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Cost, cost effectiveness and cost benefit are often key factors in determining how widely adopted an intervention will be in practice, and could figure more prominently in these models. Despite its potential usefulness as a conceptual model, the Nutbeam and Bauman model is yet to be widely tested using real-world case studies in policy and practice.

This may be partly explained by the fact that the model is a relatively new arrival, first published in In contrast, the most commonly applied model in the literature, RE-AIM, was first published in the peer-reviewed literature in , allowing more time for the model and associated concepts to permeate thinking in the field.

It is important to consider the comparative effectiveness of these frameworks in supporting the development and implementation of successful programs and policies. All the frameworks in this review have the common goal of bridging the gap between evidence and practice. Understanding which is most effective and in what contexts will support the development of better policies and programs that have the greatest impact on improving population health.

Further, more work is needed to determine how research translation frameworks are being used by researchers, policy makers and institutions. This review has identified a number of published case studies, all of which demonstrated successful application of research translation frameworks. We encourage authors to document accounts of successful and unsuccessful application of these frameworks in real-world case studies and, importantly, encourage journals to publish these data.

To comprehensively investigate the relative success of the application of these frameworks, further research involving document analysis and interviews with users of these frameworks is recommended. A better understanding of how research translation frameworks are being used in health policy and program development will allow us to better identify the key challenges to effective research translation and assist in understanding the role that these frameworks can potentially play in bridging the evidence—practice gap.

A single database was searched for this review, which may mean that papers were missed. However, PubMed is a large database, so it is likely that the most relevant frameworks and models were identified. The study applied a systematic review methodology with narrative synthesis, which differs from approaches used in Cochrane reviews. This decision was made as the topic under consideration was better suited to narrative analysis.

Conceptual models for research translation are interpreted and applied by different health fields in different but related ways. All of the reviewed models acknowledge a gap between research knowledge and its application to treatment options, policy and practice, and propose pathways to closing this gap. All the models articulate processes of applying evidence from research to intervention development, then applying interventions with demonstrated efficacy into new settings with different populations, and ultimately disseminating effective interventions into policy and practice.

Copyright Sax Institute Web design and development by 4mation Technologies. Advanced search. Toggle navigation. Home Issues February , Volume 27, Issue 1 Narrative review of frameworks for translating research evidence into policy and practice. Collapse all. Expand all. Author details. Corresponding author Andrew J Milat amila doh. Competing interests None declared. Author contributions AM developed the concept for the paper, framed the search strategy, categorised papers and led the manuscript production. Full text.

Introduction Methods Results Discussion Conclusion. Methods Literature review search strategy The review included publications on theoretical frameworks and models that describe processes and issues associated with translation of research evidence into policy and practice. Box 1. Most frequently applied research translation frameworks and models RE-AIM Number of studies: 17 citations Key elements: Reach proportion of the target population that participated in the intervention Efficacy or effectiveness success rate if implemented, e.

Context applied: Postoperative pain management, nursing, neonatal health. Evidence based public health EBPH models Number of studies: 6 citations 10 , Key elements: Community assessment Quantifying the issue Developing a concise statement of the issue Determining what is known through the scientific literature Developing and prioritising a policy or program Developing plans and implementing interventions Evaluating the policy or program.

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Special Feature: Evidence Is Not Enough: Knowledge Translation in the ICU

Stages of research progression rocket model Number of studies: 6 citations 1 , Key elements: Problem definition Solution generation program development Intervention testing process and impact evaluation to determine program efficacy or effectiveness Intervention replication effective programs are adapted for other settings to determine if similar outcomes can be reproduced Dissemination research upscaling of a program to a population-wide level.

Interactive Systems Framework for Dissemination and Implementation ISF Number of studies: 4 citations Key elements: Three levels: Implementing prevention — prevention delivery system general capacity use, innovation-specific capacity use Supporting the work — prevention support system general capacity building, innovation-specific capacity building Distilling the information — prevention synthesis and translation system.

