Step KTA 3.C

Assess barriers (B) to use of the discovery for each KU group.

Primary findings

Secondary findings

Primary findings

Barriers

Novel management changes in lieu of legal intellectual property protections are correlated with fewer patents. Techniques like strategy re-alignment and changing organizational structure are not recommended as means to increase patenting.
Questionnaire findings
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76% of the decision makers they surveyed cited the lack of evidence relevance to their setting as a major barrier to its use. Relevance is largely an issue of external validity, an issue that has been neglected by most scientific investigators as they strive for greater internal validity in its work.
Literature Review
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An absence of trust between researchers and stakeholders can impede knowledge translation. Negative perceptions or past experiences of researchers or stakeholders can adversely influence the start-up and continuity of a research project. Be sure to probe early and often during interactions between researcher and stakeholders for signs of skepticism or mistrust and have strategies available to remedy them.
Project evaluation findings.
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Factors that may limit or impede the ability of knowledge translation to positively impact stakeholder behaviour and decision-making include the resources required by an organization to apply the knowledge; the compatibility of the leadership style and organizational culture; the alignment of existing organization structures and processes; and the impact of organizational politics. Researchers may be better positioned to influence these factors if they secure training for, and experience with organizational change.
Project evaluation findings.
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Knowledge translation literacy — Policy development process — Many researchers do not understand the policy development process or how they might influence it, and may benefit from seminars that explain how government works.
Literature review and experience.
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Knowledge translation literacy — Research methods and results — Many decision-makers and policy-makers lack a critical understanding about the methods that are used to conduct research (or have the time to independently acquire it) and as a result, are unable to assess the quality of the findings they may receive. They may also be unclear about how to interpret and apply the findings.
Literature review and experience.
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One of the factors practitioners may cite as an impediment to applying research-based knowledge is requirement for specialized skills or equipment, which may not be available.
Application of Graham’s Knowledge-to-Action Process model in occupational therapy.
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One of the factors that can impede knowledge translation is incomplete knowledge. In some cases, research findings provide only a subset of the total knowledge that is required to fully understand an issue. Researchers should ensure that knowledge users are aware of any limitations.
Literature review and conceptual framework development.
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Researchers and stakeholders are usually able to quickly identify situations where rhetoric has replaced agreed upon and expected project behaviour. Rhetoric often triggers mistrust and a re-evaluation of commitments in response. Consider ‘partnering’ in collaborative research as one example. Partnering with stakeholders is a relatively new trend in research. Researchers and stakeholders must be able to consistently demonstrate, through their words and actions that genuine partnering behavior will occur. This can be challenging, especially early in the project when the capabilities of the respective parties are not fully known to each other. Creating formal (e.g., joint development of deliverables) and informal (e.g., social events) opportunities for parties to interact can help to provide evidence of agreed upon behaviour or provide a shared platform to challenge exceptions.
Project evaluation findings.
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Structures and cultures within organizations can be substantial barriers to the identification, acceptance and use of evidence-based practices. Organizational barriers include being a low management priority; difficulties establishing teamwork or management innovations; inadequate systems for professional development or knowledge dissemination; constraints on resources and on accessing new evidence.
Individual interviews with key members of a clinical organization (n=24) and informal focus groups with clinical nurse and medical managers and staff (n=56).
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System level barriers to access and use of research evidence in clinical practice: Lack of administrative support; physical inaccessibility; perceived lack of applicability. Individual level barriers include: lack of knowledge and skills; lack of motivation; attitude about research findings; learning style; and available time to seek relevant findings while engaged in practice.
Review of literature cited in paper.
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Therapists reported multiple barriers to the access and use of research results in practice: About 60% reported that time was provided on the job to attend continuing education, but 45% strongly disagreed that time was available at work to access research information. Respondents cited a lack of time on the job, high cost of continuing education, weak research analysis skills, and valuing clinical experience over research studies, as additional barriers.
Survey of 209 practicing occupational therapists.
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When using the Knowledge to Action Process model to effect an evidence-based change (e.g., in a clinical practice), it is critical to identify potential barriers that may interfere with the successful application of the new knowledge. One way to identify potential barriers is to conduct focus groups with key stakeholders.
Applying the Graham Knowledge to Action Process model in stroke rehabilitation.
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Carriers

