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Nicole Robinson

Bio: Nicole Robinson is an academic researcher from Ottawa Hospital Research Institute. The author has contributed to research in topics: Knowledge translation & Randomized controlled trial. The author has an hindex of 6, co-authored 6 publications receiving 3454 citations.

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Journal ArticleDOI
TL;DR: The implications of knowledge translation for continuing education in the health professions include the need to base continuing education on the best available knowledge, the use of educational and other transfer strategies that are known to be effective, and the value of learning about planned‐action theories to be better able to understand and influence change in practice settings.
Abstract: There is confusion and misunderstanding about the concepts of knowledge translation, knowledge transfer, knowledge exchange, research utilization, implementation, diffusion, and dissemination. We review the terms and definitions used to describe the concept of moving knowledge into action. We also offer a conceptual framework for thinking about the process and integrate the roles of knowledge creation and knowledge application. The implications of knowledge translation for continuing education in the health professions include the need to base continuing education on the best available knowledge, the use of educational and other transfer strategies that are known to be effective, and the value of learning about plannedaction theories to be better able to understand and influence change in practice settings.

3,589 citations

Journal ArticleDOI
TL;DR: Funding agencies need to think about both their conceptual framework and their operational definition of KT, so that it is clear what is and what is not considered to be KT, and adjust their funding opportunities and activities accordingly.
Abstract: Health and health care research has the potential to improve people's health, the delivery of health care, and patients' outcomes. Despite the well-documented cases in which publication alone was sufficient to move research into practice very quickly (Beral, Bull, and Reeves 2005; Hersh, Stefanick, and Stafford 2004), the incorporation of research findings into health policy and routine clinical practice is often unpredictable and can be slow and haphazard (AHRQ 2001), thereby diminishing the return to society from investments in research. Effective and efficient means, therefore, are required to realize the benefits of such investments, and as a result, health-funding agencies are increasingly interested in the process of knowledge translation. Knowledge translation is a term that is used frequently and rather loosely and has been defined in different ways. A recent Google search (“definition knowledge translation”), restricted to Canadian web pages, yielded 1,350,000 hits. Many websites cite the definition developed by the Canadian Institutes of Health Research (CIHR, the organization that funded this study): “the exchange, synthesis and ethically-sound application of knowledge—within a complex system of interactions between researchers and users—to accelerate the capture of the benefits of research for Canadians through improved health, more effective services and products, and a strengthened health care system” (see http://www.cihr-irsc.gc.ca/e/29418.html, accessed September 20, 2007). In their view, knowledge translation is a broad concept encompassing all the steps between the creation of new knowledge and its application in the real world. Although other terms are used, including knowledge transfer, dissemination, research use, and implementation research (Graham et al. 2006), we shall use the term knowledge translation (KT) in this article because it was introduced by the CIHR and because we used it throughout our research protocol. Lomas (1993) offered a useful categorization of knowledge translation activities that groups them into three conceptually distinct types: diffusion, dissemination, and implementation. He defined diffusion as those efforts that are passive and unplanned. In this category of knowledge translation activities, the onus is on the potential adopter to seek out the information. Dissemination is an active process to spread the message that involves targeting and tailoring the evidence and the message to a particular target audience. Although these strategies raise awareness and may influence attitudes, they may or may not change the behavior of the target audience. Implementation is an even more active process that involves systematic efforts to encourage adoption of the evidence by identifying and overcoming barriers. An alternative way of thinking about knowledge translation is based on the degree of engagement with the potential audience. In this conceptualization, activities are considered to be “push,” concentrating on diffusion and efforts to disseminate to a broad audience; “pull,” focused on the needs of users, thereby creating an appetite for research results (Lavis, McLeod, and Gildiner 2003); or “linkage and exchange,” building and maintaining relationships in order to exchange knowledge and ideas (Canadian Health Services Research Foundation 1999; Lomas 2000). The process of KT in health research depends on the activities of a wide range of actors, including health professionals, researchers, the public, policymakers, and research funders (Grimshaw, Ward, and Eccles 2001). KT often requires a range of interventions of varying complexity and resource intensiveness, targeting different levels of health care systems as well as different audiences (Lomas 1997). There has been, however, relatively little empirical research on the actual or potential knowledge translation roles, responsibilities, and activities of the different actors. A review of the effectiveness of guideline dissemination and implementation strategies directed at health professionals (Grimshaw et al. 2004) found median effect sizes ranging from 8.1 to 14.1 percent for individual strategies targeting behavior change in practitioners (e.g., audit and feedback, or academic detailing). The strategies identified were of variable effectiveness and were used in many different settings, making it impossible to predict which would work best in a given context. Furthermore, despite the growing body of evidence (Heap and Parikh 2005) regarding how new ideas disseminate through an industry, the dissemination of knowledge produced by health researchers (Ramlogan et al. 2005) has received relatively less attention. But a recent survey of applied health researchers conducted by Graham and his colleagues (Graham, Grimshaw, et al. 2005) indicated that researchers were most successful and confident when disseminating the results of their research to their academic colleagues. Most were less successful, however, in disseminating these results to other target audiences, even when they felt that their results were of considerable importance to both the public and decision makers. When considering the public's role in the KT process, it seems intuitively obvious that the media can and do play an important role in influencing the public in matters of health and health care (see, e.g., Grilli, Ramsay, and Minozzi 1998; Petrella et al. 2005), but little is known about how to harness and control this potential KT vehicle. Policymakers also are important actors in the KT realm. A systematic review of health policymakers' perceptions of their use of evidence in making policy decisions (Innvaer et al. 2002) suggested that decision makers might make more use of research results if there were more linkage and exchange between the research and the policy world and if researchers answered the kinds of questions that policymakers asked, in a time frame useful to them.