These three levels are encapsulated by four pillars: Funding Macro policy Existing research and theory Climate. Major changes over time: None. Context applied: Teenage pregnancy. UK Medical Research Council MRC framework Number of studies: 2 citations 43 , 67 Key elements: A cycle consisting of: Development identifying the evidence base Feasibility and piloting testing procedures Evaluation assessing effectiveness Implementation dissemination, surveillance, follow-up.

Context applied: Coronary heart disease and depression, osteoporosis. Table 1. RE-AIM evaluation dimensions Dimension a Level Reach proportion of target population that participated in the intervention Individual Efficacy success rate if implemented as in guidelines; defined as positive outcomes minus negative outcomes Individual Adoption proportion of settings, practices and plans that will adopt this intervention Organisation Implementation extent to which intervention is implemented as intended in the real world Organisation Maintenance extent to which program is sustained over time Individual and organisation a The product of the five dimensions is the public health impact score population-based effect.

T0—T4 phases of translational research click to enlarge Source: Glasgow et al. Strengths and weaknesses of the models when applied in practice The evidence based public health framework proposed by Brownson and colleagues 10 offers a practical evidence-to-practice approach and, in more recent iterations, acknowledges the importance of contextual implementation factors.

Areas for further research It is important to consider the comparative effectiveness of these frameworks in supporting the development and implementation of successful programs and policies. Limitations of the review A single database was searched for this review, which may mean that papers were missed. Conclusion Conceptual models for research translation are interpreted and applied by different health fields in different but related ways.

Acknowledgements The authors thank Dr Michael Giffin for editing the manuscript. Translating research for evidence-based public health: key concepts and future directions. CrossRef PubMed 2. The meaning of translational research and why it matters. CrossRef PubMed 3. Research today … vision tomorrow. Available from: nei. Australian Government. National Health and Medical Research Council. Available from: www. The NIH roadmap. CrossRef PubMed 6. The emergence of translational epidemiology: from scientific discovery to population health impact.

Knowledge Translation in Health Care: Moving from Evidence to Practice

CrossRef PubMed 7. National Institutes of Health approaches to dissemination and implementation science: current and future directions. CrossRef PubMed 8. Lost in knowledge translation: time for a map? CrossRef PubMed 9. Using the Knowledge to Action Framework in practice: a citation analysis and systematic review. CrossRef PubMed Evidence-based public health: a fundamental concept for public health practice. Rethinking the efficacy-to-effectiveness transition. RE-AIM: evidence-based standards and a web resource to improve translation of research into practice.

Beginning with the application in mind: designing and planning health behavior change interventions to enhance dissemination. Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues. RE-AIMing research for application: ways to improve evidence for family medicine. Translating clinical informatics interventions into routine clinical care: how can the RE-AIM framework help?

Using the RE-AIM framework to translate a research-based falls prevention intervention into a community-based program: lessons learned. The many faces of translational research: a tale of two studies. Application of the RE-AIM framework to evaluate the impact of a worksite-based financial incentive intervention for smoking cessation. Can physical activity interventions for adults with type 2 diabetes be translated into practice settings?

Dementia London. The continuum of translation research in genomic medicine: how can we accelerate the appropriate integration of human genome discoveries into health care and disease prevention? The role of translational research in addressing health disparities: a conceptual framework.

Books on Evidence-Based Medicine

PubMed Translational research: understanding the continuum from bench to bedside. Moving from research to large-scale change in child health care. Close to the bench as well as at the bedside: involving service users in all phases of translational research. Addressing core challenges for the next generation of type 2 translation research and systems: the translation science to population impact TSci Impact framework. Applying a knowledge translation model to the uptake of the Baby Friendly Health Initiative in the Australian health care system.

