Knowledge to action framework and the G.R.E.A.T. project
Identification of problems and their articulation into questions that can be answered through known scientific methods lies at the heart of problem-solving in health care. For some problems, the solutions may be already available in existing knowledge sources (published research literature, guidelines, etc.), but for some others new solutions will need to be found through appropriate research. In the context of health care, experience shows that implementation of research-based knowledge in real life is complex and riddled with barriers. Therefore, available research data need to be synthesized and the resulting knowledge contextualized prior to implementation. Moreover, interventions to introduce evidence-based knowledge in practice may need to be tailored to overcome specific local barriers. Knowledge generation (for problem-solving) for health care and implementation of existing and new solutions is an intricate cyclical process that has been summarized by Graham et al. (Figure 1) as "knowledge to action" framework.
For the process to run efficiently, it is imperative to remain vigilant to problems (gaps in knowledge) at each stage of the knowledge generation, synthesis and exchange process and document the problems (in reports, discussion forums, clinic logs, research papers) in a way that they can be identifying by those (researchers, experts, institutions, etc.) who can develop a solution. For example, gaps in knowledge are identified by researchers at the stage of research itself. They can also be identified during the process of knowledge synthesis and guidance development (when the robustness of available knowledge is analysed using evidence-grading systems). Alert programme managers can identify barriers to implementation of knowledge in their practice environs, and so on. The dynamic, continuous integration of these steps in the field of maternal and perinatal health led to the development of the G.R.E.A.T. Project.
UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction Department of Reproductive Health and Research: (last revised: June 2010). World Health Organization.