Actions taken in one organization to promote evidence-based practice: Clinical effectiveness strategy drafted; new clinical board proposed; ward manager training to be reviewed; established ward action research project; course on multi-disciplinary skills for EBP; initiated strategy for communication, dissemination and management of evidence; EBP to be included in staff and management performance reviews; focus on creating culture of a learning organization.
Individual interviews with key members of a clinical organization (n=24) and informal focus groups with clinical nurse and medical managers and staff (n=56).
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Conducting KT with communities not traditionally involved in research application or decision making, requires clear definition of roles. Formal agreements can detail expectations and resources, but they need to be grounded in trusting and open-relationships. Establishing a reciprocal understanding of contexts, needs and expectations may require significant effort.
Casebook of KT examples drawn from Canadian population and public health projects.
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For any community-based KT to be successful, the community must demonstrate the capacity to adopt new knowledge and adapt to any changes the implementation of the new knowledge requires. Capacity-building to enhance efforts to uptake and use research are most effective when supported at the level of the organization.
Casebook of KT examples drawn from Canadian population and public health projects.
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Given the reality of organizational and professional barriers, and the reliance on routine practices, overcoming barriers to evidence-based practice requires adopting multiple strategies to facilitate and promote the use of evidence in clinical decision-making.
Individual interviews with key members of a clinical organization (n=24) and informal focus groups with clinical nurse and medical managers and staff (n=56).
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Important to consider barriers to knowledge use for individuals as well as for organizations. Barriers for individuals may include existing knowledge, attitudes, skills or habits, with effective interventions including interactive educational sessions and outreach visits. Barriers at the level of the organizations may be addressed through reminder systems, modifying the documentation and audit process, changing staff levels or support equipment, or changing compensation/incentive systems.
Summary of the Knowledge To Action Model and its application to knowledge translation.
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Individual determinants of research utilization - personal characteristics that influence use of research findings in practice include: 1) a positive attitude toward research; 2) autonomy in action; 3) awareness of agency policy and educational level; 4) professional conference attendance; 5) cooperativeness and self-sufficiency; 6) job satisfaction; 7) involvement in work-related research activities; 8) time spend reading professional journals.
Literature review in context of professional practice.
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KT is most successful when there are tangible benefits to all partners. KT works best when all partners in the initiative have the possibility of making concrete gains toward their own priorities, shared or otherwise.
Casebook of KT examples drawn from Canadian population and public health projects.
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KT must be tailored to the target community. Good KT is appropriate to its context, and local processes of knowledge uptake and utilization must be understood in order to create effective KT strategies. This is in addition to KT being timely, clearly presented and grounded in the local context.
Casebook of KT examples drawn from Canadian population and public health projects.
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KT requires constant effort. Relationships need to be carefully maintained, which is difficult given the constraints on investigators of funding levels and cycles. However, such vigilance avoids misunderstandings, reaffirms commitment to change and overcomes any attempts to undermine the effort. The most successful KT initiatives actively evolve in parallel with the needs of the user communities.
Casebook of KT examples drawn from Canadian population and public health projects.
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Knowledge translation literacy — Establishing relevant research questions — Researchers tend to begin by observing a broad or abstract problem and then narrowing down to a very specific question that can be answered with confidence following a scientific method. In our experience, practitioners may take the inverse approach. They encounter a very specific or practical problem, and, in the course of framing research questions, their inquiry broadens and they see a whole family of interconnected issues that impinge on the question that also need to be addressed. In both cases, the process of defining the problem and the question are learning exercises. But the processes seem to move in opposite directions, and it can be challenging to execute a delimited project that makes sense and is meaningful to everyone. Involving stakeholders can help to isolate and hone the research question. They can be helpful in identifying policy nuances, complexities, contradictions, and systemic links that needed to be taken into account for the study to be comprehensive.
Literature review and experience.
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The organizational climate is crucial to the adoption and use of new knowledge, yet individuals can make a huge difference as well. A researcher's genuine passion for practice change can play a vital role in KT success. It is important to identify and capitalize on such strengths. It is also important to select participants for discussion and consensus-building groups with care, as they can be a key determinant of an initiatives success or failure.
Casebook of KT examples drawn from Canadian population and public health projects.
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Methods

