Step KTA 6.D

Depending on B, select and implement interventions.

Primary findings

Secondary findings

Primary findings

Barriers

Existing hierarchical structures within organizations and between professional groups, emphasize the routine or status quo in clinical decision-making. The cultural and practice norms mean that one cannot assume a motivation to change practice; there are ill-defined and competing interpretations of clinician roles and practices; and there exists a culture focused on doing while inhibiting questioning of current practices.
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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Mutually exclusive roles for researchers as 'knowledge brokers' and participants as 'knowledge users', sometimes creates we/they relationships, rather than a more desirable collaborative relationship.
Summary of a KT intervention based upon the participatory action KT (PAKT) model.
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Organizational executives often favour incremental implementation of new ideas (research findings). Researchers need to demonstrate sensitivity in these situations and offer complementary strategies, tools and techniques.
Lessons from a health research network evaluation.
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Carriers

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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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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In some cases, and where possible, it may be advisable to translate and apply knowledge in small units, rather than all at once. The knowledge user is less likely to be overwhelmed, and incremental application of the knowledge enables the user to see immediate benefits. ‘Tricking’ is a helpful metaphor for the thinking about how the process works.
Case study.
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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 can become a non-boundaried part of everyday work, where neither KT nor any of its components have an identifiable beginning, ending, or place in a fixed sequence. This occurs when social interaction focuses attention on the co-creation of knowledge, through the adoption of mutual engagement, shared enactment and transformative leadership – enabling existing boundaries and barriers to be jointly confronted and collaboratively removed.
Summary of a KT intervention based upon the participatory action KT (PAKT) model.
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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 — Research methods and results- Researchers must take step to inform stakeholder about research methods and their implications in stakeholder-accessible language. One approach that can be used is to involve stakeholders in the co-writing of a plain language research summary.
Knowledge translation competencies for transdisciplinary health practice.
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Organizational determinants of research utilization — characteristics of organizations and their operating units, and of relevant governance structures that influence the use of research findings in practice include: 1) organizational size, complexity; 2) administrative support; 3) access to research; 4) available time; 5) centralization of management; 6) presence of a research champion; 7) traditionalism; 8) organizational resource slack.
Literature review in context of professional practice.
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Participatory Action Knowledge Translation (PAKT) model — Having participants choose an internal facilitator offsets the we/they relationship problem somewhat, rendering researchers more 'equal' group members.
Summary of a KT intervention based upon the participatory action KT (PAKT) model.
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Removal of KT barriers is aided when KT participants interact openly and intentionally confront existing individual, team and organizational barriers; resolve conflict; and mutually construct KT strategies and facilitators.
Summary of a KT intervention based upon the participatory action KT (PAKT) model.
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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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Throughout the KT process, participants collectively construct an organization encompassing their co-created, shared beliefs and assumptions about their organizational identity, one that increasingly espouses the principles of empowering partnering.
Summary of a KT intervention based upon the participatory action KT (PAKT) model.
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Models

Literature review of existing models shows that knowledge is produced from negotiations among people as they go about their everyday practice. It is produced over time as groups solve the problems they encounter in their practice.
Literature review, synthesis and author expertise.
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Methods

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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Knowledge brokering — supplementing in-person brokering services with an electronic network can enhance stakeholder interaction and knowledge sharing. Networks can be used to optimize project time and resources. Useful network features include, tailored literature retrieval; collaborative evidence appraisal, interpretation and application; and other facilitated group-oriented interactions (e.g., teleconferencing, webinars).
Description of knowledge broker roles.
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One way to transfer knowledge (and best practices) is to blend knowledge (and best practices) from multiple sources into one new source (e.g., Taiwan Semiconductor Manufacturing Company, which also transfers executive knowledge by employing a ‘copy executive’ approach that leverages the executive onsite). Lessons learned are captured in an electronic knowledge management system (knowledge repository), that optimizes knowledge reporting through standardization and knowledge accessibility through codification and indexing. User-friendly coding systems and content submission screening techniques can maximize efficiency and minimize information overload.Culture and incentive systems should encourage sharing.
Literature review.
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Measures

When evaluating a research project for knowledge translation success, one useful researcher-stakeholder knowledge application (passive or active) indicator would be, knowledge being used to help create and support interventions.
Literature review.
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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 brokers can act as bridging agents, helping researchers to understand stakeholders and their environment and helping stakeholders to understand researchers and the research project — and the mutual benefits associated with their involvement. Knowledge brokering is demanding and often difficult work. Knowledge brokers can benefit from the availability of a formal support infrastructure, adequate resourcing, and allocations of time that enable them to build and sustain an understanding of researcher and stakeholders operations. Knowledge brokers may also be good candidates for co-authorship of scholarly papers and co-presenters at workshops or conferences.
Lessons learned from close researcher-stakeholder partnerships.
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Research execution: Face-to-face engagement with stakeholders and active participation in community-based activities can be effective KT strategies.
Applying integrated KT in Mental Health research.
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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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Storytelling is often a very effective technique for getting stakeholders’ attention.
Project evaluation findings.
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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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Secondary findings

