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Identification of Knowledge Translation Theories, Models Or Frameworks Suitable for Health Technology Reassessment: a Survey of International Experts

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Identification of Knowledge Translation Theories, Models Or Frameworks Suitable for Health Technology Reassessment: a Survey of International Experts Open access Original research BMJ Open: first published as 10.1136/bmjopen-2020-042251 on 22 June 2021. Downloaded from Identification of knowledge translation theories, models or frameworks suitable for health technology reassessment: a survey of international experts Rosmin Esmail ,1,2,3,4 Heather M Hanson,1,2 Jayna Holroyd- Leduc,1,2,3,4,5 Daniel J Niven,1,2,3,6 Fiona M Clement1,3 To cite: Esmail R, Hanson HM, ABSTRACT Strengths and limitations of this study Holroyd- Leduc J, et al. Objective Health technology reassessment (HTR) is a field Identification of knowledge focused on managing a technology throughout its life cycle ► This was the first study to solicit the perspectives of translation theories, models for optimal use. The process results in one of four possible or frameworks suitable international health technology reassessment (HTR) recommendations: increase use, decrease use, no change for health technology and knowledge translation (KT) international experts or complete withdrawal of the technology. However, reassessment: a survey of on the suitability of KT theories, models and frame- implementation of these recommendations has been international experts. BMJ Open works (TMFs) for HTR. 2021;11:e042251. doi:10.1136/ challenging. This paper explores knowledge translation ► Purposeful and snowball sampling was employed to (KT) theories, models and frameworks (TMFs) and their bmjopen-2020-042251 obtain HTR and KT experts from different jurisdic- suitability for implementation of HTR recommendations. Prepublication history and tions with a depth and breadth of knowledge in both ► Design Cross- sectional survey. additional supplemental material KT and HTR to ensure a representative sample. Participants Purposeful sampling of international KT for this paper are available ► Through a survey, experts were asked to rate each and HTR experts was administered between January and online. To view these files, KT TMF as ‘yes’, ‘partially yes’ or ‘no’ on six crite- March 2019. please visit the journal online ria to select potential KT TMFs for HTR: familiarity, Methods Sixteen full- spectrum KT TMFs were rated (http:// dx. doi. org/ 10. 1136/ logical consistency/plausibility, degree of specificity, bmjopen- 2020- 042251). by the experts as ‘yes’, ‘partially yes’ or ‘no’ on six accessibility, ease of use and HTR suitability. criteria: familiarity, logical consistency/plausibility, Received 29 June 2020 ► Only full- spectrum KT TMFs (KT phases: planning/ degree of specificity, accessibility, ease of use and http://bmjopen.bmj.com/ design, implementation, evaluation and sustainabil- Accepted 26 May 2021 HTR suitability. Consensus was determined as a rating ity/scalability) were included as these phases are of ≥70% responding ‘yes’. Descriptive statistics and critical to the KT process and necessary for the HTR manifest content analysis were conducted on open- ended process. comments. ► The sample size of HTR and KT experts was small, Results Eleven HTR and 11 KT experts from Canada, which may have reduced the ability to generate con- USA, UK, Australia, Germany, Spain, Italy and Sweden sensus (≥70% experts selected ‘yes’) on a suitable participated. Of the 16 KT TMFs, none received KT TMF for HTR. ≥70% rating. When ratings of ‘yes’ and ‘partially yes’ were combined, the Consolidated Framework for on September 25, 2021 by guest. Protected copyright. Implementation Research was considered the most suitable KT TMF by both KT and HTR experts (86%). One technologies that are currently in the health additional KT TMF was selected by KT experts: Knowledge system to ensure that they are being used to Action framework. HTR experts selected two additional optimally.1 Recommendations from the KT TMFs: Co-KT framework and Plan-Do- Stud y-Act cycle. HTR process can result in increase in use, Experts identified three key characteristics of a KT TMF decrease in use, no change or complete that may be important to consider: practicality, guidance withdrawal of the technology.2 However, on implementation and KT TMF adaptability. implementation of these recommendations © Author(s) (or their Conclusions Despite not reaching an overall ≥70% rating 2 on any of the KT TMFs, experts identified four KT TMFs has been challenging. It has been argued employer(s)) 2021. Re- use that the field of knowledge translation (KT) permitted under CC BY-NC. No suitable for HTR. Users may apply these KT TMFs in the commercial re- use. See rights implementation of HTR recommendations. In addition, KT could play a role in the implementation 3 and permissions. Published by TMF characteristics relevant to the field of HTR need to be process for HTR recommendations. KT has BMJ. explored