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Cited by 760Health Policy Implementation ScienceClinical practice guidelines implementationHealth Sciences Research and Education

Mapping new theoretical and methodological terrain for knowledge translation: contributions from critical realism and the arts

Open access
Kontos, Pia C, Poland, Blake D·2009·Implementation Science
DOI 10.1186/1748-5908-4-1PMC PMC2639531
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Abstract

BACKGROUND: Clinical practice guidelines have been a popular tool for the improvement of health care through the implementation of evidence from systematic research. Yet, it is increasingly clear that knowledge alone is insufficient to change practice. The social, cultural, and material contexts within which practice occurs may invite or reject innovation, complement or inhibit the activities required for success, and sustain or alter adherence to entrenched practices. However, knowledge translation (KT) models are limited in providing insight about how and why contextual contingencies interact, the causal mechanisms linking structural aspects of context and individual agency, and how these mechanisms influence KT. Another limitation of KT models is the neglect of methods to engage potential adopters of the innovation in critical reflection about aspects of context that influence practice, the relevance and meaning of innovation in the context of practice, and the identification of strategies for bringing about meaningful change. DISCUSSION: This paper presents a KT model, the Critical Realism and the Arts Research Utilization Model (CRARUM), that combines critical realism and arts-based methodologies. Critical realism facilitates understanding of clinical settings by providing insight into the interrelationship between its structures and potentials, and individual action. The arts nurture empathy, and can foster reflection on the ways in which contextual factors influence and shape clinical practice, and how they may facilitate or impede change. The combination of critical realism and the arts within the CRARUM model promotes the successful embedding of interventions, and greater impact and sustainability. CONCLUSION: CRARUM has the potential to strengthen the science of implementation research by addressing the complexities of practice settings, and engaging potential adopters to critically reflect on existing and proposed practices and strategies for sustaining change.

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  • Implementation science to date suffers a dearth of economic evaluations from which to draw.

    “Although budget impact is a key concern to administrators and some funding agencies require budget impact analysis, implementation science to date suffers a dearth of economic evaluations from which to draw [96,97].”

    From Writing implementation research grant proposals: ten key ingredients (2012) · cites this paper as [96]

  • Implementation research exemplifies multidisciplinary team science, informed by a diverse range of substantive and methodological fields.

    “Implementation research exemplifies multidisciplinary team science, informed by a diverse range of substantive and methodological fields [96,109].”

    From Writing implementation research grant proposals: ten key ingredients (2012) · cites this paper as [96]

  • There is a need for the development of a suite of reporting guidelines for different types of implementation research.

    “However, there is a need for the development of a suite of reporting guidelines for different types of implementation research [3].”

    From Implementation strategies: recommendations for specifying and reporting (2013) · cites this paper as [3]

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Research works printed but not linked: 2

  1. Rogers EM Diffusion of Innovation 2003 5 New York: Free Press
  2. Kitson A Harvey G McCormack B Enabling the implementation of evidence based practice: a conceptual framework Quality in Health Care 1998 7 149 158 10185141 10.1136/qshc.7.3.149 PMC2483604 · DOI · Paper page

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Authors
Kontos, P. C., & Poland, B. D.
Affiliations
University of Toronto (CA)
Corresponding author
Kontos, Pia C
ORCID
Venue
Implementation Science
Publisher
Springer Science and Business Media LLC
Published
2009-01-05
Volume
4
Issue
1
Pages
1-1
ISSN
1748-5908 (ISSN-L)
DOI
10.1186/1748-5908-4-1
PMC
PMC2639531
OpenAlex
W2071304386
Cited by
760
References
97
Citations by year
2026: 3 · 2025: 12 · 2024: 11 · 2023: 19 · 2022: 16 · 2021: 139 · 2020: 74 · 2019: 48 · 2018: 64 · 2017: 94 · 2016: 45 · 2015: 56 · 2014: 46 · 2013: 51 · 2012: 28
FWCI
48.99
Type
journal article
Language
en
Open access
Licence
Locations
  • Implementation Science (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • TSpace (University of Toronto) (submittedVersion, cc-by)
  • TSpace (University of Toronto) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Ontario Ministry of Health and Long-Term Care
  • Canadian Institutes of Health Research
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Keywords
knowledge translation, critical realism, arts-based methodologies, implementation research, individual agency, sustainability of change, critical reflection, innovation adoption

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