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Knowledge brokering for healthy aging: a scoping review of potential approaches Van Eerd, Dwayne; Newman, Kristine; DeForge, Ryan; Urquhart, Robin; Cornelissen, Evelyn; Dainty, Katie N Oct 19, 2016

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SYSTEMATIC REVIEW Open AccessKnowledge brokering for healthy aging:a scoping review of potential approachesDwayne Van Eerd1,2*, Kristine Newman3, Ryan DeForge4, Robin Urquhart5, Evelyn Cornelissen6 andKatie N. Dainty7,8AbstractBackground: Developing a healthcare delivery system that is more responsive to the future challenges of an agingpopulation is a priority in Canada. The World Health Organization acknowledges the need for knowledgetranslation frameworks in aging and health. Knowledge brokering (KB) is a specific knowledge translation approachthat includes making connections between people to facilitate the use of evidence. Knowledge gaps exist about KBroles, approaches, and guiding frameworks. The objective of the scoping review is to identify and describe KBapproaches and the underlying conceptual frameworks (models, theories) used to guide the approaches that couldsupport healthy aging.Methods: Literature searches were done in PubMed, EMBASE, PsycINFO, EBM reviews (Cochrane Database ofsystematic reviews), CINAHL, and SCOPUS, as well as Google and Google Scholar using terms related to knowledgebrokering. Titles, abstracts, and full reports were reviewed independently by two reviewers who came to consensuson all screening criteria. Documents were included if they described a KB approach and details about theunderlying conceptual basis. Data about KB approach, target stakeholders, KB outcomes, and context wereextracted independently by two reviewers.Results: Searches identified 248 unique references. Screening for inclusion revealed 19 documents that described15 accounts of knowledge brokering and details about conceptual guidance and could be applied in healthy agingcontexts. Eight KB elements were detected in the approaches though not all approaches incorporated all elements.The underlying conceptual guidance for KB approaches varied. Specific KB frameworks were referenced ordeveloped for nine KB approaches while the remaining six cited more general KT frameworks (or multipleframeworks) as guidance.Conclusions: The KB approaches that we found varied greatly depending on the context and stakeholdersinvolved. Three of the approaches were explicitly employed in the context of health aging. Common elements ofKB approaches that could be conducted in healthy aging contexts focussed on acquiring, adapting, anddisseminating knowledge and networking (linkage). The descriptions of the guiding conceptual frameworks(theories, models) focussed on linkage and exchange but varied across approaches. Future research should gatherKB practitioner and stakeholder perspectives on effective practices to develop KB approaches for healthy aging.Keywords: Knowledge transfer, Knowledge broker, Healthy aging* Correspondence: dvaneerd@iwh.on.ca1Institute for Work and Health, 481 University Avenue, Suite 800, Toronto,Ontario, Canada M5G 2E92School of Public Health and Health Systems, University of Waterloo, 200University Avenue West, Waterloo, Ontario, Canada N2L 3G1Full list of author information is available at the end of the article© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Van Eerd et al. Implementation Science  (2016) 11:140 DOI 10.1186/s13012-016-0504-5IntroductionDeveloping a healthcare delivery system that is more re-sponsive to the future challenges of an aging populationis a priority in Canada [1–5]. The Canadian populationaged 65 and over is expected to double over the next25 years [6]. The rising number of people entering olderage makes it likely that issues related to multi-morbidity,frailty, and chronic life-limiting illness will be a key chal-lenge for healthcare systems in the next half-century.Healthcare providers and policy makers are expected todraw on research evidence in their provision of care orpolicy making [7–11]. Indeed, as acknowledged by theWorld Health Organization (WHO), understanding howto use research evidence (i.e., access, assess, and applyresearch knowledge to inform healthcare practices) iscritical to maintaining healthy aging societies and ad-dressing chronic diseases, housing, and community andsocial elements of aging [12].The WHO recently released their World Report onAging and Health, which defines healthy aging as “theprocess of developing and maintaining the functionalability that enables well-being in older age” [13]. The re-port provides a public health framework for healthyaging [13]. In addition, the report suggests key areas foraction: (i) align health systems to the needs of older pop-ulations; (ii) develop long-term care (LTC) systems; and(iii) create age-friendly environments. To make progressin these areas of action, health system stakeholders(planners, providers, consumers) are encouraged to drawon research evidence to inform their decisions, be thatthe creation of new knowledge through the conduct ofnew research projects, or through the use of existing re-search evidence.Increasing research use to improve practice is the pur-view of the field of Knowledge Translation (KT). KT refersto the practice and scientific inquiry that aims to ensurethat stakeholders (i.e., care providers and recipients) areaware of and use research evidence to inform their healthand healthcare decision-making [8], and its strategies arewidely considered to help optimize the use of researchevidence. One emerging approach to supporting the use ofresearch is that of knowledge brokering (KB), a specific KTapproach that includes making connections betweenresearchers and decision-makers to facilitate the use ofevidence in the promotion and provision of health andhealthcare [14–17]. Knowledge brokers connect researchersand knowledge