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JCPSLP Volume 14, Number 1 2012 39
techniques into clinical practice” (Molfenter et al., 2009, p.
86). While many frameworks and models are available,
further research is needed to test their use in actual
practice environments and their relevance for speech
pathology (Estabrooks et al., 2006; Sudsawad, 2007).
While the evidence is mounting, clinicians should take time
to identify the most appropriate KTE model or strategy to
meet the needs of a particular practice environment or
clinical problem.
Clearly identify a knowledge-to-action
or evidence–practice gap
Before selecting the most appropriate KTE framework, it is
important to have a KTA gap or clinical problem in mind.
This gap in best practice is the driving force behind a
translation initiative and should be clearly defined before
devising a KTA intervention. Surveys, audits, interviews,
focus groups, and reflective practice are all strategies that
can be used to demonstrate a divide between what is
known and what is actually being implemented in practice
in terms of evidence based assessment, intervention, or
adherence to recommended clinical guidelines or pathways.
Objectively demonstrating a gap in service provision
provides local, pre-intervention data, which is useful for not
only advocating the need for change, but also for providing
a critical reference point for measuring the success of a
Draw upon frameworks, models, and
theories to guide knowledge transfer
and exchange
One of the most important themes to emerge from the
literature under review was that a multidimensional KTE
framework is beneficial for facilitating the successful transfer
of knowledge into practice. There are many different KTE
models available for clinicians to select from and readers
are directed to a number of sources for a more
comprehensive overview (Estabrooks, Thompson, Lovely, &
Hofmeyer, 2006; Kagan et al., 2010; Rose & Baldac, 2004;
Sudsawad, 2007). As an excellent example Molfenter et al.
(2009) provide evidence that KTA processes and KTE
principles are effective and can be used successfully to
guide the planning, implementation and evaluation of
translation projects. In particular, they drew upon the KTA
process developed by Graham and colleagues (2006),
which involves both knowledge creation (the synthesis,
tailoring and clear, targeted dissemination of knowledge)
and then knowledge action (the transfer of knowledge into
practice) with a cyclical and dynamic relationship between
the two. Application of the model ensures that testable and
useful translation interventions are devised and
implemented (Estabrooks et al., 2006; Kagan et al., 2010),
providing a “road map for introducing… evidence-based
Table 2. Critically appraised article
Article purpose To determine whether communicative access to information and decision-making could be improved for people with aphasia
across three health care facilities in Canada by targeting systems-level change. This study sought to address limitations in the
translation of evidence regarding the benefit of supported conversation and aphasia-friendly principles into routine practice.
Citation Simmons-Mackie, N.N., Kagan, A., Christie, C.O., Huijbregts, M., McEwan, S., & Willems, J. (2007). Communicative access
and decision-making for people with aphasia: Implementing sustainable health care systems change. Aphasiology, 21(1),
39–66.
Design Qualitative research design (thematic analysis). No randomization or control group.
Level of evidence Level IV (Qualitative descriptive study without experimental control)
Participants Three facilities participated in the project. The facilities included a large tertiary medical centre; a rehabilitation centre; and
a long-term care facility. A manager that was associated with stroke care was identified within each of the facilities. These
managers then selected “a team” to be involved in the project. A total of 37 team members participated across facilities and a
range of disciplines.
The intervention The KTA intervention involved a 2-day training program based on Supported Conversation for AphasiaTM (SCA) training
procedures, followed by post-training support. Participants received information about aphasia and the opportunity to practise
using SCA techniques. Participants also brainstormed issues surrounding communication access in their facility, leading
to the formulation of specific goals for that site to enhance and improve access. Post-training follow-up occurred with all
sites 4 months later with periodic on-site support to address any problems with implementation and to provide teams with
individualised resources.
Results Qualitative data was collected before and after training, and at the 4-month follow-up via observation, interviews, and focus
groups. Through observation checklists data regarding the actual use of strategies and resources was collected however,
the amount of observation was described as insufficient by the authors. The interviews and focus groups elicited information
about the participants’ knowledge and perspectives regarding the access to information and decision-making ability of people
with aphasia. After training, the knowledge of all participants concerning how to support people with aphasia to access
information improved. Changes were most positive for the rehabilitation and long-term care facilities, with examples provided
of system changes that improved access and participation of people with aphasia within their programs. Unfortunately,
implementation was less successful in the acute care facility.
Limitations No control group or randomisation. Four month follow-up unlikely to provide a reliable index of sustainable change.
Consumers or people with aphasia were not involved in the training or evaluation of project outcomes. Insufficient
observational data collected to obtain objective direct evidence of implementation of communicative access strategies. Only 3
facilities were included in the study with a need to increase sample size.
Summary The project was successful in improving communicative access and decision-making for people with aphasia at a systems-
level for 2 of 3 facilities. That is, the systems and procedures of the facilities did change with positive implications for
consumers with aphasia. The outcomes provide support for involving front-line service providers in the evaluation of their own
service and strategies for change to enable effective, sustainable, and long-term changes in health services to take place. The
successful involvement of service providers suggests that active collaboration between researchers and clinicians can help
guide the translation of evidence into practice. Further research does need to take a more controlled, experimental approach
to investigate the effectiveness of systems-change projects and address potential barriers to change in the planning stages.