Incubators often tout networking as a major attribute because social networks are informal and valuable relationships which take time and positioning to build.
Case study findings
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Multi-site R&D mandates can be characterized based on their degree of market orientation and technology orientation. A matrix exists of: Local adaptors (high market orientation, low tech orientation), Product excellence centers (high market orientation, high technology orientation), Extended workbench (low market orientation, low technology orientation), Technology excellence center (Low market orientation, high technology orientation).
Case study findings
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According to the researcher’s guide to planning for knowledge translation there are five essential elements of knowledge translation, including: the problem (the problem or issue to be addressed by the research/knowledge), context (the circumstances surrounding the user and researcher), knowledge (properties of the pre-existing knowledge/evidence about the problem or the generation of new knowledge/evidence), intervention (specific activities designed to translate knowledge/research into action), and use (ways in which the knowledge/research is or might be used). For each element, a series of questions is provided. Each question encourages the researcher to think broadly and deeply about the knowledge translation implications. Elements and related questions are evidence-based, which adds to their credibility.
Knowledge translation guidance for researchers.
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Action Cycle within the KTA Model — The third step involves an assessment of the potential barriers to communication the knowledge to stakeholders, or that may interfere with stakeholder use of the knowledge. These may include issues related to the knowledge itself, the potential adopters, or the context/setting in which the knowledge will be use. Also important to consider any carriers to facilitate knowledge use.
Summary of the Knowledge To Action Model and its application to knowledge translation.
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Identify a problem that needs addressing; Identify the need for change; Identify change agents (i.e., the appropriate actors to bring about the change); Identify target audience; Assess barriers to using the knowledge; Review evidence and literature or develop or adapt innovation; Select and tailor interventions to promote the use of the knowledge; Link to appropriate individuals or groups who have vested interests in the project; Implement; Evaluate; Develop a plan to evaluate use of the knowledge; Pilot test; Evaluate process; Evaluate outcomes; Maintain change or sustain ongoing knowledge use.
Results from a knowledge synthesis
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Implementation Issues: These include potential barriers or carriers and can b organized in nine categories: 1) Organizational; 2) Financial; 3) Legal; 4) Ethical; 5) Professional; 6) Users; 7) Logistics; 8) Cognitive; 9) Content.
Literature review grounded in practical experience of health care professionals.
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The study mapped out what the research findings would mean to different groups of actors (stakeholders) involved. In the process they identified six Stakeholder Groups: 1) Clinicians; 2) Consumers; 3) Researchers; 4) Policy Makers; 5) Information Brokers; 6) Manufacturers.
Comparative analysis of policy-related research results and the expectations of policy-makers regarding information useful for application in their decisions.
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When intending to implement change, one also needs to consider the impact of the following factors to fully understand what is involved in completing each of the steps: 1) nature of the evidence or knowledge, 2) attributes of change or innovation, 3) who the audience is, 4) organizational context and culture in which the change is to take place, 5) the organizational resources and support for the proposed change, and 6) implementation-related factors.
Results from knowledge synthesis
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Tips