Knowledge translation for effective consumers. Defining knowledge translation. Lost in knowledge translation! Knowledge translation is the use of knowledge in health care decision making. Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care. Application of the Knowledge-to-Action and Medical Research Council frameworks in the development of an osteoporosis clinical decision support tool.

Using the knowledge-to-action framework to guide the timing of dialysis initiation. Enabling the implementation of evidence based practice: a conceptual framework. Getting evidence into practice: ingredients for change. Developing postoperative pain management: utilising the promoting action on research implementation in health services PARIHS framework. From workshop to work practice: an exploration of context and facilitation in the development of evidence-based practice. Outcomes-focused knowledge translation: a framework for knowledge translation and patient outcomes improvement.

Evidence-based decision making in public health. Evidence-based public health: an evolving concept. Beyond EBM: new directions for evidence-based public health. Tools for implementing an evidence-based approach in public health practice. CrossRef An evidence-based public health approach to climate change adaptation. Evaluation in a nutshell: a practical guide to the evaluation of health promotion programs. Available from: eprints. The strategic development of the NSW health plan for prevention of falls and harm from falls among older people: —; translating research into policy and practice.

Public health research outputs from efficacy to dissemination: a bibliometric analysis. Research to practice: application of an evidence-building framework to a childhood obesity prevention initiative in New South Wales. Bridging the gap between prevention research and practice: the interactive systems framework for dissemination and implementation. Promoting science-based approaches to teen pregnancy prevention: proactively engaging the three systems of the interactive systems framework. Advances in bridging research and practice: introduction to the second special issue on the interactive system framework for dissemination and implementation.

The interactive systems framework for dissemination and implementation: enhancing the opportunity for implementation science. Government of Canada. Canadian Institutes of Health Research. Ottowa: Canadian Institues of Health Research; Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Moreover, continuous interaction with potential users and setting the activities based on their needs is critical because different groups of people participate in the process.

These groups include knowledge producers, knowledge facilitators, and knowledge users from different levels such as patients, health care practitioners, managers, decision makers, and policymakers. Applying a unique strategy, facilitating interaction among groups, and convincing them to practice and make a decision based on the evidence on the one hand, and continuous evaluation to support the sustainability of located changes and desired outcomes on the other hand make the process challenging.

In this way, keeping the process congruent with legal frameworks, ethical principles and social norms and values is critical too. Efficient change as the output of KT process: Change in target groups and systems are the most cited output of KT process in the literature.

This change can occur in quality of clinical practice and policy making. The defining attributes of the output change are: cost-effective, clinically effective, and on-time Table 1. In fact, these attributes show the capacity of KT process to create effective and ethical changes in clinical setting without wasting resources and time. It means that KT process causes efficient changes , because it can improve health outcome, reduce the adverse effects of care and the length of stay at hospital, and finally decrease the financial burden on patients, health system, and community.

The Health care system is a social setting and implementing knowledge in it needs a relationship-based approach. It takes place in a complex context of interaction between knowledge users and producers. Regular meetings and open discussion not only facilitates the sharing of the knowledge and experiences but helps to build a trust-based relationship.

Having an ongoing relation provides practitioners with a real-time access to evidence and ensures researchers that the generated knowledge is relevant and applicable. In this interconnected network, people from different disciplines with different levels of thinking collaborate. They participate in all steps of the process from knowledge production to knowledge application.

Introduction to Knowledge Translation | KT Books

Based on intended impact, they can be a specialist in informatics, patient education, organizational learning, social marketing, continuous quality improvement, and other related disciplines. Then it can be concluded that KT occurs in a participatory context. A model case is a pragmatic example of the concept which includes all defining attributes of the concept. It can be a real instance, retrieved from the literature or constructed by analyst 18 , 19 , We introduce a real case with all defining attributes of KT process. This case has all defining attributes of KT.

