Knowledge to Action Framework
The MCHRI team are aware that the creation of knowledge does not, itself, lead to widespread implementation and positive impacts on health. To do so requires a broader process that generates new knowledge that must be proactively implemented, translated and scaled into changes in practice and policy. This is underpinned by an iterative framework for research and evidence driven impact, as proposed here (figure). This MCHRI framework for impact has been adapted form multiple sources and from internal learnings and is underpinned by the Canadian knowledge to action process.
The MCHRI framework includes 6 Key Steps summarised below:
Steps 1 & 2 – Formative Research: engage stakeholders to identify problem from all perspectives, to scope and prioritise and to inform on enablers, barriers and optimal processes to drive reach, effectiveness and sustainability when programs are implemented and scaled-up in the ‘real world’.
Step 2 – Knowledge Synthesis: synthesis of relevant guidelines and research evidence to inform next steps.
Step 3 – Knowledge Generation: is consolidated following steps 1 and 2 and if required involves efficacy research.
Step 4 – Implementation Research: the planned use of co-designed implemetnation strategies to effectively transfer evidence-based approaches into practice in real-world settings. Pilot testing of resources, programs and systems approaches is needed with sustainability and scalability vital considerations.
Step 5 – Dissemination and Scale-Up: The distribution of information and resources with the intent of spreading knowledge and promoting use of evidence-based interventions. This is needed to inform how to maximise reach, effectiveness and sustainability to facilitate scale up of evidence-based approaches into practice in real-world settings. Scale-up refers to the development of organisational capacity for sustained, widespread use and the evaluation and monitoring of uptake and rollout , primarily facilitated through non reserach agencies such as government and health services. Broader uptake can be maximised through national communication channels to reach health professionals and organisations wishing to change practice based on these learnings. Direct alignment with National/International priorities optimises government engagement for policy development and funding.
Step 6 – Evaluation: Research to evaluate initiatives and factors that influence scale-up and sustainability is important and can use process and outcome eavluation approaches and existing frameworks including REAIM to assess Reach, Effectiveness, Adoption, Implementation and Maintenance. Health and economic outcomes also require evaluation to evaluate long-term sustainability and continuous quality improvement.
Harrison et al, Midwifery In Press 2017.