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Theme 2: Determinants of knowledge use

2.1 Development of an International Consensus on KT Core Concepts and Terminology

Grimshaw, Straus, Chignell, Légaré
13-48 months
Researchers, Decision makers
MRC Phase:


The development of any scientific field is dependent upon a standardised language to describe core concepts to allow meaningful discussion and debate within the field and enhance the ability to conduct meaningful knowledge syntheses. Unfortunately we lack consensus on terminology relating to core concepts in KT science (relating to key contextual factors, intervention components, mediating mechanisms and effect modifiers). The confusion created by the lack of a standardized language was graphically demonstrated in a recent study we conducted with 33 applied research funding agencies in 9 countries that identified 29 terms used to refer to KT! There have been some attempts to standardize terminology in some areas such as a taxonomy of KT interventions,and key domains relating to behavioural determinants, however these have not been subject to discussion and validation within the international community. To date there has not been a forum for researchers from the KT and related research communities to develop consensus on core concepts and terminology.


  1. To establish an international consensus for terminology of core KT concepts using web-enabled discussion among relevant researchers; and
  2. To describe the development of an international e-network of KT researchers, interactions within the Network, the extent to which consensus is achieved and collaborations and activities generated through the Network.


Developing the consensus (0-36 mths)

We will establish an international e-community to develop a standardized terminology for core KT concepts using existing contacts of Network members, e-mail list servers (for example, KU-UC and CC-Info), and invitations to participate in the journal, Implementation Science. With colleagues with expertise in computer science and human factors, we will create and evaluate an e-environment to support this project. It will include a password protected discussion area and a public area for finalized definitions and summaries of the discussion. Using conceptual analysis of results from a systematic literature search and electronic discussion, domains for core concepts in KT (e.g. contextual factors, intervention components) will be identified. The literature search and e-discussion will used to standardize the domains and their definitions. In particular, proposed definitions will be posted to generate discussion and encourage revision. This portion of the website will be password-protected and researchers will be invited to register. Agreed terminology will be posted on the public website, published in relevant journals and provided to relevant stakeholders including funders, researchers and journal editors.

Evaluating the process (0-60 mths)

Prior to implementation of the electronic collaboration portal, an iterative cycle of usability testing will be completed with the target user group of researchers to ensure that the prototype technology meets their needs. 5 to 8 participants will be invited to participate in individual user testing, using the think-aloud process. They will be asked to use the technology to complete relevant tasks such as initiating discussion around the components of a KT intervention. Sessions will be audiotaped and the results analysed for common themes. A series of methods will be used to evaluate the impact of the technology on team collaborations and development of consensus documents. First, records of all online communications amongst participants will be recorded and analysed using qualitative methods. Second, a random sample of participants will be invited to participate in a series of semi-structured interviews throughout the 5 years of KT Canada to explore their experiences with this technology and their perception of its impact on collaborations. Third, we will compare this against the standard measures of collaborations including grants, publications, and training of graduate students.


This project will not only result in a standardized language for KT research but will also implement novel technology to achieve consensus and evaluate the impact of this technology on the resulting collaborations. If found to be of benefit, this technology will be made available to funders and other researchers.

2.2 Measuring Organizational Determinants of KT

Gagnon, Légaré, Ouimet, Sales, Estabrooks, Grimshaw
0-60 months
Researchers, decision makers
MRC Phase:
Community Partners:
Champlain HLIN


While it is not clear that all of the factors associated with behavior change can be measured, it appears increasingly likely that much of the variation in whether or not we observe behavior change is influenced at multiple levels (5,6). For example, patients (or consumers) are embedded in families, social networks, communities, municipalities, regions, and nations. And, providers are embedded in microsystems, teams, units, clinics, service lines, departments, organizations, industries, and sectors. In this project, we will focus on the organizational level, defining an organization as a formal group of people who work together under specified conditions with shared goals. More specifically, our focus will be on health care organizations.


