‘It seems like common sense now’: experiences of allied health clinicians participating in a knowledge translation telementoring program : JBI Evidence Implementation

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ORIGINAL RESEARCH

‘It seems like common sense now’: experiences of allied health clinicians participating in a knowledge translation telementoring program

Wilkinson, Shelley A. PhD, AdvAPD1; Hickman, Ingrid PhD, AdvAPD2,3; Cameron, Ashley PhD4,5; Young, Adrienne PhD, AdvAPD6; Olenski, Samantha PhD, APD6; BPhty, Prue McRae3,7; O’Brien, Maxine PhD8,9

Author Information
doi: 10.1097/XEB.0000000000000297

Abstract

What is known about the topic?

  • Clinicians understanding and applying the skills of knowledge translation is essential for the delivery of high value, effective health care. However, many clinicians lack confidence and capacity to undertake knowledge translation.
  • Formal knowledge translation training is generally only available from the university sector or larger metropolitan health services. Addressing the inequality of access to knowledge translation training, support, and mentoring is a priority.
  • While the value of videoconferencing to support clinician training is emerging, the use of telementoring strategies is limited and not previously tested for knowledge translation support of multidisciplinary teams.

What does this article add?

  • Telementoring is a viable and effective method of providing geographically spread allied health clinicians’ knowledge translation training and support.
  • The delivery of a knowledge translation telementoring program must acknowledge and address the ‘early’ anxiety, uncertainty, and motivation of participants for successful engagement of participants.
  • At the team and organization level, greater success will be achieved through strategies that enhance organizational involvement and support, engage AHPs early through innovative peer-modelling methods of promotion of the program as well as its benefits, while staging the timing and content of program participation.

Introduction

Implementing the translation of research findings into clinical practice in healthcare can be challenging1 and many clinicians do not feel confident in their skills and ability to undertake the various phases of knowledge translation.2,3 However, it is essential in the delivery of high value, effective health care.4

Approaches to address this shortcoming in clinicians knowledge translation confidence typically include efforts such as presentations by visiting scholars, short courses, and more recently, university-based courses in knowledge translation and/or evidence-based practice. Despite the potential for these approaches to successfully increase relevant knowledge and skills, these benefits can be biased towards those working in the university sector (where these networks and expertise typically lie) or in larger metropolitan health services. This may be particularly true in Australia, where vast geographical expanses between metropolitan areas result in inequity of access to face-to-face training in smaller regional centres. For effective and impactful change to be sustained across a health service or system, broad-reaching, accessible support for knowledge translation is required. This approach must go beyond information delivery or dissemination, acknowledging and addressing the clinicians’ capability, opportunity, and motivation5 and must also consider the impacts or limitations introduced by an organization's context and capacity, including proximity to metropolitan centres.6,7

The role of individual or group-based face-to-face mentoring as a low cost, broad reach research capacity building training strategy is emerging.8–11 However, the feasibility and effectiveness of mentoring via virtual platforms is less clear, with no known previous attempts to provide telementoring for knowledge translation support for allied health professionals (AHPs).6,12,13

Accordingly, the knowledge translation support service (KTSS) was recently developed, piloted and evaluated with AHPs undertaking knowledge translation in their practice.14,15 KTSS was a 6-month program that involved monthly 1-h facilitated group mentoring sessions using online videoconferencing for discussion of up to two projects per month. Each month, projects were presented in the style of a case study with a standard proforma format followed for all presentations. Invitation to participate was advertised via allied health specific email lists within Queensland Health hospitals. Eligible AHPs included those working in Queensland in a clinical capacity, undertaking a knowledge translation project within their workload, completed foundation training webinars, available to attend all meetings and had reliable access to the necessary technology (i.e., video enabled device and internet connection). Panel members were purposively selected to ensure expertise in knowledge translation and research methods, as well as hospital managers and executives with enthusiasm for testing innovative strategies to support knowledge translation in a health system. Hospital executives brought valuable insights into organizational context and change strategies. An expression of interest process screened project proposals to ensure each knowledge translation project had identified a clinical problem and evidence practice gap and proposed an implementation process. Projects were declined if inadequate evidence existed to warrant practice change. All project teams and panel members who agreed to participate in the program were asked to complete a one-on-one virtual orientation session which consisted of familiarization and testing of technology, description of the aims and expectations of the initiative, and setting individual goals. Mentoring was provided by a panel of three knowledge translation enthusiasts (knowledge translation experts and health service leaders), who provided constructive critique and knowledge translation support. Sessions were supported by prerecorded webinars and online resources. The telementoring offered in KTSS was deemed feasible, effective at improving clinician confidence with knowledge translation, and had a positive impact on project progression through offering exposure to a breadth of expertise not normally accessible and successfully building a team environment in the virtual space.15

