What are the objectives for knowledge translation?
The first step in selecting KT interventions is to state specific KT objectives. Goal setting may contribute to effective behavioural change. It is usually not possible to analyze and address each objective in substantial detail, so prioritizing objectives is important. Ultimately, the objectives should be related to outcomes for patients, populations, and society. Several methods can be used to select the objectives for KT, such as a Delphi method.
What are the indicators that can be used to measure implementation?
The KT objectives need to be defined in terms of specific indicators that can be used to measure the degree of implementation. The indicators should have good measurement properties, support from key stakeholders, and high feasibility in use. Current best practice involves using a structured Delphi method with panels of stakeholders who review available evidence, followed by a test in real practice.
What are potential barriers to change?
Once the objectives have been identified, most planning models suggest that the implementer analyze each objective with respect to barriers to change.
Barriers to change can be collected using interviews, questionnaires, and group methods from professionals, patients and others. It can be done relatively simply or more systematically, but a disadvantage is that the reported factors may have little or no impact on knowledge translation. Alternatively, this information can be collected using large observational datasets and statistical methods for analysis of variation in health care delivery across patients.
How can we link KT interventions to these barriers?
The next step is to link specific KT interventions to the identified barriers. Linking KT interventions to barriers is probably the most creative step in the design of KT programs, because it is challenging to provide clear guidance on how to proceed. The concept of “tailoring interventions to relevant determinants” is often used in a loose way, but it has, in fact, different dimensions. These include the following
- Intensity of Tailoring – matching interventions to determinants at the population level, practice level, and clinician level
- Stage of Tailoring – matching interventions to determinants of change at the design and delivery stages of an improvement project
- Range of Options Considered – choosing the primary type of implementation interventions versus optimization of chosen interventions
- Basis for Inclusion or Exclusion of the Intervention as a Component of the Tailored Intervention – considering perceived impact/importance and feasibility/cost of the component
Both exploratory and theory-inspired methods can be used to link KT interventions to barriers. Exploratory methods try to avoid implicit assumptions on what would work, but instead advocate using an “open mind.” Alternatively, theory is used to understand the factors that determine practice variation and change. A “common sense” use of theories would be to consider the chosen objectives and decide what interventions various theories suggest to influence the determinants of change.
After a KT intervention has been chosen, it may be refined on the basis of an “intervention modelling experiment”. Modelling experiments aim to test one or more selected interventions in a simulated situation, using written scenarios and/or self-report measures of performance.
What factors should we consider when deciding to use a single- or multi-component intervention?
One of the key decisions that organizations must make when developing (or selecting) a KT intervention is whether to use a single intervention or a multifaceted intervention. The assumption is often that multi-component interventions address a larger number of barriers to change, and are therefore more effective. However, a multi-component intervention that combines different types of professional education interventions , for example, still only addresses lack of knowledge. We suggest that multi-component interventions could be more effective than single interventions if they address different types of determinants of behaviour change.
*For more information on interventions, please refer to the full publication “Knowledge Translation in Health Care: Moving from Evidence into Practice” (2013).
