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      Systematic review of knowledge translation strategies in the allied health professions

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          Abstract

          Background

          Knowledge translation (KT) aims to close the research-practice gap in order to realize and maximize the benefits of research within the practice setting. Previous studies have investigated KT strategies in nursing and medicine; however, the present study is the first systematic review of the effectiveness of a variety of KT interventions in five allied health disciplines: dietetics, occupational therapy, pharmacy, physiotherapy, and speech-language pathology.

          Methods

          A health research librarian developed and implemented search strategies in eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, CENTRAL) using language (English) and date restrictions (1985 to March 2010). Other relevant sources were manually searched. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. Within each profession, evidence tables were created, grouping and analyzing data by research design, KT strategy, targeted behaviour, and primary outcome. The published descriptions of the KT interventions were compared to the Workgroup for Intervention Development and Evaluation Research (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions.

          Results

          A total of 2,638 articles were located and the titles and abstracts were screened. Of those, 1,172 full-text articles were reviewed and subsequently 32 studies were included in the systematic review. A variety of single (n = 15) and multiple (n = 17) KT interventions were identified, with educational meetings being the predominant KT strategy (n = 11). The majority of primary outcomes were identified as professional/process outcomes (n = 25); however, patient outcomes (n = 4), economic outcomes (n = 2), and multiple primary outcomes (n = 1) were also represented. Generally, the studies were of low methodological quality. Outcome reporting bias was common and precluded clear determination of intervention effectiveness. In the majority of studies, the interventions demonstrated mixed effects on primary outcomes, and only four studies demonstrated statistically significant, positive effects on primary outcomes. None of the studies satisfied the four WIDER Recommendations.

          Conclusions

          Across five allied health professions, equivocal results, low methodological quality, and outcome reporting bias limited our ability to recommend one KT strategy over another. Further research employing the WIDER Recommendations is needed to inform the development and implementation of effective KT interventions in allied health.

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          Most cited references36

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          Changing provider behavior: an overview of systematic reviews of interventions.

          Increasing recognition of the failure to translate research findings into practice has led to greater awareness of the importance of using active dissemination and implementation strategies. Although there is a growing body of research evidence about the effectiveness of different strategies, this is not easily accessible to policy makers and professionals. To identify, appraise, and synthesize systematic reviews of professional educational or quality assurance interventions to improve quality of care. An overview was made of systematic reviews of professional behavior change interventions published between 1966 and 1998. Forty-one reviews were identified covering a wide range of interventions and behaviors. In general, passive approaches are generally ineffective and unlikely to result in behavior change. Most other interventions are effective under some circumstances; none are effective under all circumstances. Promising approaches include educational outreach (for prescribing) and reminders. Multifaceted interventions targeting different barriers to change are more likely to be effective than single interventions. Although the current evidence base is incomplete, it provides valuable insights into the likely effectiveness of different interventions. Future quality improvement or educational activities should be informed by the findings of systematic reviews of professional behavior change interventions.
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            Individual determinants of research utilization by nurses: a systematic review update

            Background Interventions that have a better than random chance of increasing nurses' use of research are important to the delivery of quality patient care. However, few reports exist of successful research utilization in nursing interventions. Systematic identification and evaluation of individual characteristics associated with and predicting research utilization may inform the development of research utilization interventions. Objective To update the evidence published in a previous systematic review on individual characteristics influencing research utilization by nurses. Methods As part of a larger systematic review on research utilization instruments, 12 online bibliographic databases were searched. Hand searching of specialized journals and an ancestry search was also conducted. Randomized controlled trials, clinical trials, and observational study designs examining the association between individual characteristics and nurses' use of research were eligible for inclusion. Studies were limited to those published in the English, Danish, Swedish, and Norwegian languages. A vote counting approach to data synthesis was taken. Results A total of 42,770 titles were identified, of which 501 were retrieved. Of these 501 articles, 45 satisfied our inclusion criteria. Articles assessed research utilization in general (n = 39) or kinds of research utilization (n = 6) using self-report survey measures. Individual nurse characteristics were classified according to six categories: beliefs and attitudes, involvement in research activities, information seeking, education, professional characteristics, and socio-demographic/socio-economic characteristics. A seventh category, critical thinking, emerged in studies examining kinds of research utilization. Positive relationships, at statistically significant levels, for general research utilization were found in four categories: beliefs and attitudes, information seeking, education, and professional characteristics. The only characteristic assessed in a sufficient number of studies and with consistent findings for the kinds of research utilization was attitude towards research; this characteristic had a positive association with instrumental and overall research utilization. Conclusions This review reinforced conclusions in the previous review with respect to positive relationships between general research utilization and: beliefs and attitudes, and current role. Furthermore, attending conferences/in-services, having a graduate degree in nursing, working in a specialty area, and job satisfaction were also identified as individual characteristics important to research utilization. While these findings hold promise as potential targets of future research utilization interventions, there were methodological problems inherent in many of the studies that necessitate their findings be replicated in further research using more robust study designs and multivariate assessment methods.
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              Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group.

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                Author and article information

                Journal
                Implement Sci
                Implement Sci
                Implementation Science : IS
                BioMed Central
                1748-5908
                2012
                25 July 2012
                : 7
                : 70
                Affiliations
                [1 ]Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, Edmonton, AB, Canada
                [2 ]Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 8213 Aberhart Centre, Edmonton, AB, Canada
                [3 ]Alberta Research Centre for Health Evidence, University of Alberta, Level 4, Edmonton Clinic Health Academy, Edmonton, AB, Canada
                [4 ]School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
                [5 ]Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 3-48 Corbett Hall, Edmonton, AB, Canada
                [6 ]Manitoba Institute of Child Health, Department of Pediatrics and Child Health, University of Manitoba, Level 5, John Buhler Research Centre, Winnipeg, MB, Canada
                [7 ]Winnipeg Regional Health Authority, 650 Main Street, Winnipeg, MB, Canada
                [8 ]Health Sciences Council and Interdisciplinary Health Research Academy, University of Alberta, 3–398 Edmonton Clinic Health Academy, Edmonton, AB, Canada
                [9 ]Glenrose Rehabilitation Hospital, 10230 111 Avenue, Edmonton, AB, Canada
                [10 ]Women and Children’s Health Research Institute, University of Alberta, 4–081 Edmonton Clinic Health Academy, Edmonton, AB, Canada
                [11 ]Stollery Children’s Hospital, 8440 112 Street, Edmonton, AB, Canada
                [12 ]Northern Ontario School of Medicine, 955 Oliver Road, Thunder Bay, ON, Canada
                Article
                1748-5908-7-70
                10.1186/1748-5908-7-70
                3780719
                22831550
                16a7adc6-cc0a-4571-9f66-9e85e3adc9fd
                Copyright ©2012 Scott et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 9 November 2011
                : 4 July 2012
                Categories
                Systematic Review

                Medicine
                systematic review,research use,knowledge translation,behaviour change interventions,allied health

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