Introducing additional cases, borderline, related and contrary, is another way to gain deeper insight about the concept. They may provide examples of what the concept is not and help us to differentiate that from related or similar concepts 18 , Antecedents: Antecedents are those events and circumstances which happen before occurrence of the concept and may be associated with the occurrence or necessary condition for its occurrence 19 , Following thematic analysis of the literature, three key themes were identified as antecedents of KT process: an integrated source of knowledge, a receptive context, and preparedness Table 2.

It means that prior to attempt to implement knowledge to action, providing a body of knowledge, having receptive context and preparing the requirements are necessary. It may also mean that the success of the process is significantly related to the occurrence of these conditions. It means that the knowledge used in the KT process should be provided from these different sources. There are several reasons which confirm that using multiple sources of knowledge to address the health system issues increases the chance of implementing knowledge to practice. First, the complicated nature of health care system issues requires the use of a rich and mature source of knowledge to cover all aspects of issues.

Second, studies revealed that health practitioners and policy makers have no interest to use pure research findings and tend to use contextual knowledge. Finally the integration of different resource of knowledge will compensate for the shortcoming of using a single resource. Receptive context: A receptive context has been developed based on the integration of four subthemes: conductive culture, supportive leadership and evaluation system Table 2 and refers to an environment which has enough readiness and willingness to change.

According to the literature, any change in health care system requires a comprehensive involvement of the organization in terms of conductive culture, using supportive leadership styles and effective evaluation system. In addition, practitioners should have a strong tendency to change, accept the necessity of that change, and work as a team to establish it. Developing a collaboration network in health system including key individuals with different type of skills, experience and knowledge i.

Moreover, peers and other staff support can be a force to persuade decision makers to adopt the change. Furthermore, authority and lack of concern about ethical and legal issues play a critical role in occurrence of knowledge-based change in professional behavior. The most frequent cited strategy in the literature for these issues is organizational support.

It gives the staff power and authority to change and encourages them to be creative and do the things in a different way. In addition, establishing an evaluation system to identify the contextual barriers and facilitators before starting the activities and giving an on-going feedback during the process are other effective factors that increase the probability of success and sustainability of outcomes. Review of the literature showed that interventions that are based on an on-going evaluation and feedback are more successful than others. Preparedness: Preparedness means arranging necessary elements [individual and organizational] and requirements and readiness for commencing the KT process.

In this study, preparedness means designing a plan, preparing infrastructures, building capacity and engaging facilitators Table 2. Access to the change-based outcomes will not be attained without purposeful efforts for persuading users to apply evidence into their practice and policy making. Based on studies, success in implementing knowledge into practice depends on access to appropriate infrastructures.

These include well-equipped libraries and databanks, and designed structures to facilitate interaction between knowledge producers and users such as research centers in clinical settings, incubator centers, science and technology parks, and community-based research centers. In addition, allocating an inclusive budget, assigning a specific time in work places for research activities, reading and interpreting relevant research findings and engaging a number of expert people in clinical setting to train practitioners can facilitate implementing new knowledge or ideas in daily practice.

Enabling practitioners in conducting research or evaluating research findings and applying evidence in their own decisions and practices are of the important prerequisites of success that will be implemented by engaging facilitators. According to the literature, facilitators are expert people with specific skills and defined tasks and roles to enable individual and organizations about understanding the context, specify the needed knowledge, prepare the infrastructures, and then try to make a change. They can facilitate the exchange of knowledge between researchers and practitioners.

Researchers and academic individuals, expert people [managers, decision makers, clinical instructors and specialists and health system practitioners], brokers, opinion leaders, champions and change agents can undertake the role of facilitator. Consequences: Consequences are those events which take place as the outcomes or results of concept occurrence 18 , As the review shows, a change in quality of care, professional practice, health care systems, and community are the main outcomes of the KT process as identified in the literature Table 3.

Undoubtedly, KT is the most comprehensive approach to applying knowledge to action because it addresses all influential fields on health. KT attempts to promote the health professions by growing the awareness and professional behavior of practitioners, and tries to improve the quality of care and patient outcomes by integrating knowledge into caring.

