Developing a knowledge translation program for health practitioners: Allied Health Translating Research into Practice

Background: Front-line health practitioners lack confidence in knowledge translation, yet they are often required to undertake projects to bridge the knowledge-practice gap. There are few initiatives focused on building the capacity of the health practitioner workforce to undertake knowledge translation, with most programs focusing on developing the skills of researchers. This paper reports the development and evaluation of a knowledge translation capacity building program for allied health practitioners located over geographically dispersed locations in Queensland, Australia.

Methods: Allied Health Translating Research into Practice (AH-TRIP) was developed over five years with consideration of theory, research evidence and local needs assessment. AH-TRIP includes five components: training and education; support and networks (including champions and mentoring); showcase and recognition; TRIP projects and implementation; evaluation. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation Maintenance) guided the evaluation plan, with this paper reporting on the reach (number, discipline, geographical location), adoption by health services, and participant satisfaction between 2019 and 2021.

Results: A total of 986 allied health practitioners participated in at least one component of AH-TRIP, with a quarter of participants located in regional areas of Queensland. Online training materials received an average of 944 unique page views each month. A total of 148 allied health practitioners have received mentoring to undertake their project, including a range of allied health disciplines and clinical areas. Very high satisfaction was reported by those receiving mentoring and attending the annual showcase event. Nine of sixteen public hospital and health service districts have adopted AH-TRIP.

Conclusion: AH-TRIP is a low-cost knowledge translation capacity building initiative which can be delivered at scale to support allied health practitioners across geographically dispersed locations. Higher adoption in metropolitan areas suggests that further investment and targeted strategies are needed to reach health practitioners working in regional areas. Future evaluation should focus on exploring the impact on individual participants and the health service.

Introduction

The knowledge-practice gap in healthcare is substantial, with failure to optimally use evidence resulting in research waste, provision of unnecessary or potentially harmful treatments, and ineffective use of finite health service resources (1, 2). Paradoxically, a parallel knowledge-practice gap has been identified. That is, the gap between scientific knowledge on implementation (i.e., implementation science) and the use of this knowledge to implement healthcare improvements in practice (i.e., knowledge translation (KT)) (3). Simply disseminating research findings in journals or at conferences is insufficient to produce an effective or lasting change in healthcare practice. In response, implementation science has become a rapidly developing field of research, with over 100 theories, models and frameworks developed over the past two decades (4). So rife are these theoretical approaches that tools and “how-to guides” have recently been developed to help those new to the field navigate the complex language and concepts (5, 6). It has recently been suggested that these guides have too often been developed by researchers for researchers and raised questions about whether implementation science actually ever reaches healthcare practitioners so that they can use this knowledge to solve complex healthcare problems and improve outcomes (3).

The need to train researchers in dissemination and implementation research has been acknowledged for some time (7), with a recent scoping review identifying 41 distinct capability building initiatives for dissemination and implementation research (8). However, few focus on developing KT capacity within the healthcare workforce. Health practitioners are often charged with undertaking projects to translate research into practice which, given the complexity of health systems, often requires multiple non-linear steps and complex process and behavior changes of health practitioners, consumers, and decision makers (9). Given this, it should not come as a surprise that current evidence suggests health practitioners do not feel confident in their skills and ability to undertake KT, particularly when applying implementation theory, models and frameworks and evaluating the impact of the change (10–12). Without adequate training, support and resources, there is a risk of implementation failure and a sense of nihilism about KT within the healthcare workforce (13).

Developing capacity for KT has been defined as a dynamic activity that develops individual and organizational capabilities over the long term, leading to improved implementation and provision of evidence-based healthcare (14). It requires the healthcare workforce to be active participants rather than passive recipients (i.e., learning by doing, rather than by completing training courses) and a focus on multilevel learning from individuals to groups and between groups across an organization (14). Published literature on developing capacity for KT amongst the healthcare workforce has found improved knowledge and confidence, reported application of new skills, and improved local leadership and capacity for KT (15–20). These KT capacity building initiatives primarily used formal face-to-face training seminars or workshops (16, 20, 21), sometimes in combination with mentoring or coaching from “implementation support practitioners” (15, 17–19). There is emerging recognition of implementation support practitioner roles in developing KT capacity (22); however, in health organizations, they are rarely funded and, where they do exist, there may be inequitable access to their support, particularly in geographically dispersed health services.

