24
JCPSLP
Volume 16, Number 1 2014
Journal of Clinical Practice in Speech-Language Pathology
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
KEYWORDS
IMPLEMENTATION
KNOWLEDGE
TRANSFER AND
EXCHANGE (KTE)
KNOWLEDGE
TRANSLATION
EVIDENCE-BASED
PRACTICE
REHABILITATION
What’s the evidence?
Emma Power
variety of stakeholders who may produce or use knowledge
such as research evidence. These stakeholders may
include researchers, clinicians, consumers, managers, and
health care policy-makers. Processes involved in KTE are
represented in Figure 1 with a dynamic, cyclical theoretical
framework called the Knowledge-to-Action Process
Framework (Graham et al., 2006).
Knowledge creation:
Knowledge creation (red funnel) may
start from simple research inquiry (e.g., individual research
studies), move to synthesised knowledge (e.g., systematic
reviews and meta analyses), and finally the development of
user-friendly tools (e.g., clinical guidelines/pathways). These
latter forms are most useful to end users (e.g., clinicians,
policy-makers and consumers).
Tailoring of knowledge:
Knowledge creation may involve
two-way contributions from stakeholders at each stage of
the knowledge creation process. Consumers and clinicians
may have input into research priorities or clinical guideline
developments (
for
an example). Researchers may tailor their key messages to
stakeholders using a variety of modalities (e.g., a video for
consumers).
The Action Cycle:
The blue cycle suggests a series of eight
actions (see Figure 1) required for end users to implement
and sustain knowledge use in clinical practice based on 31
planned action theories (Graham, et al., 2006). These
include: (i) identifying a problem, such as an evidence–
practice gap; (ii) identifying, reviewing (appraising), and
selecting knowledge such as research evidence to inform
the problem; (iii) adapting the knowledge to the local clinical
setting; (iv) assessing barriers (and facilitators) to knowledge
use in relation to the evidence itself (e.g., strength),
adopters (e.g., clinicians and clients) and the environment
(e.g., organisations); (v) selecting, tailoring, and
implementing KTE interventions or strategies to help users
implement knowledge into practice (e.g., educational
sessions); (vi) monitoring the knowledge implementation
efforts; (vii) evaluating outcomes of knowledge use (e.g.,
clinician behaviour, client outcomes and changes at the
service/organisational level); and (viii) sustaining use of the
knowledge (e.g., maintaining implementation and
incorporating new knowledge). The action process is
dynamic and iterative, and different stages may be
addressed simultaneously and not strictly in the order
above. In subsequent sections, this paper will provide a
scenario in which KTE interventions or strategies may be
E
vidence-based practice (EBP) is highly valued
by speech pathologists (Vallino-Napoli & Reilly,
2004) because utilisation of evidence can enhance
outcomes for clients and their families (Hubbard, Harris,
Kilkenny, Faux, Pollack & Cadilhac, 2012). However,
EBP is complex and challenging in practice (Greenhalgh,
Robert, Macfarlane, Bate, & Kyriakidou, 2004). Despite
the availability of evidence, clients do not always receive
best practice based on evidence (Runciman et al., 2012).
Clinicians are pivotal to the implementation of evidence
into practice but organisational, client and evidence-related
factors can make this implementation a challenge (Hoffman,
Ireland, Hall-Mills, & Flynn, 2013; O’Conner & Pettigrew,
2009). Therefore, researchers and clinicians are increasingly
moving beyond traditional clinician-focused EBP models to
approaches that capture the creation, communication and
application of the knowledge/evidence across a broader
range of contexts (Graham, Logan, Harrison, Straus, Tetroe,
& Caswell, 2006). Knowledge transfer and exchange (KTE)
is one such approach.
Knowledge transfer and exchange
Knowledge transfer and exchange (KTE) is known by many
terms including knowledge translation (KT) and research
utilisation, with “implementation science” being the study of
KTE (McKibbon et al., 2010). KTE involves a planned,
dynamic, interchange of knowledge between knowledge
producers and users, so that research evidence can be
implemented into health policy and practice for the benefit
of clients and health services (Canadian Institutes of Health
Research, 2010). In KTE, “knowledge” is considered to
encompass multiple views/sources of information,
including, but not limited to, research evidence. Throughout
the remainder of the paper, the term “knowledge” may
encompass research evidence, but is not a substitute for
that term.
Traditionally, researchers were considered knowledge
“producers” and disseminated (or “pushed”) evidence
to clinicians through journal articles and conference
presentations. Clinicians were considered knowledge
“users” and “pulled” evidence from journals and other
sources to answer clinical questions. We understand
now that “push and pull” models alone are insufficient for
delivering best practice and some reciprocity is required in
order to deliver evidence-based public health (Grimshaw,
Eccles, Lavis, Hill, & Squires, 2012). KTE emphasises a
more collaborative “exchange of knowledge” between a
The effectiveness of knowledge
transfer and exchange
interventions for implementing
rehabilitation evidence into
clinical practice
Emma Power
