Developing and selecting interventions for translating knowledge to action

Abstract

E85O nce knowledge has been adapted to local context and the barriers to and facilitators of use of knowledge have been identified, 1 we must select, tailor and implement interventions for the uptake of knowledge. 2This article provides an approach to selecting interventions for knowledge translation.How would we select interventions to translate the knowledge from practice guidelines and research into practice? For example, major variations in the treatment of chronic heart failure have been found repeatedly. In one survey, use of β-blockers in primary care ranged from 10% to 50% between countries, and use of angiotensin-converting enzyme (ACE) inhibitors ranged from 50% to 75%.3 Differences in the recommendations of national guidelines were not sufficient to explain this variation.4 Comorbidity explained some of the variation, but 14% of prescriptions were related to characteristics of patients that were not aligned with evidence.5 A study of barriers to adherence to guidelines related to heart failure showed that many family physicians found it difficult to change treatment initiated by a cardiologist. Titrating the dosage of ACE inhibitors and initiating ACE inhibitors in patients who were already using a diuretic or were stable on their current medication were perceived as barriers. 6Interventions to facilitate the uptake of research could include training for physicians (e.g., to learn about titrating the dosage of ACE inhibitors), the use of opinion leaders to influence patterns of prescribing by cardiologists, or the provision of financial incentives to physicians for each patient with heart failure who is treated according to guidelines. Alternatively, educators could better inform patients and their families about appropriate care in the hope that they will ask for such treatment in future consultations with clinicians. Ideally, the selection of an intervention for knowledge translation should be guided by research-based evidence of the effectiveness and efficiency of the various interventions. However, this evidence cannot explicitly guide our decisions in all situations and circumstances. Therefore, in addition to science, we will need some artistry to choose or design the intervention. A review of all of the evidence on developing and selecting interventions is beyond the scope of this paper; instead we will summarize available systematic reviews. 7,8 Many interventions for knowledge translation have not been well evaluated with rigorous studies. For interventions that have been evaluated, evidence suggests that their impact is variable and, on average, the effect size is moderate.Several conclusions can be drawn from the literature. Available research focuses mainly on professional interventions, such as educational programs, feedback and reminders. The methodological quality is variable but moderate overall. The overall absolute change in professional performance is usually not more than 10% on selected outcomes, but this finding can be clinically or economically relevant.Passive educational inter...

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