Introduction
Potential application of social constructivist theories in KT
Methods
Step one: research question
Step two: identifying relevant studies and study selection
Step three: charting the data
Step four: collating, summarizing and reporting the results
Results
Nature and distribution of the studies
First author (Year) | Main theme | Area of practice | Target population | Study design | Intervention/approach | Main findings | Theory described | Theory integrated |
---|---|---|---|---|---|---|---|---|
Abad-Corpa (2010)[44] | Design of a KT activity/intervention (to improve EBP in nurses and outcomes in patient) | Primary health care setting | - Nurses | Mixed (qualitative approach, quantitative analysis) | Focus groups (reviewed articles, videos, field diaries, statistics) | -Psycho-social adjustment | Yes | yes |
- Patients (with compromised immune system) | ||||||||
-Satisfaction with nursing | ||||||||
-Family burden | ||||||||
Adler (2002)[46] | Meaning of ‘evidence’, tension between research and practice | N/A | Focus on Physicians involved in research | Qualitative | Review of the literature and history of science | Reflection on the type of evidences to use in health research | Yes | N/A |
Appleton (2002)[47] | Meaning of ‘evidence’, tension between research and practice | N/A | Focus on Health services researchers | Qualitative | Review of the types of philosophical approaches and reflection on the implication for practice | Philosophical underpinnings of constructivism and relevance to researchers in health services | Yes | N/A but links with health research emphasized |
Carr (2005)[54] | Acquisition, expression and application of knowledge for professional practice | N/A | Focus on nurses | Qualitative | Reflective/guidance elaboration | The interpretive paradigm provides one means of voicing nursing knowledge. | Briefly | N/A |
Caley (2010)[38] | Design of a KT activity/intervention | Health and human services organization | Health and Human service professionals | Intervention | Workshop on alcohol dependence screening, survey | Number of interventions implemented | Yes | Yes |
Cronin (2007)[45] | Design of a KT activity/intervention | Education (post-graduate training of health care professionals) | Post-graduate health promotion education | Intervention | Workshop on experiential learning, reflective practice, satisfaction survey | Student satisfaction | Yes in part | Yes |
Daley (2001)[39] | Acquisition, expression and application of knowledge for professional practice | Education (post-graduate training of health care professionals) | Social workers, lawyers, nurses, educators | Intervention | Post-graduate course followed by survey | Identification of key components that made knowledge useful | Yes | Yes |
Fagan(1998)[62] | To better understand clients, and their experiences/realities | Primary health care setting | Emergency nurses | Qualitative | Questionnaire | Perception of nurses regarding their roles in identifying child abuse | No | No |
Fairweather (2000)[61] | Learning in promoting professional expertise | Primary health care setting | Specialist nurses | Qualitative | Focus groups | Roles and attributes of specialist vs generalist nursing | Yes | Yes in part |
Felton (2003)[76] | Meaning of ‘evidence’, tension between research and practice | Community services | Mental health, social services, community services, hospital administrators involved in shelters and housing accessibility | Qualitative | Interview | Consensus on system-level concerns regarding involvement of outside agency in ‘Housing first’ projects | Yes | Yes |
Field (2004)[55] | Acquisition, expression and application of knowledge for professional practice | N/A | Focus on Nurses | Qualitative | Literature review | Importance of context in learning and difficulty of transferring knowledge to different context | Yes | N/A |
Fonville (2002)[53] | Acquisition, expression and application of knowledge for professional practice | Primary health care setting | Nurse executives | Qualitative | Interview | Nursing are more loyal to their professional than their organizational entity, unaware of ethics principles, need for reflective learning. | Yes in part | Yes |
Greenhalgh (2006)[65] | Design of a KT activity/intervention | Education (post-graduate training of health care professionals) | Senior professionals: senior partners in general practice, postgraduate tutors, service managers | Online course | Student Course Evaluation | Web-based learning offers potential for students to engage in rich and effective construction of knowledge. | Briefly | No |