users to identify issues and problems forwhich solutions are required and facilitate the identifica-tion, access, assessment, interpretation, and/or translationof research evidence into local policy and practice [18]. Weuse the term approach because it is by definition “a wayof dealing with a situation or a problem” (https://en.oxford-dictionaries.com/definition/approach); approaches may en-tail multiple elements. Indeed, the roles of those involveddescribed in KB approaches seem to vary greatly. BecauseKB is relatively new, many knowledge gaps continue toexist [16, 18], including understanding whether there arekey KB elements that are consistent across variousapproaches. KB approaches as described in the literature[14, 15] appear to be adaptable to healthy aging contexts.Urquhart and colleagues [17] describe a specific KBapproach that was applied in the area of healthy aging. Inaddition, many different KB models exist, including produ-cer push models, linkage and exchange models, knowledgenetwork models, and knowledge exchange team models[16, 17]. There have been increased calls for KTapproaches, such as KB, to be guided by clearly statedtheory or conceptual underpinning [19–23]. It is not clearwhether there is a predominant conceptual framework ortheory used to guide KB approaches. The terms conceptualframeworks, theories, and models are often used inter-changeably, however conceptual frameworks tend to bebroad and descriptive, while theories and models are morespecific and better suited for testing and comparison [24].Conceptual frameworks are used to guide practice andorganize approaches. For simplicity, we have used the term“frameworks” to consistently refer to the conceptual under-pinning from the KB approaches found in the literature.We conducted a scoping review of the KB literatureto better understand how to guide KB practice andorganize approaches. The specific objective of thescoping review was to identify and describe KBapproaches and the underlying conceptual frameworks(models, theories) used to guide the approaches thatcould be applied within the context of supportinghealthy aging.MethodsOur scoping review approach was guided by that ofWilson and colleagues (2010). Our scoping review in-cluded the following steps: (1) identifying the researchquestion; (2) searching for relevant studies; (3) selectingstudies; (4) charting the data; (5) collating, summarizing,and reporting the results.The following electronic databases were searched toidentify studies for inclusion: PubMed, EMBASE, Psy-cINFO, EBM reviews (Cochrane Database of SystematicReviews; ACP Journal Club; Database of Abstracts of Re-views of Effects; Cochrane Central Register of ControlledTrials; Cochrane Methodology Register; Health Technol-ogy Assessment; NHS Economic Evaluation Database),CINAHL, and Scopus. Searches in all databases coveredthe period from database inception until July 2014. Withthe support of a health sciences information specialist, alist of terms related to KB (knowledge brokerage, know-ledge broker, knowledge brokering) was devised. The in-formation specialist conducted a search using theseterms (combined with the Boolean operator “OR”) in allVan Eerd et al. Implementation Science  (2016) 11:140 Page 2 of 12fields of the databases listed above. Terms related tohealthy aging were not used in the search as we wishedto capture KB from a variety of contexts that could po-tentially be applied to health aging. No language ormethodological limits were used. In addition, a search ofthe grey literature was conducted using Google andGoogle Scholar. The grey literature search used an ex-panded list of KB and KT terms (see Additional file 1for the grey literature search strategy).We considered inclusion for review in two stages:(1)First, the documents had to(a)be in English language(b)present an explicit and detailed description of aKB approach along with an explicit conceptualframework or model that was used to guide theKB approach(2)In documents that described a KB approach alongwith conceptual guidance, we included documentsthat:(a)described older adults as a recipient of care/servicesOR(b)described objectives to improve practice in healthsystems including long-term care (LTC) systemsthat could be adapted to meet the needs of olderpopulations and/or to create age friendlyenvironments.We were inclusive and only excluded KB documentsthat were clearly not related to healthy aging contexts(as described by the WHO healthy aging report) [13]such as broad approaches related to the environment orthose related to specific workplace organizationalcontexts.Titles and abstracts were screened, according to theabove inclusion criteria, independently by two reviewers.Reviewers met to discuss screening criteria after review-ing a number of documents to ensure we were consist-ent in interpreting the inclusion and exclusion criteria.When there were disagreements, reviewers met andcame to consensus. When titles and abstracts were notexcluded, the full article was obtained for further screen-ing by two independent reviewers using the same inclu-sion/exclusion criteria. Disagreements were resolved bydiscussion. Documents that met the inclusion criteriawere reviewed and details about the KB approach, targetstakeholders, KB outcomes, and context were extracted.If more than one document described a single KB ap-proach, we extracted data from all.We were interested in how theory or conceptualframeworks/models were used to guide the KB ap-proaches found in the literature. Therefore, we extractedinformation about underlying theories, models, andframeworks from the documents. The terms conceptualframeworks, theories, and models are often used inter-changeably; however, conceptual frameworks tend to bebroad and descriptive, while theories and models aremore specific and better suited for testing and compari-son [24]. Conceptual frameworks are used to guide prac-tice and organize