Strategies to promote knowledge translation in primary health care: scoping review

Schneider, Luana Roberta; Rodrigues Junior, Sinval Adalberto

doi:10.1590/1983-1447.2022.20220107.en

Scoping Review - Knowledge translation and advances in health and nursing practices • Rev. Gaúcha Enferm. 43 (spe) • 2022 • https://doi.org/10.1590/1983-1447.2022.20220107.en linkcopy

Strategies to promote knowledge translation in primary health care: scoping review

Estrategias para promover la traducción del conocimiento en la atención primaria de salud: revisión de alcance

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To map the strategies used by health professionals to promote knowledge translation in Primary Health Care and to identify barriers and facilitators for the use of scientific evidence.

Method: Scoping review with search in PubMed, EMBASE, CINAHL, Web of Science, Scopus, LILACS, and gray literature, in April 2022, using the terms “translational medical research”, “knowledge translation”, “primary health care”. The PRISMA-ScR was used to report the review.

Results: 56 studies included. Several strategies were identified and grouped into: educational material, training, websites, educational outreach, knowledge translation networks, local facilitators, feedback and public promotion. High demand for services and content without practical information represented barriers, while assessing the context, involving stakeholders and the presence of local facilitators ease theuse of evidence.

Conclusion: The most used strategies were educational material and training. Overcoming barriers is essential to bridging the gap between evidence and practice.

Keywords:
Primary health care; Translational research; biomedical; Health services