Greenslade (2010)[63] | To better understand clients, and their experiences/realities | Primary health care setting (same-day surgery) | Breast cancer surgery patients | Qualitative | Interview | Follow-up visit for assessment, education, and psychosocial support recommended. | No | No |
Higgs (1995)[56] | Acquisition, expression and application of knowledge for professional practice | N/A | Focus on Physical Therapists | Qualitative | Literature review | Knowledge is an active and dynamic phenomenon undergoing constant changes and testing | Yes | N/A |
Holtslander (2008)[77] | Acquisition, expression and application of knowledge for professional practice | N/A | Focus on palliative nurses | Qualitative | Reflective paper | Exposition of the ways to acquire knowledge and the nursing model in palliative setting | Briefly | N/A |
Hoshmand (1992)[52] | Meaning of ‘evidence’, tension between research and practice | N/A | Focus on psychological Sciences | Qualitative | Literature review | Emphasis on broadened choices of research methods, the development of reflective skills, and better linkage between teaching in the domains of research and practice are urged. | yes | N/A |
Hunter (2008)[40] | Design of a KT activity/intervention | Education (post-graduate training of health care professionals) | Nurses | Intervention | Course and Student Course Evaluation and students’ cultural competence levels evaluations | Students’ comments were all positive or politely constructive, their competency increased. | Yes | Yes |
Kinsella (2010)[57] | Acquisition, expression and application of knowledge for professional practice | N/A | Focus on practice in nursing, health and social care professions | Qualitative | Reflective paper | Discerning philosophical underpinnings of reflective practice to advance increasingly coherent interpretations | Yes | N/A |
Labonte (1996)[48] | Meaning of ‘evidence’, tension between research and practice | N/A | Focus on health promotion | Qualitative | Literature review | A ‘constructivist’ research paradigm has the potential to resolve some of the tensions between research and practice in health promotion | Yes | N/A |
Lipman (2005)[59] | Acquisition, expression and application of knowledge for professional practice | Primary health care setting | Physicians researchers in anticoagulation in patients with atrial fibrillation | Qualitative | Interviews | Implementing research evidence is more complex than in suggested in current models of evidence-based medicine | Yes | No |
Lyddon (2006)[78] | Acquisition, expression and application of knowledge for professional practice | Focuses on counselling (mental health services) | Focus on Psychology | Qualitative | Literature review / reflection | Emerging research strategy in self confrontation method, proven to be a useful procedure for practitioners in counseling settings | Yes | Yes |
McGuckin (2006)[58] | Acquisition, expression and application of knowledge for professional practice | Not expressed, but most probably mental health services since focus is on psychiatry | Focus on Psychiatry | Qualitative | Literature review / reflection | An eclectic approach that combines elements of the directed approach and the constructivist approach seems warranted | Yes | N/A |
McWilliam (2009)[79] | Meaning of ‘evidence’, tension between research and practice | Home care programs | Service providers, case managers, administrators, researchers | Qualitative | Action groups to implement KT through social interaction | Sharing accountability for implementation is challenging for achievement-oriented researchers and quality health care practitioners | Yes | Yes |
Miller (2002)[50] | Meaning of ‘evidence’, tension between research and practice | Not expressed, but most probably mental health services since focus is on psychiatry | Focus on trauma- psychiatry researchers | Qualitative | Literature review / reflection | social constructivism can serve as a bridge between researchers and practitioners by refocusing research efforts to the needs of war-affected communities | Yes | N/A |
Neimeyer (1998)[80] | Acquisition, expression and application of knowledge for professional practice | Mental health services since focus is on psychiatry | Focus on Psychology-counselling services | Qualitative | Reflection on the literature | Discusses the theories of SC that may support the importation of this theory into the counselling context | Yes | N/A |
