Knowledge Translation in Health Care
a CIHR Perspective
Jacqueline Tetroe
Senior Advisor
Knowledge Translation and Public Outreach Portfolio
Canadian Institutes of Health Research
KTE Community of Practice
Toronto, June 17 2010
Knowledge Translation in Health Care
a CIHR Perspective
Things I will NOT be talking about today:
CIHR’s definition of knowledge translation
Why KT is important
Funding opportunities for KT science and practice at
How to be successful in the above competitions
Our partnership survey of successful researcher and
knowledge-user integrated KT grant applicants
Our analysis of funded and unfunded iKT grants to
determine how to get more of them in the fundable
Knowledge Translation in Health Care
a CIHR Perspective
What I will be talking about today:
• The knowledge to action cycle
• Its link to the book Knowledge Translation in Health
Care. Moving from Evidence to Practice
Key References
Straus, SE, Tetroe,JM & Graham ID (Eds.)(2009), Knowledge
Translation in Health Care. Moving from Evidence to Practice (pp.
185-195). Oxford: Wiley-Blackwell.
Graham ID, Logan, J., Harrison MB, Straus, S., Tetroe, JM,
Caswell, W. et al. (2006). Lost in knowledge translation: Time
for a map? Journal of Continuing Education in Health Professions,
26, 13-24.
Graham ID & Tetroe, JM (2010). The Knowledge to Action
framework. In J.Rycroft-Malone & T. Bucknell (Eds.), Models
and Frameworks for Implementing Evidence-Based Practice: Linking
Evidence to Action (pp. 207-222). Oxford: Wiley-Blackwell,
Sigma Theta Tau International Honor Society of Nursing.
Now available from
Wiley-Blackwell or
(discounted to $60.66!!)
All royalties go into a CIHR
fund for students
Select, Tailor,
Assess Barriers/
Supports to
Knowledge Use
from: Graham et al:
Lost in Knowledge Translation: Time for a Map?
to Local Context
Identify Problem
Identify, Review,
Select Knowledge
The knowledge to action (K2A)
• based on a concept analysis of 31 planned action
• was developed to help make sense of the black box
known as ‘knowledge translation’ or
• offers a holistic view of the phenomenon by
integrating the concepts of knowledge creation and
The knowledge to action (K2A)
 assumes a systems perspective
 falls within the social constructivist paradigm which
privileges social interaction and adaptation of
research evidence that takes local context and culture
into account
• designed to be used by a broad range of audiences
• has been widely cited: 103 in ISI Web of Knowledge,
244 in H – Harzings Publish or Perish, which picks
up the grey literature
• has not, as yet, been tested empirically
The knowledge to action (K2A)
framework: derivation
• the set of 31 theories on which the framework is based, can
provide more specific guidance as to what needs to be
done at each phase
• each theory has been broken down into its components
and data abstraction sheets for each can be found at
• viewed 403 times Jan-April 2010 - a lot more before then
• each of the component theories is mapped onto the K2A
• future iterations of the framework will be informed by
feedback from the researchers and knowledge-users who
are trying to apply it.
The knowledge to action (K2A)
More on the systems perspective.
• knowledge producers and users are situated within a
social system or systems that are responsive and
adaptive, although not always in predictable ways.
• the K2A process is considered iterative, dynamic, and
complex, and the boundaries between the creation and
action components are fluid and permeable.
• the action phases may occur sequentially or
simultaneously and the knowledge phases may
influence or be drawn upon during action phases.
• the cyclic nature of the process and the critical role of
feedback loops are key concepts underpinning the
The knowledge to action (K2A)
• the framework encompasses research based as well
as other forms of knowing such as contextual and
experiential knowledge
• both the knowledge creation and action components
can be “activated” by different stakeholders and
groups working independently of each other at
different points in time
• a key assumption underlying the framework is the
importance of appropriate relationships
The knowledge to action (K2A)
• the action phases enable the framing of what needs to
be done, how, and what circumstances/conditions
need to be addressed when implementing change.
