Unpacking KT Theories, Models & Frameworks

Theories are like toothbrushes. Everyone has one and no one wants to use anyone else's
“Theories are like toothbrushes. Everyone has one, and no one wants to use anyone else’s”

I heard that gem of a quote at the Knowledge Mobilization Forum last June. And there’s a certain truth to it. With the vast number of theories, models & frameworks that exist across disciplines, it’s hard to know which to choose — or why you should even use one to guide your KT research or practice in the first place.

Differentiating theories, models & frameworks

If you’re like me, you might have a little trouble discerning your theories from your models and frameworks. That’s because while they are three distinct concepts, they are often used interchangeably. To clarify:

  • A theory seeks to both describe and explain. It’s the most complex and it’s testable. A theory should help you predict and examine which factors influence your outcome.
  • A model describes but doesn’t explain. It’s commonly used to describe, or even simplify, the process of translating research into practice.
  • A framework describes (but doesn’t explain) factors believed to influence an outcome. It provides a big picture overview of various descriptive categories and how they might relate to one another.

Implementation researchers are increasingly interested in using theories, models & frameworks in their work — some are borrowed from other disciplines, while others have emerged from within the discipline itself. Last year, Nilsen published a narrative review highlighting those most commonly used in implementation science.

Three overarching aims

Nilsen contends the theoretical approaches used in implementation science fall into one of the three camps outlined below:

1. Those that describe and/or guide the process

Process models or frameworks, such as the Knowledge to Action Framework (KTA) and the CIHR Model of Knowledge Translation, seek to describe or guide a process. Older models tend to focus simply on transferring findings from researchers to users, while newer models place a stronger emphasis on the context in which research is implemented and used. Action models can even help guide the planning and execution of an implementation plan.

2. Those that help us understand and explain what influences implementation outcomes

This second aim can be further broken down into three subcategories: determinant frameworks, classic theories and implementation theories:

  • Determinant frameworks, such as the Theoretical Domains Framework (TDF) and PARIHS (Promoting Action on Research Implementation), describe what might influence an implementation outcome at the individual, organizational or societal level. The example Nilsen offers is of a health care professional’s adherence to a clinical guideline. Each determinant in that example — such as knowledge or intention — is typically compounded by a number of barriers and facilitators that impact the sought-after outcome (in this case, adherence to the clinical guideline). Context is an integral part of all determinant frameworks.
  • Classic theories, such as the Theory of Reasoned Action and the Theory of Diffusion [PDF download], are borrowed from other disciplines, such a psychology, sociology and organizational theory. They are often considered to be passive theories because they describe change mechanisms and how change occurs without inferring how to bring about change.
  • Implementation Theories, such as COM-B and the Normalization Process Theory, were developed by implementation researchers to gain a better understanding and explanation of particular aspects of, you guessed it, implementation.

3. Those that help guide the evaluation of implementation efforts

Evaluation frameworks provide researchers with a structure to evaluate implementation success. Many theories, models & frameworks noted above can also be applied for evaluation purposes because they specify measurable concepts and constructs. For example, the TDF, the Normalization Process Theory and COM-B have all been used for this purpose. Specific evaluation frameworks include RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and PRECEDE-PROCEED.

Why is theory important in the field of KT?

Theories, models & frameworks are important tools for KT practitioners because they can be used to identify potential barriers and facilitators that need to be addressed, guide the implementation process, or help pull together components for evaluation.

Yet, kind of like toothbrushes, theories are only valuable to the extent that we use them. It’s estimated to take 17 years for a mere 14% of research to make it into clinical practice [PDF download]. Many researchers are optimistic that using theoretical approaches will help reduce this research-to-practice gap by helping us reach a common understanding of what works well, what doesn’t and — perhaps most importantly — under what circumstances. Others argue that a common sense approach might work just as well.

Beyond the benefits mentioned by Nilsen, using theories, models & frameworks in KT leads to a more comprehensive and transparent approach to implementation, allowing us to:

  • Identify where implementation might fail
  • Share learnings across studies, projects and contexts
  • Understand the change process, and identify which implementation components were successful and which were not, and
  • Develop and refine theories based on learnings and challenges, ultimately leading to more effective interventions.

Read Nilsen’s paper for more information.


About the author

Leah Crockett is a Knowledge Translation Coordinator with the George and Fay Yee Centre for Healthcare Innovation and the Knowledge Broker for Translating Emergency Knowledge for Kids (TREKK), a national knowledge mobilization network for pediatric emergency medicine.

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