the principles of knowledge translation to promote nurse-led mobilisation of critically ill ventilated patients

ObjectiveProspective quality improvement project to evaluate the impact of a training programme to promote nurse-led mobilisation of intubated critically ill patients. MethodsThis project involved an educational programme to upskill nurses and overcome the barriers/challenges to nurse-led mobilisation. Initial strategies focused on educating and upskilling nurses to attain competency in active mobilisation. Subsequent strategies focused on positive reinforcement to achieve a culture shift. A pre- and post-intervention audit was used to evaluate its effectiveness. ResultsA baseline audit showed that ∼9% of ventilated patients were mobilised. Several barriers were identified. Twenty-three nurses underwent training in actively mobilising ventilated patients. This increased their confidence levels and there was reduction in reported barriers. However, the rate of active mobilisation remained low (9.7%). Subsequently, a programme of positive reinforcement with rewards and visual reminders was introduced, which saw an increase in the number of nurse-led mobilisations of both ventilated patients (from 9.7% to 34.8%; p=0.0003), and non-ventilated patients (29.5% versus 62.9%; p=<0.0001). ConclusionIt is safe and feasible to train nurses to perform active mobilisation of ventilated patients. However, to promote a culture change, training and competency must be combined with a multi-pronged approach including reminders, positive reinforcement and rewards.

Translating research findings to clinical nursing practice.

Aims and objectivesTo describe the importance of, and methods for, successfully conducting and translating research into clinical practice.BackgroundThere is universal acknowledgement that the clinical care provided to individuals should be informed on the best available evidence. Knowledge and evidence derived from robust scholarly methods should drive our clinical practice, decisions and change to improve the way we deliver care. Translating research evidence to clinical practice is essential to safe, transparent, effective and efficient healthcare provision and meeting the expectations of patients, families and society. Despite its importance, translating research into clinical practice is challenging. There are more nurses in the frontline of health care than any other healthcare profession. As such, nurse‐led research is increasingly recognised as a critical pathway to practical and effective ways of improving patient outcomes. However, there are well‐established barriers to the conduct and translation of research evidence into practice.DesignThis clinical practice discussion paper interprets the knowledge translation literature for clinicians interested in translating research into practice.MethodsThis paper is informed by the scientific literature around knowledge translation, implementation science and clinician behaviour change, and presented from the nurse clinician perspective. We provide practical, evidence‐informed suggestions to overcome the barriers and facilitate enablers of knowledge translation. Examples of nurse‐led research incorporating the principles of knowledge translation in their study design that have resulted in improvements in patient outcomes are presented in conjunction with supporting evidence.ConclusionsTranslation should be considered in research design, including the end users and an evaluation of the research implementation. The success of research implementation in health care is dependent on clinician/consumer behaviour change and it is critical that implementation strategy includes this.Relevance to practiceTranslating best research evidence can make for a more transparent and sustainable healthcare service, to which nurses are central.

Development and feasibility of an evidence-informed self-management education program in pediatric concussion rehabilitation.

BackgroundConcussion is a considerable public health problem in youth. However, identifying, understanding and implementing best evidence informed recovery guidelines may be challenging for families given the vast amount of information available in the public domains (e.g. Internet). The objective of this study was to develop, implement and evaluate the feasibility of an evidence-informed self-management education program for concussion recovery in youth.MethodsSynthesis of best evidence, principles of knowledge translation and exchange, and expert opinion were integrated within a self-management program framework to develop a comprehensive curriculum. The program was implemented and evaluated in a children’s rehabilitation hospital within a universal health care system. A retrospective secondary analysis of anonymous data from a program evaluation survey was used to evaluate program feasibility, to identify features of importance to program participants and to assess changes in participants’ knowledge.ResultsThe program, “Concussion & You” includes a comprehensive, evidence informed, population specific curriculum that teaches participants practical strategies for management of return to school and play, sleep, nutrition, relaxation and energy conservation. A ‘wheel of health’ is used to facilitate participants’ self-management action plan. Results from eighty-seven participant surveys indicate that the program is feasible and participant knowledge increased in all areas of the program with the highest changes reported in knowledge about sleep hygiene, rest and energy conservation.ConclusionFindings indicate that “Concussion & You” is a feasible program that is acceptable to youth and their families, and fills a health system service gap.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1664-3) contains supplementary material, which is available to authorized users.

What is the Impact of the Implementation of an Evidence Based Procedural Sedation Protocol in the Emergency Department?