Objective/aims

The current article describes the qualitative evaluation of the KTSS, which focussed on the end-users’ perspectives of barriers and enablers to participation and the identification of evidence-based strategies to improve future delivery of the initiative using a behaviour change theoretical framework and model for intervention selection.

Methods

Design and setting

The evaluation utilized semistructured interviews with participants who piloted the KTSS program. All KTSS participants were emailed to invite them to complete a follow-up interview via the Zoom (Zoom Video Communications Inc., San Jose, CA, USA) videoconferencing platform.

Approval was obtained from Queensland Health's Metro North Human Research Ethics Committee (LNR/2019/QRBW/57225) for the broad evaluation of the KTSS initiative. Participants were aware of the purpose of the interviews and gave verbal consent for recording the interview.

Participants

All nine AHPs involved in four projects supported by KTSS were invited to participate. Two projects were from metropolitan sites and two from nonmetropolitan sites. A personalized invitational email was sent to each potential participant from a researcher (A.C.; KTSS facilitator). This was followed up again after 3 weeks to ensure all participants were aware of and had the opportunity to participate in the evaluation interviews.

Data collection and analysis

All interviews were conducted by Zoom by a researcher (A.C.) who was known to all participants as the KTSS facilitator. Interviews were undertaken at a time convenient to the participants. Participants were offered an individual interview or could participate with their team members if preferred. Semistructured interviews explored motivation and preparation for, engagement in, and learnings from the KTSS telementoring project, using prepared questions and prompts (Appendix I: https://links.lww.com/IJEBH/A68). Interviews were recorded and transcribed verbatim for analysis.

Data were analysed by two investigators (S.A.W. and M.O.B.), who are experienced qualitative researchers not involved in the design or delivery of KTSS. They independently coded all interviews, noting illustrative text segments. Codes were then classified, sorted and synthesized by both researchers in all transcripts to derive a smaller number of themes and subthemes, agreed by discussion and consensus.16 Subthemes were also mapped to the theoretical domains framework (TDF).17 The mapping was undertaken by two researchers (S.A.W. and M.O.B.) who discussed and resolved differences with input from an independent third researcher (A.Y.). Potential effective strategies to address, overcome, or enhance issues were identified through the use of the behaviour change wheel (BCW)/COM-B (capability, opportunity, motivation – behaviour) model.18

Results

Five interviews with six participants from projects one, two, and three, were conducted, representing 67% of the KTSS cohort. The two participants in project three completed a joint interview. The three participants in project four were not able to be interviewed due to extenuating circumstances. The six participants were occupational therapists (n = 3) and dietitians (n = 2) and a social worker (n = 1). Interview duration ranged from 19 to 30 min. Barriers and enablers of KTSS participation and ideas for improvement for future sessions were identified and are outlined in Table 1. Further, these have been mapped to domains from the TDF and aligned with elements from the COM-B model (the central hub/sources of behaviour) of the BCW,17,18 and linked to appropriate evidence-informed strategies in Table 2.

Table 1 - Summary of the main themes and associated subthemes identified in the participant interviews regarding the knowledge translation support service panel
Theme Subtheme
Barriers to KTSS participation (1) Insufficient engagement and awareness with pretraining resources
(2) Knowledge gaps (fear of unknown)
(3) Competing clinical demands (time)
(4) Organizational expectations
(5) Staying focused on the project
Enablers to KTSS participation (6) Motivation and preparation
(7) Nonjudgemental panel and participants
(8) Organizational support
(9) Team work
(10) Local champions
(11) Delivery platform
Improvement ideas for future KTSS sessions (12) Additional preparatory education
(13) Initial session for orientation and rapport building
(14) Strategies to meet the emotional needs of the participants
(15) Considerations around session structure
(16) Timing of the sessions
KTSS, knowledge translation support service.