287 citations

Journal ArticleDOI
TL;DR: High baseline levels of intention to advise patients to attend retinopathy screening suggest that post-intentional and other factors may explain gaps in care, and lack of change in the primary and secondary theory-based outcomes provides an explanation for the lack of observed effect of the main OPEM trial.
Abstract: Background: Theory-based process evaluations conducted alongside randomized controlled trials provide the opportunity to investigate hypothesized mechanisms of action of interventions, helping to build a cumulative knowledge base and to inform the interpretation of individual trial outcomes. Our objective was to identify the underlying causal mechanisms in a cluster randomized trial of the effectiveness of printed educational materials (PEMs) to increase referral for diabetic retinopathy screening. We hypothesized that the PEMs would increase physicians’ intention to refer patients for retinal screening by strengthening their attitude and subjective norm, but not their perceived behavioral control. Methods: Design: A theory based process evaluation alongside the Ontario Printed Educational Material (OPEM) cluster randomized trial. Postal surveys based on the Theory of Planned Behavior were sent to a random sample of trial participants two months before and six months after they received the intervention. Setting: Family physicians in Ontario, Canada. Participants: 1,512 family physicians (252 per intervention group) from the OPEM trial were invited to participate, and 31.3% (473/1512) responded at time one and time two. The final sample comprised 437 family physicians fully completing questionnaires at both time points. Main outcome measures: Primary: behavioral intention related to referring patient for retinopathy screening; secondary: attitude, subjective norm, perceived behavioral control. (Continued on next page)

34 citations

Journal ArticleDOI
TL;DR: Strategies to promote the use of oral cobalamin should be directed at educating physicians of its efficacy and providing them with prescribing information on where it can be purchased.