Plack (2005)[49] | Meaning of ‘evidence’, tension between research and practice | N/A | Focus on Physical Therapy | Qualitative | Literature review | PT research should shift its focus from mainly positivism to include constructivism and critical theory for practitioners to better use the evidence | Yes | N/A |
Rogal (2008)[41] | Design of a KT activity/intervention | Education (post-graduate training of nurses) | Graduate nurses in a Problem-based learning session | Intervention | Course and Satisfaction about education program | Step-by-step guide of constructing a problem based learning package for large, single session groups | Yes | Yes |
Rogers (2011)[64] | Design of a KT activity/intervention | Primary health care setting | Surgeons and Nurses in OR teams | Qualitative | Focus groups on team conflict | Source of conflict are mainly task-related and concern equipment needs and scheduling. Misattribution and harsh language cause conflict transformation | Very little | Yes |
Rolloff (2006)[81] | Acquisition, expression and application of knowledge for professional practice | Education (professional training of nurses) | Focus on Nurses | Qualitative | Literature review | A constructivist approach to the baccalaureate nursing curriculum for evidence based practice | Yes | Sometimes referred to |
Smith (2007)[42] | Design of a KT activity/intervention | Primary health care setting | Nurses | Intervention | Compare 2 instructional design strategies in pain management | Constructivist design took more time, no difference between constructivist and traditional design, learner satisfaction with online experience | Yes | Yes |
Schluter (2011)[60] | Acquisition, expression and application of knowledge for professional practice | Primary health care setting | Medical and surgical nurses | Qualitative | Interviews | Limits of scope of practice between different nursing practices | Yes | Yes |
Tilleczek (2005)[43] | Design of a KT activity/intervention | Education (post-graduate training of health care professionals) | Nurses | Intervention | Online course and survey | Increased knowledge and skills, confidence in daily practice. Learners appreciated flexibility of online learning | Yes | No |
Varpio (2006)[82] | Acquisition, expression and application of knowledge for professional practice | Primary health care setting | Physicians and nurses, both novice and experts using electronic patient records | Qualitative | Non participant observation and interviews | Electronic patient records were printed and the information modified, as it did not facilitate professional work activities. | No | No |
Wilson (2000)[51] | Meaning of ‘evidence’, tension between research and practice | N/A | Focus on biomedicine | Qualitative | Literature review / reflection | Biomedicine model, debate of effectiveness of objectivism approach in health care vs. subjectivist model, which includes the new emerging theory of SC | Yes | Yes |
Study design and N of studies | Method | Number of studies |
---|---|---|
Intervention (mixed experimental)
| Workshop or course followed by survey | 5 |
Comparison of different learning programs | 1 | |
[42] | ||
Mixed (qualitative and quantitative)
| Focus Group and quantitative analysis | 1 |
[44] | ||
Workshop and reflective practice/discussion | 1 | |
[45] | ||
Qualitative
| Action Group | 1 |
[79] | ||
Focus group | 1 | |
[64] | ||
Interview/Questionnaire | 8 | |
Observation/Interview | 1 | |
[82] | ||
Other
| Editorial Opinion Or Reflective paper | 5 |
Literature review | 11 | |
TOTAL 35
|
Practice settings | Number of studies |
---|---|
Primary health care setting | 10 |
Health, health promotion, and health services organizations | 2 |
Post-graduate education | 7 |
Mental Health services | 5 |
Mental health services, social, and community services | 1 |
[76] | |
Home care programs | 1 |
[79] | |
Not applicable | 9 |
Participants/professional groups | Number of studies |
---|---|
Nurses | 9 |
Nurses and patients | 1 |
[44] | |
Nurses and physicians | 2 |
Interdisciplinary team | 8 |
Physicians | 2 |
Health services researchers | 1 |
[54] | |
Physical therapists | 2 |
Psychology/psychiatry health care professionals and researchers | 5 |
Patients | 1 |
[63] | |
Post-graduate (health care professional training) | 4 |
Social constructivist assumptions
Primary author | Abad-Corpa, E[44] | Caley, L[38] | Cronin, M[45] | Daley, B[39] | Fagan, D[62] | Fairweather, C[61] | Felton, B[76] | Fonville, A[53] |
---|---|---|---|---|---|---|---|---|
Theory used
| Participatory action research design from a qualitative methodological perspective, using Checkland’s ‘Soft Systems’ theoretical framework | Participatory action research design | Rootman et al., Freire et al.
