Knowledge translation (KT) addresses the ongoing problem of the lack of utilization of evidence-based research. Guidelines are developed, based on systematic reviews of evidence-based research, but changes will not occur in practice until systems are in place to advise service providers and support the implementation of new guidelines. A number of models have been developed to provide guidance for KT planning by encouraging the participation of both researchers and users throughout the KT process. Other models that focus on bridging research gaps can also be applied to a KT process. Following are models identified by the NCDDR (2005), Sudsawad (2007), and the Center on KT4TT (2009).
CIHR Model of Knowledge Translation
The CIHR Model of KT is "a global KT model, based on a research cycle, that could be used as a conceptual guide for the overall KT process" (Sudsawad, 2007). The model identifies six opportunities within the research process for knowledge exchange, including defining research questions and methodologies; conducting research; publishing research findings in plain language and accessible formats; placing research findings into the context of other knowledge and socio-cultural norms; making decisions and taking action informed by research findings; and influencing subsequent rounds of research based on the impacts of knowledge use (CIHR, 2005).
Canadian Institutes of Health Research (2005). About knowledge translation. Retrieved from http://www.cihr-irsc.gc.ca/e/29418.html
Understanding User Context Framework
Five domains, each with a set of questions, make up the framework: the user group, the issue, the research, the knowledge translation relationship, and dissemination strategies. According to Sudsawad (2007), “the framework offers a comprehensive approach to guide the interaction of knowledge creators and knowledge users” for the implementation of existing knowledge.
Jacobson, N., Butterill, D., & Goering, P. (2003). Development of a framework for knowledge translation: Understanding user context. Journal of Health Services Research & Policy,8(2), 94–99.
Ottawa Model of Research Use (OMRU)
The revised Ottawa Model of Research Use (OMRU) also focuses on information that is ready to be shared (the innovation). It includes six primary elements: evidence-based innovation; potential adopters; the practice environment; implementation of interventions; adoption of the innovation; outcomes resulting from implementation, monitoring, and evaluation (NCDDR, 2005; Sudsawad, 2007).
Graham, K., & Logan, J. (2004). Using the Ottawa Model of Research Use to implement a skin care program. Journal of Nursing Care Quality, 19(1), 18–26.
Logan, J., & Graham, I. D. (1998). Toward a comprehensive interdisciplinary model of health care research use. Science Communication, 20(2), 227–246. Abstract with link to fee-based full-text retrieved from http://scx.sagepub.com/cgi/content/abstract/20/2/227
Knowledge-to-Action (KTA) Process
The KTA process uses the word "action" rather than "practice" because it includes a wider range of users of knowledge (Graham et al. 2006, p. 14) After an examination of current terminology around KT the authors present the KTA process, beginning with the concept of knowledge creation, where knowledge moves through a funnel of inquiry and synthesis to become tools or products. The "Action Cycle" represents the activities that lead to implementation or application of the knowledge (Graham, et al., 2006, p. 20). The other component of the KTA process is planned-action theories, which incorporate deliberate activities to facilitate change. Feedback exists among all phases and between both the knowledge creation and the action cycles.
Graham, I. D., Logan, J., Harrison, M.B., Straus, S.E., Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in knowledge translation: Time for a map? Journal of Continuing Education in the Health Professions, 26(1), 13-24. Abstract with link to fee-based full-text retrieved from http://doi.wiley.com/10.1002/chp.47
Promoting Action on Research Implementation in Health Services (PARIHS) Framework
This framework focuses on implementing research for evidence-based practice, attending to the characteristics of the elements of evidence (research, clinical experience, and patient experience), context (culture, leadership, and evaluation) and facilitation (purpose, role, and skills/attributes). In 2004 Rycroft-Malone modified the framework to expand the evidence element to include "local data/information." The framework places these elements on a continuum from low to high, with the idea that when elements are placed higher on the continuum, implementation success is more likely (Rycroft-Malone, 2004).
Kitson, A.L., Harvey, G., McCormack B. (1998). Enabling the implementation of evidence based practice: A conceptual framework. Quality in Health Care, 7, 149–58. Abstract with link to full-text (required free registration) retrieved from http://qshc.bmj.com/cgi/content/abstract/7/3/149
Rycroft-Malone, J. (2004). The PARIHS framework: A framework for guiding the implementation of evidence-based practice. Journal of Nursing Care Quality, 19(4), 297–304.
