Field, B., Booth, A., Ilott, I. & Gerrish, K. (2014). Using the Knowledge to Action Framework in practice: A citation analysis and systematic review. Implementation Science, 9, 172 http://www.implementationscience.com/content/9/1/172
Background: Conceptual frameworks are recommended as a way of applying theory to enhance implementation efforts. The Knowledge to Action (KTA) Framework was developed in Canada by Graham and colleagues in the 2000s, following a review of 31 planned action theories. The framework has two components: Knowledge Creation and an Action Cycle, each of which comprises multiple phases. This review sought to answer two questions: ‘Is the KTA Framework used in practice? And if so, how?
Methods: This study is a citation analysis and systematic review. The index citation for the original paper was identified on three databases—Web of Science, Scopus and Google Scholar—with the facility for citation searching. Limitations of English language and year of publication 2006-June 2013 were set. A taxonomy categorising the continuum of usage was developed. Only studies applying the framework to implementation projects were included. Data were extracted and mapped against each phase of the framework for studies where it was integral to the implementation project.
Results: The citation search yielded 1,787 records. A total of 1,057 titles and abstracts were screened. One hundred and forty-six studies described usage to varying degrees, ranging from referenced to integrated. In ten studies, the KTA Framework was integral to the design, delivery and evaluation of the implementation activities. All ten described using the Action Cycle and severeferred to Knowledge Creation. The KTA Framework was enacted in different health care and academic settings with projects targeted at patients, the public, and nursing and allied health professionals.
Conclusions: The KTA Framework is being used in practice with varying degrees of completeness. It is frequently cited, with usage ranging from simple attribution via a reference, through informing planning, to making an intellectual contribution. When the framework was integral to knowledge translation, it guided action in idiosyncratic ways and there was theory fidelity. Prevailing wisdom encourages the use of theories, models and conceptual frameworks, yet their application is less evident in practice. This may be an artefact of reporting, indicating that prospective, primary research is needed to explore the real value of the KTA Framework and similar tools.
This paper is about the very popular Knowledge to Action (KTA) Cycle that describes a knowledge creation component and an action component that guides the created knowledge through to impact to sustained intervention. First a note on frameworks. There are tons of frameworks including PARIHS (which was covered in this journal club) and the consolidated framework for implementation both referenced in the paper. A framework is not the same thing as a pathway to impact. A framework helps you think about the overarching process. A pathway to impact is a description of a specific example fitting under the framework. A framework is generic and can apply across contexts. A pathway is specific. Practitioners need to be informed by frameworks but also need make a balance between what may be possible in theory with what is feasible in practice. Often what is best to do is not feasible to do.
The authors undertook a systematic review asking if researchers used KTA in practice and how they used it. While much has been written referencing KTA this article digs deeper and asks how it is actually being used.
And the answer is: not much, at least in an integrated fashion.
From 1057 titles to 146 papers describing its use only 10 studies used KTA in an integrated fashion. Integrated was defined as”The KTA Framework was integral to the design, delivery and evaluation of the implementation activities.” 43% of studies merely referenced KTA while an additional 27% were informed by KTA but only 10 studies (= 7%) actually used KTA integrated into the research program.
This implies that KTA is useful for a very few cases of implementation research. Others may be informed by KTA but it suggests that KTA itself is a very robust framework for very few cases. The dominance of KTA in Canada (8/10 studies were Canadian) is explained by the adoption of KTA as the framework for Canadian Institutes of Health Research with specific funding schemes referencing the KTA cycle. With the primary health research funder advocating KTA then researchers will naturally align with KTA in grant applications and in research programs. However, as shown by this paper, merely referencing KTA is not the same as practicing KTA.
There are a couple of interesting/incongruous thoughts arising from this paper.
Only one of the 10 studies employed a specific KT strategy. The authors excluded the many papers involving clinical practice guidelines, a KT tool. But if the KTA Cycle describes KT over the life cycle from knowledge creation to sustainable impact why aren’t there more KT tools and methods described to help move from on KTA stage to the next? Seems odd until you consider part of the design of KTA is its flexibility. KTA was designed to “accommodate different phases being accomplished by different stakeholders and groups (working independently of each other) at different points in time“. In other words, KTA was never intended to describe an single program comprising all the steps from research to impact. It was meant to describe a process that is comprised of discrete components working independently of each other. This explains why no study in this paper reported using all phases from knowledge creation through to sustainability and why sustainability was the element that was referenced the least.
The process from research to impact is long and requires multiple skill sets along the way. Since each of the 10 studies was only practicing a small slice of KTA then they wouldn’t need knowledge brokers or other KT tools to connect between the KTA stages.
But this raises another question: if different skills are being practiced by disconnected researchers/clinicians at different phases throughout the KTA cycle, and some of the stages being practiced by different folks acting independently, then who is coordinating the process? Whose job is it to ensure research moves from creation to impact? The simple answer is no one. No one is minding the shop. Individuals are acting individually and not in a coordinated fashion. This may be why we still experience significant delays getting research into practice/policy so it can have an impact.
Some networks such as the Networks of Centres of Excellence (http://www.nce-rce.gc.ca/index_eng.asp) or specific KT organizations such as Institute for Work and Health (http://www.iwh.on.ca/) and Canadian Partnerships Against Cancer (http://www.partnershipagainstcancer.ca/) may have an overarching mandate to maximize the movement of research to impact. Some organizations such as the Norlien Foundation (http://www.norlien.org/) are successful working the action cycle component but only after many years and millions of dollars of investment.
Absent an overarching structure the individual components practicing along the spectrum of KTA activities remain disconnected and thus are not operating in an integrated fashion. In order to decrease the time from knowledge creation to sustained impact we need networks and structures that integrate the different skills and centres practicing the discrete components. We also need knowledge brokers to make the connections between research, dissemination, uptake, implementation and eventual impact of research informed products, practices and services on the lives of end beneficiaries.
Questions for brokers:
- What can the research to impact community learn from supply chain management to provide integration from knowledge creation to impact?
- Everything in this study is in health – will KTA translate to other fields such as education, management, agriculture, international development?
- While KTA is not linear it nonetheless describes a process that progresses from knowledge creation to application to sustained impact. It doesn’t matter if you draw it in a circle. In reality it is a logic model. Under what conditions is a linear model ok (see a previous journal club)?
ResearchImpact-RéseauImpactRecherche (RIR) is producing this journal club series as a way to make evidence on KMb more accessible to knowledge brokers and to create on line discussion about research on knowledge mobilization. It is designed for knowledge brokers and other knowledge mobilization stakeholders. Read this open access article. Then come back to this post and join the journal club by posting your comments.