From research findings to broad scale change

Knowledge translation is a multidimensional concept that looks at the mechanisms, methods and factors that influence how evidence specifically, and knowledge more generally, is moved into use in the health system. [1] The interest in this field reflects awareness that research by itself will not improve outcomes for patients. It also acknowledges that there can be substantial gaps between what we know from the research evidence and what we do in the real world. [2]

Knowledge translation looks at the processes that affect how evidence is generated, communicated and utilised as well as barriers to the transfer and uptake of this knowledge. It pays particular attention to the actual contexts in which the knowledge will be used. [3] By determining the specific needs and issues of potential users of knowledge, more relevant and effective ways of researching, communicating and measuring health activities can be developed. [4] The central aim of KT has been simply defined as accelerating the benefits emerging from research. [5] The focus is on engagement and partnerships, dissemination and communication, and implementation process to support the integration and use of evidence and knowledge.

In common with EBP, knowledge translation begins with evidence and a need for change. However, KT efforts are often directed towards building a broader change than the knowledge and practice of an individual clinician. [5] In practical terms, EBP can be applied by individual clinicians while KT often requires a team approach to moving evidence into practice and service delivery.

There are hundreds of theories, models, and frameworks available to guide your KT program. Planning for implementation of broad scale change also benefits from an understanding of theories of change and approaches to change management. You can learn more on this in the Implementation section page on Understanding why things change.

Knowledge Translation (KT) is a broad concept that includes knowledge synthesis, dissemination or sharing of knowledge to inform practice and decision-making, as well as implementation or application of evidence to change or improve practice.

Within KT there are many distinct terms and activities that you are likely to come across including: [6]

  • Diffusion/Dissemination: This refers to the natural spread of ideas (diffusion) and deliberate efforts (dissemination) to target audiences with new knowledge.
  • Knowledge brokering: Where new partnerships are deliberately established or fostered to facilitate the transfer of knowledge.
  • Knowledge mobilisation: Originally introduced in Canada, knowledge mobilisation refers to getting "right information" to the "right people" in the "right format" at the "right time."
  • Translational research: This is the ‘bench to bedside’ process where pre-clinical research is moved closer to clinical application by conducting studies or trials in humans.
  • Implementation and Implementation science: Implementation focuses on facilitating the uptake of evidence-based interventions and practices. Implementation science is the study of processes and mechanisms required to promote the widespread and systematic uptake of research findings.

There are a range of KT theories, models and frameworks (TMF) that can be used to guide your approach to knowledge translation. [6,7] Before choosing which to use it is important to understand the purpose of each.

Translation theories

These describe and explain the ‘why’ of a particular KT phenomenon through the presence of interrelated concepts, definitions, and/or propositions. That is, how change occurs. Examples include: theory of planned Behaviour, Theory of Diffusion, Diffusion of Theory (Rogers).


These describe but do not explain the KT process. Models provide you with the steps required to translate research into practice. Examples of process models include: the Knowledge to Action model, Plan-Do-Study-Act (PDSA) model, Action Research, Collaborative model for achieving breakthrough improvement.


These provide a systematic way to assess what influences the outcomes (determinant framework) or provide a structure to evaluate what is happening (evaluation frameworks). Examples include: PARiHS, CFIR, Quality Improvement Framework, RE-AIM, Ottawa.

Selecting a model, theory, or framework

KT theories, models, and frameworks help guide activities addressing some or all of the following:

  • dissemination (including synthesis),
  • planning/design,
  • implementation,
  • evaluation, and
  • sustainability/scalability.

Many TMF do not cover all activities and many groups will draw on more than one model to guide a project. Full-spectrum TMFs cover all categories. They can be used to guide part or all of KT activity. An extensive review of published literature to 2016 identified 159 theories, models, and frameworks for cancer and chronic disease. [8] Given the relevance of this context to applications in palliative care, you could use the extensive descriptions in Strifler's [8] article of what is covered by each model to select a TMF depending on the specific needs of your project.

With so many models, theories, or frameworks available, deciding which to use can be difficult. Health Research Practice provides guidance and a webtool to help you choose from a list of dissemination and implementation models. To help you choose an appropriate model they are categorised based on:

  • Dissemination and/or implementation models,
  • Socio-Ecological levels e.g. community organisation, system, policy,
  • Constructs e.g. dissemination, health equity, outcomes, process, cost.

Key reading

Palliative care faces particular issues with regard to the translation of evidence from research to use. Its multidisciplinary nature means that there are different research paradigms and frameworks. There are challenges in defining outcomes and in establishing outcome measures. Palliative care is provided in many different settings adding to the difficulty in developing effective communication and dissemination strategies. Most health professionals will require some understanding and familiarity with palliative care practice. Many palliative care providers do not work only in palliative care, meaning that palliative care research competes with the findings of other fields and specialties. There may also be resistance to changing practice and a belief that reliance on evidence will undermine the care concepts that have driven the development of palliative care. By recognising these considerations, we can start to develop processes and approaches that support change and development in the field and enhance patient and family outcomes.

Of the full-spectrum theories, models, and frameworks examined by Strifler only five had been applied in end of life: Action research, Collaborative model for achieving breakthrough improvement, PDSA, and Re-AIM. [8]

Since then, the Evidence-based Model for the Transfer and Exchange of Research Knowledge (EMTReK) has been developed for palliative care. [9] Developed in Ireland, “EMTReK works by highlighting the six primary components of knowledge transfer: the message; various stakeholders; multiple processes; the local context; the wider social, cultural and economic context; and evaluation of the model.” Hearing how others have used KT models in end of life projects can also be helpful.

