clinical physiotherapy

Knowledge translation frameworks: Narrowing the gap between evidence and practice

There is a large gap between what we know and what we practice and the way to narrow that gap is not always clear, especially in the context of clinical practice where clinical guidelines are often ignored by healthcare professionals. There is often considerable time that elapses before research findings are transferred to common practice.

Various strategies are used to try and bring about a movement towards evidence-based practice and associated change in practitioners’ behaviour. These include Continuing Medical Education (CME), Continous Professional Development (CPD) and Knowledge Translation (KT). KT has been positioned as a construct that subsumes and builds upon CME and CPD, minimising the limitations of those approaches, as well as offering new insights into behavioural change (Davis, et al., 2003). See pg. 34 of Davis, et al. (2003) for a table comparing the basic characteristics of CME, CPD and KT.

For example, workshops are often suggested as possible ways to help implement change by inviting stakeholders and getting them to participate in discussion around the change. However, workshops in the context of CME and CPD are either teacher- or learner-focused and relatively rarely include the patient or health systems context. In addition, change is a process and not an event, which may be another reason for why workshops often don’t work in this context. It seems clear that logic and pragmatism are not necessarily the best way to implement and drive change in clinical practice and knowledge translation frameworks show some promise as potentially useful tools to help guide the process.

The effectiveness of strategies that aim to bring about behavioural change is highly variable and dependent on the setting, and success is often determined by whether or not the strategies have been appropriately tailored to the unique context of the setting (Santesso & Tugwell, 2006). The Ottawa Model of Research Use (OMRU) is one example of a KT framework that incorporates this concept, as well as having an interdisciplinary focus. It consists of six elements:

  1. Setting the stage
  2. Specify the innovation
  3. Assess the innovation, potential adopters and the environment for barriers and facilitators
  4. Select and monitor the knowledge translation strategies
  5. Monitor innovation adoption
  6. Evaluate outcomes of the innovation

Underlying the OMRU model is the idea that success rests with tailoring the KT strategies to the relative barriers and supports that are found within the setting in which behavioural change is sought (Santesso & Tugwell, 2006).

Knowledge translation encourages the integration of insights and experiences from many disciplines, including informatics, social and educational psychology, organisational theory, and patient and public education. This means that the approach incorporates a range of perspectives beyond what healthcare professionals are able to provide on their own, with the possibility for more diverse and creative solutions to arise. This seems prudent since the most effective strategies for behavioural change tend to be those that are more active in nature, and which incorporate multiple interventions (Davis, et al., 2003).

Graham et al., (2006, pg. 22) offer the following practice points regarding KT:

  1. Knowledge translation is about turning knowledge into action and encompasses the process of both knowledge creation and knowledge application.
  2. Knowledge translation subsumes and builds on continuing education and continuing professional development.
  3. Healthcare professionals need to learn about planned-action theories and frameworks so as to be able to understand and influence change in their practice settings.
  4. Continuing education should be based on the best available knowledge, whether in the form of knowledge tools (e.g. practice guidelines), knowledge syntheses, or primary knowledge enquiries.
  5. Continuing education should apply strategies known to be effective at transferring knowledge.

It should be noted that, while KT seems to show some promise for changing clinician behaviour when it comes to adopting evidence-based practices in healthcare, there are some limitations to the approach, including the fact that the approach remains largely intuitive and untested in large-scale, rigorous studies (Davis, et al., 2003).

Resources and references

By Michael Rowe

I'm a lecturer in the Department of Physiotherapy at the University of the Western Cape in Cape Town, South Africa. I'm interested in technology, education and healthcare and look for places where these things meet.