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One of the primary purposes of SV-7 is to communicate which measures are considered most crucial for the successful achievement of the mission goals assigned and how those performance parameters will be met. These particular measures can often be the deciding factors in acquisition and deployment decisions, and figures strongly in systems analysis and simulations done to support the acquisition decision processes and system design refinement.

It is sometimes useful to analyze evolution by comparing measures metrics for current and future resources. For this reason, a hybrid SV-7 model which spans architectures across multiple phases may be useful. SV-1 Systems Interface Description. SV-4 Systems Functionality Description.

SV-8 Systems Evolution Description. Skip to main content Press Enter. The intended usage of the SV-7 includes: Definition of performance characteristics and measures metrics. Once the target groups have been identified, they should be consulted at the outset of the research program to make sure that the information will be realistic for use by them and to learn of the type of information that would provide convincing evidence for them to use.

In this model, the primary inputs for a utilization effort are research findings. The research findings need to be evaluated in two aspects: quality and importance. Quality of the research findings relates to their sufficiently high validity and reliability, which could be verified by either consultation with other researchers or replication of the research in a similar setting.

Determination of importance can also be obtained in several ways, such as the potential users' rating on the degree of importance; assessing socially significant implications; and assessing the clarity of recommendation for action—that is, whether it can be understood by the users. According to Conner , other inputs should also be considered in addition to the research findings.

The materials to be disseminated should be assessed for their appeal, clarity, and appropriateness for the target users. The people who will direct the utilization effort should be assessed for whether their skills and temperament would be suitable to conduct such an effort. For the process component, Conner suggested that there is a need to monitor and document the course of dissemination and utilization efforts, particularly because the course could change from what was originally planned.

Documenting the deviations from the plan will help in adjusting the evaluation to reflect the program that was actually implemented rather than one that was planned to be implemented. The monitoring includes documenting who received the information to be utilized; their opinions of the information and their judgment of subsequent use of such information pattern ; their reasons for use or nonuse of the information rationale ; and the organizational arrangement and personal state and situation of the potential users state of utilizers.

The central question of this evaluation process is whether the results of the research are utilized. Conner indicated that evaluation of outcomes must occur for the type, level, and timing of the utilization process. This information can be determined in part by analyzing who has used the information level of utilization , how the information was used type of utilization , and the various time frames of utilization activities timing of utilization.

Outcomes assessment could focus on one of the two target groups: the actual targets people who have been the direct target of utilization efforts and the potential targets people who are most relevant for utilization of the findings although they may not be the direct targets of the utilization efforts. The focus on potential targets is intended to address the issue of self-selection bias that could perceivably occur should the assessment focus on the actual targets, who tend to be more involved.

Dunn conducted an month project involving a review of existing literature to develop an inventory of concepts, procedures, and measures available for conducting empirical research on knowledge use. Dunn found that there were widely varied linguistic usages that made it difficult or impossible to compare, contrast, and evaluate essential variations in the concepts, methods, and measures in this area.

However, three basic dimensions were found to underlie different concepts of knowledge use: 1 composition, a dimension that distinguishes between individual for decision making and collective for enlightenment uses of knowledge; 2 expected effects, a dimension that contrasts conceptual and instrumental use of knowledge; and 3 scope, a dimension that contrasts processes of use in terms of their generality general use of knowledge and specificity e.

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As indicated by Dunn, the scope of use may also be viewed as a continuum ranging from general processes of being familiar with or aware of something to specific processes of being able to explain or perform some action. More than 60 procedures used to study knowledge utilization were identified through this review and were categorized into three main methods of inquiry: 1 naturalistic observation; 2 content analysis; and 3 questionnaires and interviews. Within the questionnaires and interviews, there were three categories of procedures: 1 relatively structured procedures; 2 semistructured procedures; and 3 relatively unstructured procedures.

As reported by Dunn , at least 30 different questionnaires and interviews or schedules were employed to study various aspects of knowledge use, and these were the most frequently used method of the studies included in this review. Naturalistic observation was rarely employed. Content analyses were employed with various kinds of documents, including research reports, case materials, and other records of experience. Recently, Hakkennes and Green conducted a structured review of original studies published in peer-reviewed journals to identify the outcome measures used to determine effectiveness of strategies aimed at improving development, dissemination, and implementation of clinical practice guidelines.