First author (year) Country of origin	Objective(s)	Study design	Single/Multiple intervention	KT strategy(ies)
Wensing (1994) Netherlands¹⁸	To evaluate the effectiveness of different strategies, applied single or combined, to implement changes in primary care practice.	Systematic review	Multiple	Educational Material, Training and Feedback
Swinglehurst (2001) United Kingdom¹⁹	To develop and evaluate an information service.	Descriptive study	Single	Educational outreach
Forsetlund (2003) Norway²⁰	To evaluate whether a theory-based, multifaceted, intervention increased the integration of research into the decision-making of public health physicians.	Randomized controlled trial	Multiple	Training, Educational outreach, Educational material andWebsite
Lindbloom (2004) USA²¹	To describe the organization and work of networks of practice-based research.	Descriptive study	Single	KT Networks
Stevenson (2006) United Kingdom²²	To investigate whether physical therapists’ clinical management of patients with low back pain would change after an evidence-based education programme.	Randomized controlled trial	Single	Local facilitators
Dobbins (2009) Canada²³	To describe the intervention of the knowledge mediator and reflect on the future development of the role in public health, as well as in other health settings.	Randomized controlled trial	Single	Local facilitators
McGowan (2010) Canada²⁴	To describe the process and lessons learned from developing and operating a rapid response library consultation service for primary care physician.	Qualitative study - interviews	Single	Educational outreach
Armstrong (2010) Australia²⁵	To describe how interdisciplinary Knowledge Networks can support knowledge translation into practice.	Descriptive study	Single	KT Networks
Goldman (2010) Canada²⁶	To examine the interprofessional protocol development process and pilot implementation.	Exploratory case study	Single	Educational material
Labrecque (2010) Canada²⁷	To evaluate continuing medical education articles for mention of evidence-based information about benefits and harms of available treatment and/or preventive options.	Cross-sectional study	Single	Educational material
Dolor (2011) USA²⁸	To develop an open access website that provides adaptable resources to facilitate best practices.	Cross-sectional study	Single	Website
Estrada (2011) USA²⁹	To determine the effectiveness of a web-based education and implementation intervention to improve diabetes control.	Cluster randomized trial	Multiple	Training and feedback
Souza (2011) Canada³⁰	To review randomized clinical trials evaluating the effects of computerized clinical decision support systems for primary preventive care.	Systematic review	Single	Website
Tieman (2012) Australia³¹	To describe two strategies used to assist those who work in primary care in the care for their patients who have palliative care needs.	Descriptive study	Multiple	Website
Hofmeyer (2012) Canada³²	To discuss a decision-maker-researcher partnership that investigated practice in primary care networks in Alberta.	Descriptive study	Single	KT Networks
LaRocca (2012) Canada³³	To identify the effectiveness of knowledge translation strategies used to promote evidence-informed decision making among public health decision makers.	Systematic review	Multiple	Website and Educational material
Bailie (2013) Australia³⁴	To describe the Partnership Learning Model in Primary Care and the successes and challenges in its application.	Descriptive study	Single	KT Networks
Liddy (2013) Canada³⁵	To provide an overview on practice facilitators.	Descriptive study	Single	Local facilitators
Barreto (2013) Brazil¹	To describe the experience of the Nucleus of Evidence in Health.	Descriptive study	Single	Educational material
Dadich (2013) Australia³⁶	To determine what works to facilitate evidence-based sexual health in the primary care unit.	Cross-sectional study	Multiple	Educational material and Training
Ryan (2013) Canada³⁷	To use a knowledge-to-practice intervention for primary care teams to help professionals develop their capacity to care for frail elderly people.	Non-randomized intervention trial	Multiple	Website, Educational material and Local facilitators
Armstrong (2013) Australia³⁸	To describe the design and implementation plan of a knowledge translation intervention for public health decision-making.	Cluster randomized controlled trial	Multiple	Educational material and Training
Bernhardsson (2014) Sweden³⁹	To evaluate the effect of a intervention for implementation in primary care physical therapy in western Sweden.	Non-randomized intervention trial	Multiple	Websiteand Educational material
Pluye (2014) Canada⁴⁰	To explore whether stimulated family physicians’ feedback could further optimize research-based information delivered via email.	Cross-sectional study	Single	Feedback
Giguere (2014) Canada⁴¹	To measure the value and intent of using decision boxes in practice and describe barriers and facilitators to their use.	Mixed methods implementation study	Single	Educational material
McColl (2015) Canada⁴²	To design and test an innovative methodology to translate the latest and best evidence on spinal cord injury for family physician to use in practice.	Mixed methods	Single	Educational material
Badran (2015) Canada⁴³	To explore the advantages and disadvantages of educational email alerts.	Qualitative descriptive study	Single	Educational material
Redaèlli (2015) Germany⁴⁴	Identify the best strategies for implementing an asthma guideline.	Non-randomized controlled study	Single	Training
Clark (2015) Canada⁴⁵	To assess the impact of telephone consultations between pain specialists and primary care physicians in the care of patients with chronic pain.	Pragmatic randomized trial	Single	Educational outreach
Naik (2015) USA⁴⁶	To describe the process of building a partnership between a research team and a community of primary care providers.	Community-based participatory research	Single	KT Networks
Siron (2015) Canada⁴⁷	To describe the current state of research on knowledge transfer strategies to improve public health in low-income countries.	Scoping review	Multiple	Training, Educational material and Local facilitators
Perrier (2015) Canada⁴⁸	To describe the development and pilot testing of an shortened systematic review format for use by physicians.	Mixed methods study	Single	Educational material
McIntyre (2016) Australia⁴⁹	To report how the Primary Health Care Research and Information Service operates to accelerate the use of research and evidence in primary healthcare policy and practice.	Descriptive study	Single	Website
Carroll (2016) Canada⁵⁰	To determine the value of Gene Messengers as a continuing education strategy in genomic medicine for family physicians	Non-randomized study of interventions	Single	Educational material
Gupta (2016) Canada⁵¹	To evaluate a knowledge translation intervention to address both the poor quality of spirometry and the underuse of spirometry in primary care.	Prospective study	Multiple	Training and Educational outreach
Grudniewicz (2016) Canada⁵²	To understand what design and content attributes primary care physicians perceive as key to increase acceptance of printed educational materials and their ease of use.	Qualitative study - focus group	Single	Educational material
Oelke (2016) Canada⁵³	To describe the use of dialogic methods as a participatory knowledge translation approach to promote integration of nursing professionals in primary healthcare settings.	Intervention study	Single	KT Networks
Davis (2017) USA⁵⁴	To explore what clinic and community users want from intervention toolkits and identify factors that support application in practice.	Qualitative study - focus group	Single	Educational material
Morténius (2017) Sweden⁵⁵	To analyze the role of strategic communication in raising awareness and interest in research and development among dental professionals and compare findings with primary care professionals.	Intervention study	Multiple	Educational material, WebsiteandPublic promotion
Wang (2017) China⁵⁶	To determine the effectiveness of a nurse-led education and knowledge translation programme.	Cluster randomized controlled trial	Single	Training
Cornick (2018) South Africa⁵⁷	To describe the lessons learned during the development of the Practical Approach to Care Kit (PACK).	Descriptive study	Single	Educational material
Wattrus (2018) Brazil⁵⁸	To describe the adaptation and implementation of the Practical Approach to Care Kit (PACK) in Brazil.	Descriptive study	Single	Educational material
Vedel (2018) Canada⁵⁹	To discover conditions associated with change in primary care practice following passive dissemination of recommendations for the diagnosis and management of Alzheimer’s disease and related dementias.	Mixed methods study	Single	Educational material
Schütze (2018) Australia⁶⁰	To assist primary care physicians and nurses to better understand, diagnosis and management of dementia in primary care.	Cross-sectional study	Multiple	Training
Klaic (2018) Australia⁶¹	To enhance uptake of evidence-based practices with allied health professionals.	Mixed methods study	Single	Training
Anderson (2019) Australia⁶²	To report on the development and feasibility study of Stepped Care, a scaled online mental health service.	Cross-sectional study	Single	Educational outreach
Fritz (2019) Sweden⁶³	To explore the mechanisms of impact on implementing a behavioral medicine approach in physiotherapy by examining the dose, scope and experiences of participants.	Mixed methods study	Multiple	Educational material, Training andPublic promotion
Brimble (2020) Canada⁶⁴	To evaluate the impact of the launch of the Kidney Wise toolkit on the characteristics of primary care nephrology referrals.	Prospective study	Single	Educational material
Barbosa (2020) Portugal⁶⁵	To describe the development of the Prevention and Management Program.	Descriptive study	Single	Website
Casey (2020) Australia⁶⁶	To evaluate the effectiveness of a nation-wide Continuing Medical Education.	Prospective study	Single	Training
Gattellari (2020) Australia⁶⁷	To evaluate an intervention to improve anticoagulation uptake in patients with atrial fibrillation.	Randomized controlled trial	Multiple	Training and Feedback
Kjaergaard (2020) Kyrgyzstan and Vietnam⁶⁸	To evaluate whether carrying out the same training program in two contextually different countries would lead to differences in translating increased knowledge into clinical change.	Prospective study	Single	Training
Stander (2020) South Africa⁶⁹	To develop and test a tailored training program.	Mixed methods study	Single	Training
Howie (2021) Canada⁷⁰	To test whether printed educational materials improve care on a larger scale within usual primary care clinical practice.	Cluster randomized controlled trial	Single	Educational material
Minian (2021) Canada⁷¹	To evaluate the effectiveness of generic and email-only prompts versus a custom remote knowledge broker.	Cluster randomized controlled trial	Single	Educational material
Phillips (2021) USA⁷²	To evaluate how primary care professionals use general health care reports and primary care research and how well the reports provide what they need to inform clinical practice.	Cross-sectional study	Single	Educational material