Table 2 - Mapping subthemes (barriers, enablers, and improvement ideas) to the theoretical domains framework and behaviour change wheel/capability, opportunity, motivation – behaviour elements to determine the appropriate intervention
Domains of the TDF Definitions Aligned barriers Aligned enablers Aligned suggested improvement ideas COM-B item and suggested BCW ‘intervention’
Social influences Those interpersonal processes that can cause individuals to change their thoughts, feelings, or behaviours Competing clinical demands (time)Organizational expectations Organizational supportTeam work Local champions Initial session for orientation and rapport building Opportunity → restructuring the environment
Environmental context and resources Any circumstance of a person's situation or environment that discourages or encourages the development of skills and abilities, independence, social competence and adaptive behaviour Insufficient engagement and awareness with pretraining resourcesCompeting clinical demands (time) Delivery platform Additional preparatory educationConsiderations around session structureTiming of the sessions Opportunity → restructuring the environment
Skills – cognitive An ability or proficiency acquired through practice Knowledge gaps (fear of unknown) Organizational support Additional preparatory education Capability→ education
Skills – physical An ability or proficiency acquired through practice Organizational expectationsCompeting clinical demands (time) Organizational support Additional preparatory education Capability→ education
Knowledge An awareness of the existence of something Knowledge gaps (fear of unknown)Insufficient engagement and awareness with pretraining resources Local champions Additional preparatory education Capability→ education; training; enablement
Memory, attention, and decision processes The ability to retain information, focus selectively on aspects of the environment and choose between two or more alternatives Organizational expectations Organizational support Capability→ education; training; enablement
Behavioural regulation Anything aimed at managing or changing objectively observed or measured actions Team work
Social/professional role/identity A coherent set of behaviours and displayed personal qualities of an individual in a social or work setting Team work Nonjudgemental panel and participants Motivation → education; persuasion; incentivization; coercion
Beliefs about capabilities Acceptance of the truth, reality or validity about an ability, talent or facility that a person can put to constructive use Competing clinical demands (time) Motivation and preparationOrganizational support Motivation → education; persuasion; incentivization; coercion
Optimism The confidence that things will happen for the best or that desired goals will be attained Knowledge gaps (fear of unknown)Insufficient engagement and awareness with pretraining resources Motivation and preparationNonjudgemental panel and participants Strategies to meet the emotional needs of the participants Motivation → education; persuasion; incentivization; coercion
Beliefs about consequences Acceptance of the truth, reality, or validity about outcomes of a behaviour in a given situation n/a Staying focused on the project Capability → education; training; enablement
Intentions A conscious decision to perform a behaviour or a resolve to act in a certain way Motivation and preparation
Goals Mental representations of outcomes or end states that an individual wants to achieve Local champions Motivation and preparation Additional preparatory education (including exposure to past projects)
Reinforcement Increasing the probability of a response by arranging a dependent relationship, or contingency, between the response and a given stimulus Organizational expectations Organizational supportNonjudgemental panel and participants Motivation → education; persuasion; incentivization; coercion
Emotion A complex reaction pattern, involving experiential, behavioural, and physiological elements, by which the individual attempts to deal with a personally significant matter or event Knowledge gaps (fear of unknown) Motivation and preparationNonjudgemental panel and participantsTeam work Strategies to meet the emotional needs of the participantsInitial session for orientation and rapport building Motivation → modelling, environmental restructuring; persuasion; incentivization; coercion
BCW, behaviour change wheel; COM-B, capability, opportunity, motivation – behaviour; TDF, theoretical domains framework.

Barriers to knowledge translation support service participation

The first subtheme was insufficient engagement and awareness with pretraining resources. There were mixed reports about preparation for the KTSS sessions, with some staff aware, while others did not know about the preparation (including the pretraining webinars) required,

Yes, I was aware of TRIP [translating research into practice]. I had been exposed to projects while working at the [hospital]. [P3]

No. I didn’t know [the webinars] existed. I knew nothing about [the online training program] until starting the process. [P2]

The unfamiliarity with knowledge translation, particularly resulting from the lack of orientation, is linked with the second subtheme of knowledge gaps (fear of unknown). These related to expectations and lack of preparation, and gaps in research knowledge relating to knowledge translation, especially for those who had entered without completing the pretraining,