| Linking new to past experiences, probing deeply in past experiences | The research study was undertaken via a constructivist paradigm. | The study was guided by the methodology of constructivism. This approach to qualitative inquiry is based on the assumption that in order to gain an understanding of the social world we need to examine it from the perspective of those who arc the active participants in that world. | The case study described in this paper used a ‘constructivist’ methodology, that is, a research technique that utilizes key actors’ and close observers’ understandings and interpretations of the implementation (Guba and Lincoln, 1989). | Constructivist paradigm |
Aspects of theory used
| Social environment plays a critical role in the development of knowledge. | Social environment plays a critical role in the development of knowledge. | Social environment plays a critical role in the development of knowledge. | Learning is a result of the individual’s interaction with the environment | Cognitive dissonance as the stimulus for learning | Learning is a result of the individual’s interaction with the environment | Learning is a result of the individual’s interaction with the environment | Learning is a result of the individual’s interaction with the environment |
KTA phase
| Step 4: Select, tailor and implement intervention | Step 4: Select, tailor and implement intervention | Step 4: Select, tailor and implement intervention | Step 3: Assessing barriers and facilitators | Step 3: Assessing barriers and facilitators | Step 3: Assessing barriers and facilitators | Step 2: Adapting knowledge to local context | Step 1: Identify problem |
Primary author
|
Lipman, T[59] |
Smith, C[42] |
Tilleczek, K[43] |
Varpio, L[82] |
Greenslade, 2010[63] |
McWilliam, 2009[79] |
Rogers, 2011[64] |
Schluter, 2011[60] |
Theory used
| Constructivism approach | Learning Constructivism Theory | Contructivism approach - general | Constructivist grounded theory | Constructivist approach with in-depth interviews and comparative analysis to develop and systemically organize data into four major interrelated themes and a connecting essential thread. | Constructivism approach | A constructivist grounded theory approach was adopted for this study on the basis that it would allow for the use of sensitising concepts or guiding interests derived from the conflict literature, as well as an investigation of the features of conflict unique to the OR team. | Situated within a constructivist methodology that considered individual experiences, abilities, and knowledge in the construction of scope of practice |
Aspects of theory used
| Social environment plays a critical role in the development of knowledge. | Learning is a result of the individual’s interaction with the environment | Learning is a result of the individual’s interaction with the environment | Learning is a result of the individual’s interaction with the environment | Learning is a result of the individual’s interaction with the environment | Learning is a result of the individual’s interaction with the environment | Social environment plays a critical role in the development of knowledge. | Learning is a result of the individual’s interaction with the environment |
KTA phase
| Step 1: Identify problem | Step 4: Select, tailor and implement intervention | Step 4: Select, tailor and implement intervention | Step 3: Assessing barriers and facilitators | Step 3: Assessing barriers and facilitators | Step 1: Identify problem | Step 2: Adapting knowledge to local context | Step 3: Assessing barriers and facilitators |
Primary author
|
Adler, R[46] |
Carr, S[54] |
Field, D[55] |
Greenhalgh,T[65] |
Higgs, J[56] |
Holtslander, L[77] |
Hoshmand, L[51] |
Hunter, J[40] |
Theory used
| Theories and definitions of evidence based on Descartes, Locke's theory of ‘tabula rasa; Hume, von Uexkull - Merk-Mal theory; Ginzburg; Glaserfeld's understanding of constructivism in knowledge; clinical examples to illustrate models of organisms (Richter; Wolf and Wolff) | Highlights the potential value and contribution of hermeneutic phenomenology and constructivist approaches to exploring and knowing nursing as a means to addressing some of the practice learning challenges | learning is a mental process, in terms of the con-structivist view of learning or whether it owes more to enculturation into social processes as with the situated learning and legitimate peripheral participation approaches to learning | Although we believe the constructivist approach has general validity, it is particularly appropriate for the promotion of the knowledge and skills for knowledge translation. | In this paper, the critical question of knowledge as the underpinning of clinical practice is examined. The nature of knowledge is explored in this paper, with support being given to the constructivisit perspective | Constructivism | Constructivism (Berger and Luckmann, 1966; Bruffee, 1986; K. J. Gergen, 1985) calls for multiple paradigms of knowledge. The potential of multiple rationalities and methods of construction is recognized by the cognitive interpretation of science | Constructivist learning theory was an appropriate conceptual framework for the course as it acknowledges multiple, socially constructed truths, perspectives, and realities versus a single reality |
Aspects of theory used
| All 3 aspects | Learning is a result of the individual’s interaction with the environment | Social environment plays a critical role in the development of knowledge. | Learning is a result of the individual’s interaction with the environment | All 3 aspect | All 3 aspects | All 3 aspects | All 3 aspects |