approaches. For simplicity, we haveused the term “frameworks” to consistently refer to theconceptual underpinning from the KB approaches foundin the literature.Data extraction was carried out independently by tworeviewers (DVE and KN) who then came to consensusabout the data. A narrative synthesis of the KB ap-proaches was done to explore and consider commonal-ities and underlying conceptual guidance. Thedescriptions of KB approaches were explored to identifycommon elements of KB, which we described accordingto the terminology from the CHSRF [14] and Ward [15]models.ResultsThe searches identified 248 unique references (see Fig. 1).Screening titles and abstracts resulted in the exclusionof 108 references. The remaining 140 full reports werescreened to reveal 19 documents that described 15 dis-tinct KB approaches (in two cases, multiple documentsdescribed the same KB approach) in sufficient detail.The documents were mostly from peer-reviewed jour-nals (13 of 15) and were published/posted between 2003and 2015, although 10 of 15 were produced since 2011.Two documents found in the grey literature searcheswere publically available reports issued by governmentalagencies [14, 25].Records identified through database searching (n =202)Additional records identified through searching other sources (grey literature) (n =51)Records after duplicates removed (n =248)Records screened: Titles & Abstracts (n =248)Full-text documentsassessed for eligibility (n =140)19 documents describing 15 KB approachesFig. 1 Inclusion of knowledge brokering (KB) approachesVan Eerd et al. Implementation Science  (2016) 11:140 Page 3 of 12Ten documents described seven distinct KB ap-proaches that had been implemented in various health-care or public health contexts [17, 18, 26–33]. Theremaining nine documents described eight proposed KBapproaches [14, 15, 22, 25, 34–38]. In some cases, thepurpose of the documents was to develop and describeconceptual frameworks [14, 15, 22, 36, 38]. Table 1 pro-vides a description of the 15 KB approaches in the finalset of documents included in this scoping review.There were eight elements of KB that emerged fromthe literature (Table 2). The KB elements that were de-scribed in three or more KB approaches include: creat-ing knowledge (knowledge production, generation) [15],acquiring knowledge (gathering evidence, searching,accessing) [14], assessing knowledge (critical appraisal ofevidence) [14, 15], adapting/translating knowledge (tai-loring, preparing messages for stakeholders) [15], apply-ing knowledge (implementing evidence in practice) [15],disseminating knowledge (transferring knowledge to tar-get users/stakeholders) [14, 15], linking/networking (con-necting with others, developing relationships) [14, 15],and enhancing capacity (developing skills in target users/stakeholders) [15].KB approachesThe KB approaches implemented or proposed differedbased on stakeholders and desired outcomes (Table 1).However, there were common elements that were de-scribed in a majority of approaches. Disseminating know-ledge was an element mentioned in 13 of 15 KBapproaches [14, 15, 17, 18, 22, 25–34, 36, 38]. Linking/net-working was also mentioned in 13 of 15 KB approaches[14, 15, 17, 18, 22, 25–29, 31, 32, 34, 36, 38]. In addition,adapting/translating knowledge was noted in 10 of 15approaches [15, 18, 22, 25–30, 32–34, 36, 38].Acquiring knowledge was an element described in 10of 15 KB approaches [14, 15, 18, 22, 25–30, 32–36, 38].Enhancing capacity was mentioned in seven approaches[15, 26, 27, 30, 32, 34, 35, 37]. The remaining elementsassessing knowledge, synthesizing knowledge, creatingknowledge, and applying knowledge were mentioned lessoften (Table 2).Target stakeholdersThree of the approaches included in the review wereused in the context of aging [17, 26, 27, 30] and consid-ered clinicians, program administrators, and caregiversas target stakeholders. Otherwise, nine of the other12 KB initiatives we reviewed considered specific health-care settings and targeted decision-makers, practitioners,and patient stakeholders. Three other approaches fo-cused on public health decision-makers. As such, thetarget stakeholders relevant to healthy aging addressedin these 15 KB approaches varied and included policymakers, nurses, researchers, community members,health services managers/administrators, and otherknowledge brokers.KB outcomesOutcomes specifically related to the KB approacheswere reported or proposed in seven of the 15approaches [17, 18, 22, 26, 27, 29–32, 34]. Outcomesreported were disparate and included measures of KBskills/role [26, 27, 34], research use/uptake/awareness[18, 22, 29, 30, 32], KT process [17, 26, 27], andpractice change [18, 22, 29, 30, 32]. Other documentsdescribed an approach to KB but did not report onoutcomes [14, 15, 22, 25, 33, 35–38].Conceptual underpinning for KBTable 3 shows the conceptual frameworks or modelsthat guided the KB approaches described. Most pro-jects (i.e., 9 of 15) described specific KB frameworks[14, 15, 17, 22, 30, 31, 35–38], while the remainingsix linked KB approaches to more general KT models[18, 22, 25–27, 29, 32–34].The “linkage and exchange” model (created by theCanadian Health Services Research Foundation, nowknown as Canadian Foundation for Healthcare Improve-ment) (CHSRF 2003) was most often cited as the guidingframework for KB approaches [15, 17, 30, 31, 36, 37]. TheCHSRF model was used either as the conceptual guidancefor a KB approach or as the basis for developing new con-ceptual frameworks.General KT models were noted as guiding three of theKB approaches [22, 26, 27, 33, 38]. Conklin et al. [26, 27]drew upon the PARiHS framework [39, 40] to guide theevaluation of the KB approach, while also using the CHSRFmodel [14]. Wahabi et al. [33] referred to the Knowledgeto Action model [41] to guide a training approach for fam-ily physicians. In the development of a knowledge ex-change model, Ward et al. [22, 