Facilitators	Barriers
Evidence-based teaching in undergraduate courses²⁰	Lack of portable devices or internet access in the workplace²⁴
Research agenda informed by the professional working in PHC²¹	High demand for healthcare services²⁹^,³⁶^,⁶³^,⁶⁵
Research in partnership²⁵^,³²^,⁴⁶^,⁵⁷	Resistance to change²⁶
Local facilitator who adapts the main messages of the research evidence to the local perspective²³^,³⁵^,³⁷	Lack of managerial support⁶³
Bond with the community studied⁽³²⁾	Lack of resources to implement the recommended translation strategies⁴⁷^,⁶⁵
Creation of research networks to share information²¹^,³⁸	Shortened or intensive training courses⁴⁷
Adapt the research according to the context⁴⁶^,⁴⁷	Systematic reviews without practical information³³^,⁴⁸
Shortened recommendation guides⁴⁸^,⁵²^,⁵⁴

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[TFN1] Source: Research data, 2022.

Educational material (n=28)	1.Multiprofessional protocols, synthesis of evidence, scientific abstracts sent by email, posters and printed leaflets, recommendation guide (guidelines).
Training (n=16)	2.Workshops, online and face-to-face courses, seminars, practical training, peer training, interactive lectures, and case discussions.
Website (n=10)	3.Website (with resources from project design to dissemination), website with customized material, website of the Service of Research and Information on Primary Health Care, automated search in PubMed, computerized systems to support clinical decisions.
Educational outreach (n=6)	4. Assistance to the librarian, telephone consultation with specialist, continuous guidance from specialists (online, e-mail, telephone, or in-person).
Knowledge translation networks (n=6)	5. Creation of networks to connect researchers, service providers, funding bodies and consumers, such as practice-based research networks or research networks.
Local facilitators (n=5)	6. Health practice facilitators.
Feedback (n=3)	7. Performance feedback and constructive feedback on research outcomes.
Public promotion (n=2)	8. Research seminars and promotion visits.