Three types of data were collected from the included studies: 1 the measures used to assess the effectiveness of the intervention; 2 the methods used for such assessment; and 3 the reliability and validity of those outcome measures when reported. Hakkennes and Green grouped the outcome measures into three main categories of measurement, at 1 patient level, 2 health practitioner level, and 3 organizational or process level.

The outcome measures that focused on patient level were further categorized into those that measure the actual change in health status of the patient, such as mortality, quality of life, and actual symptom change, and those that use surrogate measures of the patient's change in health status, such as patient satisfaction, length of hospital stay, or number of health-care visits and hospitalizations. The outcome measures at the health practitioner level also followed the same pattern of either measuring actual change in health practice of the practitioner, such as their compliance or noncompliance with the implemented guidelines, or surrogate measures, such as measurement of the practitioner's knowledge or attitudes.

For the organizational or process level, the focus was on measuring change in the health system, such as to cost, policy and procedures, and the time spent by the practitioner. The authors reported that approximately half of the included studies used a medical record audit to collect data for the outcomes. Overall, the measures of change in health practitioner behavior were the most common, followed by the measures that assess change at a patient level either actual measures of change or surrogate measures of change , health practitioners' knowledge and attitudes, and changes at an organizational level.

Several approaches employed to measure knowledge use were reported in the literature. One approach is to measure users' discrete behaviors related to the use of research-based knowledge. Pelz and Horseley used survey questionnaire items that were part of an page questionnaire to measure research utilization by nursing staff.

Five items on the questionnaire directly measured research utilization activities, and the mean score of those five items was used as an index of research utilization. A response scale of 0, 1, 2—4, and 5 or more times in the past year was used for each activity. The Cronbach's alpha of this research utilization index representing the internal consistency was reported to be. The five research utilization activities are as follows:. Vercoe and Hilton , in a study investigating factors affecting acute-care nurses' use of research findings, measured both general use of research and use of specific research findings.

However, the actual statements were not reported. As reported by the authors, internal consistency of the items was. Content validity was tested through peer review. A different approach is to view knowledge use as a chronological process. In this approach, each step within the process could be measured to gauge the progress on the knowledge use continuum, as opposed to just measuring whether the use of knowledge occurs at the end of the process.

Using this approach, Hall, Loucks, Rutherford, and Newlove developed the Levels of Use Scale to measure levels of use of innovation. The scale addresses only the behavioral aspect of use and does not focus on other aspects of use, such as attitudinal, motivational, or affective. The Levels of Use Scale consists of eight levels. Decision points were also provided to distinguish each level. The descriptions of those levels are as follows:.

As presented by Hall et al. The seven categories are 1 knowledge, 2 acquiring information, 3 sharing, 4 assessing, 5 planning, 6 status reporting, and 7 performing. For example, within Level I orientation stage , each category was described as follows:. The psychometric properties of the Levels of Use Scale Hall et al. However, the scale is one of the most comprehensive in measuring use and could conceivably be quite sensitive in detecting small increments of progress in knowledge use.

Particularly, the scale would be useful in evaluating steps taken toward implementation even when the full implementation has not yet occurred. Larsen developed a utilization scale containing seven ranked stages of knowledge use and non-use. A piece of information whether it be a research finding, an idea, a suggestion, or a recommendation is assigned a rank value based on an ordinal scale outlined in the following list. No reliability or validity were reported. Brief descriptions of 14 innovations were provided in the questionnaire.

Using Rogers' stages of innovation adoption Rogers, as a guide, seven questions measuring the nurse's stage of innovation adoption were developed to be used with each of the 14 nursing practices. The seven questions, as later described by Michel and Sneed , are listed here:. These questions address the four stages of innovation adoption identified in the Diffusion of Innovation framework: 1 knowledge awareness , 2 persuasion, 3 decision, and 4 implementation Rogers, Each question represents a specific stage of the innovation adoption:.

The ranges of possible scores assigned to the various stages of adoption are as follows:. The overall internal consistency Cronbach's alpha was. Content validity was assumed because the 14 innovations were derived from published nursing research reports using specific criteria. Also following the stages-of-use approach, Landry, Amara, and Lamari measured the use of social science research with a scale derived from the Knott and Wildavsky stages of knowledge utilization.