KTA phase
| Knowledge creation: knowledge synthesis | Knowledge creation: knowledge inquiry | Knowledge creation: knowledge synthesis | Step 4: Select, tailor and implement intervention | Knowledge creation: knowledge inquiry | Knowledge creation: knowledge synthesis | Step 1: Identify problem | Step 4: Select, tailor and implement intervention |
Primary author
|
Kinsella, E[57] |
Labonte, R[48] |
Lyddon, W[78] |
McGuckin, C[58] |
Miller, K[50] |
Neimeyer, R[80] |
Plack, M[49] |
Rogal, S[41] |
Theory used
| The constructivist perspective is founded on the idea that humans actively construct their personal realities and create their own representational models of the world’ | This article argues further that a ‘constructivist’ research paradigm not only has the potential to resolve some of the tensions between research and practice in health promotion but also is inclusive of knowledge generated by the conventional paradigm. | Constructivism approach in general | Constructivist learning is based on an eclectic mix of ideas derived primarily from cognitive neuroscience including information processing theory. | Constructivism emphasizes the socially constructed nature of reality; it shifts attention away from the search for universal truths and toward an exploration of what is considered real within particular social contexts. | In sharp contrast to this worldview, social constructivism endorses a form of postmodernism (Anderson, 1990) that turns nearly every aspect of this modern psychological program on its head. Gone is the faith in an objectively knowable universe, and with it the hope that elimination of human bias, adherence to canons of methodology, and reliance on a pure language of observation would yield a ‘true’ human science, mirroring psychological reality without distortion. | The constructivist emphasizes the personal meaning made by the inquirer and the inquired. | Constructivism relates to the philosophy that the meaning of new learning is constructed upon current knowledge |
Aspects of theory used
| Cognitive dissonance as the stimulus for learning | Cognitive dissonance as the stimulus for learning | Cognitive dissonance as the stimulus for learning | Social environment plays a critical role in the development of knowledge | Learning is a result of the individual’s interaction with the environment | All 3 | All 3 | Learning is a result of the individual’s interaction with the environment |
KTA phase
| Knowledge creation: knowledge synthesis | Knowledge creation: knowledge synthesis | Knowledge creation: knowledge tools/products | Step 3: Assessing barriers and facilitators | Knowledge creation: knowledge inquiry | Knowledge creation: knowledge inquiry | Knowledge creation: knowledge synthesis | Step 4: Select, tailor and implement intervention |
Primary author
|
Rolloff, M[81] |
Wilson, H[51] |
Appleton, J.[47] | |||||
Theory used
| Constructivism assumes that learners construct knowledge as part of a process of making sense of their experiences: ‘Learners, therefore, are not empty vessels waiting to be filled, but rather active organisms seeking meaning’ (Driscoll, 2005, p. 387). | The underlying science here is located in a constructivist philosophy while other descriptive terms would be phenomenological, interpretivist or subjectivist | Philosophical underpinnings of constructivism, post-positivism, critical realism (in terms of realistic evaluation) and participatory inquiry | |||||
Aspects of theory used
| Learning is a result of the individual’s interaction with the environment | Social environment plays a critical role in the development of knowledge. | All 3 | |||||
KTA phase
| Knowledge creation: knowledge synthesis | Step 3: Assessing barriers and facilitators | Knowledge creation: knowledge inquiry |
Stages of the knowledge-to-action cycle
Thematic analysis
THEME 1 | THEME 2 | THEME 3 | THEME 4 | THEME 5 |
---|---|---|---|---|
Meaning of ‘evidence’ | Understanding acquisition, expression and application of knowledge in and for professional practice | Promoting professional expertise as a component of evidence-based practice | Understanding clients and their experiences | Designing interventions to a) increase knowledge and skill acquisition; b) change behaviour |
Post-modernist views on knowledge and knowledge acquisition | Practice based on experience | Knowledge of ethics and professional practice | Outcomes regarding patient care | For generating EBP knowledge |
Original/authentic problems to be addressed | Role of personal and professional values vs. formal knowledge | Novice vs. expert | Understanding of clients’ realities | For sharing knowledge |
Meaning of evidence | Experiential learning | Progress and role | For impacting on knowledge, attitudes and intentions to apply o evidence in practice | |
Meaning of experiences | SC in how learning and expertise develop | For promoting reflective practice | ||
Patient welfare as a motivator | Differences between specialist and generalist in skills and knowledge | For problem solving, critical thinking and reflection | ||
Perceived support | Combining experiences | For changing attitudes | ||
Loyalty to profession | Working together | For creating meaning | ||
Learner satisfaction and involvement | For sharing knowledge (Theoretical and practical) | |||
Meaning of competency | For knowledge that is actionable | |||
Role of previous experience | For practice based evaluations | |||
Direct, reflective learning | ||||
Role of context | ||||
Feedback from colleagues | ||||
Learners guide learning process | ||||
Threat of evaluation |