To find ways to provide evidence-based health information to healthcare systems, Straus, Tetroe, and Graham (2011) outlined knowledge translation (KT) through a conceptual framework developed by Graham and colleagues termed the "Knowledge-to-Action Cycle." This framework provides an approach that builds on the commonalities in assessing action-planned theories (Graham et al., 2006, as cited in Straus et al., 2011).
Adapted also by the World Health Organization, the Canadian Institutes of Health Research defines KT (also known as knowledge exchange or transfer) as "a dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products and strengthen the healthcare system" (As cited in Straus et al., 2011, p. 6, para 3).
Knowledge creation, distillation and dissemination are not enough on their own to ensure evidence-informed decision-making, therefore ensuring that KT to decision-makers at all healthcare system levels are aware and can access and use research evidence to inform health-related decision-making (Straus et al., 2011).
The KT initiative to implement strategies that minimize harm, aiming to improve health and reduce the prevalence and transmission of infectious syphilis, emphasizing females of reproductive age, preventing any cases of congenital syphilis in the North Bay Parry Sound District, includes key stakeholders in public health, community health care and service providers who play an essential role in the cascade of syphilis care for females. Through increasing understanding of the factors contributing to this shift in the female population to support health promotion efforts and preventative measures, the evidence suggests that addressing this public health concern and reducing transmission will lead to attempts to change knowledge, awareness and skills, and changes to behavior, practice, advocacy and policy changes. Straus et al. (2011) argue that changing behavior is a complex process requiring evaluation of the entire health system, including systematic barriers to change and target all those involved in decision-making, and emphasize that KT interventions must be compelling to close the knowledge to practice gaps, including all aspects of care such as access to and implementation of valid evidence and organizational and systems issues.
The "Knowledge-to-Action" framework involves an interactive and complex process where knowledge creation and application (action cycle) with the boundaries between the two is fluid. In the knowledge creation stage, Straus et al. (2011) explain that as knowledge is filtered through each stage, the resulting knowledge becomes more refined and more beneficial to the end users.
An example as it relates to my health promotion initiative to reduce the prevalence and transmission of infectious and CS, minimizing risks associated with delayed interventions, the synthesis stage would bring together research findings that exist on actionable health promotion strategies and interventions to identify common patterns such as increase awareness and education, enhance screening and provide equitable access. At the tools development stage, the best quality knowledge and research are further synthesized and distilled into decision-making tools such as practice guidelines.
Figure 1
Knowledge-to-Action Framework
(Graham et al., 2006, as cited in Straus et al., 2011)
Straus et al. (2011) suggest that the seven action phases can occur sequentially or simultaneously, and the knowledge phases can influence the action phases at any point in the cycle. The various stakeholders who are the end users of the knowledge that is being implemented are integral to the multiple stages of the action plan, including:
Identify the problem (Identify, review, and select the knowledge to implement)
Adapt or customize the knowledge to the local context
Assess the determinants of knowledge use
Select, tailor, and implement interventions
Monitor KT interventions and knowledge uptake
Evaluate the outcomes or impact of using the knowledge
Determine strategies for ensuring sustained knowledge use
To illustrate this cycle, an example was provided with consideration for a local group of advocates (public health, home care and internal medicine clinicians), which identified that many people in their area who were admitted to hospital with falls or fractures were not previously assessed for osteoporosis or risks for falls (Straus et al., 2011). The evidence was controversial, but the group was still interested in tackling this problem. With considerations for how to adapt the evidence to their context, the appropriate tools were created; however, there were barriers to implementation, including evaluation (Straus et al., 2011). Straus et al. (2011) identified several gaps in their review, including developing strategies for assessing knowledge use determinants and evaluating the KT intervention's sustainability. Through critical analysis of the "Knowledge-to-Action" framework, the strengths demonstrated are the ongoing collaboration to change practice and the opportunities to address stakeholders' questions. In all KT, Straus et al. (2011) emphasize the need to ensure "there is a mature and valid evidence-based before expending resources on implementation of this evidence" (p. 9, para 5). The stages involved would lead to effective translation; however, in my KT initiative, I would consider an additional stage to work with stakeholders to prioritize KT activities, which may be beneficial given the realities of insufficient resources in today's healthcare climate.
References
Straus, S., Tetroe, J., & Graham, I. (2011). Knowledge translation is the use of knowledge in healthcare decision-making. Journal of Clinical Epidemiology, 64. 6-10. http://www.jclinepi.com/article/S0895-4356(09)00267-4/fulltext
Comments