However, this scale measures knowledge utilization from the perspective of the knowledge producers who were university researchers rather that of the knowledge users. A question was posed to the respondents as to what had become of their research of the last 5 years. No psychometric properties were reported. The six stages are listed here:. The items representing the six stages of knowledge utilization are listed as follows. Another approach is to measure not only the behavioral aspect of the knowledge user, but also other aspects related to knowledge use. Anderson, Ciarlo, and Brodie used a structured interview method to measure knowledge utilization in the behavioral, cognitive, and affective dimensions.

The behavioral aspect was measured by examining reported changes in the activities, practices, or policies that resulted from the researchers' feedback based on their program evaluation for the participating organization. The researchers used two questions, one open-ended and one recommendation-cued, to gather information for behavior change. In the open-ended question, they asked the respondents to describe specific instances of any activities undertaken related to the issues being evaluated.

In the recommendation-cued question, they read each respondent a list of the recommendations from their evaluation research and then asked the respondent to cite specific instances of activities relevant to the recommendations. Information was then extracted and coded by category of utilization derived by the research team. The authors stated that after each set of interviews was coded, a measure of the interrater reliability of the coding was computed.

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However, the reliability results were not reported. The coding was nominal in nature, and the evaluation of knowledge use was descriptive rather than statistical. To measure the cognitive aspect, the researchers compared the rating of the respondents' beliefs about various aspects of the issue they were studying. Those themes were extracted from the coding of the pre-intervention interviews. The participants were asked to rate their agreement with each of the themes earlier in the project and at 1-month and 6-month intervals after the completion of their intervention.

In addition to the original themes obtained from the pre-intervention interviews, a list of "data themes," or statements based on the actual data analysis, was added. In some cases, as stated by the authors, an original theme may also become a data theme. For data themes not originally generated in the pre-intervention interview, the researchers examined whether the postevaluation views of the panel were in agreement or in conflict with those themes.

For the affective aspect, respondents were asked to rate their concern about the problem or issue and their satisfaction with the team's solutions. The timing and rating comparisons were the same as the methods outlined in the cognitive change measurement. Using a similar orientation, Champion and Leach developed a scale to measure nurses' research utilization in their study to determine variables related to research utilization in nursing.

Four sets of items were measured: 1 attitude, 2 availability, 3 support, and 4 research utilization. The attitude items measured feelings about incorporating research into practice. The availability items measured the opportunity a nurse had to access research findings in his or her institution. The support items measured the degree to which a nurse's administrative leaders and professional colleagues encouraged research utilization.

The research utilization items measured the degree to which the nurse felt he or she incorporated findings into practice. The questionnaire consists of 38 items, with 21 items measuring attitude, 7 measuring availability, 8 measuring support, and 10 measuring use. Examples of items representing each of the four aspects are provided below:.

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As reported by the authors, the content validity was judged by experts. Internal consistency as measured by Cronbach's alpha ranged from. Another possible approach in measuring research use is to separately measure each type of use, including conceptual, instrumental, and symbolic use. Therefore, it seems logical to measure each type of use separately. Estabrooks developed a measurement scale using four questions to measure overall research utilization, direct research utilization instrumental use , indirect research utilization conceptual use , and persuasive research utilization symbolic use.

The overall-research-utilization question was "Overall, in the past year, how often have you used research in some aspect of your nursing practice? Each time, the question was preceded by the definition of overall research utilization as "The use of any kind of research findings nursing and non-nursing in any aspect of your work as a registered nurse. Do not count as research things you learned in nursing school where you did your basic nursing training. The direct-research-utilization question was "Overall, in the past year, how often have you used research findings in this direct way in some aspect of your nursing practice?

Do not count as research things you learned in your basic training. The indirect-research-utilization question was "Overall, in the past year, how often have you used research findings in this nondirect way in some aspect of your nursing practice? The persuasive-research-utilization question was "Overall, in the past year, how often have you used research findings in this persuasive way?

Amara et al. The instrumental use was described as "The use of university research led to concrete action in my field of work. Focusing on the product of research use rather than on users' behavior, Hanney, Gonzalez-Block, Buxton, and Kogan proposed a draft scale to measure research utilization in policymaking by directly examining the policy of interest in four areas:.

The first area, consistency of policy with research findings, concerns the agreement between the policy and the body of international research. The policy would be examined, using documentary analysis, on its consistency with research findings by determining the level of agreement between the policy and the findings of the research. The second area, degree of influence of research on policy agenda setting, relates to the extent that research helps in getting the issue onto policymakers' agendas, such as by showing the existence of a problem, pointing to actions to be taken and having those actions turned into policy, or enlightening policymakers on the importance of the issue.