In addition, it plans to improve the health System through improving the organizational efficacy and informing policies and decisions. Ultimately, at community level, a successful KT process can cause a facilitated access to health services, cost reduction, equity in resource allocation, poverty reduction, and improvement in quality of life. In fact the final consequence of all these changes is health improvement. Based on identified attributes, antecedents, and consequences we proposed a synthesized definition of KT that is described below.

Expected changes will happen when the knowledge is gathered from multiple resources, the context is receptive, and the system is prepared. Empirical referents are indicators that show the occurrence of the concept by their existence 19 , In fact defining attributes of the concepts of interest can play the role of empirical referents to show occurrence of them. These indicators can be used to develop checklist or tools which would be able to show the occurrence of the KT process.

Based on the findings, the defining attributes of KT are: using refined knowledge; applying dynamic, comprehensive, evaluation based, user- oriented, context based and on-time activities; occurrence in a multidisciplinary, social, interactive, collaborative and dialogue- based context; and leading to cost effective, timely and clinically effective output.

These defining attributes help us to differentiate KT from similar concepts. Although several terms are used interchangeably to address getting knowledge into action and have some overlaps and similarities with KT, there are some important differences between them. First, many of the concepts related to moving knowledge to action focus on production or application of the knowledge and the main source of knowledge in these approaches is scientific knowledge or research findings 5 , 9 , 40 , while KT process not only covers all steps between creation and application of the knowledge but uses various research and non-research sources 5 , 25 , 41 , Second, KT is an all-inclusive process involving knowledge producers, knowledge users and context or organization in which the knowledge is applied 9 , 22 , 36 , while other concepts such as evidence based practice and knowledge diffusion are focused on just one or two of these issues 5 , 33 , Furthermore, the extent of activities and diversity of audiences in the KT process make it more comprehensive than others 4 , 9 , 33 , KT has an overarching structure encompassing other concepts so that, many of them like continuing medical education and continuing professional development can be considered as a strategy used during the process 1 , 22 , 46 , Third, successful KT depends on the engagement of knowledge users and the application of knowledge to inform health decisions.

Specific focus of KT on interaction, users' engagement, improving health outcomes and using knowledge not only differentiates that from other similar concepts, but these criteria can be used as an indicators of the process 9. KT intends to bridge the gap between knowing and doing by applying a dynamic approach, ongoing interaction with users and involving a multidisciplinary team consists of all stakeholders 1 , 9 , 13 , 24 , 48 while, in most approaches, applying a linear, inactive and one-sided method without involving the users 5 , 49 is prominent.

Fifth, KT is an evaluation-based process. It means the whole process is influenced by evaluation. It is started before commencing the process to identify the contexts barriers and facilitators, followed by evaluating the validity and relevance of the knowledge. The next step is continuous monitoring of the activities, evaluating the outcomes and the sustainability of occurred changes by taking ongoing feedback from the context and users. These steps are repeated in each cycle of iterative process of KT. This attribute is not seen in other approaches 2 , 52 - Sixth, KT is a process focused primarily on health and is able to improve health outcomes and system competencies.

In fact, it aims to achieve the greatest possible benefits along with saving the time and resources. KT is a multidimensional and complex process needing various antecedents to happen successfully including; an integrated source of knowledge, a receptive context, and preparedness. Based on literature, providing these antecedents as a rigid guideline will not be successful because the effectiveness of applied strategies varies in different contexts 46 , It is recommended to apply the strategies which are more in line with context characteristics and desired change and combine those to address different aspects of the system 5 , 35 , 46 , According to the results, if all mentioned antecedents are provided and KT process run successfully, it will lead to a set of positive changes and consequences in different fields of the health: in quality of patient care, professional practice, health system, and community.

In fact, change in community as a macro consequence of successful KT is the outcome of sustained changes in other fields.