30 citations

Journal ArticleDOI
TL;DR: The theoretical basis of this evaluation suggests possible explanations for the failure of the PEM intervention to change professional behaviour, which can directly inform the design and content of future theory-based PEM interventions tochange professional behaviour.
Abstract: Pragmatic trials of implementation interventions focus on evaluating whether an intervention changes professional behaviour under real-world conditions rather than investigating the mechanism through which change occurs. Theory-based process evaluations conducted alongside pragmatic randomised trials address this by assessing whether the intervention changes theoretical constructs proposed to mediate change. The Ontario Printed Educational Materials (PEM) cluster trial was designed to increase family physicians’ guideline-recommended prescription of thiazide diuretics. The trial found no intervention effect. Using the theory of planned behaviour (TPB), we hypothesised that changes in thiazide prescribing would be reflected in changes in intention, consistent with changes in attitude and subjective norm, with no change to their perceived behavioural control (PBC), and tested this alongside the RCT. We developed and sent TPB postal questionnaires to a random sub-sample of family physicians in each trial arm 2 months before and 6 months after dissemination of the PEMs. We used analysis of covariance to test for group differences using a 2 × 3 factorial design. We content-analysed an open-ended question about perceived barriers to thiazide prescription. Using control group data, we tested whether baseline measures of TPB constructs predicted self-reported thiazide prescribing at follow-up. Four hundred twenty-six physicians completed pre- and post-intervention questionnaires. Baseline scores on measures of TPB constructs were high: intention mean = 5.9 out of 7 (SD = 1.4), attitude mean = 5.8 (SD = 1.1), subjective norm mean = 5.8 (SD = 1.1) and PBC mean = 6.2 (SD = 1.0). The arms did not significantly differ post-intervention on any of the theory-based constructs, suggesting a possible ceiling effect. Content analysis of perceived barriers suggested post-intentional barriers to prescribing thiazides most often focused on specific patient clinical characteristics and potential side effects. Baseline intention (β = 0.63, p < 0.01) but not PBC (β = 0.04, p = 0.78) predicted 42.6 % of the variance in self-reported behaviour at follow-up in the control group. Congruent with the Ontario Printed Educational Messages trial results and aligned with the TPB, we saw no impact of the intervention on any TPB constructs. The theoretical basis of this evaluation suggests possible explanations for the failure of the PEM intervention to change professional behaviour, which can directly inform the design and content of future theory-based PEM interventions to change professional behaviour. ISRCTN, Canada ISRCTN72772651

25 citations


Cited by
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Journal ArticleDOI
TL;DR: The process of conducting a thematic analysis is illustrated through the presentation of an auditable decision trail, guiding interpreting and representing textual data and exploring issues of rigor and trustworthiness.
Abstract: As qualitative research becomes increasingly recognized and valued, it is imperative that it is conducted in a rigorous and methodical manner to yield meaningful and useful results. To be accepted ...

9,963 citations

Journal ArticleDOI
TL;DR: Specific recommendations to clarify and enhance this methodology are outlined for each stage of the Arksey and O'Malley framework, to support the advancement, application and relevance of scoping studies in health research.
Abstract: Scoping studies are an increasingly popular approach to reviewing health research evidence. In 2005, Arksey and O'Malley published the first methodological framework for conducting scoping studies. While this framework provides an excellent foundation for scoping study methodology, further clarifying and enhancing this framework will help support the consistency with which authors undertake and report scoping studies and may encourage researchers and clinicians to engage in this process. We build upon our experiences conducting three scoping studies using the Arksey and O'Malley methodology to propose recommendations that clarify and enhance each stage of the framework. Recommendations include: clarifying and linking the purpose and research question (stage one); balancing feasibility with breadth and comprehensiveness of the scoping process (stage two); using an iterative team approach to selecting studies (stage three) and extracting data (stage four); incorporating a numerical summary and qualitative thematic analysis, reporting results, and considering the implications of study findings to policy, practice, or research (stage five); and incorporating consultation with stakeholders as a required knowledge translation component of scoping study methodology (stage six). Lastly, we propose additional considerations for scoping study methodology in order to support the advancement, application and relevance of scoping studies in health research. Specific recommendations to clarify and enhance this methodology are outlined for each stage of the Arksey and O'Malley framework. Continued debate and development about scoping study methodology will help to maximize the usefulness and rigor of scoping study findings within healthcare research and practice.