The Queensland public health system is funded, managed, and regulated by the federal and state governments to deliver services across acute, sub-acute and community health settings, spanning an area of more than 1.8 million km2 and servicing a population of around 5.2 million people (23). Developing capacity for KT in the allied health workforce within the Queensland public health system needs to ensure equity of access to KT training and implementation support practitioners (mostly located within metropolitan centers) and delivery of these strategies in a way that fits within constraints commonly experienced in health services (e.g., time, high clinical workload, competing demands (10, 12)). In response, we developed the multimodal Allied Health Translating Research into Practice (AH-TRIP) initiative to build capacity for KT (at an individual, group and organizational level) amongst the allied health workforce working in the public health system in Queensland, Australia. Allied health includes health practitioners from non-medical and non-nursing disciplines such as dietitians/nutritionists, occupational therapists, pharmacists, physiotherapists, psychologists, medical radiation therapists, social workers, and speech pathologists.

In this paper, we describe the AH-TRIP initiative to share our approach for developing KT capacity amongst front-line allied health practitioners for other health services to learn from and build on. Specifically, this includes how AH-TRIP was developed, the inputs (resources) associated with delivery, and the evaluation of reach, adoption, and reaction of the program.

Materials and methods

This paper uses the Medical Research Council framework for developing complex interventions (24) to describe the approach taken to develop the AH-TRIP initiative, a KT capacity building program for front-line allied health practitioners. As this framework was only recently developed, it was not applied prospectively to guide the development but provides a useful structure to describe the steps taken to develop AH-TRIP. The Template for Intervention Description and Replication (TIDieR) checklist (25) has been used to describe the AH-TRIP initiative.

A description of the AH-TRIP initiative is provided in Table 1. AH-TRIP was developed over a five-year period (2014 to 2019) and implemented across all 16 Queensland Hospital and Health Service districts, as well as a public/private partnership health service, from 2018. The development process is outlined in Table 2. Whilst this table suggests that the development process was somewhat linear, many steps were completed concurrently and/or repeated to refine the final intervention. On reflection, a pragmatic approach to intervention development was used, including approaches consistent with our values of partnership (with end users involved in working groups and steering committees to inform decision making), theory and evidence (with literature review and needs assessment at commencement informing a competency framework and development of individual intervention components), and implementation-focused (with monitoring of uptake and delivery to inform refinements) (24).

TABLE 1

Table 1. Summary of the allied health translating research into practice (AH-TRIP) initiative.

TABLE 2

Table 2. Description of the steps and activities completed to develop the allied health translating research into practice (AH-TRIP) initiative.

This paper reports the cost associated with developing and delivering AH-TRIP (inputs) and the evaluation of the participation (reach and adoption) and short-term outcomes (satisfaction) over a three-year period (2019–2021). This evaluation is informed by the program logic model and underpinned by the RE-AIM (Reach, Adoption, Effectiveness, Implementation, Maintenance) framework (30) (Figure 1). Implementation and learning outcomes of the telementoring program have been reported elsewhere (27, 32).

FIGURE 1

Figure 1. Allied health translating research into practice (AH-TRIP) program logic and evaluation. *Funded program lead positions [total 1.2 full-time equivalent (FTE) across two positions] and in-kind research fellow time (approximately 0.1FTE) were inputs for all components of AH-TRIP. **As per the RE-AIM framework(26); italicised evaluation measures are not reported in this paper.

Inputs are defined as the resources involved in delivering AH-TRIP, including funding, time and materials (33); these are outlined in detail in Figure 1. Data were collected via documents from the AH-TRIP program manager and working groups (e.g., meeting minutes) to estimate the funded and in-kind time (i.e., not funded) dedicated to AH-TRIP by all contributors. Cost of materials were calculated via invoices (for purchased materials, e.g., software licenses) and estimates for those donated or provided in-kind (e.g., prizes, venue hire). All costs are reported in Australian dollars.

Reach was defined as the number and representativeness of individuals who participated in the AH-TRIP telementoring, champion and showcase initiatives in 2019, 2020 and 2021, and the number of page views for the webinars between January 2019 and December 2021. The AH-TRIP program manager collected participation data via attendance lists (telementoring and showcase), submissions to present a TRIP project (showcase), and email list (champions). Website statistics were obtained from the health service publishing team. Adoption was defined as the number of hospital and health service districts with at least one AH-TRIP champion and at least one TRIP project supported by AH-TRIP (determined by either submission to the telementoring program or showcase).