further. been described as ‘a dynamic and iterative For numbered affiliations see process that includes the synthesis, dissemi- end of article. nation, exchange and ethically- sound appli- Correspondence to BACKGROUND cation of knowledge to improve the health Dr Fiona M Clement; Health technology reassessment (HTR) of [populations], provide more effective fclement@ ucalgary. ca is the systematic process of evaluating health services and products, and strengthen Esmail R, et al. BMJ Open 2021;11:e042251. doi:10.1136/bmjopen-2020-042251 1 Open access BMJ Open: first published as 10.1136/bmjopen-2020-042251 on 22 June 2021. Downloaded from the healthcare system’.4 In essence, KT is the applica- Box 1 List of criteria developed by authors for round 3 of tion of putting knowledge into practice and policy. KT modified Delphi process approaches could be used in the HTR process to bridge the gap between the generation of recommendations Criteria regarding optimal technology use and their implemen- ► The KT TMF must have face validity (KT TMFs that are common and 3 tation in practice. Thus, KT can be seen as complemen- well known should be included). tary to the HTR process, but there has been a paucity ► The KT TMF must be active KT TMF (passive KT TMFs were excluded). of research in this area.3 Moreover, there is a gap in our ► The KT TMF must be feasible to apply to take something out of understanding of which KT theories, models or frame- practice. works (KT TMFs hereafter) would be best suited for the ► The KT TMF was pragmatic (theoretical KT TMFs were excluded). The KT TMF must be specific (vague or those that were not prescrip- translation of HTR recommendations.3 ► tive were excluded). In the literature, two narrative reviews and two ► The KT TMF could build on other KT TMFs but needed to be generic scoping reviews have reported from 41 to 159 KT TMFs rather than for a specific context. 5–8 depending on how they are identified and considered. ► The KT TMF is easily understood and practical. KT TMFs have been used in different contexts, settings ► Any KT TMF that the committee was undecided on. and populations.5–8 Moreover, there has been some use KT, knowledge translation; TMFs, theories, models and frameworks. of the KT interventions, strategies and TMFs to decrease or remove low value care.9 10 These KT TMFs have been used to help identify determinants, barriers and enablers Consensus on the list of KT TMFs using a modified Delphi to behaviour change related to HTR.11 12 However, the process use of these KT TMFs has not been applied consistently To ensure that the list of 36 full-spectrum KT TMFs was to the development of KT interventions or the field of adequate and concise, a convenience sample consisting HTR.3 13 There are also no recommendations about which of the authors of this study reviewed this initial list to KT TMFs could be used for HTR. Through an interna- determine if any KT TMFs had been missed or could be tional survey of KT and HTR experts, this study aims to eliminated based on HTR suitability. This sample was provide an understanding of which KT TMFs could be considered suitable as the authors had clinical training appropriate for the HTR process and implementation of combined with expertise in KT or HTR and/or were its recommendations. experts at the doctorate level in these fields. A three- round modified Delphi process was undertaken.15–17 The Delphi process is iterative and used to determine expert group consensus where there is a lack of evidence 18 METHODS and expert opinion is important. The first and second http://bmjopen.bmj.com/ This study used three approaches to the selection of rounds involved independent review of each KT TMF KT TMFs for HTR: identification of suitable KT TMFs, to determine which would be suitable for HTR. Each consensus on the list of KT TMFs through a modified author rated the KT TMF as ‘yes’, ‘potentially yes’ or ‘no’ Delphi process, and selection of potentially suitable KT for HTR suitability. Consensus to keep the KT TMF was TMFs through a survey of international KT and HTR defined as 100% of the authors rating the KT TMF as ‘yes’ experts. and/or ‘potentially yes’. Consensus to eliminate the KT TMF was defined as 100% of the authors rating the KT Identification of suitable KT TMFs TMF as ‘no’. Any KT TMFs that did not reach consensus on September 25, 2021 by guest. Protected copyright. Only full- spectrum KT TMFs were included. ‘Full- were discussed in subsequent rounds. The third round entailed a 2- hour face- to- face meeting held in October spectrum’ includes all four KT phases: planning/ 2018. Prior to the discussion at this meeting, the authors design, implementation, evaluation and sustainability/ agreed on ground rules, principles and criteria for selec- scalability.8 These four KT phases are critical to the KT tion of KT TMFs for HTR suitability (box 1). The authors process and are thought to be necessary for the HTR deliberated on the remaining KT TMFs until consensus process and the implementation of its recommenda- was reached.
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