38] and Armstrong [34]were influenced by diffusion of innovations [42, 43].Nearly half of the KB approaches we examinedwere guided by multiple frameworks [15, 22, 26, 27, 31,32, 34–36, 38]. Frameworks or models related toorganizational learning [36], community navigators [32],and capacity development [15, 18, 35] were included alongwith the CHSRF and general KT models.DiscussionThis scoping review was undertaken to find anddescribe existing knowledge on KB approaches alongwith their components and guiding conceptualframeworks. More specifically, we sought to identifyKB approaches that could be applied in the contextof healthy aging research as part of a larger researchstudy. We found 15 distinct KB approachesVan Eerd et al. Implementation Science  (2016) 11:140 Page 4 of 12Table 1 Knowledge broker approaches, target stakeholders, and outcomes described in relevant KB documentsAuthor,(year, jurisdiction)KB approach implemented or proposed Target Stakeholders Outcomes evaluated or proposed?Conklin (2013, Canada)[26, 27]IMPLEMENTED:KB roles within a network (Seniors HealthResearch Transfer Network (SHRTN))described:- coach/mentors to develop skills/capacity- knowledge translators (locate, appraise,create, package, disseminate knowledge)- developers of relationships/networksBut note that the roles must be fluid andcontext dependent.Facilitating knowledge to action (KTA),communities of practice, and improvedhealth services delivery for seniors.• Caregivers• Policy makers• ResearchersPROPOSED:Proposed examining Knowledge to Action(KTA) processes and KB roles.No explicit KB outcomes evaluatedDobbins (2009, Canada)[18, 28, 29]IMPLEMENTED:1. Access to a repository of high-quality re-search evidence (systematic reviews);2. Tailored messages based on researchevidence;3. Individual knowledge brokers workingone-on-one with decision-makers.• Public healthdepartments• Decision-makers• Researchers• Knowledge transferpractitionersEVALUATED:The primary outcome assessed the extent towhich research evidence was used in arecent program decision, and the secondaryoutcome measured the change in the sumof evidence-informed healthy body weightpromotion policies or programs being deliv-ered at health departments.Gerrish (2011, UK) [30] IMPLEMENTED:Description of advanced practice nursesdisseminating information to clinical nursesthrough knowledge management(generating, accumulating, synthesizing,translating, disseminating research) andpromoting the uptake of knowledge(capacity building, problem solving,facilitating change).• Advanced practicenurses• Clinical nursesEVALUATED:Promoting the uptake of knowledge:capacity building, problem solving, andfacilitating change. (Evidence-based practice)Goering (2003, Canada)[31]IMPLEMENTED:Dissemination of information from twoorganizations in partnership. This was donethrough joint presentations by researchersand the ministry to the decision-making bod-ies in an interactive forum that alloweddecision-makers to ask questions and seekclarification on information presentedUsing a tiered approach to linkage andexchange:- Inter-organizational relationship- Interactive research designs (workingtogether)- Dissemination- Policy formation• Policy makers;• Administrators/managers;• Frontline clinicians;• Decision-makersEVALUATED:The researchers found that the forum formatincreased dissemination of the researchproduct, provided clarification on languageuse with research and it provided insightinto more targeted research based onexperts in the field.Henderson, (2011, Australia)[32]IMPLEMENTED:Description of trained community-basedhealth workers or "Community Navigators"helping disadvantaged community membersnavigate the health system and to promotepositive health.Community navigators were based on a laycultural health worker model and theydescribed their knowledge broker rolesincluding:.- Broad knowledge acquisition to provideinformation and knowledge not only abouthealth issues, but also about the broadersocial determinants of health, such ashousing, employment, and education.- operate in culturally appropriate wayswithin sub-groups of the community, in-cluding taking on interpreter roles for med-ical visits• Citizens/communitygroups• Administrators,managersPROPOSED:Do community navigators make a differenceto health equity in “culturally andlinguistically diverse” communities with lowaccess to health services?Focus on: awareness of health/healthylifestyles, capacity for communities toeffectively manage their own health (to seekmedical assistance and to be able tocommunicate with doctors).Van Eerd et al. Implementation Science  (2016) 11:140 Page 5 of 12Table 1 Knowledge broker approaches, target stakeholders, and outcomes described in relevant KB documents (Continued)- Build capacity in the community: “workingwith the community to facilitateempowerment”Urquhart (2011, Canada)[17]IMPLEMENTED:Introduction of Knowledge Broker within alarge research team to facilitate anintegrated knowledge translation approach.Brokering tasks encompassed all activitiesrelating to team interactions,communications, networking, stakeholderengagement/interaction, and researchsynthesis and dissemination.• Cancer/health servicesresearchers (largeresearch teams)EVALUATED:1. Facilitation of an integrated KT approachto research conduct.2. Development of collaboration betweenthe research team and externalstakeholders, including other researchers.Wahabi (2011, Kingdomof Saudi Arabia) [33]IMPLEMENTED:Family medicine physicians trained inevidence-based medicine to enhance theirabilities as knowledge brokers through(1) Debates, where teams were scored on (i)comprehensiveness of their research, (ii)critical appraisal and grading of the evidenceused during the debate, (iii) adaptation ofevidence to participants’ local context, and(iv) the quality of the communication skillsused to articulate the evidence to non-medical end users.