This information would be obtained via interviews, documentary analysis, and questionnaires to determine degree of influence of research findings on the policy agenda setting. The third area, degree of influence of research on policy formulation, concerns the actual influence that the research had during the policy formulating process. The actual influence, as indicated by Hanney et al. The degree of influence of research on the policy content, either for instrumental impact or enlightenment, would be determined primarily via interviews but also through survey and documentary data.

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The fourth area, degree of influence of research on policy implementation, concerns the use of research in policy implementation, either to determine appropriate implementation strategies or to secure support for the policy in terms of financial resources, political commitment, and public opinion. Information in this area will come from interviews and documentary analysis. For each area, the ranking scale of considerable, moderate, limited, or no indication is used to measure the degree of research utilization in the four areas indicated above.

As evidenced in this review, knowledge translation KT is a complex and multifaceted construct that requires a consideration of a multitude of dimensions together to form a comprehensive picture. It should be noted that the literature included in this review came mostly from disciplines other than rehabilitation.

Although the information from such literature could provide some understanding of KT in general, its direct applicability to KT in rehabilitation is not known. For instance, the degree of similarity between the context of policymaking, of which a substantial amount of information contributes to the body of the literature in this area, and the context of everyday practice in rehabilitation is not clear. Can it be assumed that the same influencing factors exist and play similar roles in both environments?

Are the types of knowledge use similar in both contexts? Do practitioners and policymakers make the same kind of decisions? It is certainly important to create a body of empirical knowledge that is directly relevant and applicable to rehabilitation. Future questions may include the following: What types of use occur in practice settings, and how prevalent are they?

Are the determinants for each type of use the same? What are the common predicting factors that transcend contexts, and what are the unique factors related to specific contexts? What is the relative importance of each of these contextual factors in predicting research use? Amara, N. New evidence on instrumental, conceptual, and symbolic utilization of university research in government agencies. Science Communication, 26, 75— Anderson, C. Measuring evaluation-induced change in mental health programs.

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Ciarlo Ed. Beverly Hills, CA: Sage. Backer, T. Information alchemy: Transforming information through knowledge utilization. Journal of the American Society for Information Science, 44, — Bekkering, G. Implementation of clinical guidelines on physical therapy for patients with low back pain: Randomized trial comparing patient outcomes after a standard and active implementation strategy. Physical Therapy, 85, — Bennett, S. Perceptions of evidence based practice: A survey of Australian occupational therapists.

Australian Occupational Therapy Journal, 50, 13— Bero, L. Closing the gap between research and practice: An overview of systematic reviews of interventions to promote the implementation of research findings. British Medical Journal, , — Berta, K. Information seeking, research utilization, and barriers to research utilization of pediatric nurse educators. Journal of Professional Nursing, 11, 49— Beyer, J. Research utilization: Bridging the gap between communities.

Journal of Management Inquiry, 6, 17— Brett, J. Use of nursing practice research findings. Nursing Research, 36, — Organizational integrative mechanisms and adoption of innovations by nurses. Nursing Research, 38, — Canadian Institutes of Health Research Knowledge translation strategy — Innovation in action. About knowledge translation. Champion, V. Variables related to research utilization in nursing: An empirical investigation. Journal of Advanced Nursing, 14, — Conner, R. The evaluation of research utilization. Teilmann Eds. Measuring evaluation utilization: A critique for different techniques.

Coyle, L. Innovation adoption behavior among nurses. Nursing Research, 39, — Davis, D. Quality, patient safety and the implementation of best evidence: Provinces in the country of knowledge translation [Special issue]. Healthcare Quarterly, 8 , — Dunn, W.

Measuring knowledge use. Knowledge: Creation, Diffusion, Utilization, 5, — Estabrooks, C. The conceptual structure of research utilization. The Alberta nurses survey: Utilization of health research results in medical practice. Foxcroft, D. Organizational infrastructures to promote evidence-based nursing practice Review. Cochrane Database of Systematic Reviews, 3, Art.

DOI: Fritz, J. Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain. Spine, 28, — Graham, I. Innovations in knowledge transfer and continuity of care. Canadian Journal of Nursing Research, 36, 89— Lost in knowledge translation: Time for a map?

