Background
Methods
Aims of the co-KT framework
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Produce community-based knowledge for application within and by the community to increase the effectiveness of health service delivery and health outcomes for agreed priority groups, and in an integrative, cross-disciplinary way.
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Allow for the community-based adaptation of externally derived knowledge to local health issues guided by the research team.
The study context (or research setting)
Evidentiary inputs
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A purpose designed health census [12]
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Subsequent surveys of those persons reporting specific prevalent conditions in the foregoing health census and consenting to be re-contacted
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Focus groups with service providers.
Community engagement
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Face to face discussions with local service providers
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Face to face discussions with the residents (that is, the potential service user population).
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Engagement of policy administration, and regional governance bodies.
Establishing linkages with the community
Basis of co-KT framework
Co-create KT Step | Knowledge sought | Tool(s) | Strategies |
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Step 1: Initial contact and framing the issue.
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Contact between the study context and research context occurs in response to a broadly phrased issue.
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Information from the study context that covers a broad spectrum within the issue(s).
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Data gathering tool(s) that will generate a pool of information from which subsequent inquiries can be refined.
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View research as a means and not an end.
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Establish a KT research lead and advisory team within the study.
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Identify persons in both contexts as points of contact and information.
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LINKIN EXAMPLE
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Issue: What is the health status of the people in Port Lincoln and how do they utilise health services?
| Researcher context made initial inquiry of population-wide incidence of conditions. | Quantitative data tool: | Appointment of 3 boundary spanners. |
Health Census – a written structured survey to population of study context via households. | |||
Inclusion of local people as part of the Health Census operational delivery team. | |||
Use of varied media to convey information about the research Create a presence and identity by participation in local public events. | |||
Step 2: Refining and testing
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Research team lead the knowledge refinement process (of data and local evidence into context-relevant knowledge) by obtaining the perspectives of multiple stakeholders.
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Contextual information to interpret the quantitative data.
Qualitative data on defined aspects of the initial issue.
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Community engagement strategies, participatory action research, information and knowledge products, communication strategies.
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Use of an action research approach to methodically explore a problem within a designated context.
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Use of facilitators, connectors, boundary spanners, knowledge brokers.
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LINKIN EXAMPLE
Selection of four key issues such as specific health conditions and health service user groups in Port Lincoln.
Comparison of information gathered with other data sources such as national surveys.
| Validation and explanation from the study context of the Health Census results. Knowledge that was related to the condition types nominated for further research. Knowledge on equity of experience within the study context. Knowledge on social determinants. Computer Assisted Telephone Interviewing (CATI) results to be communicated to stakeholders and provide opportunity for input. | Production of recorded source data into accessible forms for the community (newsletters, project website, local radio, local newspaper, printed copies of data presentations). Consultation strategy that included identified stakeholders (health service providers, residents, and key organisations). CATI (telephone) survey to ‘Health Census recontactees’ to obtain more condition specific information from study context. | Boundary spanners. Large scale campaign Community meetings Opportunities for open discussion (eg library). Focus groups. Creation of knowledge products (newsletters, webpages, hard and electronic copies of data presentations). Use of varied media channels (radio, newspaper, internet). |
Step 3: Interpreting, contextualising and adapting
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Local evidence is refined and tested against the existing evidence. Contextual information is incorporated into the evidence base to provide a basis for adapting the knowledge to form the basis for intervention ‘prototypes’ to be introduced and tested in the study context.
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Customising intervention for practitioners involved.
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Methods of developing and/or canvassing options with those stakeholders affected.
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Feedback to study context of interpretation of evidence base.
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Development of options to address the issues.
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Agreement on interpretation of implications of knowledge base. Identification and prioritisation of key aspects to address.
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Part of the process of making knowledge useful: interpretation, negotiation, debate. The knowledge needs to be linked or related to what is already known or experienced within the community.
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Audit and feedback mechanism to providers participating in the intervention development.
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Participant observation, Questionnaires, Interviews, focus groups.
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LINKIN EXAMPLE
| What stakeholders think of current recommended best practice. | Questionnaires | Reference Bone and Joint literature review. |
For the Bone and Joint condition group
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Knowledge used to select features that will be addressed through pilot interventions. | Interviews, focus groups. | ||
This step would involve the development of an intervention(s) that takes up community-based knowledge and is includes shaping by agents and participators within the context. The LINKIN study has not defined its interventions as yet.