(2) KT presentations using the KTAframework(3) EBM knowledge sessions whereparticipant learned about EBM and how theymay enhance their EBM skills.• Frontline clinicians;(physicians)NO:No KB outcomes describedArmstrong, (2013, Canada)[34]PROPOSED: “KT4LG”A knowledge translation intervention forpublic health decision-making in local gov-ernment. The intervention was designed tobe implemented by a Program Coordinatorwho would also provide a point-of-contactand act as a KB.1. Provision of evidence summaries andadditional individualized support, such astailored messages.2. Training in accessing research, assessingtrustworthiness, and applying researchevidence to local context. 3. Developingand implementing strategies that assist inthe development of an organizationalculture that supports evidence-informeddecision-making (EIDM) within localgovernments.• Administrators/managers (decision-making staff at localgovernments)• Policy makersPROPOSED:Intervention not yet implemented. Intentionto measure individuals’ confidence, skills, andaccess to research evidence and to assesschanges in organizational culture for EIDM.CHSRF (2003, Canada) [14] PROPOSED:Describes common core skills of KB inpossible approaches: evidence gathering,critical appraisal, mediation, imagination/intuition, communication, and listening• Healthcare stakeholdersbroadlyNO:Challenges of evaluation noted because willbe context specific. No evaluation guidanceprovided.Catello (2015, Canada) [35] PROPOSED:Proposes key competencies for nurses to beknowledge brokers: evidence acquisition,critical appraisal, evidence-based decision-making experience, and networking.• Nurses NO:No evaluation conducted or proposed.Hammami (2013, Canada)[36]PROPOSED:A knowledge transfer process in whichknowledge brokers are at the core, as well asa series of five activities to facilitate the linkbetween researchers and users:- acquisition- integration- adaptation- dissemination• Knowledge brokers inthe health service fieldNO:Suggest organizational climate has a directpositive impact on brokers’ knowledgetransfer activities through autonomy grantedto brokersVan Eerd et al. Implementation Science  (2016) 11:140 Page 6 of 12providing details about broker activities, roles, skills,and competencies as well the underlying conceptualbasis for the approaches. The goal of our review wasnot to evaluate the effectiveness of KB but rather tosummarize the various KB approaches and concep-tual guidance. We discuss the insights and implica-tions of these scoping review findings now, first withrespect to the elements and conceptual guidance ofKB approaches, then in terms of supporting healthyaging.KB approaches and conceptual guidanceThe KB approaches found in our review varied depend-ing on the context and stakeholders involved. Not sur-prisingly, a majority of KB approaches describedelements of disseminating knowledge and linking/net-working, as well as acquiring and adapting knowledge.However, not one KB element was described in all of theapproaches. The diversity of KB approaches was also de-scribed in recent literature reviews [16, 44]. Bornbaumand colleagues [16] reported that descriptions of KBTable 1 Knowledge broker approaches, target stakeholders, and outcomes described in relevant KB documents (Continued)- creation of linksLemire (2013, Canada) [25] PROPOSED:Exchange is central and knowledgetranslation is filtered through a multitude ofintermediary actors, such as knowledgebrokers: through a number of KT approaches:- as part of the social system in KT (i.e., anexchange network supporting theproduction and transfer of knowledge),- as a credible messenger,- facilitators (between two groups),- as a strategy to promote relationshipdevelopment.• Managers• Decision-makers• Stakeholders• Public policy makers• Professionals (liaisonofficers)• Knowledge translationofficers• Researchers orknowledge brokersNO:No evaluation was conducted.MacDermid (2009, Canada)[37]PROPOSED:KB noted as one of multiple methods of KT.KB role is to link decision-makers with re-searchers, facilitating their interaction to workcollaboratively on using evidence fordecision-making. Trust and development ofcommon ground are essential.Suggest that KB should be used when:changes in policy are needed and wherecommon goals/outcomes can be achievedamong policy makers, end users, andknowledge developers.• Healthcare providers(particularly handsurgeonsrheumatologists, andtherapists)NO:No outcomes and no evaluation but basedon improving evidence-based practice.Ward (2009, England) [15] PROPOSED:Multiple knowledge brokering approachesadvocated, including(i) knowledge management through activedissemination and knowledge creation(ii) linkage and exchange though relationshipbuilding and facilitationand(iii) capacity building though education andtraining activities• General healthcarepolicy and practicestakeholders (notnecessarily policymakers)NO:No specific KB outcomes described.Suggest a broader, more process orientedapproach based on the underlying principlesand processes of transferring knowledge intoaction.Ward (2012, England)[22, 38]PROPOSED:Interactive problem solving approach:The intervention involves helpingparticipants identify, refine, and reframe theirkey issues, finding, synthesizing and feedingback research and other evidence, facilitatinginteractions between participants andrelevant experts and transferring informationsearching skills to participants.Three KB approaches advocated: (i)information management (helping teamsfind, package, and disseminate information),(ii) linkage and exchange (facilitatingdiscussions between the teams and relevantexperts), and iii) capacity building (helpingteams develop their capacity to exchangeknowledge into the future).