Graham, K. Using the Ottawa Model of Research Use to implement a skin care program. Journal of Nursing Care Quality, 19, 18— Grimshaw, J. Changing provider behavior: An overview of systematic reviews of interventions. Medical Care, 39 8, Suppl. Effectiveness and efficiency of guideline dissemination and implementation strategies.

Health Technology Assessment, 8 6. Grol, R. Successes and failures in the implementation of evidence-based guidelines for clinical practice. Hakkennes, S. Measures for processing practice change in medical practitioners [Electronic version]. Implementation Science, 1 Hall, G.

Levels of use of the innovation: A framework for analyzing innovation adoption. Journal of Teacher Education, 26, 52— Hanney, S. The utilization of health research in policymaking: Concepts, examples and methods of assessment [Electronic version]. Health Research Policy and Systems, 1 2. Heinemann, A. The impact of stroke practice guidelines on knowledge and practice patterns of acute-care health professionals. Journal of Evaluation in Clinical Practice, 9, — Hogan, D.

Clinical Nurse Specialist, 18, — Hysong, S. Audit and feedback and clinical practice guideline adherence: Making feedback actionable. Implementation Science, 1 9. Jacobson, N. Development of a framework for knowledge translation: Understanding user context. Jamtvedt, G.

Audit and feedback: Effects on professional practice and healthcare outcomes review. Cochrane Database of Systematic Reviews, 2. Johnson, L. From knowledge transfer to knowledge translation: Applying research to practice. Kerner, J. Dullest translation versus knowledge integration: A "funder's" prospective. Kirkhart, K. Evaluating and maintaining planned change.

Glaser, H. Garrison Eds. San Francisco: Jossey-Bass. Kitson, A. Enabling the implementation of evidence-based practice: A conceptual framework. Quality in Health Care, 7, — Knott, J. If dissemination is the solution, what is the problem? Knowledge: Creation, Diffusion, Utilization, 1, — About knowledge translation: Definition. Landry, R. Climbing the ladder of research utilization: Evidence from social science research. Science Communication, 22, — The extent and determinants of the utilization of the university research in government agencies. Public Administration Review, 63, — Larsen, J.

Knowledge utilization: What is it? Information utilization and non-utilization Report No. Logan, J. Toward a comprehensive interdisciplinary model of health care research use. Science Communication, 20, — Canadian Journal of Nursing Research, 31, 37— Lomas, J. Retailing research: Increasing the role of evidence in clinical services for childbirth. The Milbank Quarterly, 71, — Meline, T.


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Evidence-based practice in schools: Evaluating research and reducing barriers. Metcalfe, C. Barriers to implementing the evidence based in for NHS therapies. Physiotherapy, 11, — Michel, Y. Dissemination and use of research findings in nursing practice. Journal of Professional Nursing, 11, — Milner, F. Clinical nurse educators as agents for change: Increasing research utilization. International Journal of Nursing Studies, 42, — National Center for the Dissemination of Disability Research.

What is Knowledge Translation? Paisley, W. Introduction and overview. Pelz, D. Measuring utilization of nursing research. Pennington, L. Promoting research use in speech and language therapy: A cluster randomized controlled trial to compare the clinical effectiveness and costs of two training strategies.

Clinical Rehabilitation, 19, — Rich, R. Knowledge creation, diffusion, and utilization: Perspectives of the founding editor of Knowledge.

Knowledge: Creation, Diffusion, Utilization, 12, — Rodgers, S. A study of the utilization of research in practice and the influence of education. Nurse Education Today, 20, — Rycroft-Malone, J. Journal of Nursing Care Quality, 19, — Ingredients for change: Revisiting a conceptual framework. Quality and Safety in Health Care, 11, — Shaw, B. Tailored interventions to overcome identified barriers to change: Effects on professional practice and healthcare outcomes Review. CD Southwest Educational Development Laboratory Stacey, D.

Adoption and sustainability of decision support for patients facing health decisions: An implementation case study in nursing. Implementation Science, 1 17 , DOI Sterr, A. Application of the CIT concept in the clinical environment. Stetler, C. Nursing Outlook, 42, 15— Updating the Stetler model of research utilization to facilitate evidence-based practice.

Nursing Outlook, 49, — Evaluating research findings for applicability in practice. Nursing Outlook, 24, — Straus, S. Evidence based medicine: How to practice and teach EBM 3rd ed. Philadelphia: Elsevier—Churchill Livingstone. Thomas, L. Guidelines in professions allied to medicine Review. Cochrane Database of Systematic Reviews, 1, Art. Turner, P. Physiotherapists' use of evidence based practice: A cross-national study. Physiotherapy Research International, 2, 17— Vercoe, C. Factors affecting acute-care nurses' use of research findings.

