Table 6 Detailed application of the phases with the Action Cycle

1

Bjrøk et al., 2013 [18]

Problem of qualifying nursing students in practical skill acknowledged by educators, researchers and students

‘Research in nursing skills group’ refined theoretical model; developed a supplement to the model; developed ‘heuristic’ devices

‘Research in nursing skills’ group created; identifies barriers; language of manual; lack of examples

Implementation skills centres and clinical practice; working with students, teachers, clinical supervisors

Monitoring as part of defined projects; process and outcome evaluation of the model in ongoing studies; sustaining knowledge use planned

2

Claude et al., 2012 [17]

Reviewed evidence that spina bifida is preventable through use of peri-conceptual maternal folate supplements; reviewed local surgical cases at one hospital

–

Knowledge, attitude and practices questionnaire (n =150 women attendees at prenatal consultations) and focus group identified limited use and awareness of folic acid, willingness to take it and to pay cost

Radio broadcasts and educational video

142 women completed questionnaires before and after video; 95% agreed video was understandable and should be widely disseminated. Short-term knowledge gain (pre/post-test) was found to have increased significantly. Evaluation and sustaining phases stated as beyond the scope of this project

3

Hua et al., 2012 [20]

‘Canadian Hypertension Education Program Recommendations Task Force’ identifies what is old but still important from evidence base and previous recommendations

Small group workshops; pilot testing of recommendations led by committee representative of the target health care professionals

‘Implementation task force’ ‘addresses barriers to knowledge use’; specific barriers not reported

Information and educational resources for health care practitioners, patients and policymakers (e.g. fact sheets, one-page summaries, post cards); ‘train the trainer’ programme to aid dissemination of materials (1-day course offered throughout the year in English and French, across Canada)

‘Outcomes Review Task Force’ examines national and provincial administrative data; for example, improved self-reported awareness of hypertension, use of multiple hypertensive agents, greater control of hypertension and improved age- and sex-standardised mortality rates

4

Keyser, 2010 [19]

Problem identified by focus group that families of elderly lacked understanding of delirium; literature reviewed and synthesised to ensure that information given was up to date

Existing educational resources gathered and appraised for level of appropriateness to lay population; best available chosen

Focus group with families identified limited awareness

Six education sessions and information package given to participants

‘Knowledge test’ before and after intervention; limitations of this approach to monitoring and evaluation and sustaining knowledge use discussed

5

Molfenter et al., 2009 [23]

‘Knowledge to action’ gap identified in swallowing rehabilitation; despite training, speech and language therapists not using recommended tool in practice; research team reviewed literature, designed treatment protocol

Adapted knowledge to the facility and individual clinicians—discussed potential application to their caseloads

Discussions between research team and clinicians identified time; appropriate patient selection; discomfort with the technology; competing priorities

Tailored support for clinicians; assistance to select appropriate patients on site; individualised training, ad hoc support and mentorship available via email, telephone and in person

Mentors monitored progress. Outcomes evaluated via qualitative interviews with clinicians; thematic analysis identified key themes. Sustaining knowledge use described as ongoing partnership between the research team and clinicians; clinicians continue to access support from mentors

6

Petzold et al., 2010 [24]

Two multicentre studies identified limited best practice for management of unilateral spatial neglect post stroke

Not reported

Focus groups with clinicians; interviews between researchers and clinicians; key themes re: barriers and facilitators identified; specific barriers not reported

Plans reported a for multimodal knowledge translation intervention, informed by barriers and facilitators identified

Plans reported for follow-up studies to address whether desired change has occurred

7

Russell et al., 2010 [25]

Survey revealed wide variation in practice of paediatric occupational therapists and physiotherapists treating re: best practice guidelines and measurement tools

‘Knowledge brokers’ given materials, for example, manual and instructional DVD for particular measurement tools, key articles, summaries and case scenarios; intranet site established; PowerPoint presentation for knowledge brokers to adapt as they wished

‘Support and barriers’ questionnaire completed by knowledge brokers re: organisational structure, resources, target therapists, the children and families and the measurement tools themselves; specific barriers not reported

Knowledge brokers in multiple sites—knowledge brokers recorded their activities, regular teleconferences and use of intranet to facilitate sharing of strategies

To monitor and evaluate outcomes, knowledge brokers and physiotherapists completed online survey re: knowledge and use pre and post intervention, and at 6, 12 and 18 months; semi-structured telephone interviews held with knowledge brokers, physiotherapists and centre administrators at 6 and 18 months

8

Stacey et al., 2009 [21]

Audit of nursing curriculum course identified lack of awareness and use of patient decision support resources (by nursing students and faculty members)

Plan for the integration of decision support throughout the nursing curriculum shared with key stakeholders; project advisory team established

Needs assessment with faculty members identified limited awareness , time pressures, limited resources in French and lack of instructional tools (e.g. case scenarios, exam questions assignments)

Faculty development activities to address identified barriers. For example, staff workshop, newsletter profiling different resources, exam questions, case scenarios, assignments created

Monitoring identified use of scenarios and assignments; lectures given; knowledge use observed amongst students in course assignments, seminars and exam questions; faculty members requested session on patient support plans for evaluation and sustaining knowledge use discussed

9

Straus et al., 2008 [22]

Need to provide adequate mentorship for clinical researchers identified by researchers and research funders

Workshop for funders, university administrators and clinician scientists to review evidence on mentorship tools

Workshop identified barriers as: lack of recognition of importance of mentoring at departmental/university levels; lack of educational intervention for mentors/mentees and difficulty finding mentors; lack of time and capacity

Written summary of key messages, local opinion leaders/academic detailing, website, newsletters targeting administrators, departmental chairs, researchers, mass media, chairs of research institutes

Monitoring identified development of mentorship facilitators and workshops. Plans reported to evaluate impact of adopted mentorship strategies, for example, repeating qualitative study re: experiences of mentorship; sustainability considered for example by trying to ensure ongoing participation of stakeholders, and qualitative evaluation—if the intervention not found to be effective, iterative cycle of design and testing to try and refine it

10

Tugwell et al., 2007 [26]

People with musculoskeletal conditions, family members and physicians were interviewed as part of another project—results indicated people wanted information about treatments and what they could do to help themselves, but health care providers had difficulty translating information into lay language

Evidence was adapted, for example, by describing situations when individuals may want to consider treatment, by presenting benefits and harms out of 100 people and decision aids

Interviews re: barriers identified the Internet as an important source of information but that physicians were still regarded as gatekeepers to information and services; literature re: barriers and facilitators also considered and identified lack of awareness, difficulty accessing them or limited time of physicians

Aimed to increase consumer awareness of and access to knowledge products/tools (patient decision aids on key websites and given to key helplines/call centres); on website for physicians to access and print out decision aids

Describe plans to monitor use of these tools; basic evaluation of website visits and a web survey completed. Authors discuss challenges of evaluating outcome and sustaining knowledge use and other work related to this