Chapter 2.3. Searching for Research Findings and KT Literature (word count 1692, 2 tables)
K. Ann McKibbon Cynthia Lokker
Searching for evidence in the health literature is difficult for almost any topic. The major problems of searching centre around the time it takes, knowing the most promising resources to use, and how best to use the resource once it is chosen(1). The knowledge to action cycle prescribes the need to identify studies, research, synthesis and knowledge tools that comprise the knowledge creation funnel as well as the need to identify literature on the KT process (e.g., KT theories, KT interventions). People involved in KT research and practice benefit from using information from several categories. We need to identify evidence and summaries of evidence (e.g., systematic reviews, clinical practice guidelines, health technology assessments [HTAs]). And, we may need to identify evidence to develop the knowledge syntheses which form the basis of guidelines as discussed in Chapters 2.1 and 2.2. We need to identify information on successful KT interventions—the evidence showcasing successful KT applications that can be used to model projects. And, information describing the theoretical basis (e.g., models or frameworks for KT) is also important for those interested in designing and evaluating KT (2). This chapter has several purposes. First we want to provide a description of where to find the information referred to above. Second we want to provide the vocabulary that can be used to search in resources that might be encountered. We have incorporated information from Bzdel et al’s very useful Web resource (3). We encourage consulting this guide as a starting point for almost any KT project or proposal.
Getting started: How do we find knowledge syntheses?
Summaries or syntheses of evidence should provide the foundation of KT interventions. Busy practitioners do not have time to summarize the total evidence on important questions; researchers starting studies can also benefit from using existing summaries. It is much more efficient to use or build upon existing well-done summaries of evidence than to produce new summaries. These summaries are even more useful if they are published in specific, multiple formats for such various audiences as the public, patients, physicians, nurses, and policy staff. Several categories of summaries exist and their identification varies by category. The largest category is systematic reviews including meta-analyses. These are often published and indexed in the large bibliographic databases such as Medline and CINAHL (Cumulative Index to Nursing and Allied Health Literature) or other smaller databases. The health-evidence.ca site (http://www.health-evidence.ca/) provides systematic reviews in the area of public health useful to decision makers. The Cochrane and Campbell Collaborations produce highquality clinically important systematic reviews on all areas of health care (http://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/HOME?CRETRY=1&SRETRY=0) and social science (http://www.campbellcollaboration.org/frontend.aspx). The Joanna Briggs Institute in Australia produces systematic reviews in nursing and other health disciplines and provides access to many health-discipline specific resources (http://www.joannabriggs.edu.au/about/home.php). Reviews are also available from the UK Centre for Reviews and Dissemination at York University (http://www.york.ac.uk/inst/crd/crddatabases.htm). Their databases include reviews (Database of Reviews of Effects or DARE), economics studies (National Health Service Economic Evaluation Database), and HTAs (HTA Database). A searching guide for HTAs and similar material can be found at http://www.ahfmr.ab.ca/publications/?search=Internet+sources+of+information&type=1 As mentioned in Chapter 2.2, clinical practice guidelines can be thought of as summaries of evidence that have directions or recommendations for patient care. The largest site for guidelines is produced by the US Agency for Healthcare Research and Quality (National Guidelines Clearinghouse at http://www.guideline.gov/). Although their title indicates national coverage they include many
guidelines from other countries. The Canadian Medical Association provides links to Canadian guidelines (CMA infobase http://mdm.ca/cpgsnew/cpgs/index.asp). NICE (UK National Institute for Health and Clinical Evidence) produces UK guidelines (http://www.nice.org.uk/ and Chapter 2.2). GIN or the Guidelines International Network brings together individuals and organizations committed to developing high-quality guidelines (http://www.g-i-n.net/index.cfm?fuseaction=about). However, most of these guidelines are not appraised for quality and it is useful to develop skills in appraising them for validity and importance prior to deciding on implementation.
