Brief Report
Allied health usually comprises physiotherapy, occupational therapy,
speech and language therapy, and clinical nutrition 1.
Research into knowledge translation (KT) in allied healthcare has lagged
behind medicine, however KT intervention studies in allied healthcare
generally report significant positive effects for behavioural change.
They unfortunately have low methodological quality and rigor, and are
influenced by outcome reporting bias and poorly described interventions2–5.
For a successful KT intervention, KT strategies should address local
issues and barriers that may hinder regular application of
evidence-based practice 6. Local issues often relate
to the service delivery elements rather than strength of the evidence
(reported by WHO (2010) 7. Service delivery elements
include Workforce, Comprehensiveness, Resources, Continuity,
Coordination and Accountability. Therefore contextualised, tailored KT
strategies are needed to translate best-evidence approaches into local
clinical practice 6. The aim of this brief report is
to provide simple instructions regarding how to contextualise a training
programme for the uptake of clinical practice guidelines (CPG) for a
targeted audience in a clearly defined setting.
We previously published research on the development and validation
(content and utility validation) of a training programme targeted to
physiotherapists to educate them on the use of CPG in daily practice8. The development of the programme was underpinned by
the five-step Implementation of Change model 9.
Furthermore, it adhered to the template for intervention description and
replication (TIDiER) checklist for implementation intervention studies
to ensure a robust and rigorous development process10. The TIDiER checklist is an extension of the
CONSORT 2010 statement and included 12 items: “brief name, why,
what (materials), what (procedure), who provided, how, where, when and
how much, tailoring, modifications, how well (planned), how well
(actual) ” (p.1) 10. This training programme was
developed for a specific purpose, which was to write optimum content in
a way that met end-user-needs. We believe that the content of the
training programme is relevant to other healthcare professionals in
other settings. However, different end-user groups will have specific
needs and contextual factors influencing their participation in such a
training programme. Therefore, we recommend that the following steps be
taken in order to contextualise the training programme for the intended
target audience:
Clearly define the end-user group in terms of:
- What are their needs?
- What is their working environment: do they have internet access;
ability to take time off work to do the training; restrictions on
their ability to practice autonomously; high workload; etc.?
- Do they have an interest in CPG-uptake? Is the training important
enough for them to make time to engage with the programme?
- Determine the barriers to CPG-uptake of the end-user group. Research
shows that most healthcare professionals have similar barriers to
CPG-uptake 11,12. However, it is the underlying
reasons for the barriers that need to be determined to ensure that
each barrier is carefully addressed during training13,14. It is only when actionable strategies to
overcome barriers are put into place, that these barriers will be
effectively addressed 8.
- What is the preferred learning style of the target audience? Specific
healthcare professionals have specific learning styles, for instance
nurses seem to learn by gathering and organising information and
through experiencing then reflecting on the situation15. Furthermore, occupational therapists also learn
through experiencing and reflecting on the situation and through
hands-on experiences 15,16. It is important to
design teaching programs using strategies that appropriately address
different learning styles. We have previously reported on the
preferred learning style of physiotherapists being active participants
in the learning activity that is underpinned with a strong theoretical
basis 17. This assisted us in determining which KT
strategies would be appropriate to ensure optimum learning of PTs17. Determining the preferred learning style of the
target audience, and tailoring training to it, will assist in
increasing the chances of successful implementation of CPG-uptake.
- Search for existing training programmes that conform to the TIDiER
recommendations, including whether the chosen training programme
material is readily available 10. Considering the
previously described steps, will you be able to use the programme in
its existing form, or can you ‘unpick’ the programme elements to
address most of your target audience’s needs?
- What will be the KT strategies that you will implement with your
chosen end-user group?
- Are you travelling to the group?
- What is the length of the training, content presentation? Will there
be online versus face-to-face sessions or both?
When determining the elements of potentially-relevant training
programme, start by identifying which components are fixed and which are
variable 18. Our published programme consisted of an
online and one-day face-to-face training – this constituted the fixed
component of the programme 8. The variable component
consisted of email support, a social media group with regular
interaction for a 2-month period post-training, and the use of a 2-page
printed summary CPG for daily referral 19.
- Identify a condition that is relevant to your target audience. The
search for current, quality CPGs addressing the identified condition.
During our study, we used a condition, commonly treated by PT: acute
and subacute low back pain. We searched for a CPG for this condition
to be used as a vehicle to teach the PTs how to implement CPG
recommendations into daily practice. After completing a comprehensive
online search, there was no contextualised CPG found for the South
African population. However, we identified three current, high quality
CPGs with which we developed a summary CPG document as a user-friendly
document to use as part of the training programme19. Whether you are adapting, adopting or
contextualising an existing CPG, it should fit the purpose of
providing a vehicle to show your audience where and how to source it
and how to use the document to increase evidence-based practice
behaviour 8.
- Finally, determine whether your training program is feasible for your
audience regarding cost, acceptability of the programme content,
likelihood that practice behaviour will change, and value placed on
the time spent completing the programme 8,20. This
may be achieved by piloting the programme on a small group of your
proposed target audience. Once the training programme is piloted, the
programme can be finalised for the full target audience.
- When determining which outcome measures to use, the implementalists
need to distinguish between implementation effectiveness and outcomes
(i.e. “the effects of deliberate and purposive actions to
implement new treatments, practices, and services ” (p.65)) from
treatment effectiveness and service outcomes (quality criteria of
healthcare: efficiency, safety, effectiveness, equity,
patient-centredness, timeliness) 21,22. As with most
KT intervention studies, ensure that you evaluate the programme for a
change in knowledge, skill and practice behaviour of the participants2–4. Furthermore, using mixed methods designs may
assist in understanding the participants’ perspective on the training
and how it influences their practice in addition to implementation
effectiveness 8,23.
- Ongoing training need to be considered to ensure continued
professional behaviour change 13. Ongoing training
may include social media groups for support and further research
evidence dissemination 24, activity behaviour
diaries 18, audit and feedback and journal clubs25.