Canadian Journal of Nursing Research, 27 4 , 51— Vingillis, E. Integrating knowledge generation with knowledge diffusion and utilization. Canadian Journal of Public Health, 94, — Wolfe, D. The uptake and costs of guidelines for stroke in a district of southern England. Journal of Epidemiology and Community Health, 51, — Pimjai Sudsawad, at the time of this manuscript preparation, was an assistant professor at the University of Wisconsin-Madison.

Her main research area was knowledge translation in the context of evidence-based rehabilitation. Specific interests included barriers to and facilitators of the use of research evidence for rehabilitation practice, research methodology that could increase the usability of research evidence for practice, and rehabilitation researchers' readiness to adopt such methodology for their research.

Descriptions of the 6 KT strategies are superimposed on the diagram for ease in referencing what they are. The research cycle consists of several components. The global knowledge is connected to two parts: the contextualization of knowledge that leads to the application of knowledge that creates impacts, and to publication. The cycle represents an ongoing feedback from the dissemination and use of research knowledge to the creation of research knowledge. Six KT strategies are embedded into the research cycle to demonstrate that KT could occur at several junctions within the cycle.

A description of each KT strategy is superimposed onto the diagram for ease in referencing. The descriptions of KT strategies, and where they could occur within the research cycle, are provided below. KT3: Publishing in plain language and accessible formats, occurs during the transition from global knowledge to publication. KT4: Placing research findings in the context of other knowledge and sociocultural norms, occurs during the transition from global knowledge to contextualization of knowledge. KT5: Making decision and taking actions informed by research findings, occurs during the transition from contextualization of knowledge to application of knowledge.

Three domains of the research use process are organized in three consecutive columns from left to right, providing a structure for the diagram: Assess barriers and support, Monitor intervention and degree of use, and Evaluates outcomes. Under the domain of Assess barriers and supports, there are three components that should be assessed: Evidence-based innovations, Potential adopters, and Practice environment.

These components are represented by boxes, organized vertically. The Evidence-based innovation component has 2 subcomponents: Development process and Innovation attributes. These subcomponents indicate specific areas in which barriers and supports to research use should be assessed.


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  • There are two components under the next domain of Monitor intervention and degree of use: Implementation intervention strategies and Adoption. The components are represented by boxes, connected horizontally as a continuation of the research use process from the Assess barriers and supports column.

    The Implementation intervention strategies components has three subcomponents: Barrier management, Transfer, and Follow up. The Adoption component includes two subcomponents: Intention and Use. Under the Evaluate outcomes domain, there is a single component of Outcomes with three subcomponents: Patient, Practitioner, and System. These subcomponents signify the areas on which an evaluator should focus during the evaluation of the outcomes of the research use process. There is a feedback loop from the components under the Monitor intervention and degree of use and Evaluate outcomes domains to the components under the Assess barriers and supports domain.

    These feedback loop signify an ongoing incorporation of information obtained later in the process into the reassessments of the barriers and supports. This figure shows a diagram of the Knowledge-to-Action Process. The diagram contains two parts: the knowledge creation cycle illustrating the process of knowledge creation, and the Action cycle illustrating the process of knowledge application.

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    The Knowledge creation cycle is positioned within the Action cycle. The Knowledge Creation cycle is represented by an inverted cone shape surrounded by a circle of arrows. The tailoring of knowledge to knowledge users is a required element through all three steps. The circle of arrows represents an ongoing process of knowledge creation through the three steps. The Action cycle contains 7 steps, and forms an outer circle encompassing the knowledge creation cycle.

    Each Action cycle step is listed in a box connected by an arrow in clockwise direction to the next step. The steps are in the following order: Identify problem and identifying, review, and select the knowledge to solve the problem; Adapt knowledge to local context; Assess barriers to knowledge use; Select, tailor, implement intervention; Monitor and knowledge use; Evaluate outcomes; and Sustain knowledge use-- which is connected back to the first step of Identify problem and identify, review, and select the knowledge to solve the problem to form a complete circle.

    This figure shows a diagram of the Coordinated Implementation Model. The diagram illustrates the process of moving research information into its application in practice with patient, and factors that can influence such process. Research information first goes through synthesis, distillation, and appraisal.