… at first … I found myself in there by the seat of my pants trying to follow what was going on and not realising that I had a big content gap and I sort of came in expecting that that would be delivered … but obviously the people and the expert panel were anticipating that you’d already done that work so it was bit of a gap until I … quickly caught up and it made a lot more sense at that point. [P4]

Or had trouble keeping up with the language of knowledge translation,

There were some acronyms that were thrown around though, that I must admit … we all sat with the mute button on, going, ‘what does that mean, what is that acronym?’ … and we’re trying to Google them and keep up, which meant that we probably got a bit lost. [P2]

Or had gaps in their knowledge translation research methodology knowledge,

… ‘cause I come from a research methodology of randomised control trials as being the methods I’m most comfortable with so it was quite a deviation from that [P4].

In considering additional challenges encountered by KTSS participants, finding time away from clinical demands while still balancing personal, team, and organizational expectations was a strong theme noted by a majority of participants,

… with me trying to do that project in a 0.8 FTE with no research time allocated to it, so those are sort of the hard things. To do, try and do this right, but do it within the limited time that you’ve got. But it's important. [P5]

The fourth subtheme describing barriers to KTSS participation related to (lack of) organizational expectations and support,

… certainly within allied health a huge amount of support. [and also] … not a tremendous amount at [line management] level. [P4]

Staying focused on others’ projects and being an active participant for projects from other disciplines was challenging at times,

Some projects … to be honest some projects were a lot more interesting than others. Like if it was an area I just can’t grasp, sometimes it's a bit hard not, like I’m being honest, not to zone out a little bit, if you don’t. [P1]

Enablers to knowledge translation support service participation

The first subtheme related to the participant's motivation and preparation to participate in the KTSS sessions. Participants mentioned motivators including the importance of clinicians gaining these skills to facilitate best practice,

… as a clinician-researcher … if we’re not translating what we’re doing into practice then why are we doing it? So I suppose that's what motivated me. To me that was kind of the missing link and quite an obvious one, and now there's a concept and a process and a way of doing this so it's just like, yeah, this is what we need to do. [P1]

While it requires time, being prepared was perceived as vital,

… if I didn’t do that [prepare] my mind was so much into our project that actually then getting my head around somebody else's and having meaningful engagement in that discussion around their projects was hard. [P4]

and participants learnt the value of using the program's structure and keeping to the established timeframes, rather than falling behind,

… I think [scheduled meetings] also helps keep the project on track. Because I think as clinicians sometimes who don’t have dedicated project time, then it can sometimes slip away so being able to have that commitment as well I think it was really good. [P1]

… one (learning) was accountability to keep to project time frames. [P2]

A second enabler related to the access to nonjudg-emental panel and participants,

… it was a really positive atmosphere, and a really sort of just inclusive atmosphere, [P5]

The third subtheme related to organizational support, which included mainly positive, but some more mixed experiences, as noted in barriers.

… yes, I was very supported. My team leader. And the department. And [colleague]. And everyone else. [P5]

Teamwork was reported to be a great enabler to KTSS participation for developing and delivering projects,

… I would not have been able to do all of this on my own. Given my workload, and the fact that I’m still very fresh in all of this. So like I’ve had lots of support in order to be able to kind of get all the bits and pieces done. Having it as a team project has been the only way that's been able to go forward. [P5]

Separate from the teamwork enabling KTSS panel participation, the local champions were celebrated while recognizing that this responsibility should be shared,

… [we need] as many people as we can to share the workload. But it does take a couple of key drivers in each team. And I think in the past we’re probably relying on the same people to drive those things … [P1]

Finally, the delivery platform chosen for delivery was appreciated,

And the Zoom platform seemed to workseamlessly.… I think it was flexible, for example, that first session I was still on holidays. So although the rest of the department were able to dial in without me, I could still see them, to a degree, from, when I dialled in from home. So … I would definitely recommend that in the future. [P2]

Improvement ideas for future knowledge translation support service sessions

Many comments were made regarding requests for further preparatory education to clarify the aims and process,

… trying to understand what implementation science is and what it isn’t and where the delineation is between that and evidence-based practice. And maybe something, a webinar that would really clear that up for me would be awesome. I would love that – an idiots’ guide to exactly what it is and what it isn’t. [P4]