As action group discussions unfold, participants can move more naturally between knowledge creation, transfer, uptake, and application, addressing and integrating each component into everyday work, if and as appropriate, in no particular order.
Summary of a KT intervention based upon the participatory action KT (PAKT) model.
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Culture, language, perceptions, attitudes, mindsets, etc., play a very important part in terms of how the products and services are designed, integrated and marketed to the end customer.
Researchers observations with companies
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Knowledge brokering — knowledge brokers should factor-in the potential influences of powerful intangibles, such as, the political environment of the project, its stakeholders and organization(s); confidentiality protocols and practices; and, competing interests and priorities.
Description of knowledge broker roles.
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Stakeholder engagement strategies must be tailored to each stakeholder group. Strategies to engage strategic direction-setters will be different from strategies required to engage perception-influencers and/or adopters.
Literature review and case example.
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The inherently complex nature of knowledge translation implies that, to be comprehensive, there would need to be an equally complex set of knowledge translation guidelines. This is not practical for design or practice, as it could involve a significant number of permutations and combinations and could easily overwhelm a researcher — especially a novice one. One alternative is to provide a simple template that explains the essential knowledge translation guideline categories (e.g. problem statement, research context, knowledge objectives, possible research interventions, and potential knowledge uses) and associates sample questions and hypothetical examples with each category to reinforce deliberation, understanding and application.
Knowledge translation guidance for researchers.
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When it comes to knowledge application, health professions, policy-makers and managers of public health organizations tend to rely on the use of complementary types of knowledge in a context where explicit research knowledge does not usually dominate.
Literature review and conceptual framework development.
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When it comes to knowledge application, technical experts are inclined to depend almost exclusively on explicit knowledge. For example, evidence-based medicine is dominated by an intensive use of explicit knowledge.
Literature review and conceptual framework development.
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Secondary findings

Barriers

Barriers to evidence practice include: Access to libraries; lack of knowledge about databases and related initiatives; lack of critical appraisal, change management or IT and implementation skills; research and researchers are inaccessible and intimidating; insufficient time and resources; lack of autonomy; dissemination limitations; inter-professional problems.
Source: Mulhall (1996). In: Newman, M., Papadopoulos, I., & Sigsworth, J. (1998)

Clinical effectiveness is not a frequent consideration for managerial boards; Two-thirds of boards had no written clinical effectiveness strategy; few innovative approaches have been widely take up; few health authorities generate clinical effectiveness bulletins.
Source: Walshe & Ham (1997). In: Newman, M., Papadopoulos, I., & Sigsworth, J. (1998)

Contextual factors, including space and time issues, organizational impediments, and structural barriers affect the management of KT.
Source: Birdsell J.M. et al. (2002). In: McWilliam, C. L., Kothari, A., Ward-Griffin, C., Forbes, D., Leipert, B. & South West Community Care Access Centre Home Care (2009)

In many cases, public policy making does not follow a linear process. The process can be unpredictable. Policy issues can languish for years and even decades on the governmental agenda. Only a relatively small number of them may ever make it to the decision agenda.
Source: Kingdon (2003). In: Lavis, John (2006)

In many ways, public policy making can be a challenging process. Often, when a policy issue is placed on the government agenda for a decision, battles can be fought over how the policy is framed. The viability of a policy and its options often hinge on how the underlying issue or problem is framed.
Source: Kingdon (2003). In: Lavis, John (2006)

Individuals’ (knowledge users’) negative attitudes toward research evidence and lack of skill and expertise can decrease the prospects for research use.
Source: Lavis (2005). In: Lavis, John (2006)

New knowledge might not be used if it cannot be readily applied to policy and practice imperatives, or if it is released in the context of heated or incompatible political contexts.
Source: Boutiler (2001). In: Jansson, S. M., Benoit, C., Casey, L., Phillips, R., & Burns, D. (2010)

Researchers that use the integrated KT (which leverages the involvement of key stakeholders from research inception to completion) process may encounter several challenges when they attempt to use research evidence to influence government policy in program delivery. Research evidence competes for the attention of policy-makers with other influencers, such as, public opinion, institutional constraints and fiscal constraints. Researchers can strengthen the likelihood of KT success by better understanding the policy-making process, regularly interacting with policy-makers, building trusted relationships and partnerships, and engaging in the timely communication of research findings.
Source: Waddell (2005). In: McGrath, P.J., Lingley-Pottie, P., Johnson Emberly, D., Thurston,C., McLean, C. (2009)

