Anne Hofmeyer

A Guide to Knowledge Translation Theory

&NA; Despite calls over several decades for theory development, there remains no overarching knowledge‐translation theory. However, a range of models and theoretical perspectives focused on narrower and related areas have been available for some time. We provide an overview of selected perspectives that we believe are particularly useful for developing testable and useful knowledge‐translation interventions. In addition, we discuss adjuvant theories necessary to complement these perspectives. We draw from organizational innovation, health, and social sciences literature to illustrate the similarities and differences of various theoretical perspectives related to the knowledge‐translation field. A variety of theoretical perspectives useful to knowledge translation exist. They are often spread across disciplinary boundaries, making them difficult to locate and use. Poor definitional clarity, discipline‐specific terminology, and implicit assumptions often hinder the use of complementary perspectives. Health care environments are complex, and assessing the setting prior to selecting a theory should be the first step in knowledge‐translation initiatives. Finding a fit between setting (context) and theory is important for knowledge‐translation initiatives to succeed. Because one theory will not fit all contexts, it is helpful to understand and use several different theories. Although there are often barriers associated with combining theories from different disciplines, such obstacles can be overcome, and to do so will increase the likelihood that knowledge‐translation initiatives will succeed.

Systematic review of knowledge translation strategies in the allied health professions

BackgroundKnowledge translation (KT) aims to close the research-practice gap in order to realize and maximize the benefits of research within the practice setting. Previous studies have investigated KT strategies in nursing and medicine; however, the present study is the first systematic review of the effectiveness of a variety of KT interventions in five allied health disciplines: dietetics, occupational therapy, pharmacy, physiotherapy, and speech-language pathology.MethodsA health research librarian developed and implemented search strategies in eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, CENTRAL) using language (English) and date restrictions (1985 to March 2010). Other relevant sources were manually searched. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. Within each profession, evidence tables were created, grouping and analyzing data by research design, KT strategy, targeted behaviour, and primary outcome. The published descriptions of the KT interventions were compared to the Workgroup for Intervention Development and Evaluation Research (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions.ResultsA total of 2,638 articles were located and the titles and abstracts were screened. Of those, 1,172 full-text articles were reviewed and subsequently 32 studies were included in the systematic review. A variety of single (n = 15) and multiple (n = 17) KT interventions were identified, with educational meetings being the predominant KT strategy (n = 11). The majority of primary outcomes were identified as professional/process outcomes (n = 25); however, patient outcomes (n = 4), economic outcomes (n = 2), and multiple primary outcomes (n = 1) were also represented. Generally, the studies were of low methodological quality. Outcome reporting bias was common and precluded clear determination of intervention effectiveness. In the majority of studies, the interventions demonstrated mixed effects on primary outcomes, and only four studies demonstrated statistically significant, positive effects on primary outcomes. None of the studies satisfied the four WIDER Recommendations.ConclusionsAcross five allied health professions, equivocal results, low methodological quality, and outcome reporting bias limited our ability to recommend one KT strategy over another. Further research employing the WIDER Recommendations is needed to inform the development and implementation of effective KT interventions in allied health.

Building social capital in healthcare organizations: Thinking ecologically for safer care

Research on patient safety and health human resources, 2 critical issues for 21st century healthcare, converges on similar findings. Specifically, it is apparent that along with the patients, families, and communities we serve, nurses and other healthcare professionals navigate a volatile health care system where persistent restructuring, market pressures, and workforce instability present ongoing threats to the delivery of safer care. Drawing from the fields of nursing, healthcare ethics, health systems management, and ecological restoration, we outline the role of social capital for organizational integrity, healthy workplace cultures, sustainable resource management, improved nurse retention, effective knowledge translation, and safer patient care. Nursing leaders can use ecological thinking to build the vital resource of social capital by taking concrete steps to commit the necessary human and material resources to: (1) forge relations to foster bonding, bridging and linking social capital; (2) build solidarity and trust; (3) foster collective action and cooperation; (4) strengthen communication and knowledge exchange; and (5) create capacity for social cohesion and inclusion.

Identification of patients with noncancer diseases for palliative care services

OBJECTIVE To identify criteria for measuring the eligibility of patients with end-stage noncancer diseases for palliative care services in Australian residential aged care facilities. METHODS No validated set if guidelines were available so five instruments were used: an adaptation of the American National Hospice Association Guidelines; a recent adaptation of the Karnofsky Performance Scale; the Modified Barthel Index; the Abbey Pain Score for assessment of people who are nonverbal and a Verbal Descriptor Scale, also for pain measurement. In addition, nutritional status and the presence of other problematic symptoms and their severity were also sought. RESULTS The adapted American National Hospice Association Guidelines provided an initial indicative framework and the other instruments were useful in providing confirmatory data for service eligibility and delivery.