Rycroft-Malone, J., Kitson, A., Harvey, G., McCormack, B., Seers, K., Titchen, A., & Estabrooks, C. (2002). Ingredients for change: Revisiting a conceptual framework. Quality and Safety in Health Care, 11, 174–180. Full-text (required free registration) retrieved from http://qshc.bmj.com/cgi/content/full/11/2/174
Framework for Knowledge Transfer
The proposed framework asks five questions to be considered for each unique situation:
- What should be transferred to decision makers (the message)?
- To whom should research knowledge be transferred (the target audience)?
- By whom should research knowledge be transferred (the messenger)?
- How should research knowledge be transferred (the KT process and support system)?
- With what effect should research knowledge be transferred (evaluation)? (Lavis et al. 2003. p. 222).
Lavis, J. N., Robertson, D., Woodside, J. M., Mcleod, C. B., & Abelson, J. (2003). How can research organizations more effectively transfer research knowledge to decision
makers? Milbank Quarterly, 81(2), 221—248. Abstract with link to full-text (free with access to JSTOR) retrieved from http://www.jstor.org/pss/3655841.
Lavis, J. N., Ross, S. E., Hurley, J. E., Hohenadel, J. M., Stoddart, G. L., Woodward, C. A., et al. (2002). Examining the role of health services research in public policymaking. Milbank
Quarterly, 80(1), 125—154. Abstract with link to full-text (free with access to JSTOR) retrieved from http://www.jstor.org/pss/3350497.
Coordinated Implementation Model
After examining the literature related to diffusion and dissemination of information, Lomas discussed the practitioners' environment that affects adoption of new information, using the case of the research synthesis "Effective Care in Pregnancy and Childbirth (ECPC)" (Chalmers, Enkin, & Keirse, 1989). Lomas proposed a coordinated implementation plan that includes the distillation of research evidence, adoption by a credible dissemination body, and the competing factors in the overall practice environment (Lomas, 1993, p. 445). Coordination is also needed among external audiences including patients, clinical policymakers, community groups, administrators, and public policymakers.
Lomas, J. (1993). Retailing research: Increasing the role of evidence in clinical services for childbirth. The Milbank Quarterly, 71(3), 439–475. Abstract with link to full-text (required access to JSTOR) retrieved from http://www.jstor.org/pss/3350410.
Stetler Model of Research Utilization
The Stetler Model of Research Utilization (Stetler, 2001) is oriented for use by "individual practitioners as a procedural and conceptual guide for the application of research in practice" (Sudsawad, 2007). The first iteration was the Stetler/Marram Model of Research Utilization (Stetler & Marram, 1976), which was later revised as the Stetler Model of Research Utilization to reflect the concept of evidence-based practice and its relationship to research utlilzation (Stetler, 1994, 2001). There are five phases in the model: preparation, validation, comparative evaluation/decision making, translation/application, and evaluation. The model also implements a set of applicability criteria: substantiating evidence, current practice, fit, and feasibility (Stetler, 2001).
Stetler, C. B. (2001). Updating the Stetler model of research utilization to facilitate evidence-based practice. Nursing Outlook, 49(6), 272–278. Abstract with link to fee-based full-text retrieved from http://www.nursingoutlook.org/article/PIIS0029655401478390/abstract
Stetler, C. (1994). Refinement of the Stetler/Marram model for application of research findings to practice. Nursing Outlook, 42, 15–25.
Stetler, C. B., & Marram, G. (1976). Evaluating research findings for applicability in practice. Nursing Outlook, 24, 559–563.
Need to Knowledge (NtK) Model
Developed by the Cetner on Knowledge Translation for Technology Transfer (KT4TT), the Need to Knowledge (NtK) model is a guide to innovation for technology-based commercial devices and services. It connects the academic research process with industry standards for new product development to improve the quality and relevance of applied research project outputs so that they are more likely to generate socio-economic outcomes and impacts. The NtK includes knowledge translation concepts to improve communication and information sharing between parties in academic, industry and government sectors. Source: http://kt4tt.buffalo.edu/knowledgebase/model.php (Center on KT4TT, 2009)
Flagg, J. L. & Lockett, M. (2010). The Need to Knowledge Model: A roadmap to successful outputs for NIDILRR grantees. FOCUS Technical Brief (28). Austin, TX: SEDL, National Center for the Dissemination of Disability Research.
Lane, J. P., & Flagg, J. L. (2010). Translating three states of knowledge—discovery, invention, and innovation. Implementation Science, 5(9), 1–14. Retrieved from: http://www.implementationscience.com/content/5/1/9