Chris Lovato

Background:Population health evidence suggests a broad range of contexts for the use of knowledge. Researchers identify the need for new services, and they suggest ways to prevent exposure to known harm, often through public policy or structural changes. These suggestions are often beyond the funding and mandates of existing health service organizations. There is still limited guidance to inform knowledge translation when implementation requires collaboration between multiple institutions or where the use of knowledge calls for new resources or infrastructure.Method:This research investigates context-informed knowledge translation to improve population health. It collects and analyzes interview data from experienced knowledge translation practitioners in a case study organization that seeks to promote universal programs and public policy to improve health at a population level. Knowledge translation is examined at two levels, first at an organizational level and then in two sub cases that represent divergent knowledge products and different contextual barriers and opportunities. Qualitative analysis is used to investigate the range of approaches used and the rationale for the use of specific approaches in different contexts.Discussion:Findings suggest that there are identifiable links between the nature of contextual challenges and the approaches used in the case study. Challenges for knowledge translation can be conceptually divided into three categories: 1. Ensuring reach and understanding, 2. Ensuring capacity for implementation, and 3. Ensuring that those positioned to act effectively on the knowledge are motivated to do so. Findings suggested that the categories of approach used by knowledge translation practitioners correspond with the nature of identified challenges: exchange and transfer of information to build awareness and understanding, processed focused approaches to build implementation capacity, and strategic approaches to persuade or motivate uptake.Findings operationalize knowledge, context, and facilitation in ways that can be used in further study of conditions where knowledge translation may need to build capacity or motivation to advance the use of reliable knowledge. Practitioners can use the proposed categories to identify context specific challenges and can then draw from the hierarchically structured menu of approaches to build theories of change that can plausibly address them.

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The overarching purpose of this study was to explore the implementation of an innovation in the North American quitline network using qualitative data and a systems approach. The innovation chosen to explore in more depth was evaluating effectiveness of the tobacco cessation quitlines. The three research questions guiding the study were 1) What are the factors influencing implementation of the innovation, 2) How do system structure and dynamics impact implementation of the innovation, and 3) What strategies can be used to achieve successful implementation of the innovation. To answer the research questions, 19 semi-structured interviews were conducted with decision-makers in the quitline network. The interview data were analyzed using a thematic analysis technique and a systems change framework from the literature. The findings suggest that there were a broad range of factors influencing implementation of the innovation at multiple levels of the system. The findings also provide insights into how differences in quitline structure and system dynamics influenced implementation of the innovation. Lastly, these findings were used to identify potential strategies and provide recommendations to improve future implementation efforts in the quitline network.

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