• Mental healthpractitionersNO:No specific KB outcomes described. Focuswas on process and frameworkdevelopment.Van Eerd et al. Implementation Science  (2016) 11:140 Page 7 of 12roles consisted of multiple tasks that could be classifiedas knowledge management, linking agents, or capacitybuilding. This is consistent with our findings of elementsrelated to accessing, adapting, and disseminating know-ledge as well as linking/networking. However, we did notfind as much emphasis on capacity building in ourreview.The goal of our review was not to evaluate the effect-iveness of KB but rather to consider how KB is con-ducted. As such, our review was not limited toevaluation studies. In those studies that included evalu-ation, we noted a variety of study designs including arandomized controlled trial (18, 28, 29), multiple casestudy designs (26, 27, 30), and qualitative phenomeno-logical analysis (32). We also explored the conceptualguidance of KB approaches. While there is no evidencethat knowledge translation approaches guided by theoryare more effective than those that are not [45, 46], thereis support for using conceptual frameworks (models,theories) to direct approaches [19–23, 47].We found that the “linkage and exchange” model fromCHSRF [14] was the predominant guiding framework re-ported in the KB approaches we reviewed. General KTframeworks such as the Knowledge to Action modelTable 2 KB elements in approaches described in relevant KB documentsAuthor, (year,jurisdiction)KB elementsCreatingknowledgeAcquiringknowledgeAssessingknowledgeAdapting/translatingknowledgeSynthesizingknowledgeApplying(implementing)knowledgeDisseminatingknowledgeLinkage/networkingEnhancingcapacityConklin, (2013,Canada) [26, 27]+ + + + – – + + +Dobbins,(2009, Canada)[18, 28, 29]– + – + + – + – –Gerrish, (2011,England) [30]+ + – + + + + – +Goering, (2003,Canada) [31].– – – – – + + + –Henderson,(2011, Australia)[32]– + – + – – + + +Urquhart,(2011, Canada)[17]– – – – + – + + –Wahabi, (2011,Kingdom ofSaudi Arabia)[33]– + + + – – + – –Armstrong,(2013, Canada)[34]– + + + – + + + +CHSRF, (2003,Canada) [14]– + + – – – + + –Catello, (2015,Canada) [35]– + + – – – – + +Hammami,(2013, Canada)[36]– + – + + – + + –Lemire (2013,Canada) [25]+ – – + – – + + –MacDermid,(2009, Canada)[37]– – – – – – – + +Ward, (2009,England)+ v – + – + + + +Ward, (2012,England)[22, 38]– + – + – – + + –Van Eerd et al. Implementation Science  (2016) 11:140 Page 8 of 12[41] or PARHIS [40] were also used to guide some KBapproaches. As well, the approaches we found wereoften informed by multiple frameworks. Using multipleframeworks appeared to allow the KB approach to ad-dress specific contexts and stakeholders to achieve spe-cific outcomes. More research is required to determineif KB approaches guided by theory will have greater im-pacts [20, 45]. However, as we consider KB approachesfor healthy aging, we agree that conceptual guidance isimportant [19, 20, 41, 47, 48].Building a KB approach for healthy agingConcurrent to our focus on describing KB approachesand conceptual guidance was our focus on aging. Ourconception of healthy aging was guided by the WHO re-port on aging and health [13]. Specifically, we consideredthe WHO’s key areas of action: (i) align health systemsto the needs of older populations; (ii) develop long-termcare (LTC) systems; and (iii) create age-friendly environ-ments to represent the contexts for KB approaches [13].Three of the KB approaches examined in this scopingTable 3 Conceptual frameworks (models, theories) noted in relevant KB documentsAuthor, (year), [jurisdiction] KB conceptual framework, model, or theory (adopted, developed, or referenced) ContextConklin, (2013, Canada)[26, 27]Adopted: the “linkage and exchange” model (CHSRF 2003) and the PromotingAction on Research Implementation in Health Services (PARIHS) framework (Kitson1998; Kitson 2008). Also notes Ward (2009a) models as descriptive of KB rolesHealth services delivery:communities of practiceDobbins, (2009, Canada)[18, 28, 29]Adopted: linkage and exchange model (CHSRF 2003; Lomas 2007) along with theframework for dissemination and utilization of research evidence for health carepolicy and practice (Dobbins 2002).Public healthGerrish (2011, England)[30]References: linkage and exchange model (CHSRF 2003) and Ward (2009a) models HealthcareGoering (2003, Canada)[31]Developed: A linkage and exchange framework that conceptualizes four tiers(inter-organizational relationship, interactive research projects, dissemination, andpolicy reform). Draws on Huberman 1994, Lomas 2000, Lavis 2002.Public health: policyHenderson (2011,Australia) [32]Developed: the Community Navigators Model drawing on Lay cultural healthworker model (Henderson et al. 2010), Community health worker approach(Lewin et al. 2007).Healthcare, public healthUrquhart (2011, Canada)[17]References and adopts: the CHSRF (2003) linkage and exchange model Healthcare, health servicesWahabi (2011, Kingdomof Saudi Arabia) [33]References: the Knowledge to Action framework (Graham 2007) as the basisfor developing KB skills.HealthcareArmstrong (2013, Australia)[34]Developed: KT logic model based on Bowen and Zwi (2005): KnowledgeTranslation for Local Government (KT4LG). A process model designed to guidea KT intervention with KB as coordinator.Public healthCHSRF (2003, Canada) [14] Developed: linkage and exchange model. The basis of the model is in knowledgemanagement and the spreading of ideas leading to innovations. KB areintermediaries—linking and promoting exchange.HealthcareCatello (2015, Canada) [35] References: linkage and exchange models (Lomas 2007, Ward 2009, Lavis 2013)as well as capacity development (Dobbins 2009, Robeson 2008, and Ward 2009).HealthcareHammami (2013, Canada)[36]Developed: a new exploratory framework based on KBs’ knowledge transfer activities:acquisition of new knowledge, integration of new knowledge, adaption of researchresults, dissemination of research, creating links between researchers and users.Multiple KT models were consideredHealth services deliveryLemire (2013, Canada) [25] Developed: a process framework to guide dynamic KT approaches. KB role (calledintermediaries) is