Background: Procedural sedation and analgesia (PSA) enables emergency physicians to provide pain and anxiety relief for many procedures. However, PSA introduces an independent risk factor and requires continuous monitoring. Recently, we applied the principles of knowledge translation (KT) to develop and implement a PSA protocol in our ED. Objectives: To evaluate the impact of a PSA protocol developed and implemented using KT principles on changes in ED physician practices with respect to length of monitoring time in resuscitation area, complication rate, medication types and doses. Methods: Design: Pre- Post retrospective chart review. Setting: Adult tertiary-care academic centre. Participants: Patients who underwent PSA in the ED as per physician billing code from September 2008 to August 2010. The Pre protocol implementation was from Sept 2008 to Aug 2009 and the Post was from Sept 2009 to Aug 2010. One of the authors (NM) reviewed all charts and recorded patient information such as sociodemographics, past medical history, allergies, monitoring time, complications, medication and doses. Pre and post periods information was compared using two-sample T-test and Chi-square test as appropriate. Results: There were 318 billing codes for PSA from September 2008 to August 2010 of which the 150 occurred during the Pre protocol period and 134 during the Post protocol implementation period. Excluded were 34 patients due to lack of documentation. There were no statistical differences in Pre vs. Post for baseline characteristics (mean age+standard deviation (52+20 vs. 53+22 years), male gender (54% vs. 53%), with a past medical history (36% vs. 47%) and allergies (16% vs. 15.7%)). As well no differences in outcomes with respect to complication rate (7.4% vs. 9.9%) and medication types (70% vs. 65% Ketafol, 23% vs. 23% propofol) and doses used. However, monitoring time in minutes recorded from time of first medication given until patient was moved out of resuscitation area was significantly reduced during the Post period (Pre period: mean 49 (95% CI: 42-56) versus Post period: mean 19 (95% CI: 17-21). Conclusion: The implementation of the PSA protocol using KT principles resulted in a significant and important decrease in monitoring time required for PSA thus liberating important resources in busy EDs.

282 Implementation of a Pulmonary Embolism Diagnostic Protocol Reduces Imaging

Knowledge translation (KT) in health care is defined by the synthesis, dissemination, and application of knowledge to improve health, provide more effective health services and products, and strengthen the health care system. Pulmonary artery computerized tomography (PACT) is considered the test of choice for diagnosis of pulmonary embolism (PE); however, it has well-known potential complications and implications for cost, throughput, patient satisfaction, and resource allocation. The Wells Criteria and pulmonary embolism rule-out criteria (PERC) are validated tools to rule out PE and can safely avoid PACT in patients; nonetheless they are not universally applied. In October 2012 ACEP sponsored a seminar on KT and the rational use of clinical rules in ruling out PE in the ED. Subsequently, to reduce the number of unnecessary PACTs in our department, and in keeping with the principles of KT, we implemented a rational, evidence-based protocol to reduce the number of PACTs performed in our emergency department (ED). We undertook to study the effectiveness of this protocol. This is a prospective observational before and after study. We compared the number of PACTs ordered in 2011 as a control to the number ordered in the 6 months after instituting a KT program followed by a departmentally mandated protocol for the ordering of PACT for all patients with suspected PE. The setting is an urban teaching tertiary care hospital with an ED census of 100,000. The patient population is those suspected of having PE. The protocol calls for a Wells score to be calculated for all patients. Low risk patients then have their PERC score calculated. No further testing is performed on PERC negative patients. Those who fail PERC criteria have d-dimer testing. Intermediate risk patients have immediate d-dimer testing, and high risk patients have a PACT ordered. Those patients who have negative d-dimer results have no further testing. An automatic report for all PACT for PE was generated. All providers who order a PACT outside the protocol are asked to explain why they thought the PACT necessary despite the negative evaluation. Primary endpoint was number of PACT ordered for which a sample size to detect a 20% reduction was determined to be 174 patients. During the six-month study period, 361 PACT were reported ordered. This represents 7.39 scans per 1000 patient visits versus 11.27 in the control period or a reduction of 34% (P<.0001). However, of PACTs ordered, only 263 PACTs were performed, the difference due to cancelled orders, miscounted scans done for other diagnoses, etc. This represents 5.38 scans per 1000 visits or a reduction of 52% (P<.0001). Mean age was 60.9 (SD 19.8) and 57.8% were women. The overall prevalence of PE was 13.4%. There were a total of 70 protocol violations during the protocol period. The PE prevalence when the protocol was followed was 14.5% versus 5.7% when it was not (P=.0368). The proportion of positive PE CTAs was significantly higher during the study period compared to a historical control from 2011 (13.4% versus 7.3%, P<.0001). The goal of this KT project was to reduce the number of PACTs performed in our ED by reinforcing the best evidence-based approach, and as departmental policy. We found the use of our protocol resulted in a significant reduction in PACTs. Our results show that KT can benefit patients with suspected PE in the ED by reducing unnecessary PACT.