Participant satisfaction with the AH-TRIP components was determined using surveys administered after completion of AH-TRIP webinars (available as a link on the webpage) and after participation in AH-TRIP telementoring and showcase (provided to all participants directly via email/QR code). Copies of these surveys are provided as Supplementary Material. Approval to undertake this program evaluation was granted by the chairperson of the hospital human research ethics committee (LNR/2019/QRBW/57225). Participants gave their consent to participate in the evaluation by their completion and return of their surveys.

All data are presented descriptively for the AH-TRIP initiative in its entirety, as well as evaluation for each individual component. Where possible, reach and adoption are also reported by geographical location (metropolitan vs. regional hospitals and health services) and allied health discipline to determine the representativeness of participating individuals and sites.

Results

The cost to deliver the AH-TRIP initiative was $AU197,595 per year. This includes $AU143,000 for two funded positions for a total of 44 h per week: 0.6FTE statewide program manager to support the statewide coordination and delivery of all AH-TRIP components; 0.5FTE implementation practitioner funded internally by a specific metropolitan health service to support local mentoring and contribute to the delivery of select statewide AH-TRIP components. Additional costs included $AU475 in software licenses, and direct in-kind contribution of $AU54,120 per year (e.g., steering committee and working group meetings, webinar content development, telementoring panelists, showcase event expenses). Detailed cost data and assumptions are provided as Supplementary Material.

The AH-TRIP website that hosts online training and resources was launched in March 2019. Between its launch in March 2019 and December 2021, there was an average of 944 unique page views per month (range: 480–1,422 per month), with total unique page views of 32,112 over this period (Figure 2). Only 19 surveys were completed online to evaluate the satisfaction with these resources. The AH-TRIP champion network comprised of more than 100 champions (2019: n = 103, 2020: n = 112, 2021: n = 105) who promoted AH-TRIP and knowledge translation within their departments. The champions represented all major allied health disciplines (Table 3), with a third of champions (n = 36) located in regional health services.

FIGURE 2

Figure 2. Unique page views of the allied health translating research into practice website.

TABLE 3

Table 3. Project topics supported by telementoring or presented at the showcase.

The initiation of the AH-TRIP telementoring program supported 19 knowledge translation projects across four cohorts (2019: n = 4, 2020: n = 5, 2021: n = 10 across two cohorts). Project topics are summarized in Table 3. Twenty-five allied health practitioners across seven disciplines and one nurse participated in the program as “telementees” (Table 4). Seven (37%) projects were led by allied health practitioners from regional health services (2019: n = 2; 2020: n = 1; 2201: n = 4 projects across two cohorts), with a total of nine individuals from regional health services supported by the program. All “telementees” (100%, n = 26) reported that the telementoring support they received was relevant to their project, and all (100%, n = 26) reported that they would recommend it to their colleagues. Local program funding from one metropolitan health service district enabled individual project support by an experienced implementation practitioner for an additional 99 projects involving allied health practitioners.

TABLE 4

Table 4. Number of allied health practitioners participating in each allied health translating research into practice (AH-TRIP) program component (2019–2021) by allied health discipline.

Completed TRIP projects were submitted for the AH-TRIP annual showcase event by 49 allied health practitioners (2019: n = 17, 2020: n = 19, 2021: n = 13). Almost half of these (n = 23) were submitted by dietetics (Table 4), with representation from both metropolitan (n = 38) and regional areas (n = 11). Project topics presented at the showcase are summarized in Table 3. A total of 733 people registered to attend the showcase events over the evaluation period (2019: n = 285, 2020: n = 263, 2021: n = 185). This included 186 (25%) attendees from regional areas of Queensland and 89 (12%) from outside Queensland Health (e.g., universities, private practice). Evaluation surveys were completed by 146 attendees (2019: n = 76, response rate: 27%; 2020: n = 43, response rate: 16%, 2021: n = 27, response rate: 15%). Almost all respondents agreed that the event was valuable (n = 138, 95%), could identify at least one key learning about TRIP from the event (n = 138, 95%), would think about how they used research in practice because of the event (n = 140, 96%) and had increased understanding and confidence about what TRIP is (n = 126, 86%). Qualitative comments showed that attendees particularly liked that the showcase provided a safe space to share reflections and learning, including failed TRIP attempts and “real world learnings” from across the state, and that it was an engaging way to learn about research and TRIP.