considered central to the KT process. Conceptual basis for KB isnot explicitly described.Public healthMacDermid (2009, Canada)[37]References: KB intervention description based on linkage and exchange (CHSRF2003; Lomas 2007)HealthcareWard (2009, England) [15] References: three frameworks from Oldham and McLean (1997) to describe thefunctions of brokering:(1) The knowledge system framework (creation, diffusion, and use of knowledge);(2) transactional framework (interface between “creators” and “users” of knowledge);(3) social change framework (enhancing access to knowledge or capacity building)HealthcareWard (2012, England)[22, 38]Developed: based on sociological frameworks of diffusion and innovation (van deVen 1999; Rogers 2003) a single conceptual framework of knowledge exchange(with KB as central component) with five loosely defined components: (i) problemidentification and communication, (ii) analysis of context, (iii) knowledgedevelopment and selection, (iv) knowledge exchange activities/interventions,(v) knowledge useHealthcare: mental healthVan Eerd et al. Implementation Science  (2016) 11:140 Page 9 of 12review were actually used in the context of health aging[17, 26, 27, 30]. The remaining KB approaches weredeemed applicable to the field of healthy aging becausethey were described as adaptable and flexible to contextand target stakeholders.The three KB approaches from healthy aging contextswere guided by linkage and exchange frameworks [14, 15]and were applied in healthcare or health service contexts.However, the approaches did not describe the same KB el-ements. The only common KB element across these ap-proaches was disseminating knowledge to a variety ofstakeholders including clinicians, caregivers, policymakers, and researchers. Urquhart et al. [17] describe anemphasis on linkage and networking whereas Conklin[26, 27] and Gerrish [30] also include descriptions ofacquiring and adapting knowledge. Similarly, theremaining 12 KB approaches were variable in the KBelements employed, suggesting that the approachesmay emphasize different elements depending on con-text and objectives. However, taken together, we seethat the KB approaches consistently consider acquir-ing, adapting, and disseminating knowledge as well aslinkage/networking. One brief example from Gerrish [30]highlights a KB (eldercare nurse specialist) providingtraining to staff about elder abuse. The KB considered (ac-quired) information from guidelines (national and local)and her own experience, as well as from the media (TV,newspapers). Synthesizing the evidence and adapting it forthe specific audience, the training (dissemination) was toimpact on practice (application and enhancing capacity).The KB approach could be adapted for many contexts.The findings from this scoping review can informhealth system planners whose focus is on mobilizingknowledge to support healthy aging. The literature wereviewed presents a variety of approaches that can beadapted to the context of healthy aging, and within theseapproaches, we categorized eight KB elements that weredescribed across the documents: creating knowledge, ac-quiring knowledge, assessing knowledge, adapting/trans-lating knowledge, applying knowledge, disseminatingknowledge, linking/networking, enhancing capacity. Allof the elements were not applied in a single approach,which speaks to the flexibility and adaptability of KB ap-proaches designed for specific contexts and outcomes.However, moving forward to design a KB approach forhealthy aging, we suggest that all elements should beconsidered.For instance, the evidence to support healthy agingpractices will come from a broad range of research areas(e.g., gerontology, health services, geriatrics, primarycare, public health, palliative care); therefore, tailoringthe KB elements related to creating, acquiring, assessing,and synthesizing knowledge will be important and po-tentially challenging [14, 18, 22, 29, 30]. Given the agingpopulation and increased global attention towardshealthy aging [13, 49], we anticipate that the volume ofrelevant research will grow exponentially. Accordingly,close attention to target audiences’ needs and prioritiesis required in gathering and synthesizing high-quality re-search to support the practices and policies needed forhealthy aging.Beyond acquiring and synthesizing research evidence,and given the breadth of potential target stakeholdersthat will be involved in healthy aging practice and policy,the KB elements of adapting/translating and disseminatingknowledge will also be essential [18, 22, 25–29, 32, 34, 38].According to the WHO recommended actions, stake-holders from healthcare and LTC will be primary targets.Similar to other areas of health, the target stakeholdersare wide ranging including administrators, healthcare pro-viders, community providers, family members (caregivers),as well as policy makers at local and national levels. More-over, the focus on creating age-friendly environments [13]suggests that in addition to the stakeholders noted above,there would be a need to connect with municipal, provin-cial/state, and a broader range of care providers. This is abroader audience than would be required for disease-spe-cific KB and requires a level of connection (network-ing) across stakeholder groups from a range ofgeographical locations. KB approaches will have toconsider the broad range of stakeholders and their di-verse research and networking needs. Disseminationwill need to be broad ranging and creative to effect-ively reach the stakeholders.Perhaps the most important element of a KB ap-proach, linkage, and network building will require muchattention [14, 17, 25, 31]. The breadth of the potentialstakeholders alone will be daunting to consider. Con-necting, building, and maintaining relationships withmultiple stakeholder groups will be time consuming andresource intensive. Linkage and networks are keys to thesuccess of dissemination and