What should we do next: How do we search large databases? If we cannot find a summary of the evidence in the sources just listed or if we need original study results we may need to go to such databases as Medline, the large bibliographic database for all health care with emphasis on medicine or CINAHL for material important to nursing and allied health professions. The Bzdel Resource Guide (3) describes other databases and resources important to KT. Librarians can help with searching or provide training on searching. Many online tutorials also exist. For example, the tutorial for PubMED, the easy-to-use, free Medline searching system is located at http://www.nlm.nih.gov/bsd/disted/pubmedtutorial/. Searching for articles on KT interventions or KT theory or frameworks is difficult. CIHR has provided funding to the authors of this chapter to produce searching “filters” to identify KT material in Medline and CINAHL much more easily. These filters aim to retrieve only that material that deals with KT in relation to content of your choice (e.g., improving cancer screening rates or hand washing programs). Similar filters exist as PubMed clinical queries (http://www.ncbi.nlm.nih.gov/entrez/query/static/clinical.shtml) that retrieve other content such as randomized controlled trials. Watch the various sites of KT tools for this searching innovation by late 2008.
Should we search the Internet? The Internet can provide access to technical reports and other non-journal material related to KT. Google and its companion site, Google Scholar (a more scholarly set of documents than full Google) are good places to start. A summary of many of the other non-Google search engines is located at http://searchenginewatch.com/showPage.html?page=2156221. In addition, some websites allow you to search in multiple databases and resource collections with one searching window. One such resource that consolidates much information that is useful to KT practitioners and researchers is TRIP—Turning Research into Practice website: http://www.tripdatabase.com/index.html.
What are some existing collections of KT material? Several sites collect and present KT material, tools, or both: See Table 2.3.1 Table 2.3.1 Sites that provide KT material, tools, or both.
Site name and web location Atlantic Health Promotion Research Centre KT Library, Dalhousie University http://www.ahprc.dal.ca/kt/library.cfm Material contained “This is a searchable database for KT-related resources (including information and resources about stroke and how organizational and health systems resources affect an organization's ability to absorb and apply research evidence)” “We provide tools in this section to help make "linkage and exchange" - the regular sharing of issues and results between researchers and the people who need research - easier. We also provide other reports and publications of interest on this page.” “This online database is full of knowledge translation resources that have been selected based on their relevance to research in environmental and occupational health and health policy.” Collection of articles to support their goals: “The focus of EPOC is on reviews of interventions designed to improve professional practice and the delivery of effective health services. This includes various forms of continuing education, quality assurance, informatics, financial, organisational and regulatory interventions that can affect the ability of health care professionals to deliver services more effectively and efficiently.”
Canadian Health Services Research Foundation http://www.chsrf.ca/knowledge_transfer/index_e.php
Centre for Health & Environment Research KT database, University of British Columbia http://web.cher.ubc.ca/ktdatabase/ Cochrane Effective Practice and Organisation of Care Group, University of Ottawa http://www.epoc.cochrane.org/en/index.html
Institute of Knowledge Transfer, UK—
Their library is planned for 2008.