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Dialogue with stakeholders during the development of the intervention. | |||
Perceived impact of intervention by study context. | |||
Step 4: Implementing and evaluating
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Involvement, trial uptake and response to interventions.
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Evaluation data.
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Communicate results and outcome of evaluation.
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Consultation and evaluation strategies.
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Extent and effectiveness of intervention uptake and implementation.
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Use of knowledge utilisation strategies.
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Use of knowledge utilisation measurement tools.
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Use outcome measures for each level of the health system: patient level, health practitioner level and system (or organisational) level.
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Community engaged in evaluating the interventions and modifications for ongoing use.
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Qualitative data on why an intervention was successful or not effective, and how it could be improved.
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LINKIN EXAMPLE
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An intervention will be evaluated in real-time to monitor its reception and response in the community. This step is framed by examining how we would define and resource the intervention.
| Knowledge about the features of the intervention to retain in sustained interventions. | Routinely collected data (such as from audits). | Use of knowledge broker role. |
Context appropriate responses to evaluation data and extent of agreement with evaluation data. | |||
Semi-structured discussion groups. | |||
An example could be how professionals might work better to facilitate referral pathways that work within Port Lincoln.
| Perceived impact and sustainability of intervention by study context. | ||
Establish an awareness of feedback being elicited at completion of evaluation. | |||
Step 5: Embedding into context and translating to other contexts
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Within the research context, evidence is formalised for local community and for the wider scientific community.
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Knowledge that is to be included in final and lasting knowledge products.
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Guidelines
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Communication strategies of research outcomes and ongoing plans.
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LINKIN EXAMPLE
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Following the intervention the research team leads consideration of how it might be sustained and in what form.
| How might this influence funding packages and reform taking place in primary care? | Discussion groups with key agents and participators from context. | Inform the national health agenda |
Use of guidelines and process documents. | |||
Elements of the intervention that are particular to this context and how adaptable the intervention is to other contexts. | |||
How does it lead to new research questions?
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Step 1: Initial contact and framing the issue
Step 2: Refining and testing
Evaluation
Step 3: Interpreting, contextualising and adapting
Evidence synthesis
Steps | Knowledge bases to conduct co-KT | Content and data analysis |
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Steps | ||
1
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First data collection set
| Conditions seen to impact on the population and key associated characteristics |
2
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Emergent consultation issues
| Informative issues raised by health services and residents |
3
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Further data collection
| More in depth understanding of population use of service providers and key concerns relating to health conditions of interest |
4
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Emergent consultation issues
| Informative issues raised by health services and residents |
5
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Application of knowledge: intervention development
| Features of the health system to address: |
Distillation of a range of health system features based on context related knowledge base formed through preceding steps. | ||
6
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Question: is there an intervention to...........[specify purpose]
| Agree on intent of potential intervention and explore wider evidence base and how interventions might be aligned with robust context related knowledge base. |
7
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Define outcome expectations
| Nominate specific outcomes of changes introduced |
Evaluation
Step 4: Implementing and evaluating
Evaluation
Step 5: Embedding into context and translating to other contexts
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a finished set of guidelines as to changes to be implemented as having arisen from the research study
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a communication strategy for research based products developed by the research team and made accessible to the study population
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study results will be communicated to the study context in the form of knowledge products developed to translate the research findings and face to face communications. It is also likely that the researcher context will produce other knowledge products such as written publications about outcomes, learnings and interventions for wider communication beyond Port Lincoln or in compliance with funding bodies.
Evaluation
Description of Co-KT Framework components and features
Knowledge
Knowledge products
Evidence
Context
Facilitation
Use of connectors
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Mediate between the two contexts and moderate, translate and explain knowledge
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Identify other people or resources to facilitate the study project
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Provide culturally specific information that allow for the appreciation of community traditions, symbolic behaviours or practices that may be relevant to improving population health outcomes [5].
Stakeholder engagement
Ethical issues
Discussion
Challenges
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Limited staff resources who will be concurrently engaged in information analysis and needing to prepare outcome based knowledge products to maintain momentum gained following data collection
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Engaging with busy health professionals at times that coincide with research steps and do not hold up the information gathering processes too long
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Cultivating local trust when seen to be inclusive of various stakeholders and building a ‘shared project culture’ [50]
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Achieving project timeframes when both community engagement and quantitative data analysis are features of the research design and can be time-consuming
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Avoiding ‘over consulting’ the community in fulfilling the need for both information collection and evaluation.