  1. To systematically review the literature on conceptual frameworks, models and theories on organizational readiness to change with specific attention to tools or instruments designed to measure organizational readiness to change in the health care context;
  2. To produce a database of measurement tools for organizational readiness to change with key information about their properties and utility, and summaries for use by decision-makers and policy makers;
  3. To propose and test a comprehensive integrated tool to measure organizational readiness to change for health care organizations across Canada.


Phase 1:

We will convene a panel of experts on organisational behaviour to identify domains of organisational readiness that may impact KT.

Phase 2:

This will provide a framework for completion of a systematic review on organizational readiness models and tools for measuring organizational readiness to change. The review will include qualitative, quantitative and mixed-methods studies. Systematic reviews conducted by the team (7,8) and other systematic reviews in the field of health care innovation (9,10) will guide the methods. Standardised literature searches will be conducted on all relevant databases with the assistance of an information specialist. We will use specific scales to assess the quality of each type of designs, based on consensual criteria for quantitative (11,12), qualitative (13) and mixed-methods(14) studies. Studies published in English and French will be included. Selected articles will include a clear description of a theory, model or framework of organizational readiness AND report the use and testing of a tool to measure organizational readiness to change based upon these theories/models/frameworks. We will perform a quality assessment of the identified measures of organizational readiness to change using an existing checklist for assessing the various aspects of their validity and reliability.[15]

Phase 3:

A deliberative process[16] will be used to seek consensus amongst team members and a panel of experts in the field of organization science for a comprehensive conceptualization of factors influencing organizational readiness to change. The domains covered will be compared to those that were proposed by the consensus process in Phase 1. We will propose a set of valid and rigorous measurement tools that could be readily used in healthcare settings to assess the degree of readiness to change.

Phase 4:

Individual interviews and focus groups will be conducted with key stakeholders to explore the face and content validity of the proposed measurement tools and suggestions for improvement. Preparation work will be done in advance of the validity testing including determining access to appropriate hospital data and relevant accreditation data, developing sampling frames.

Phase 5:

The comprehensive measurement tool will be field tested in three different provinces during the fourth and fifth years of the project assessing its reliability and its convergent and discriminant validity. Validity assessment will be completed using data from hospital accreditations (CCHSA) and recent report cards from provinces that are involved with their use including Ontario and Quebec.


This project will result in the development and assessment of an integrated consensual tool to measure organizational readiness to change in health care organizations. The results will be useful to researchers, funders, health care managers and decision makers and will advance the understanding of the determinants of KT.


  1. Estabrooks CA, Midodzi WK, Cummings GG, Wallin L. Predicting research use in nursing organizations: a multilevel analysis. Nurs Res 2007;56:S7-23.
  2. Ferlie EB, Shortell SM. Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q 2001;79:281-315.
  3. Gagnon MP, Légaré F, Labrecque M, et al. Interventions for promoting information and communication technologies adoption in healthcare professionals. (Protocol) Cochrane Database of Systematic Reviews 2006;Issue 3. Art. No.: CD006093. DOI: 10.1002/14651858.CD006093.
  4. Gravel K, Legare F, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: A systematic review of health professionals' perceptions. Implement Sci 2006;1:16.
  5. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004;82:581-629.
  6. Kimberly JR, Evanisko MJ. Organizational innovation: the influence of individual, organizational, and contextual factors on hospital adoption of technological and administrative innovations. Acad Manage J 1981;24:689-713.
  7. Des Jarlais DC, Lyles C, Crepaz N. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health 2004;94:361-6.
  8. The Cochrane Collaboration. The Cochrane Collaboration open learning material for reviewers.
  9. Popay J, Rogers A, Williams G. Rationale and standards for the systematic review of qualitative literature in health services research. Qual Health Res 1998;8:341-51.
  10. Kmet L, Lee RC, Cook LS, et al, Alberta Heritage Foundation for Medical research (AHFMR). Systematic review of the social, ethical, and legal dimensions of genetic cancer risk assessment: AHFMR: Edmonton;, 2004.
  11. McDowell I, Newell C. Measuring Health. A guide to rating scales and questionnaires. New York: Oxford University Press, 1987.
  12. Okoli C, Pawlowski SD. The Delphi method as a research tool: an example, design considerations and applications. Inform Manage 2004;42:15-29.