A moral imperative to improve the quality of work-life for nurses: Building inclusive social capital capacity

The complexity and incessant change in the corporatised health care workplace has influenced nurses’ work choices, morale, quality of work-life and the wellbeing of patients. Thus, there is an urgent moral imperative to improve the quality of work-life for nurses. To this end, it is crucial to re-define progress beyond the sole economic markers of success and profit in the health care workplace. This paper argues for the identification of ethical markers and indicators of organisational success based on bridging and linking social capital which could be used to re-organise health care organisations, hence crafting inclusive moral spaces where nurses can safely work and provide quality care for patients. Social and ethical evaluation is well suited to examine current workplace dilemmas from a psychosocial perspective and provide a framework for best practice in building capacity in effective social relations and family friendly, ethical workplaces.

Researcher-decision-maker partnerships in health services research: Practical challenges, guiding principles

BackgroundIn health services research, there is a growing view that partnerships between researchers and decision-makers (i.e., collaborative research teams) will enhance the effective translation and use of research results into policy and practice. For this reason, there is an increasing expectation by health research funding agencies that health system managers, policy-makers, practitioners and clinicians will be members of funded research teams. While this view has merit to improve the uptake of research findings, the practical challenges of building and sustaining collaborative research teams with members from both inside and outside the research setting requires consideration. A small body of literature has discussed issues that may arise when conducting research in one’s own setting; however, there is a lack of clear guidance to deal with practical challenges that may arise in research teams that include team members who have links with the organization/community being studied (i.e., are “insiders”).DiscussionIn this article, we discuss a researcher-decision-maker partnership that investigated practice in primary care networks in Alberta. Specifically, we report on processes to guide the role clarification of insider team members where research activities may pose potential risk to participants or the team members (e.g., access to raw data).SummaryThese guiding principles could provide a useful discussion point for researchers and decision-makers engaged in health services research.

Acknowledging complexity: Critically analyzing context to understand interdisciplinary research

It is timely to develop improved understandings about strengthening interdisciplinary contexts to guide effective and quality healthcare research; contexts in which health and social issues occur do not recognize disciplinary boundaries. Similar to the notion of “partnership”, the terms multidisciplinary, interdisciplinary and transdisciplinary are in danger of becoming conceptually indistinct and thus of limited usefulness for researchers, practitioners and teams. In this paper, we review basic concepts related to cross-disciplinary relationships as well as common arguments for and against interdisciplinary research. We then extend this critique by adding considerations of the influence of context, specifically social and spatial influences on interdisciplinarity. In doing so, we advocate the need for research that explicitly acknowledges complexity and considers context to advance understanding of effective interdisciplinary research.

Moral Geography of Focus Groups with Participants Who Have Preexisting Relationships in the Workplace

Focus group interviews have become increasingly popular in the past three decades, but ethical issues related to conducting focus groups with participants who have preexisting power relationships in workplaces has received scant attention in the methodological qualitative literature. In this paper the authors offer three propositions to strengthen the moral geographical space between researchers and participants: (a) prior to data collection: highlight the risks and benefits of the method and stress that confidentiality cannot be assured outside the group; (b) during data collection: document group dynamics and encourage participants to share insights after the session; and (c) ongoing: researchers to research and write about the dynamics of the moral space between researcher-participant.

Measuring the Nursing Work Environment: Can a Social Capital Framework Add Value?

Background: A suite of robust instruments are required to investigate the range of contextual and social dimensions in the nursing workforce that contribute to desired outcomes such as resilient work environments, high retention rates, and provision of quality health care. However current instruments do not adequately measure the formal and informal social relationships between nurses and others on the team. This gap is problematic because social relationships can influence how well nurses work together to achieve the desired outcomes. To this end, instruments from other disciplines could be adapted to investigate social dimensions. Purpose: To examine how a social capital framework could measure social relationships in nursing work environments and inform policy and managerial initiatives to reduce turnover and improve quality. Method: Eight contemporary instruments that assess social dimensions and sub-scales in nursing work environments were reviewed. An instrument that measures social dimensions known as social capital (networks, norms, outcomes) was also reviewed for adaptation in nursing. Findings: The eight contemporary instruments do not adequately measure the nature of social relationships (networks, norms, outcomes) between nurses. A social capital instrument developed by social researchers and economists could be adapted to add value and understanding of social relationship issues. Policy Implications and Conclusions: It is timely to develop robust qualitative and quantitative instruments that will permit the examination of social capital in nursing populations globally, and identify mechanisms to achieve desired outcomes, such as job satisfaction, retention, and quality health care.

More than mingling: The potential of networks in facilitating knowledge translation in health care

Health care practitioners and managers often report difficulty keeping up with new health care research and may lack the skills to use research evidence in their workplace, and researchers often report constrained time and opportunity to exchange ideas with those who can benefit from their work. Although studies suggest micro ~one-on-one! and meso ~organizational0group! engagement are effective research translation strategies for addressing these barriers, less attention has been given to the role of macrolevel structures, such as networks, in facilitating micro and meso interchange. As a structure that connects many individuals, organizations, and groups, networks can act as key information-delivery and capacity-building arrangements, promoting connections and interpersonal development between health care practitioners, administrators, and researchers who may not otherwise interact. Why We Undertook This Initiative