JCPSLP Vol 14 No 1 2012

Table 2. Critically appraised article Article purpose To determine whether communicative access to information and decision-making could be improved for people with aphasia across three health care facilities in Canada by targeting systems-level change. This study sought to address limitations in the translation of evidence regarding the benefit of supported conversation and aphasia-friendly principles into routine practice. Simmons-Mackie, N.N., Kagan, A., Christie, C.O., Huijbregts, M., McEwan, S., & Willems, J. (2007). Communicative access and decision-making for people with aphasia: Implementing sustainable health care systems change. Aphasiology , 21 (1), 39–66. Citation Level of evidence Level IV (Qualitative descriptive study without experimental control) Participants Three facilities participated in the project. The facilities included a large tertiary medical centre; a rehabilitation centre; and a long-term care facility. A manager that was associated with stroke care was identified within each of the facilities. These managers then selected “a team” to be involved in the project. A total of 37 team members participated across facilities and a range of disciplines. The intervention The KTA intervention involved a 2-day training program based on Supported Conversation for Aphasia TM (SCA) training procedures, followed by post-training support. Participants received information about aphasia and the opportunity to practise using SCA techniques. Participants also brainstormed issues surrounding communication access in their facility, leading to the formulation of specific goals for that site to enhance and improve access. Post-training follow-up occurred with all sites 4 months later with periodic on-site support to address any problems with implementation and to provide teams with individualised resources. Qualitative data was collected before and after training, and at the 4-month follow-up via observation, interviews, and focus groups. Through observation checklists data regarding the actual use of strategies and resources was collected however, the amount of observation was described as insufficient by the authors. The interviews and focus groups elicited information about the participants’ knowledge and perspectives regarding the access to information and decision-making ability of people with aphasia. After training, the knowledge of all participants concerning how to support people with aphasia to access information improved. Changes were most positive for the rehabilitation and long-term care facilities, with examples provided of system changes that improved access and participation of people with aphasia within their programs. Unfortunately, implementation was less successful in the acute care facility. No control group or randomisation. Four month follow-up unlikely to provide a reliable index of sustainable change. Consumers or people with aphasia were not involved in the training or evaluation of project outcomes. Insufficient observational data collected to obtain objective direct evidence of implementation of communicative access strategies. Only 3 facilities were included in the study with a need to increase sample size. The project was successful in improving communicative access and decision-making for people with aphasia at a systems- level for 2 of 3 facilities. That is, the systems and procedures of the facilities did change with positive implications for consumers with aphasia. The outcomes provide support for involving front-line service providers in the evaluation of their own service and strategies for change to enable effective, sustainable, and long-term changes in health services to take place. The successful involvement of service providers suggests that active collaboration between researchers and clinicians can help guide the translation of evidence into practice. Further research does need to take a more controlled, experimental approach to investigate the effectiveness of systems-change projects and address potential barriers to change in the planning stages. Results Limitations Summary Design Qualitative research design (thematic analysis). No randomization or control group.

Draw upon frameworks, models, and theories to guide knowledge transfer and exchange One of the most important themes to emerge from the literature under review was that a multidimensional KTE framework is beneficial for facilitating the successful transfer of knowledge into practice. There are many different KTE models available for clinicians to select from and readers are directed to a number of sources for a more comprehensive overview (Estabrooks, Thompson, Lovely, & Hofmeyer, 2006; Kagan et al., 2010; Rose & Baldac, 2004; Sudsawad, 2007). As an excellent example Molfenter et al. (2009) provide evidence that KTA processes and KTE principles are effective and can be used successfully to guide the planning, implementation and evaluation of translation projects. In particular, they drew upon the KTA process developed by Graham and colleagues (2006), which involves both knowledge creation (the synthesis, tailoring and clear, targeted dissemination of knowledge) and then knowledge action (the transfer of knowledge into practice) with a cyclical and dynamic relationship between the two. Application of the model ensures that testable and useful translation interventions are devised and implemented (Estabrooks et al., 2006; Kagan et al., 2010), providing a “road map for introducing… evidence-based

techniques into clinical practice” (Molfenter et al., 2009, p. 86). While many frameworks and models are available, further research is needed to test their use in actual practice environments and their relevance for speech pathology (Estabrooks et al., 2006; Sudsawad, 2007). While the evidence is mounting, clinicians should take time to identify the most appropriate KTE model or strategy to meet the needs of a particular practice environment or clinical problem. Clearly identify a knowledge-to-action or evidence–practice gap Before selecting the most appropriate KTE framework, it is important to have a KTA gap or clinical problem in mind. This gap in best practice is the driving force behind a translation initiative and should be clearly defined before devising a KTA intervention. Surveys, audits, interviews, focus groups, and reflective practice are all strategies that can be used to demonstrate a divide between what is known and what is actually being implemented in practice in terms of evidence based assessment, intervention, or adherence to recommended clinical guidelines or pathways. Objectively demonstrating a gap in service provision provides local, pre-intervention data, which is useful for not only advocating the need for change, but also for providing a critical reference point for measuring the success of a

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JCPSLP Volume 14, Number 1 2012

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