How to Choose a KT Theory, Model or Framework
An Overview of Existing Recommendations
By Masood Khan
A recent scoping review identified 159 knowledge translation (KT) frameworks, models, and theories [1]. With so many options to choose from, the selection of an appropriate theoretical basis for KT and implementation research can be challenging.
In a survey of 223 implementation scientists from 12 countries, Birken et al. found over 100 different theories, models and frameworks had been used in various settings (e.g. healthcare services, research institutions, government). Respondents to Birken et al.’s survey reported using a total of 19 different criteria when selecting theories, models and frameworks for their work (including empirical support, uniqueness, and analytic level) [2]. The main reasons for using a theory, model or framework were to:
- Identify determinants of behaviour;
- Inform data collection;
- Enhance conceptual clarity; and
- Guide implementation planning.
Given the inherent challenges in selecting a KT theory, model or framework, this post aims to provide some general tips based on various studies, including a recent pragmatic article by Lynch et al. [3].
Tips for Appropriate Selection
Despite increasing evidence that the use of theories, models and frameworks improves intervention effectiveness , KT and implementation research faces challenges in their use — including under-use, superficial use, and misuse [4]. These challenges are compounded by the sheer abundance of available theories, frameworks, and models, making choosing an appropriate and useful theoretical basis difficult. The following collection of key considerations should help researchers in choosing one or more theories, models and/or frameworks for their work.
1. Overarching Research Goal
Nilsen and colleagues recommend ensuring you have a clear idea of the overall goal of your research [5]. What is the purpose of the research? Is it to:
(a) Describe or guide the process of knowledge translation;
(b) Determine the factors affecting implementation outcomes; or
(c) Evaluate an implementation?
Answering this key question will help identify what kind of theory, model or framework is most appropriate. For example, the Knowledge-to-Action (KTA) Framework is best suited for guiding the process of knowledge translation. The Theoretical Domains Framework or the Promoting Action on Research Implementation in Health Services (PARiHS) Framework would be better if you’re looking to identify influences (such as barriers and facilitators) of a given behaviour. The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) Framework would be most appropriate if the goal is to evaluate the effectiveness of an intervention. On the other hand, having more than one implementation goal might require applying multiple theories, models or frameworks.
2. Target Population
There are theories, models and frameworks focused on different populations or levels of study, such as individuals, organizations or groups, and overall society. Having a clear idea of the target population for an intervention will facilitate the decision about what level your selected theory, model or framework needs to focus on (i.e. micro-, meso-, or macro-level implementation).
Interventions aimed at behaviour change of patients would benefit from an individual-level theory, model, or framework, such as the Theory of Planned Behavior, which predicts an individual’s intentions to adopt a given behaviour. Interventions focused on behaviour change within a specific hospital department would be best suited to group- or systems-level theories, models, and frameworks, such as the Diffusion of Innovations Theory, which explains how new innovations get spread and adopted over time in a given social setting.
3. Differences Between Theories, Models & Frameworks
As mentioned in Leah’s post, theories, models and frameworks have distinct purposes: theories are used to describe and explain a phenomenon, such as the Diffusion Innovations Theory; models guide the process of translating research into practice, such as the KTA Framework; and frameworks determine and describe factors believed to influence an outcome; such as the Theoretical Domains Framework.
4. Research Discipline
Lynch et al. [3] suggest asking yourself “what theories, models and frameworks have been used in my topic area?” to find practical examples of their use specific to your field, and identify any potential gaps. Most KT and implementation theories, models and frameworks have been derived from other disciplines, such as sociology (Normalization Process Theory) and psychology (Theory of Planned Behavior). Others integrate theories from more than one field (e.g. the Theoretical Domains Framework).
Due to the cross-disciplinary nature of theories, models and frameworks (and of many interventions), working with researchers from diverse disciplines will help facilitate selection and proper use of theory. A 2006 article by Estabrooks et al. provides an overview of key theories, models and frameworks from different disciplines [6].