7,536 citations

Journal ArticleDOI
Per Nilsen1
TL;DR: A taxonomy that distinguishes between different categories of theories, models and frameworks in implementation science is proposed to facilitate appropriate selection and application of relevant approaches in implementation research and practice and to foster cross-disciplinary dialogue among implementation researchers.
Abstract: Implementation science has progressed towards increased use of theoretical approaches to provide better understanding and explanation of how and why implementation succeeds or fails. The aim of this article is to propose a taxonomy that distinguishes between different categories of theories, models and frameworks in implementation science, to facilitate appropriate selection and application of relevant approaches in implementation research and practice and to foster cross-disciplinary dialogue among implementation researchers. Theoretical approaches used in implementation science have three overarching aims: describing and/or guiding the process of translating research into practice (process models); understanding and/or explaining what influences implementation outcomes (determinant frameworks, classic theories, implementation theories); and evaluating implementation (evaluation frameworks). This article proposes five categories of theoretical approaches to achieve three overarching aims. These categories are not always recognized as separate types of approaches in the literature. While there is overlap between some of the theories, models and frameworks, awareness of the differences is important to facilitate the selection of relevant approaches. Most determinant frameworks provide limited “how-to” support for carrying out implementation endeavours since the determinants usually are too generic to provide sufficient detail for guiding an implementation process. And while the relevance of addressing barriers and enablers to translating research into practice is mentioned in many process models, these models do not identify or systematically structure specific determinants associated with implementation success. Furthermore, process models recognize a temporal sequence of implementation endeavours, whereas determinant frameworks do not explicitly take a process perspective of implementation.

2,392 citations

Journal ArticleDOI
TL;DR: There is a substantial (if incomplete) evidence base to guide choice of knowledge translation activities targeting healthcare professionals and consumers and there are a profusion of innovative approaches that warrant further evaluation.
Abstract: One of the most consistent findings from clinical and health services research is the failure to translate research into practice and policy. As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare and are exposed to unnecessary risks of iatrogenic harms, and healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs. Over the last decade, there has been increasing international policy and research attention on how to reduce the evidence-practice and policy gap. In this paper, we summarise the current concepts and evidence to guide knowledge translation activities, defined as T2 research (the translation of new clinical knowledge into improved health). We structure the article around five key questions: what should be transferred; to whom should research knowledge be transferred; by whom should research knowledge be transferred; how should research knowledge be transferred; and, with what effect should research knowledge be transferred? We suggest that the basic unit of knowledge translation should usually be up-to-date systematic reviews or other syntheses of research findings. Knowledge translators need to identify the key messages for different target audiences and to fashion these in language and knowledge translation products that are easily assimilated by different audiences. The relative importance of knowledge translation to different target audiences will vary by the type of research and appropriate endpoints of knowledge translation may vary across different stakeholder groups. There are a large number of planned knowledge translation models, derived from different disciplinary, contextual (i.e., setting), and target audience viewpoints. Most of these suggest that planned knowledge translation for healthcare professionals and consumers is more likely to be successful if the choice of knowledge translation strategy is informed by an assessment of the likely barriers and facilitators. Although our evidence on the likely effectiveness of different strategies to overcome specific barriers remains incomplete, there is a range of informative systematic reviews of interventions aimed at healthcare professionals and consumers (i.e., patients, family members, and informal carers) and of factors important to research use by policy makers. There is a substantial (if incomplete) evidence base to guide choice of knowledge translation activities targeting healthcare professionals and consumers. The evidence base on the effects of different knowledge translation approaches targeting healthcare policy makers and senior managers is much weaker but there are a profusion of innovative approaches that warrant further evaluation.

1,796 citations