I think it would be quite beneficial for all participants in future rounds … just to maybe have some sort of a snapshot of the previous round. Whether it's a little, you know audio grab or a video grab or something to see it actually in action. [P4]

Along with an initial joint session of education, team building, and discussion,

So maybe the first session is an actual project and you go through, yeah, even how you went about it, pros and cons, challenges, troubleshooting that type of thing. Why you picked that framework. … [P4]

Maybe some more ice-breaker ideas or activities just to kinda build that rapport with the panel and also any of the other project participants in future rounds [P2]

And introducing a strategy/process to meet the emotional needs of participants to manage nerves about asking questions, and build rapport among participants,

… ask ahead of time if people have got specific questions that the panel can just kind of address in general. That way you don’t know who it's coming from and no one has to sort of pipe up and, you know … especially ‘cause I was always quite intimidated because, in a room full of people that are way more experienced about it, but you’ve just got to be open to asking questions [P5]

Suggestions were also made regarding some considerations of session structure. There were also requests for some sessions to be focussed on projects according to the stage of completion, in addition to some broader sessions where teams can share across the board,

… whether or not you can kind of have a few sessions where you open it up to everyone and sort of have that experience of seeing other projects that are further along in the process. But also have specific sessions where you’re talking amongst people who are really in that sort of initial planning stage, or in that implementation stage, just so you can get that really specific feedback at the time you really need it. I suppose would be a benefit or … just a way you could tune that. [P5]

The decision to include a limited number of projects at each meeting was appreciated,

I did think it was a good idea that not everyone presented at once. Cause then I think people got the opportunity to really have in depth discussion around the project. … I think the number of projects discussed was good. ‘Cos I think too many, then again you lose quality aspect. [P1]

A minimum number of three mentors was suggested to ensure shared onus of mentoring activity at sessions,

… in essence I think the panel is really good. I think the only thing was that sometimes it was only just two [on the panel]… or two and a half, and … that's a hard one because obviously those that sit on the panel are in busy and important positions … you might need [to] cast a wider, wider net to ensure that there's a good representation. [P3]

It was also noted that teams who complete KTSS might benefit from longer term follow-up to assist them in completing unfinished projects,

I suspect with some of the … more busy clinical people, it could be very easily lost and whether there's … in the future for [KTSS] a long-term plan to follow up and motivate … consider the carrots that might actually get these projects that were started up to actually complete [P3]

When reflecting on the timing of the sessions, it was suggested that support be provided over a longer period, and perhaps with more time between sessions,

… we applied in February … and then got approvals for all .… on something like the 8th August. So that, you know, we couldn’t do anything with the project during that timeframe. So I guess what I’m saying [is] .… I’d rather have had a lot longer between the sessions so that we could have made some progress on the project and actually had real questions to ask you. [P4]

Getting the timing of support sessions right was also seen as important,

… more workup before we had the first meeting – you had to be at some kind of stage as in readiness to go - because I think what held us up hugely was research ethics application and getting all of those approvals through. [P4]

… what we saw from our project is perhaps if we’d been there at an earlier stage, it may have prevented a lot of heartache and provided a little bit more direction. [P1]

Finally, some participants seemed to really enjoy and appreciate their experience with the KTSS program. They reflected on their journey with gratitude and recognized that the knowledge translation approach just seemed like common sense now,

… to complete the whole process was really good, and it is still working as we would like now over a year on and we had lots of people contacting us from other sites. … although it's not the most exciting thing in the world … it's just really practical. So simple and you think, why wasn’t this done ten years ago? [P1]

Discussion

The current article describes the experience of participants involved in a knowledge translation telementoring program and identified barriers and enablers to telementoring support for knowledge translation, along with identified learnings for future program improvements. While participants mentioned barriers including lack of preparation, time pressures, and limited support within their projects, enablers such as internal motivation, access to an expert panel of mentors, and organizational support that included local champions, as well as the easy-to-use delivery platform helped to overcome them. Some of these findings mirror those found in the Project ECHO engagement literature, as well as wider allied health training strategies to support rural and regional clinicians, with participants valuing the structured learning and interactive nature of engagement, but reporting system-level constraints, competing clinical demands, and a low degree of endorsement by leadership that detracts from participation.19–22 Rural and regional allied health clinicians being supported through an outreach training program also reported time and organizational factors as barriers AND enablers to engagement, with targeted policies recommended to address barriers and enhance enablers.20