Over the three-year evaluation period, nine out of the 16 Queensland Hospital and Health Service districts, as well as the private/public health service, adopted AH-TRIP, with all ten having at least one AH-TRIP champion, four having at least one AH-TRIP project supported by the telementoring program and nine having submitted a project to the annual showcase event. Of those seven hospital and health service districts who had not fully adopted AH-TRIP, six had partially adopted AH-TRIP (at least one AH-TRIP champion, n = 4; project supported by the telementoring program, n = 1; submitted to present at the showcase, n = 1). All non or partial adopters were located in regional areas.

Discussion

In this paper, we have shared both the development and evaluation of this multimodal KT capacity building program that has resulted in strong adoption and high participation within its first three years of implementation. Almost 1,000 allied health practitioners have participated in AH-TRIP through being a local champion, receiving mentoring, or attending the showcase. The online training platform has received over 1,000 unique page views each month, and over 60 known TRIP projects have been undertaken across the state. This has been achieved even during times of high demands on health services and health practitioners due to the COVID-19 pandemic. Importantly, evaluation demonstrates some penetration in health services outside of metropolitan centers, working towards achievement of its aim to provide equitable access to KT capacity building for health practitioners in regional areas who typically do not access the same support as their colleagues in metropolitan areas. AH-TRIP fills an identified gap in KT capacity building by specifically focusing on novice implementers and teams embedded in the health service rather than advancing dissemination and implementation skills of individual researchers (8).

The AH-TRIP initiative was developed with five key components: training and education; support and networks (including mentoring); showcase and recognition; TRIP projects and implementation; and evaluation. Although we provide a summary of the steps and activities to developing the initiative to date, this non-linear process has required continuous monitoring and adaptation to achieve the scale and spread across a geographically large health service with a workforce of over 9,000 allied health practitioners. Critical success factors of the AH-TRIP pilot sites were identified as the collaborative engagement, teaching and coaching by research fellows (acting as “implementation support practitioners” (22)), operational support from key opinion leader managers, a motivated workforce with an expressed desire for TRIP training (10, 12) and recognition of effort at an annual showcase. The formation of formal governance structures such as a steering committee and working groups with clear reporting lines were crucial to securing ongoing, albeit short term funding for project officer support. Local needs assessment surveys influenced success by generating data by which decisions to support or invest in local AH-TRIP activities or projects were made. Consistent with findings from previous studies (16, 20), a strong organizational commitment to research and quality improvement and dedicated resources to workforce development were clearly identified as factors associated with the sites that were able to integrate AH-TRIP successfully.

Attempts at scale and spread to other hospitals were limited by research fellow capacity in regional health services (34) and the uncertainty of the short-term, non-recurring nature of funding new program initiatives within health services during the initial years of AH-TRIP establishment. The lack of physical location of research fellows at each regional location was a challenge that was not overcome simply with virtual engagement. The awareness and recognition of implementation science and KT as distinct teachable skills for a healthcare workforce is still evolving within health services. There remains some permeation of expectation across levels of health service management that staff should be able to identify evidence practice gaps and implement, evaluate, and sustain knowledge translation without dedicated training and support to do so. The AH-TRIP experience has demonstrated that with a relatively small investment, the rewards of KT training are broad across disciplines and project types.

Whilst this and other studies (27, 32) have demonstrated high engagement and KT skill development of allied health practitioners participating in AH-TRIP, measuring its value is challenging. Since its inception, considerable “in-kind” time has been provided by research fellows, allied health practitioners and managers to develop, implement and sustain AH-TRIP, which is not possible to quantify. However, based on the accounted costs, the cost of the initiative is $200 per participant or $19,760 per year for each hospital and health service district that has adopted AH-TRIP. This is likely to be far less expensive than more traditional models of education and mentoring requiring dedicated positions within each hospital and health service district. To measure the true value of AH-TRIP, there is a need to capture the impact beyond short-term skill development and project completion, to measure impact on the health system and patient outcomes. Data is also needed to demonstrate the impact of capacity building for the individual and potential “ripple effects” as capabilities are spread within groups and organizations (14) (e.g., mentoring of others in KT, integration of KT into policies and processes). It is possible that enhancing KT capacity of health service staff may provide them with a new language, skills and networks to forge new academic partnerships, providing the opportunity to undertake larger-scale funded KT projects within a research framework. An important consideration when measuring the value of KT capacity building is capturing the cost associated with the avoidance of poorly executed projects. It is our experience that AH-TRIP mentoring supports health practitioners to take a slower and more structured approach to problem definition and selection of implementation strategies (27); however, to our knowledge, this has not been evaluated to date.