5. Available Resources
Though they may be ideal to use in a given research context, some theories, models and frameworks can be costly to employ comprehensively, often due to the time and resources required. For example, employing the “evaluating outcomes” component of the KTA Framework to measure long-term outcomes of an implementation may not be feasible. The number of constructs and domains in other frameworks, such as the Theoretical Domains Framework (which has 82 constructs and 14 domains), and the Consolidated Framework for Implementation Research (with 39 constructs and five domains), are daunting. The potential burden on research teams, as well as participants, needs to be taken into account.
6. Data Collection Methods
In their pragmatic article, Lynch et al. recommend implementation researchers consider their data collection methods when selecting a theory, model or framework. A Theoretical Domains Framework-based intervention is well-suited for qualitative interviews. Similarly, an intervention based on the Consolidated Framework for Implementation Research (CFIR) will require qualitative methods to elicit data for each of its constructs, whereas a RE-AIM-based project will warrant quantitative surveys.
7. Stage of Research
Another important consideration is at what stage of the process of research you will employ your theory, model or framework. For example, Lynch et al. suggest that some theories, models and frameworks lend themselves best to the planning stages of implementation research, such as the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework, or the Theoretical Domains Framework in conjunction with the Behaviour Change Wheel. Others, such as the KTA Framework, are better suited for tracking project development while others (such as the RE-AIM Framework) work best for evaluation planning and selecting outcome measures.
8. Other Considerations
Lynch et al. provide some additional considerations when choosing a theory, model or framework for KT and implementation research, such as:
- Face validity — have the measures used been shown to be effective in achieving their stated aims?
- Does the theory, model or framework look at aspects of KT or implementation that you wouldn’t have thought about otherwise?
Additional Resources
Dissemination & Implementation Models in Health Research and Practice is a website created by the Center for Research in Implementation Science and Prevention (CRISP). This interactive online resource allows you to select and compare multiple theories, models and frameworks and provides guidance on adapting, integrating, and finding existing measurement instruments for specific study and practice contexts.
More recently, Birken and colleagues developed a tool called T-CaST to help implementation researchers and practitioners in the selection of an appropriate theory, model or framework for their implementation project [7]. The tool consists of four criteria domains (usability, testability, applicability, and familiarity) and has separate versions for implementation researchers and practitioners. Although useful, the T-CaST tool is only suitable to use when selecting from a pool of theories, models, or frameworks, rather than starting with a blank slate.
As you can see, there is no singular process for selecting the appropriate theory for KT and implementation research. The list of factors could be as large as that of the theories, models and frameworks themselves. What factors do you think are important for theory selection? What criteria do you use for selecting a theory for your research? Let us know in comments below.
References
1. Strifler L, et al. Scoping review identifies significant number of knowledge translation theories, models, and frameworks with limited use. J Clin Epidemiol, 2018; 92–102.
2. Birken S, et al. Criteria for selecting implementation science theories and frameworks: results from an international survey. Implement Sci, 2017; 12:124.
3. Lynch E, et al. “There is nothing so practical as a good theory”: a pragmatic guide for selecting theoretical approaches for implementation projects. BMC Heal Serv Resr, 2018; 18:857.
4. Gourlan M, et al. Efficacy of theory-based interventions to promote physical activity. A meta-analysis of randomised controlled trials. Heal Psy Rev, 2016; 10(1):50–66.
5. Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci, 2015; 10:53.
6. Estabrooks CA, et al. A guide to knowledge translation theory. J Contin Health Educ Prof, 2006; 26(1):25–36.
7. Birken SA, et al. T-CaST: an implementation theory comparison and selection tool. Implement Sci, 2018; 13:143.
About the Author
Masood Khan is a Research Coordinator with the George & Fay Yee Centre for Healthcare Innovation (CHI) and the Department of Community Health Sciences at the University of Manitoba.