essential to the element ofcapacity building [15, 26, 27, 30, 32]. Given the increasesexpected in the aging population, it will be vital that theKB approach build capacity to ensure that the effectivepractices and policies result in the changes desired. The“linkage and exchange” model [14] or many underlyingaspects of the model (knowledge exchange and relation-ship elements) were a central part of all of the KB ap-proaches in this review. The KB elements from theliterature could fit within the concepts of linkage and ex-change and therefore we propose that we use this as aguiding model for the KB approach for healthy aging.Strengths and limitationsA particular strength of this scoping review was that wesought and described KB approaches along with the the-ory/conceptual frameworks that guided them. Doing soVan Eerd et al. Implementation Science  (2016) 11:140 Page 10 of 12allowed us to go beyond simply describing KB roles andactivities and consider the broader approach and how itwas guided. In addition, we described the KB approachesaccording to elements that were described in the litera-ture. Considering KB elements can allow for the descrip-tion of KB with less emphasis on the competencies andattributes of brokers. While broker talents are importantto consider, we believe that KB approaches could be de-veloped based on theory and the relevant elements basedon the context of interest.It is possible that we did not capture all KB ap-proaches available in the literature, despite searchingboth peer-reviewed and grey literature sources. The lit-erature on KT and KB are challenging to search withover 100 terms that can be used to describe similar KTpractices, including KB [50]. We worked with an infor-mation specialist to develop parsimonious searches thatwere guided by the principles described by McKibbon etal. [50]. We did not limit our searches with terms relatedto aging because we wanted to capture a broad varietyof KB approaches that could potentially be applied tohealthy aging contexts. In addition, our inclusion criteriarequired a description of theory or conceptual guidancethat resulted in a different set of documents from recentreviews of KB [16, 44, 48].ConclusionsThe results from our scoping review reveal a number ofdocuments that described KB approaches that can be con-sidered relevant to healthy aging. Within these approaches,there was an emphasis on acquiring, adapting, and dissem-inating knowledge and networking (linkage). The elementsof KB that most consistently characterized the studies inthis scoping review suggest a good fit with the “linkage andexchange” conception of KB [14, 16, 17, 35]; and given thecomplex and multi-stakeholder nature of healthy agingcontexts and practices, we suggest that linkage and ex-change practices are likely to benefit KB efforts focused onsupporting healthy aging.The recent review by Bornbaum and colleagues [16]also reported on the variability of KB practice and didnot find strong evidence of effectiveness. Therefore, fu-ture research should include gathering KB practitionerand stakeholder perspectives on effective practices andtriangulate those data with the results of this scoping re-view to develop an evidence-informed KB approach forhealthy aging. In addition, careful consideration shouldbe given to appropriate conceptual guidance in develop-ing KB approaches for healthy aging [20, 47, 48, 51–53].Additional fileAdditional file 1: Grey literature search strategy. (DOCX 13 kb)AbbreviationsCHSRF: Canadian Health Services Research Foundation; KB: Knowledge broker;KT: Knowledge translation; LTC: Long-term care; PARiHS: Promoting Action onResearch Implementation in Health Services; WHO: World Health OrganizationAcknowledgementsSpecial thanks to the Ryerson University Research Assistants and Institute forWork and Health Knowledge Exchange Staff (Siobhan Cardoso, Trevor King,Sara Macdonald, Ron Saunders) for reviewing help, and Carolyn Ziegler,Information specialist at the Health Sciences Library at St Michael’s Hospital,for running the literature searches for this paper.FundingThis research is supported with funds from the Ryerson Health ResearchFund and Ryerson University, Faculty of Community Services Funding.Availability of data and materialNot applicable.Authors’ contributionsKN, DVE, RDF, RU, EC, and KD conceived of the study and participated in itsdesign. KN secured funding for the study. DVE and KN participated in allreview steps. RDF, RU, EC, and KD contributed to the synthesis and helpedto draft the final manuscript. DVE drafted and led the writing of the finalmanuscript. All authors read and approved the final manuscript.Competing interestsThe authors declare that they have no competing interests.Consent for publicationNot applicable.Ethics approval and consent to participateNot applicable.Author details1Institute for Work and Health, 481 University Avenue, Suite 800, Toronto,Ontario, Canada M5G 2E9. 2School of Public Health and Health Systems,University of Waterloo, 200 University Avenue West, Waterloo, Ontario,Canada N2L 3G1. 3Daphne Cockwell School of Nursing, Faculty ofCommunity Services, Ryerson University, 350 Victoria Street, Toronto, Ontario,Canada M5B 2K3. 4World Health Innovation Network, Odette School ofBusiness, University of Windsor, 401 Sunset Avenue, Windsor, Ontario,Canada N9B 3P4. 5Department of Surgery, Dalhousie University, 6299 SouthStreet, Halifax, Nova Scotia, Canada B3H 4R2. 6Department of Family Practice,Faculty of Medicine, University of British Columbia, 2312 Pandosy Street,Kelowna, British Columbia, Canada V1Y 1T3. 7Li Ka Shing Knowledge Institute,St. Michael’s Hospital, 209 Victoria Street, Toronto, Ontario, Canada M5B 1T8.8Institute of Health Policy, Management and Evaluation, University ofToronto, 155 College Street, Toronto, Ontario, Canada M5T 3M6.Received: 6 May 2016 Accepted: 7 October 2016References1. 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