Clinical research and leadership training program as a knowledge translation initiative across an Australian health care service

Health professionals need to be integrated more effectively in clinical research initiatives to ensure that research addresses key clinical needs and provides practical, implementable solutions at the coal face of care. The recent McKeon review of Health and Medical Research in Australia suggested that the best way to achieve practical and implementable solutions in healthcare is to involve the health-delivery workforce in research to ensure that research addresses key clinical needs [1]. Through a partnership with Monash Health and Monash University, goals of the Monash Centre for Health Research and Implementation (MCHRI) are to deliver clinical research and leadership training to build capacity in implementation and support clinical research at Monash Health. Here we describe the informative phase of a broader program to enable and support health professionals at Monash Health who do not have a research background, to engage in and lead research to improve healthcare outcomes. As one of the largest health services in Australia, comprising more than 40 community services and hospitals across Melbourne, Monash Health provides the ideal setting. The broader program is based on a framework that has been shown to lead to successful implementation and long-term sustainability and draws upon knowledge translation principles, as well as medical education frameworks. The study design incorporates mixed methods within a collaborative action research approach involving multidisciplinary researchers across MCHRI, Monash Health and Monash University. Ethics approval has been obtained and literature review completed. Within the informative phase, an online survey and semi-structured interviews are being conducted to explore knowledge, perceptions, experience and training preferences in clinical research methods, evidence based principles and research leadership. We anticipate information from a representative group of people working across different areas and at different levels at Monash Health. The findings will be used to develop a dedicated clinical research and leadership training program. The training program will support Monash Health staff to up-skill or enhance skills to conduct rigorous research; engage and lead multidisciplinary, collaborative teams; and to use research to guide practice, as well as identify and address gaps in clinical research.

A study protocol for applying the co-creating knowledge translation framework to a population health study

BackgroundPopulation health research can generate significant outcomes for communities, while Knowledge Translation (KT) aims to expressly maximize the outcomes of knowledge producing activity. Yet the two approaches are seldom explicitly combined as part of the research process. A population health study in Port Lincoln, South Australia offered the opportunity to develop and apply the co-KT Framework to the entire research process. This is a new framework to facilitate knowledge formation collaboratively between researchers and communities throughout a research to intervention implementation process.DesignThis study employs a five step framework (the co-KT Framework) that is formulated from engaged scholarship and action research principles. By following the steps a knowledge base will be cumulatively co-created with the study population that is useful to the research aims. Step 1 is the initiating of contact between the researcher and the study contexts, and the framing of the research issue, achieved through a systematic data collection tool. Step 2 refines the research issue and the knowledge base by building into it context specific details and conducting knowledge exchange events. Step 3 involves interpreting and analysing the knowledge base, and integrating evidence to inform intervention development. In Step 4 the intervention will be piloted and evaluated. Step 5 is the completion of the research process where outcomes for improvement will be instituted as regular practice with the facilitation of the community.In summary, the model uses an iterative knowledge construction mechanism that is complemented by external evidence to design interventions to address health priorities within the community.DiscussionThis is a systematic approach that operationalises the translational cycle using a framework for KT practice. It begins with the local context as its foundation for knowledge creation and ends with the development of contextually applicable interventions. It will be of interest to those involved in KT research, participatory action research, population health research and health care systems studies. The co-KT Framework is a method for embedding the principles of KT into all stages of a community-based research process, in which research questions are framed by emergent data from each previous stage.

How does “knowledge translation” affect my clinical practice?

Knowledge translation is emerging as an increasingly important area of research and practice aiming to remedy the disconnection between evidence-based clinical care and real-life practice. The discipline is informed by a large body of literature and practical tools, which can inform providers and leaders in health care. Front-line clinicians should be aware of the principles of knowledge translation and the evidence that defines successful and suboptimal strategies for introducing evidence-based care at the system level.

A guide to the translation of the Global Initiative for Asthma (GINA) strategy into improved care

In 1995, the Global Initiative for Asthma (GINA) published an evidence-based workshop report as a guide to clinicians managing asthma patients, and has updated it annually to ensure that recommendations remain current. Although the report has been widely disseminated and influenced clinical practice and research, its major objective, of forming the basis for local and national initiatives to improve services for asthma patients, remains to be achieved. Over recent years, the science of guideline implementation has progressed, and encouraging examples of successful asthma programmes have been published. This report is intended to draw on this experience and assist with the translation of asthma guideline recommendations into quality programmes for patients with asthma using current knowledge translation principles. It also provides examples of successful initiatives in various socioeconomic settings.

Applying the principles of knowledge translation and exchange to inform dissemination of HIV survey results to adolescent participants in South Africa

It is widely accepted that researchers have an obligation to inform survey participants of research results. However, there is little evidence on the effectiveness of various dissemination strategies. The emerging field of knowledge transfer and exchange (KTE) may offer insight given its focus on techniques to enhance the effectiveness of communicating evidence-based information. To date, KTE has focused primarily on information exchange between researchers and policy-makers as opposed to study participants; however, there are principles that may be relevant in this new context. This gap in the literature becomes even more salient in the context of public health research where research results can reveal particular misunderstandings or shortcomings in knowledge that threaten to severely compromise participants' health. The objective of this article is to describe how KTE principles were used to inform dissemination of results of a self-administered sexual health survey to adolescent study participants in a resource-deprived, peri-urban area of South Africa. Strategies for enhancing two-way information exchange included constructing interactive dissemination sessions led by young, isiZulu fieldworkers. We also employed techniques to create a safe space for dialogue, encouraged the shared ownership of results and crafted targeted messages. Particularly noteworthy was the benefit accrued by the research team through this process of exchange, including novel explanations for study findings and new ideas for future research.