Authors: Presseau J, Kasperavicius D, Bruyn-Martin L, Duncan D, Giguère A, Kelly C, Hoens AM, Holroyd-Leduc JM, Moore J, Sibley K, Daalen-Smith CLV, and Straus SE, On behalf of the Intersectionality & Knowledge Translation project team
Presenters: Dr. Justin Presseau
Institution: Ottawa Hospital Research Institute
Background:
Intersectionality explores the complex nature of intersecting social factors (e.g., age, sexuality, gender identity) and their interaction with compounding power structures (e.g., education system) and forms of discrimination (e.g., sexism). Models, theories, and frameworks (MTFs) can support knowledge translation (KT) practitioners to develop rigorous KT interventions. Within our complex health system, there is increased recognition that intersecting social factors have significant impacts on KT interventions. Currently, KT MTFs lack fulsome exploration of intersectionality considerations.
Aiming to support KT intervention developers to take an intersectional approach in their work, our objectives were to select MTFs representing key steps in the Knowledge-to-Action Model (KTA): problem identification; assessing barriers/facilitators to knowledge use; and selecting/tailoring/implementing interventions, and secondly, to provide intersectionality considerations for each MTF.
Methods:
Seventeen MTF experts, KT researchers/practitioners, and intersectionality experts considered 134 KT MTFs identified from a scoping review. We used a Delphi procedure to select one MTF for each KTA stage. In round 1, participants formed sub-groups, reviewed full-text articles describing a sub-set of MTFs, and rated each MTF’s overall importance based on acceptability, applicability, and usability on a Likert scale from 1 (unimportant MTF) to 7 (important MTF). In subsequent rounds, medians and ranges for each MTF were shared and MTFs with a median <5 were excluded unless participants voiced concerns about exclusion. In round 2, all participants reviewed and rated full-text articles on MTFs selected in round 1. The same process for discussing and excluding MTFs was used. Participants completed two additional rounds to select one MTF for each KTA stage. An intersectionality lens (e.g., incorporating reflexivity) was then used to enhance application of each selected MTF by experts using co-creation principles and 12 review rounds.
Results:
Experts selected: the Iowa Model of Evidence-Based Practice for the ‘problem identification’ stage; the Consolidated Framework for Implementation Research (CFIR) for the ‘assess barriers/facilitators to knowledge use’ stage; and the Theoretical Domains Framework/Behavior Change Wheel (TDF/BCW) for the ‘select/tailor/implement interventions’ stage. To the Iowa Model of Evidence-Based Practice, experts added self-reflection as the first step, added a step for selecting practice changes, moved the team formation step to the beginning of the model, and included intersectionality reflection prompts throughout the model. In addition to embedding intersectionality prompts throughout the CFIR, experts recommended two additional constructs for consideration: outer culture and outer systems and structures. Within the existing TDF/BCW visual depiction, experts added a pictorial representation of an individual’s intersecting categories. Reflection prompts were added to all TDF/BCW constructs.
Conclusions:
An intersectional lens was used to enhance application of three MTFs perceived to be acceptable, applicable, and usable for KT practitioners. This approach could be used for enhancing use of other KT MTFs. Future project phases will investigate the usability and impact of tools to facilitate an intersectionality approach to using the selected MTFs in KT intervention development. It is hoped that this work can be used to design KT interventions that more fulsomely consider and account for unique human experiences and address inequities within our complex health system.