Knowledge Translation in Audiology

This shows that unlike other concepts of getting knowledge to practice, KT influences all related fields of health: individual, system, and community. The final result of this study was a synthesized definition of KT. Although there are several definitions of KT 22 , our definition is different from previous definition in some ways. For instance, it explicitly refers to the attributes, antecedents, and consequences of the process and then it is applicable for those who intend to evaluate the process. In fact, it is an operational definition for KT.

It has been constructed based on the literature in health, medicine and nursing and therefore, has a broader view and applicability for all these disciplines. The most important difference between our definition and others is related to the source of knowledge. In previous definitions, research findings, mainly, randomized controlled trials were considered as only valid source of knowledge, while the review of the literature show that the best knowledge to be implemented in practice is that has been obtained from multiple sources. Now by achieving clear understanding about characteristics and antecedents of KT we are able to design a theoretical framework for health care setting.

To test the framework, the identified consequences and defined empirical referents would be helpful. KT is a process in which through a set of challenging activities a body of knowledge is refined and implemented into a participatory context. It needs a set of antecedents which are elements that relate to the nature of the knowledge, all of the factors that relate to where that knowledge is going to be implemented and then they relate to how it will be done.

These are the broader impact of knowledge translation process in community. L, Schultz T. J, Athlin A. Knowledge translation in health care: a concept analysis. National Center for Biotechnology Information , U. Med J Islam Repub Iran. Homeira khoddam 1. Neda Mehrdad 2. Hamid Peyrovi 3. Alison L Kitson 4. Timothy J Schultz 5. Find articles by Timothy J Schultz. Asa Muntlin Athlin 6. Author information Article notes Copyright and License information Disclaimer.

Received Feb 8; Accepted Apr 7. This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3. Abstract Background: Although knowledge translation is one of the most widely used concepts in health and medical literature, there is a sense of ambiguity and confusion over its definition.

Introduction Knowledge translation KT is a concept first used in by the Canadian Institute of Health Research CIHR 1 - 7 to address the gap between research knowledge and its application in clinical practice in health 1 , 2 , 4 , 5. Step 1: selection of a concept We selected KT because it has become one of the most common concerns in health related fields while there is some degree of confusion and inconsistency around its definition 1 , 3 , 5 , 6 , 9 , 21 - Step 2: The purpose of analysis This study is the first stage of a larger study conducted to develop a model of KT for clinical setting.

Results Step 3: Identifying all uses of the concept KT refers to any process that contributes to integration of evidence-based information into the practices of health professionals to improve the healthcare outcomes and maximize the potential of the healthcare system 1 , 6. Step 4: Identifying the defining attributes Defining attributes are characteristics that are used repeatedly in the literature to define or describe the concept and help to differentiate the concept of interest from similar concepts The defining attributes of these elements have been given below [Italicized items]: 4.

Table 1 Attributes of knowledge translation. Open in a separate window.

Step 5: Identifying model case A model case is a pragmatic example of the concept which includes all defining attributes of the concept. Step 6: Identifying additional cases Introducing additional cases, borderline, related and contrary, is another way to gain deeper insight about the concept. Table 2 Antecedences of knowledge translation. Health improvement As the review shows, a change in quality of care, professional practice, health care systems, and community are the main outcomes of the KT process as identified in the literature Table 3. Table 3 Consequences of knowledge translation.

Step 8: Defining Empirical Referents Empirical referents are indicators that show the occurrence of the concept by their existence 19 , Discussion Based on the findings, the defining attributes of KT are: using refined knowledge; applying dynamic, comprehensive, evaluation based, user- oriented, context based and on-time activities; occurrence in a multidisciplinary, social, interactive, collaborative and dialogue- based context; and leading to cost effective, timely and clinically effective output. Conclusion KT is a process in which through a set of challenging activities a body of knowledge is refined and implemented into a participatory context.

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