• they are not meant to replace or override the
component theories from which the phases were
 e.g. when addressing the barriers to knowledge use, 18 of
the 31 planned action theories had a construct dealing with
this – some with more precision and coverage than others.
• for each action phase other (non-planned action)
theories (psychological, organizational, economic,
sociological, educational, etc) may be relevant and
useful (see, for example (Wensing et al., 2009 in …..
The K2A framework:
limitations in how we drew it
• our representation of the K2A cycle suggests
circularity or a sequence of phases that need to be
taken in order
• we realize that this is not how implementation
projects unfold in “real life”.
• they are often chaotic, and move forward in an
erratic manner with continuous course corrections as
the action phases accommodate the contextual
• a better representation of our framework would be
the probabilistic atomic model, where the action
phases are like electrons around the nucleus of
knowledge generation - and the contextual factors
influence where a given phase might be at a specific
The K2A framework:
limitations in how we drew it
• the two dimensional, linear representation of the
framework might seem to preclude the possibility
that change can occur at multiple levels.
• there is nothing inherent about the framework that
would exclude its use at multiple levels.
• Ferlie et al. confirm non-linear models of innovation
spread. They argue that there is no linear flow or
prescribed sequence of stages.
“Indeed, flow is a radically inappropriate image to
describe what are erratic, circular or abrupt
processes, which may come to a full stop or go into
Ferlie et al page 123
Ferlie, E., Fitzgerald, L., Wood, M., & Hawkins, C. (2005). The
nonspread of innovations: The mediating role of professionals.
Academy of Management Journal, 48, 117-134.
The knowledge to action (K2A)
• The framework has become a key part of messaging
about knowledge translation at CIHR since
September, 2007.
• It has been presented to a variety of CIHR’s
stakeholders and internal staff, and has been well
received in the sense that it is understandable and
relatively simple, yet comprehensive.
• Feedback from researchers and knowledge-users
suggests that it provides a useful way of thinking
about knowledge translation but more importantly,
by breaking the process into manageable pieces,
provides a structure and rationale for activities.
The knowledge to action (K2A)
• I see it cited and reproduced in CIHR grant
applications – have yet to test its application or to
analyze the fidelity of its use
• the Canadian Partnerships Against Cancer (Kerner,
2009) has adapted the framework to guide their
knowledge management strategy as has the
Canadian Stroke Strategy and at least one CLAHRC
in the UK. KT10 and KU10 had several posters using
it as well.
• has also been used as a framework for the KT
Clearinghouse (, a
repository of knowledge translation tools and
The knowledge to action (K2A)
• K2A cycle used as the organizing
framework for the book: Knowledge
Translation in Health Care. Moving
from Evidence to Practice
• FYI most of the contributing authors
created PowerPoint presentations
summarizing the chapters
• Available by e-mailing
Knowledge Translation
in Health Care
• not sure how many books have been sold
• we get lots of positive feedback on the book–
especially from people new to knowledge
• strange but true: people actually claim to have
read it chapter by chapter in weekly journal
Knowledge Translation
in Health Care
• Forward: Jonathan Lomas reprises his “Beyond the
sound of one hand clapping” monograph
• Introduction: K2A what it is and what it isn’t
• Knowledge Creation
• The K2A Cycle by each phase in the cycle
• Theories and Models of knowledge to action
• Knowledge Exchange
• Evaluation of Knowledge to Action
• Approaches to Measurement
• KM and Commercialization
• Ethics and Knowledge Translation
Knowledge Translation
in Health Care
• Each chapter provides a high level overview
of the field
• Written by well-known and highly
published and cited experts in the field
• Is admittedly very clinically focussed
• We hope to work on a new book with the
focus on evidence-informed policy making
• We hope to bring theory and a strong
evidence base to bear on health issues and
problems in order to improve health
In theory, there is no difference between theory
and practice. But in practice, there is.
Yogi Berra
For more information, visit our web page:
Thank you

Presentation slides for Jacqueline Tetroe