Barriers

Knowledge users may resist new knowledge (research findings) if it conflicts with existing organizational or political interests. Information or research findings that are consistent with our values or expectations tend to be accepted, while information that is inconsistent tends to be challenged, questioned, and often disregarded. It has been argued that the importance of alignment between research findings and institutional context should not be underestimated.
Source: Scheel (2003); Thomas (1993); Denis (2002); Lomas (2000). In: Ginsburg, L.R., Lewis, S., Zackheim, L. & Casebeer, A. (2207)

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)

Carriers

An analysis of over 2,500 research studies showed that seven general factors could account for most scientific knowledge dissemination and utilization efforts: 1) Linkage; 2) Structure; 3) Openness; 4) Capacity; 5) Reward; 6) Proximity; 7) Synergy.
Source: Havelock, R (1969). In: Estabrooks, C.; Thompson, D.S., Lovely, J.J.E., & Hofmeyer, A. (2006)

Annual community forums can be an effective way to engage a community. Forums can be targeted at prioritizing research actions or on knowledge transfer related to research results. Common objectives are to facilitate mutual learning and collaboration among research and community members and to improve research outcomes and the dissemination of research findings by providing knowledge transfer around the policy and research process to the community. Typically, forums are conducted from half to a full day and include 80–100 research knowledge producers and users.
Source: Birdsell (2002); Dunnett (2004); Williams (2005). In: Williams, A., Holden, B., Krebs, P., Muhajarine, N., Waygood, K.,Randall, J. & Spence, C. (2008)

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)

Methods

One way to transfer knowledge (and best practices) is to make a clone of the original — copying all physical/functional inputs, processes and equipment and outputs (products/services). Examples include developing a template that captures the knowledge and practices and re-applying them (e.g., 7-11 store, McDonalds restaurants, etc.) or making an exact copy (e.g., Intel chip fabrication). This approach is often used to transfer knowledge vertically (e.g., from R&D to manufacturing). Critics raise concerns that the ‘copying’ approach removes (and erodes) employee judgment and problem-solving skills. There are also concerns about the amount of time that may be required to develop a complete template.
Source: Matson (2003). In: Lu, I.Y., Moa, C.J. & Wang, C.H. (2010)

Promoting Action on Research Implementation in Health Services (PARiHS) — suggests three essential considerations: the evidence, the context, and facilitation. The evidence is described as encompassing research findings, clinical experience, and professional craft knowledge (that is, tacit 'how to' knowledge). The context ideally reflects sympathetic values and beliefs, openness to change, strong leadership, decentralized decision-making, role clarity, and appropriate monitoring and feedback. Facilitation by skilled external and internal personnel is recommended to enable teams and individuals undertaking KT to analyze, reflect upon, and change their own attitudes and behaviours, and particularize research findings.
Source: Kitson, A. et al. (2008); Rycroft-Malone, J. et al. (2002); Rycroft-Malone, J. et al. (2004). In: McWilliam, C. L., Kothari, A., Ward-Griffin, C., Forbes, D., Leipert, B. & South West Community Care Access Centre Home Care (2009)

Social interactions are essential for knowledge transfer and the transfer of tacit knowledge is an essential component of learning complex tasks. Tacit knowledge can only be transferred through detailed discussions among people from similar backgrounds and with common experiences.
Source: Nonaka (1994). In: Koners, U., & Goffin, K. (2007)

Tips

When designing a knowledge translation communication strategy, researchers should consider factors associated with the content of the communication (what will be delivered) and what resources and supporting materials are needed.
Source: Winkler (1985); CRD (1994, 2009); National Center for the Dissemination of Disability Research (1996, 2001); Scullion (2002); Lavis (2003); Canadian Health Services Research Foundation (2004); Carpenter (2005); Bauman (2006); Formoso (2007); Friese (2009); Majdzadeh (2008), Hughes (2000); Harmsworth (2001). In: Wilson, P.M., Petticrew, M., Calnan, M. W. & Nazareth, I. (2010)

When designing a knowledge translation communication strategy, researchers should consider: relevant factors associated with how the knowledge is expected to be used by stakeholders (e.g., practitioners, policy makers), provision of a set of practical implementation tools, and the value of establishing communities or networks to facilitate use.
Source: National Center for the Dissemination of Disability Research (1996, 2001); Carpenter (2005); Hughes (2000); Yuan (2010). In: Wilson, P.M., Petticrew, M., Calnan, M. W. & Nazareth, I. (2010)