Learn more

Complete the CareSearch module on Knowledge Translation. This looks at how a clinical team uses the Knowledge to Action cycle to improve outcomes for their patients. This module was developed for the Centre for Research excellence in End of Life Care.

Consideration of cultural influences is a recognised part of effective communication in health care, with culture directly influencing health-related values, beliefs, and behaviours. [10] These factors are central to evidence based practice and the partnerships required to implement change. Culture can also influence ‘whether a person thinks care is even needed. [11] This can be true for both clients and providers of care.

In a review of palliative care service delivery to Indigenous communities, culture was found to be a central theme and led services to focus on family involvement in care, respect for traditional practices, and development of culturally appropriate educational resources and materials. [12] Successful service models were those that adapted to local contexts and included family involvement and community ‘buy-in’.

Communication of evidence and knowledge is central to KT. However, few KT strategies formally consider cultural influences. Where they do it often centres on organisational culture in terms of leadership or support for change and innovation. In this context culture is often seen as a barrier or problem.

Ødemark suggests that consideration of culture in KT strategies might bridge the gap between medicine and social/human sciences to achieve the goal of enhancing the flow of knowledge. [13]

Despite many groups highlighting the promise of cultural influence to improve acceptance and uptake of health care, it is still an emerging KT field.

Beginning with what knowledge translation or exchange means to a community can help. The Lowitja Institute video describes gamma, an Australian Aboriginal metaphor for how Aboriginal and Western knowledge mixes to create new knowledge.

Understanding the likely influences of culture might also help you to see how they could be harnessed to improve KT efforts. For example, in many cultures story telling is an accepted and expected approach to sharing information and might be incorporated as part of dissemination efforts.

In addition to culturally sensitive translation of information, greater community participation from the outset and use of visual media and community gatherings can all help with cross-cultural KT. [14]

People with palliative care needs are shaped by many backgrounds. This includes diverse cultures, languages, genders, experiences, and where and how we live. When this diversity brings together multiple barriers to care this is referred to as 'intersectionality'. This can make accessing care even harder. When planning and implementing KT strategies acknowledgement of intersectionality and taking deliberate steps to address this can help to bring about inclusive change that benefits everyone. The Intersectionality Knowledge Translation Reflection booklet can help you with this as part of your KT project.

KT Implementation is an evidence-based process

The field of KT implementation has evolved over many years and led to the development of numerous models to guide activities. The following video features a seminar from Dr Melanie Barwick and provides practical insights into the core KT activities of implementation and dissemination, the effort required, and how our understanding about engaging with KT has changed since its first inception.

Tell us what you think

Please tell us about any palliative care specific challenges that palliative care health professionals or services may face in implementing evidence into practice.

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  1. Sudsawad P. Knowledge translation: Introduction to models, strategies, and measures. Austin, TX: Southwest Educational Development Laboratory, National Center for the Dissemination of Disability Research; 2007.
  2. Davis D, Evans M, Jadad A, Perrier L, Rath D, Ryan D et al. The case for knowledge translation: shortening the journey from evidence to effect. BMJ. 2003 Jul 5;327(7405):33-5.
  3. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581-629.
  4. Grol R, Wesling M, Eccles M, editors. Improving patient care: The implementation of change in clinical practice. Oxford: Elsevier; 2005.
  5. Salbach NM. Knowledge translation, evidence-based practice, and you. Physiother Can. 2010 Fall;62(4):293–7.
  6. Barwick M, Dubrowski R, Petricca K. Knowledge translation: The rise of implementation (1.32MB pdf). Washington, DC: American Institutes for Research. 2020 Nov.
  7. Esmail R, Hanson HM, Holroyd-Leduc J, Brown S, Strifler L, Straus SE et al. A scoping review of full-spectrum knowledge translation theories, models, and frameworks. Implement Sci. 2020 Feb 14;15(1):11. doi: 10.1186/s13012-020-0964-5.
  8. Strifler L, Cardoso R, McGowan J, Cogo E, Nincic V, Khan PA et al. Scoping review identifies significant number of knowledge translation theories, models, and frameworks with limited use. J Clin Epidemiol. 2018 Aug;100:92-102. doi: 10.1016/j.jclinepi.2018.04.008. Epub 2018 Apr 13.
  9. Payne C, Brown MJ, Guerin S, Kernohan WG. EMTReK: An Evidence-based Model for the Transfer & Exchange of Research Knowledge-Five Case Studies in Palliative Care. SAGE Open Nurs. 2019 Jul 26;5:2377960819861854. doi: 10.1177/2377960819861854.
  10. Betancourt JR, Green AR, Carrillo JE. The patient’s culture and effective communication [Internet]. Up To Date Inc; 2022 [updated 2021 Nov 21; cited 2022 May 13].
  11. Substance Abuse and Mental Health Services Administration. Illness Management and Recovery: Getting Started with Evidence-Based Practices. HHS Pub. No. SMA-09-4462, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services; 2009.
  12. Shahid S, Taylor EV, Cheetham S, Woods JA, Aoun SM, Thompson SC. Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: a comprehensive review. BMC Palliat Care. 2018 May 8;17(1):72. doi: 10.1186/s12904-018-0325-1.
  13. Ødemark J, Engebretsen E. Challenging medical knowledge translation: convergence and divergence of translation across epistemic and cultural boundaries. Humanit Soc Sci Commun. 2022;9:71. doi: 10.1057/s41599-022-01088-6. Epub 2022 Mar 4.
  14. Elliison C. Indigenous Knowledge and Knowledge synthesis translation and Exchange (KTSE) (1.08MB pdf). Prince George, BC: National Collaborating Centre for Aboriginal Health. 2014.

Last updated 23 May 2022