Moving evidence into practice

Description

The purpose of this guide is to provide practical information for changing practice through sharing and applying evidence-based information. Specifically, this paper explores strategies for using and applying knowledge dissemination in clinical practice. This resource is one of a series of handbooks produced by the National Health and Medical Research Council (NHMRC) in Australia.

The knowledge translation strategies presented in this method are based on theories and models of knowledge uptake and behaviour change. These theories and models are targeted at the individual level, organizational level or both, and are categorized as follows (some apply to both levels):

Individual level change theories:

- Adult learning theory (using active learning strategies to gain knowledge and skills)
- Social influence theories (focusing on positive social norms, social support and role models to facilitate behaviour change)
- Social marketing theories (creating communication to increase the likelihood that messages will be attended to and acted on)
- Behavioural theory (identifying organizational facilitators and barriers to individual behaviour change)
- Transtheoretical model (Prochaska and DiClemente, 1983) (moving behaviour change through different stages of readiness)

Organizational level change theories:

- Social ecology theory (examining the interrelationships between individuals and organizations as mutually interdependent, where behaviour change at the individual level influences organizational changes, and vice versa)
- Diffusion of innovations model (Bero et al, 1998) (focusing on the four-stage process of knowledge adoption: awareness, forming attitudes about the new idea, innovation testing and rejecting or adopting the innovation)
- Model for Accelerating Improvement (Institute for Healthcare Improvement) (examining organizations that articulate objectives, identify measures and develop changes to bring about innovation)
- Plan-Do-Study-Act cycles (focusing on organizations conducting iterative cycles of planning, implementation, evaluation and modification based on outcome measures)

The handbook provides users with specific recommendations and case examples to help move evidence into practice:

a) Planning for knowledge dissemination and application

b) Requisites for successful knowledge translation

c) Implementation strategies

Steps for Using Method/Tool

The developers present a series of recommendations for moving evidence into practice. They use case examples to contextualize the recommendations, grouped according to themes.

a) Planning for knowledge dissemination and application

These 14 steps for knowledge dissemination and application serve as an overview for those developing a clinical practice guideline implementation strategy.

1. Articulate the purpose of implementing the innovation.

2. Identify key influential individuals to provide leadership, technical expertise and support to drive adoption of the innovation.

3. Assess the local context to inform implementation through a formal situation statement.

4. Identify the target groups for knowledge dissemination and implementation and their specific information needs.

5. Develop and prioritize key messages.

6. Set specific objectives for implementation.

7. Adapt information to meet the needs of diverse target groups.

8. Identify implementation barriers from the perspectives of different target groups.

9. Evaluate the progress of the implementation strategy at critical stages.

10. Determine the effectiveness of implementation strategies appropriate for the intervention and the local context (including decision-support systems, audit and feedback, etc.).

11. Develop an implementation plan targeted to the appropriate level of change (individual, organizational or community) with appropriate strategies based on effectiveness, number (multiple vs single interventions), barriers to implementation and the target group needs.

12. Assess the types of support available to facilitate implementation (systemic, professional and public).

13. Analyze costs and the cost-effectiveness of strategies, with equity considerations (will the program be accessible to those who need it?).

14. Conduct process and outcome evaluations of the innovation.

b) Requisites for successful knowledge translation

The developers propose that successful knowledge translation requires four key elements:

1. good quality information that has been synthesized and presented in usable formats for specific target audiences

2. dissemination mechanisms that increase access to information

3. supportive organizational environments where research is valued

4. evidence-based knowledge utilization strategies

c) Implementation strategies

This section of the handbook expands on step 10 (implementation strategies) of the first section on the different steps involved in knowledge translation. The developers describe various knowledge implementation strategies and provide specific examples of how to implement strategies. They also summarize evidence about the effectiveness of these strategies.

The strategies include:

- educational outreach visits
- decision-support systems
- interactive education meetings
- multifaceted interventions
- mass media interventions
- audit and feedback
- use of local opinion leaders
- local consensus processes
- patient-mediated interventions
- educational materials
- didactic educational sessions
- financial incentives and penalties
- administrative interventions