Table 2 Facilitating factors and barriers to KT during the pneumonia guidelines updating, Cambodia 2013

1- Process level

 1.1 Expectation domain

  1.1.1 Research production

1. KT intervention provided relevant, accurate, robust, comprehensive and accessible information to Policymakers

1. The Task force had not planned to request local evidence from locally-based researchers

  1.1.2 Timing

2. Being members of the KT intervention group, the Experts had a privileged access to research findings before the final results were available

2. Limited availability of the Task force -busy with the updating of about 200 guidelines chapters at the same time

3. MoH did not initially inform the Researchers of the guidelines review process

4. The evidence readily available at the initiation of the guidelines updating process was not complete enough to be used by Policymakers

5. Researchers started working on building evidence seven months after the process was initiated by the MoH

6. Policymakers expected the Researchers to provide some evidence quicker.

  1.1.3 Policy process

3. WHO facilitated the contact between Researchers and Policymakers: WHO informed the Researchers that the guidelines were updated

7. Patients’ representatives were not associated to the process. They could not relay the need to base the Guidelines updating on local evidence

4. Policymakers received support from an international NGO for some organizational aspects of the process (organization of the Task force meetings, of the External Review Committee…)

8. Limited availability of clinicians with expertise. (limited number of skilled people dealing with too many issues in parallel)

5. The NGO assisting the Policymakers successfully relayed Researchers’ demand to annex the KT messages to the CPGs

9. The Task force left the Experts deciding to accept or refuse the External Review Committee’s suggestions for improving the final drafts of guidelines. The Expert in charge of the adult pneumonia guidelines did not accept changes suggested by the External Committee

6. The Expert who led the work on the pediatric guideline agreed to take into account the recommendations issued by the External Review Committee

 1.2 Knowledge Translation domain

7. Research synthesis included key messages

10. No communication was released to the media by the Researchers. Therefore the process did not receive any media support

8. Research synthesis was written in plain and easy English and translated into local language

11. Research synthesis and report did not present any logo at their front page, except the logo of the KT group. This may have limited the identification of authors and their perceived credibility (but facilitated the easy appropriation by all co authors)

9. Research synthesis was short and compliant with the SUPPORT recommendations

10. Research synthesis was widely made permanently available online

 1.3 Interactions between policymakers and researchers

  1.3.1 Initiated by Policymakers during Guidelines Updating process

11. Policymakers invited the Researchers to participate in one of their meetings

12. Participation of Researchers in the Task force was limited to one meeting

12. A clinician who was familiar with Research was appointed by the Task force to update the pediatric pneumonia guidelines. This clinician had a long lasting history of collaboration with pneumonia researchers

13. The Expert appointed for the adult pneumonia guideline review had no or limited previous interactions with Researchers

  1.3.2 Initiated by Researchers during the KT intervention

13. Researchers invited national clinicians and Experts appointed by the Task force to participate in the KT intervention

14. Meetings organized during the KT intervention were conducted in English which is not the working language of most clinicians in Cambodia

15. Researchers’ attempts to alert on inappropriate recommendations published in the adult pneumonia guidelines remained unanswered

2- Individual level

 2.1 Acceptance domain

  2.1.1 Perceived robustness of evidence

14. Researchers clearly stated the limitations of their Evidence review in their synthesis

16. Researchers do not know how the robustness of their findings was perceived by Policymakers

  2.1.2 Perceived credibility of source

15. Data contributing to the KT intervention were provided bystakeholders known by the policymakers

  2.1.3 ‘Fit’ with personal knowledge, values or belief systems, preference and traditions

16. Researchers analyzed data in the light of current challenges for the national health system (prevention of development of antibiotic resistance, cost effectiveness)

17. There is not much mutual knowledge on values, belief systems, preference and traditions between Researchers and Policymakers

 2.2 Interpretation domain

Connection with own personal or institutional interests

17. Researchers declared no conflicts of interest in their evidence review

18. Policymakers did not disclose potential conflicts of interest in the guidelines