The Action Cycle represents activities or actions required for effective implementation of knowledge. The seven phases of the cycle are not sequential. To address a knowledge mobilization issue, one can start at any phase, and can also move between the phases of knowledge creation and the action cycle.
IDENTIFY PROBLEM/ DETERMINE THE KNOW-DO GAP/ IDENTIFY, REVIEW, SELECT KNOWLEDGE refers to identifying a problem that should be addressed; this may involve comparing what the current practice is, with what should be in place, in order to determine a gap that ought to be closed. Resources for identifying a problem or gap:
- Appraisal of Guidelines for Research and Evaluation (AGREE) tools
- Used for the development, reporting and appraisal of clinical practice guidelines and health systems guidance documents
- Institute of Medicine (IOM) Guidelines – Clinical Practice Guidelines We Can Trust
- Eight standards for developing trustworthy guidelines
- International Patient Decision Aid Standards (IPDAS) resources
- Used for the development and appraisal of decision aids
- CIHR webpage: “Identifying the Knowledge-to-Action Gaps“
ADAPT KNOWLEGE TO LOCAL CONTEXT refers to adapting the knowledge to a particular setting, taking into consideration the population, available resources, political climate, etc. Resources for adapting guidelines:
- ADAPTE (Version 2.0)
- Developed by the ADAPTE Collaboration and later transferred to the Guidelines International Network (G-I-N)
- CAN-IMPLEMENT
- Interactive planning resource developed in response to barriers and facilitators experienced by Canadian cancer care groups engaging in guideline adaptation using the ADAPTE process
- Article describing the development of Can-Implement
ASSESS BARRIERS/FACILITATORS TO KNOWLEDGE USE refers to identifying potential barriers and facilitators to using/implementing knowledge. Methods for assessing barriers and facilitators include surveys, focus groups, interviews, observations and review of records. Resources/tools for assessing barriers and facilitators:
- Theoretical Domains Framework (TDF)
- Comprehensive, theory-informed approach for identifying determinants of behaviour
- 33 theories relevant to implementation were identified and grouped into domains to create the original version of the TDF; a validation assessment resulted in an updated version of the TDF
- Article describing the development of the original TDF
- Article describing the validation evaluation and presenting the revised TDF
- Article to help guide application of the TDF
- Consolidated Framework for Implementation Research (CFIR 2.0)
- Framework used to guide development and adaptation of health-related interventions
- Consists of constructs across five domains: innovation, outer setting, inter setting, individuals, and implementation process
- Various tools available on the CFIR website: https://cfirguide.org/tools/
- Article describing the updated CFIR 2.0 (2022)
- Article describing the original CFIR
- BARRIERS to research utilization scale
- 29-item scale to assess clinicians’ and administrators’ perceptions of barriers to research use in practice; used extensively in nursing
- Article describing development and assessment of the scale
- Systematic review evaluating the usefulness of the scale
- Promoting Action on Research Implementation in Health Services (PARiHS) Framework
- Framework to inform implementing research into practice
- Examines interactions between three factors that inform research use: evidence, context and facilitation
- Article introducing and describing the framework
- Review assessing the framework’s practicality and challenges with its use
- Alberta Context Tool (ACT)
- 56-item survey, to measure organizational context; informed by the PARiHS framework
- Intended to support implementation of interventions in busy clinical or public health settings
- Request access to the tool here: https://trecresearch.ca/alberta_context_tool
- Article describing the development and assessment of the ACT
SELECT, TAILOR, IMPLEMENT INTERVENTIONS refers to planning and implementing an intervention. Resources for selecting, tailoring the implementing interventions:
- Canadian Institutes of Health Research (CIHR)
- CIHR offers a guide for designing health-related KT interventions
- Expert Recommendations for Implementing Change (ERIC) Tool
- This matching tool was developed to guide users in choosing implementation strategies based on the results of a CFIR context assessment
- National Collaborating Centre for Methods and Tools (NCCMT) Learning Centre
- The NCCMT provides e-modules for various phases of the action cycle
- Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework
- Framework provides guidance on efforts to translate research into practice; various resources are offered
- Medical Research Council (MRC) Framework
- Framework offers guidance on the development, evaluation and implementation of complex interventions to improve health
- Standards for Reporting Implementation Studies (StaRI)
- The 27-item StaRI checklist can help to assess suggested implementation strategies and interventions
- Relevant article: From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques
- Relevant article: The behaviour change wheel: a new method for characterizing and designing behaviour change interventions
- CEBI’s KTI Casebook (highlighting effective KT interventions)
- CIHR webpage: “Selecting, Tailoring and Implementing KT interventions“
MONITOR KNOWLEDGE USE refers to tracking and recording uptake of the KT intervention. Examples of monitoring include observation and active measurement. Resources to support monitoring:
- Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework
- Framework provides guidance on tracking and reporting reach, adoption and impact
- 2021 article addressing how the framework has been described, summarizing how the model has evolved over time, and identifying and correcting misconceptions
EVALUATE OUTCOMES refers to measuring whether the KT intervention is positively influencing the desired outcomes. Resources for evaluation:
- National Collaborating Centre for Methods and Tools (NCCMT) Learning Centre
- Provides free e-modules for evaluation; registration required
- Medical Research Council (MRC) Framework
- Provides guidance on the development, evaluation and implementation of complex interventions to improve health
- Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework
- Framework provides measures and checklists for planning and evaluation
SUSTAIN KNOWLEDGE USE refers to maintenance of intervention activities to sustain the desired outcomes. Resources to support sustainability of knowledge use:
- National Health Service (NHS) Sustainability Model and Guide
- A guide used to identify strengths and weaknesses in implementation plans and to predict the likelihood of sustainability for improvement initiatives
- Dynamic Sustainability Framework
- Proposes continued learning and problem solving, ongoing adaptation of interventions, and expectations for ongoing improvement
- Relevant article: The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research.
- CIHR webpage: “Sustaining Knowledge Use“