Resistance to uptake can be particularly marked where professional roles and identities are strong, social distances between disciplines are great, and research traditions, conceptions, agendas, and questions are markedly different. This finding cautions against undertaking KT within heterogeneous provider groups.
Source: Ferlie, J.R. et al. (2005). In: McWilliam, C. L., Kothari, A., Ward-Griffin, C., Forbes, D., Leipert, B. & South West Community Care Access Centre Home Care (2009)

Social and cognitive boundaries between health professions impede spread, as individual professionals tended to operate within their own disciplinary paradigms and communities of practice.
Source: Ferlie, J.R. et al. (2005). In: McWilliam, C. L., Kothari, A., Ward-Griffin, C., Forbes, D., Leipert, B. & South West Community Care Access Centre Home Care (2009)

Some of the factors that can impede the application of research-based knowledge (evidence) include: a negative or unsupportive political atmosphere; an absence of public awareness regarding its value; and concern about how related implementation and ongoing costs will be funded.
Source: Anderson (1998); French (2005); Fuller (2005); Saxon (2005); Sindelar (2005). In: Ginexi, E. M. & Hilton, T. F. (2006)

Stakeholders may not respond well to imbalances in the distribution of decision-making power, process controls or project resources. Researcher should try to achieve a balance or explain why differences must exist.
Source: Martens (2005). In: Jansson, S. M., Benoit, C., Casey, L., Phillips, R., & Burns, D. (2010)

There are important differences between the cultures of academics and practitioners. Theories, models, research and evidence are useful parts of the researcher's conceptual and practical tool kit, but to the practitioner they often appear irrelevant to their task.
Source: Mulhall (1996). In: Newman, M., Papadopoulos, I., & Sigsworth, J. (1998)

Carriers

Ottawa Model of Research Use (OMRU) — There are six essential elements in the design of a strategy to introduce research findings into practice: 1) the practice environment; 2) the potential adopters of the evidence; 3) the evidence-based innovation; 4) research transfer strategies; 5) the evidence adoption; 6) health-related and other outcomes. The systematic assessment, monitoring and evaluation of the state of each of the six elements is required before, during and after any efforts to transfer the research findings.
Source: Logan, J et al (1999). In: Estabrooks, C.; Thompson, D.S., Lovely, J.J.E., & Hofmeyer, A. (2006)

Two attributes are required for the pursuit and implementation of evidence-based practice within the culture of a clinical organization: 1) Motivation and 2) Competence.
Source: Muir Gray (1997b). In: Newman, M., Papadopoulos, I., & Sigsworth, J. (1998)

When planning, implementing or evaluating a knowledge translation (innovation) process, diffusion theory suggests that one of the factors that can influence the appeal of new knowledge to a potential knowledge user is the timeframe over which they are expected to apply (adopt) the new knowledge. Initially, selective uptake can be common. [p41,para5] In many cases, a small set of the intended audience will apply (adopt) the new knowledge early in the process. Ideally, as more individuals become aware (exposed), the application (adoption) rate will increase, to the point of full implementation.
Source: Damanpour (1991); Wright & Charlett (1995); Backer & Rogers (1998); Scheirer (1990); Mahajan & Peterson (1985); Nutley et al. (2002); Rogers (2003). In: Ashley, S.R. (2009)

Methods

Enlightenment model of knowledge translation — A process whereby researchers help policy-makers to understand an issue in a new light, redefining the dominant interpretation of an issue based upon new evidence.
Source: Weiss (1979). In: Murphy, K., Wolfus, B. & Lofters, A. (2011)

Tips

When designing a knowledge translation communication strategy, researchers should consider the possibility of external factors that may impede or facilitate the process.
Source: Hughes (2000); Bauman (2006). In: Wilson, P.M., Petticrew, M., Calnan, M. W. & Nazareth, I. (2010)