The Institute of Knowledge Transfer (IKT) is an independent, democratic and not-for-profit professional body, established to promote the interests of the profession and the practice of 'knowledge transfer' (KT). http://www.ikt.org.uk/index.aspx KT+, McMaster University http://plus.mcmaster.ca/kt/Default.aspx
“KT+ provides access to the current evidence on "T2" knowledge translation (ie, research addressing the knowledge to practice gap), including published original articles and systematic reviews on health care quality improvement, continuing professional education, computerized clinical decision support, health services research and patient adherence. Its purpose is to inform those working in the knowledge translation area of current research as it is published.” “The KU-UC Bibliography search engine allows you to find bibliographic references on innovation and smart practices, dissemination and utilization of social sciences research, knowledge dissemination and utilization in health services, and utilization of evaluation research.” “The KT Library is designed to provide information to NIDRR grantees and interested members of the public about a wide spectrum of knowledge translation and evidence-based resources.” (disability research KT)
KU-UC (Knowledge Utilization - Utilisation des Connaissances), Laval Université http://kuuc.chair.ulaval.ca/english/index.php
US National Center for the Dissemination of Disability Research library http://www.ncddr.org/ktinfocenter/
Research Transfer Network of Alberta (RTNA) Alberta Heritage Foundation for Medical Research http://www.ahfmr.ab.ca/rtna/index.php Research Utilization Support and Help (RUSH) Southeastern Educational Developmental Laboratory, Austin TX http://www.researchutilization.org/index.html CIHR KT Clearinghouse, University of Toronto http://www.k2a.utoronto.ca/ktclearinghouse/home National Coordinating Centre for Methods and Tools. Public Health Agency of Canada http://www.nccph.ca/index.php?pid=18 Keenan Research Centre - Research Programs Joint Program in Knowledge Translation - Literature http://www.stmichaelshospital.com/research/ktlitera ture.php
This group collects and makes available their publications including conference reports, proceedings, and water cooler discussions. This site has a KT tool box of resources associated with disabilities and rehabilitation. Also a nice list of demonstration projects. Another site of tools for all areas of KT practice and research. A set of tools and methods concentrating on public health in Canada and elsewhere.
“RDRB (Research and Development Resource Base) is a literature database focusing specifically on continuing education, continuing professional development and knowledge translation in the health disciplines.” This resource is comprehensive and
covers many years.
Program in Policy Decision-Making at McMaster University, Canada http://www.researchtopolicy.ca/whatisnew/
“Through a partnership between McMaster University’s Program in Policy Decision-Making and the Canadian Cochrane Network and Centre, we have created an inventory of systematic reviews of governance, financial and delivery arrangements within health systems from two sources: 1) a manual search of the Cochrane Library (Issue 3, 2007); and 2) an overview of reviews being led by members of the Cochrane Collaboration’s Effective Practice and Organization of Care (EPOC) review group (with the search completed up to February 2004 and an updated search currently in progress).”
How do we search the grey literature? Grey literature is information that is not under the jurisdiction of commercial publishers. This material is often published by all levels of government, academic centres, and businesses for example. The material is in electronic or paper format and is very difficult to identify and obtain. Grey literature is especially important to those involved in public health KT. University of British Columbia describes how to search for unpublished literature (http://toby.library.ubc.ca/subjects/subjpage2.cfm?id=877) and the New York Academy of Medicine collects grey literature related to health services research and public health (http://www.nyam.org/library/pages/grey_literature_report). European grey literature is available through SIGLE (System for Information in Grey Literature in Europe, http://opensigle.inist.fr/) and information about searching for grey literature related to HTAs and economics studies is at the HTAi Vortal: http://22.214.171.124/vortal/.
Searching for literature about knowledge translation Searching for material related to KT interventions and theory has several characteristics that make searching even more difficult. KT is a new field that interrelates with several existing disciplines. This leads to an evolving and varied vocabulary with multiple terms for the same concept. For example Canadian researchers use the term knowledge translation while US and UK researches may use the
terms research utilization, implementation, or diffusion. Those in business use terms related to marketing, advertising, and change management while engineers speak of technology transfer. Individual clinicians deal with adoption of new techniques and evidence-based practice while policy makers speak of evidence-informed decisions. Table 2.2.2 provides a list of terms related to KT that we have identified in our attempt to develop a search filter for KT material. The terms themselves are very useful to include in search strategies. A wiki (whatiskt.wikispaces.com) includes these terms and their definitions and we invite you to enhance this site with your knowledge and experience. Bzdel et al (3) provide insights for searching for KT theories and frameworks. Additionally, the use of the named theories can be searched on the Internet and in the large databases. The KT filters project will provide help to identify these papers also.