Further ideas for improvements were suggested by participants that could enhance experiences of clinicians participating in future KTSS programs. These findings have been linked to implementation science frameworks and models to inform ongoing evidence-based program development. Significantly, the ‘ideas for improvement’ identified by the participants overlapped in many cases with those generated through the TDF/BCW mapping process. It has been noted that many implementation science approaches seem like ‘common sense’.23 However, the systematic application of a framework adds rigour to the process, particularly intervention selection.23 Suggestions of additional preparation, mandating the KTSS orientation and rapport session, mentors, and facilitators being cognizant of emotional needs of participants and structuring the sessions for more aligned learning and introduction of ideas were all suggested by participants.

Extending these ideas through the TDF/BCW mapping strategies to address and enhance identified issues can be grouped into those to address ‘capability’, such as education, training, and enablement; ‘opportunity’, such as environmental restructuring; and ‘motivation’, such as education, persuasion, and modelling. Further drawing on behaviour change literature,24 these can be opera-tionalized in concrete approaches such as developing social marketing and promotion materials for organizations, departments, teams, and clinicians that use modelling and messaging around processes and enablers identified within these interviews. This is also important to manage anxiety, uncertainty, and motivation.5 Additional changes would be addressing the program's structure (timing; project milestones; presentations) and planning ‘preparatory’ orientation/‘meet and greet’ sessions at the start of the KTSS panel.

Strengths of this study include the richness of reflections provided by the participants from diverse locations and disciplines, providing context to their experiences and opinions. Further, identifying program improvements through applying a systematic approach from implementation science methodology17,18 provides rigour to ongoing work. A limitation is not all members of the project teams participated in the interview process. In addition, the researcher A.C. (KTSS facilitator) conducted all the interviews, which may have impacted the participants’ responses and be subject to bias. This may have resulted in overlooking barriers and gaining directions for improvement; further programs will continue to deliver evaluations to ensure all participants’ opinions are captured by providing mixed-modality options, ensuring timeframes to align with participant availability and including an independent interviewer for follow-up interviews.

Conclusion: implications for research and practice

Future directions of the KTSS have been clearly outlined within this analysis. Drawing from the implementation science literature, the ‘intervention strategies’ from the BCW will be operationalized to enhance future AHPs’ knowledge translation telementoring experiences.

Through a qualitative methodology we have examined and identified the experiences of AHPs who have participated in a knowledge translation telementoring program. Through a structured approach to enhance organizational involvement and support, engage AHPs early through innovative peer-modelling methods of promotion of the program as well as its benefits, while staging the timing and content of program participation, the identified benefits of the KTSS panel will be further enhanced.

Acknowledgements

Participants (and their supporting managers), panel members and facilitators of the Allied Health-Translating Research Into Practice (AH-TRIP) Implementation Support pilot program, Metro South HHS Executive Planning and Innovation Committee, Allied Health Practitioners Office of Queensland.

Authors’ contributions: All authors have participated sufficiently in the article to take public responsibility for the content. S.A.W. (corresponding author) led article preparation with assistance from all authors. I.H. led the design of the program and evaluation questions, assisted by all authors. A.C. collected the data via interviews. All authors contributed to data analysis and interpretation, led by S.A.W. and M.O.B. with assistance from A.Y. All authors are in agreement with the article and declare that the content has not been published elsewhere.

Ethics approval and consent to participate: Approval was obtained from Queensland Health's Metro North Human Research Ethics Committee (LNR/2019/QRBW/57225) for the broad evaluation of the KTSS initiative. Participants were aware of the purpose of the interviews and gave verbal consent for recording the interview. It conformed to the provisions of the Declaration of Helsinki (as revised in Tokyo, 2004).

Consent for publication: Authors provide consent.

Availability of data and materials: These can be made available on reasonable request.

Nil funding was obtained for this study.

Conflicts of interest

The authors have no conflicts of interest to declare.

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Keywords:

allied health; knowledge translation; telementoring

Supplemental Digital Content

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A video commentary on implementation project titled: How do health professionals prioritise clinical areas for implementation of evidence into practice? The commentary is provided by Andrea Rochon RN, MNSc, Research Assistant, Queen's University, Ontario, Canada