2.3 Determining Research Knowledge Infrastructure for Health Care Systems

Lavis, Ouimet, Grimshaw, Gagnon
0-60 months
policy makers
MRC Phase:
Community Partners:
Health authorities in ON, AB, PQ


Physical and cognitive access to evidence are challenges to KT for policy makers and managers. Three primary KT approaches target health system managers and policymakers (Lavis 2006, Lomas 2007). The push approach includes activities undertaken by researchers to disseminate and transfer their research findings outside the scholarly community. Pull activities focus on the efforts by health system managers and policymakers to access and exploit research findings. Linkage and exchange activities focus on building and maintaining relationships between researchers and managers and policymakers where personal contact was found to be the most commonly cited facilitator of research use. We propose to study research knowledge infrastructures (RKIs) that include pull and/or linkage & exchanges components, but not push components, as we will solely focus on infrastructure found in research users' organizations.


To profile research knowledge infrastructure of regional health authorities and hospitals in Alberta, Ontario and Quebec to determine:

  1. what mix of components can a regional health authority or a hospital theoretically have in its RKI;
  2. what is the current state of knowledge regarding the effectiveness of these components; and,
  3. what is the mix of components these types of organization currently have in their RKI.


Environmental scan of current infrastructure internationally:

We will identify current models of RKIs in three jurisdictions -- namely France, the UK and the US. We will search the web sites of a purposive sample of health organizations in these two jurisdictions, with the sampling criteria to include size, age, and budgetary resources.

Scoping review:

We will conduct a preliminary assessment of the size and scope of the available literature on whether models (or specific components) of RKI are effective at fostering the use of research findings within health system organizations or have been associated with the use of research findings within health system organizations.

Semi-structured interviews:

We plan to conduct semi-structured interviews with a purposive sample of CEOs and library / resource centre managers in regional health authorities and hospitals in Alberta, Ontario and Quebec that employ a mix of health system organization governance arrangements (Alberta with strong regions and no hospital boards, Quebec with strong regions and weak hospital boards, and Ontario with nascent regions and strong hospital boards). The sampling criteria for the regional health authorities and budgets include size and budgetary resources. These interviews will serve to complete our identification of the range of different technology and organizational components that we might find in RKI. The interviews will also allow us to pre-test a first draft of a survey questionnaire and to identify the types of infrastructural needs these organizations have.

Cross-sectional survey:

We will survey a stratified random sample of both regional health authorities and hospitals in Alberta, Ontario and Quebec. Our survey instrument will measure whether or not each responding organizations have specific technology and organizational components in its RKI. The aim of the survey will be to profile RKI and to explore the association between organizational characteristics (e.g. size, age, and budgetary resources) and the mix of technology and organizational components included in RKI.

Intervention design, execution and evaluation in select health system organizations:

The environmental scan and scoping review will inform two parallel initiatives to design, develop and evaluate an RKI-strengthening intervention targeted at health system organizations in one or more of Alberta, Ontario and Quebec.


We anticipate that in year 5 we will prepare a proposal for a randomised trial to evaluate these two interventions in provinces across Canada.


  1. Cohen WM, Levinthal DA (1990). Absorptive capacity: a new perspective on learning and innovation. Administrative Science Quarterly;35(1), 128-152.
  2. Edwards P, Roberts I, Clarke M, DiGuiseppi C, Pratap S, Wentz R, Kwan I (2002). Increasing response rates to postal questionnaires: Systematic review. British Medical Journal; 324, 1183-1185.
  3. Innvaer S, Vist G, Trommald M, Oxman A (2002). Health policy-makers' perceptions of their use of evidence: a systematic review. Journal of Health Services Research & Policy;7(4), 239-244.
  4. Meso P, Smith R (2000). A resource-based view of organizational knowledge management systems. Journal of Knowledge Management;4(3), 224-234.
  5. Lavis J (2006). Research, public policymaking and knowledge-translation processes: Canadian efforts to build bridges. Journal of Continuing Education in the Health Professionals;26, 37-45.
  6. Lomas, J (2007). The in-between world of knowledge brokering. British Medical Journal;334, 129-132.