Summary Searching for existing knowledge is a major foundation of KT. Producing and summarizing existing evidence from multiple sources to address knowledge or action gaps is the one of the first tasks of KT. Once this is done, those involved in KT work also need to learn about methods and tools that have been used in previous KT projects and how best to build new programs as well as the theoretical constructs of KT. Searching for evidence to summarize, existing summaries in various formats, and knowledge about KT programs and theory are difficult for many reasons including vocabulary and its multidisciplinary nature. In addition to using the resources outlined in this Chapter, contacting librarians and others experienced in searching will also help you on your road to successful searching. The main areas of research in the area of searching for material important to KT researchers and practitioners include production of the searching filters for Medline and CINAHL, which has already been funded. We need more data on proven retrieval methods for internet-based resources. Related to searching is also the need to come to consensus on definitions and mapping of terms across disciplines (e.g., is technology transfer in engineering equivalent to translational research for the US National
Institutes of Health or knowledge translation for CIHR?). We also may be able to develop search engines that can search effectively across the many KT resources and sites (Table 2.3.1).
Key points/lessons KT practitioners need to identify published and unpublished material related to many elements of the KT action cycle. This material can be summaries of existing knowledge, demonstration projects and other summaries of successful and unsuccessful KT interventions, and material related to the theory of KT (e.g., models and frameworks). Many resources must be used to identify this material. Bdzel and colleagues (3) have produced a document that provides much assistance to those who want material important to KT practice. Many internet sites are available that include resources and tools useful for general and more focused KT areas. This abundance of sites makes finding material both easier and harder as the documents and resources one needs may need to be sought in multiple places. The varied terminology across disciplines and geographic areas complicates retrieval. Standardization of definitions and acknowledgment of equivalent terms will make finding material easier.
References 1. Ely JW, Osheroff JA, Ebell MH, Chambliss ML, Vinson DC, Stevermer JJ, Pifer EA. Obstacles to answering doctors' questions about patient care with evidence: qualitative study.BMJ. 2002 Mar 23;324(7339):710.
2. Sudsawad, P. (2007). Knowledge translation: Introduction to models, strategies, and measures. Austin, TX: Southwest Educational Development Laboratory, National Center for the Dissemination of Disability Research. http://www.ncddr.org/kt/products/ktintro/. Accessed March 26, 2008.
3. Bzdel L, Winther C, Graham P. Knowledge Utilization Resource Guide. September 2004 http://www.nursing.ualberta.ca/KUSP/Resources/KU%20Resource%20Guide/KUResourceGuide.pdf). Accessed March 26, 2008.
Table 2.3.2. Terms used by various stakeholder groups for KT activities/components Applied dissemination Applied health research Best practices adoption Capacity building Change implementation Changing provider/physician/doctor behavio(u)r Collaborative development Competing Complex interventions Complexity science/studies Continuing (medical/nursing/dental) education Cooperation Co-optation Crossing the quality chasm Diffusion of innovations Diffusion(s) Dissemination Effective dissemination Effectiveness research Evaluation research Evidence uptake Evidence based medicine/nursing/practice Feedback and audit (audit and feedback) Gap analysis Gap between evidence and practice Getting knowledge into practice GRIP Guideline implementation Impact Implementation Implementation research/science Implementation science interventions/strategies Implementing research evidence Information dissemination and utilization Innovation adaptation/adoption/diffusion Know-do Know-do gap Knowledge adoption/brokering Knowledge communication/cycle Knowledge development and application Knowledge diffusion/dissemination Knowledge exchange/management Knowledge mobilization (mobilization) Knowledge synthesis Knowledge to action Knowledge transfer/transformation/ translation Knowledge uptake/utili(z/s)ation KSTE Knowledge synthesis, transfer & exchange Linkage and exchange Opinion leaders Patient education Patient safety Populari(z/s)ation of research Professional behavior/behaviour change Quality assurance/improvement Research capacity Research implementation Research into action/practice Research mediation Research transfer/translation Research utili(z/s)ation Science communication Teaching Technology transfer Third mission Third wave Total quality assurance/quality improvement Transfer of technologies Translating research into practice Translation research Translational research Transmission Turning research into practice TRIP Utili(z/s)ation