Participation in AH-TRIP by allied health practitioners in regional areas demonstrates that it is suitable to be delivered at scale and can overcome barriers related to geographical distance, congruent with the aims of the initiative. However, the lack of adoption in seven regional hospital and health service districts suggests that further work is needed to enable adoption by the health service and participation by the workforce. Slower adoption in regional, rural, and remote health services was expected, with previous research highlighting lower levels of prior KT training outside metropolitan health services (10). In response, we have realigned our working groups to have one specifically focused on regional workforce engagement, with strategies such as positions in the AH-TRIP steering committee and working groups filled by regionally located practitioners/champions, dedicated rural and remote bursaries to support AH-TRIP activities and practical support specifically offered to regional projects by the program manager, e.g., review and feedback on resources, project materials and showcase submissions. Three years on, there continues to be a need for ongoing resourcing to refine and sustain AH-TRIP and adaption of the delivery approach and content within the initiative with advancement in implementation science knowledge and capacity building theory, as well as inevitable changes in the health service practice setting and ecological system (35).

Some limitations should be noted. Without dedicated evaluation funding, data used in this evaluation was limited to those embedded within routine delivery of the program related to reach, adoption, and satisfaction. These data were not available for users of the open-access online training resources on the AH-TRIP website; with fewer than twenty surveys completed over three years, alternative strategies should be used to evaluate the online training. Evaluation of any additional KT training and mentoring provided by AH-TRIP champions and research fellows beyond the core components was not undertaken. It is likely that the cost of AH-TRIP has been underestimated due to significant in-kind contributions from a wide range of supporters who engaged indirectly in AH-TRIP development and promotion that was unable to be quantified or costed. Whilst the authors were also heavily involved in the development and delivery of the AH-TRIP program, inclusion of two external evaluators with expertise in KT capacity building (SB, GH) may have reduced bias in interpretation of evaluation data. Finally, we acknowledge that our definition of adoption represents a minimum level of adoption of the program and does not capture whether it has been adopted and embedded within multiple discipline groups or individual health care facilities within the hospital and health service district.

In conclusion, AH-TRIP is a low-cost KT capacity building initiative which can be delivered at scale to support allied health practitioners across geographically dispersed locations. Specific strategies are needed to further support the adoption of AH-TRIP in regional health services, and to ensure its sustainability within health services that have adopted the initiative. Future evaluation should focus on exploring the impact on individual participants, their teams, and organizations, as well as the potential impact on health service outcomes.

Data availability statement

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author/s.

Ethics statement

The studies involving human participants were reviewed and approved by Royal Brisbane and Women's Hospital Human Research Ethics Committee. The ethics committee waived the requirement of written informed consent for participation.

Author contributions

AY, AC, NM, SB, KC, SW, LMcB, RB and IH contributed to the conception, development and/or delivery of the AH-TRIP initiative; AY, AC, NM, SB, KC, SW, LMcB, RB, SB, GH and IH contributed to the development of the evaluation protocols; AC, NM, SB collected data; AY analysed data and prepared the draft manuscript; AY, AC, NM, SB, KC, SW, LMcB, RB, SB, GH and IH read and approved the final manuscript. All authors contributed to the article and approved the submitted version.

Funding

The AH-TRIP initiative has received funding from Queensland Health (Office of the Chief Allied Health Officer; Metro North Health and Metro South Health).

Acknowledgments

The authors would like to acknowledge the contribution of the members of the AH-TRIP steering committee and working groups, and support from allied health leaders, in particular the support from Julie Hulcombe, Rachelle Pitt, Mark Butterworth, Jan Hill, Merrilyn Banks, Sally Eames and Angela Wood.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Supplementary materials

Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/frhs.2023.1103997/full#supplementary-material.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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