A scoping review of full-spectrum knowledge translation theories, models, and frameworks

Esmail, R., Hanson, H., Holroyd-Leduc, J., Brown, S., Straus, SE, Niven, DJ., and Clement, FM. (2020) A scoping review of full-spectrum knowledge translation theories, models, and frameworks. Implementation Science 15,11. https://doi.org/10.1186/s13012-020-0964-5.


Background: Application of knowledge translation (KT) theories, models, and frameworks (TMFs) is one method for successfully incorporating evidence into clinical care. However, there are multiple KT TMFs and little guidance on which to select. This study sought to identify and describe available full-spectrum KT TMFs to subsequently guide users.
Methods: A scoping review was completed. Articles were identified through searches within electronic databases, previous reviews, grey literature, and consultation with KT experts. Search terms included combinations of KT terms and theory-related terms. Included citations had to describe full-spectrum KT TMFs that had been applied or tested. Titles/abstracts and full-text articles were screened independently by two investigators. Each KT TMF was described by its characteristics including name, context, key components, how it was used, primary target audience, levels of use, and study outcomes. Each KT TMF was also categorized into theoretical approaches as process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks. Within each category, KT TMFs were compared and contrasted to identify similarities and unique characteristics.
Results: Electronic searches yielded 7160 citations. Additional citations were identified from previous reviews (n = 41) and bibliographies of included full-text articles (n = 6). Thirty-six citations describing 36 full-spectrum were identified. In 24 KT TMFs, the primary target audience was multi-level including patients/public, professionals, organizational, and financial/regulatory. The majority of the KT TMFs were used within public health, followed by research (organizational, translation, health), or in multiple contexts. Twenty-six could be used at the individual, organization, or policy levels, five at the individual/organization levels, three at the individual level only, and two at the organizational/policy level. Categorization of the KT TMFs resulted in 18 process models, eight classic theories, three determinant frameworks, three evaluation frameworks, and four that fit more than one category. There were no KT TMFs that fit the implementation theory category. Within each category, similarities and unique characteristics emerged through comparison.
Conclusions: A systematic compilation of existing full-spectrum KT TMFs, categorization into different approaches, and comparison has been provided in a user-friendly way. This list provides options for users to select from when designing KT projects and interventions.

Key to this article is appreciating that a full spectrum KT TMF is a theory, model and/or framework (TMF) for knowledge translation is “one that has been used in the literature by study authors to inform their KT work and guide all four KT phases: (i) planning/design (identifies a knowledge gap, engages stakeholders, develops an intervention), (ii) implementation, (iii) evaluation, and (iv) sustainability/scalability.” If a framework only covered a portion of these phases then it didn’t make it into this review.

The authors went from 7160 + 41 = 7201 references down to 36 articles describing full spectrum KT TMFs. We definitely don’t need more TMFs and those we have would benefit from some empirical testing. But testing was beyond scope of this article. It serves as a compendium of full spectrum TMFs that have been sorted into

  • Primary target: patients/public, professionals, organizational, and financial/regulatory
  • Use: within public health, followed by research (organizational, translation, health), or in multiple contexts
  • Use: individual, organization, or policy levels
  • Type: process models, classic theories, determinant frameworks, evaluation frameworks,

They are all from the health system which leaves a huge gap for knowledge mobilization TMFs from social sciences, creative arts and humanities. KT researchers really need to get out more. There is so much those of us working in social and community settings learn from health-based KT and the learning should be reciprocal.

The authors did the work because, “the use of full-spectrum KT TMFs to anchor a KT project is considered an important and foundational starting point.” Basically, if you want your research to have an impact beyond scholarship then you need a full spectrum TMF to guide the work. This article presents 36 full spectrum TMFs for you to choose from, and while you do use them you are then testing them and you can write about how they worked in your context.

The article would have benefitted from a live case study showing how a researcher selected and applied a full spectrum TMF. Instead they provide a couple of scenarios. “By providing a detailed description and comparison of TMFs within each category, users can scan the available TMF options and determine which may be best suited to their KT approach. For example, a user searching for a process KT TMF to apply within multiple target audiences at the policy level could select from three potential process TMFs, (KTA, Collaborative Model for Achieving Breakthrough Improvement, PDSA cycle). Moreover, if users are looking for a KT TMF that has both a process and evaluation approach, they could select the EDCHIP model. Therefore, users have a concise list of KT TMFs to select from based on approach, purpose, context, and the level of use.

So what was left out? The authors indicate the PARIHS framework was omitted as it wasn’t a full spectrum TMF.  The Co-Produced Pathway to Impact wasn’t mentioned likely because it isn’t health specific so didn’t surface in their review. But it was surprising not to see the Canadian Academy of Health Sciences impact framework as that is foundational in Canada and covers all the elements of “full spectrum”.

Questions for brokers:

  1. If you are in social sciences/social service sector what do you learn from health? And vice versa. And if you don’t, why not?
  2. There was no case study where a researcher actually applied this set of 36 TMFs. What do you think about authors who write about but don’t (yet) do what they tell us to do?
  3. If your research or service is not engaging the full spectrum possible in a KT TMF can you engage only a portion of a full spectrum TMF?

Research Impact Canada is producing this journal club series to make evidence on knowledge mobilization more accessible to knowledge brokers and to facilitate discussion about research on knowledge mobilization. It is designed for knowledge brokers and other parties interested in knowledge mobilization.