From Knowledge to Action: Reducing the impact of infant altered head shape on an Australian, rural community health service.

An Australian, rural health district, over a period of years, used Knowledge translation to guide the community health team to implement a preventative care approach for infants with altered head shape. Currently, infant referrals are at an average age of 11 weeks but are not seen for an additional 4 weeks due to large wait lists, which overwhelmed therapy services. A knowledge to action (KTA) project was selected as the best choice to develop steps to change practice to preventative intervention and improve outcomes for families. The project aimed to decrease numbers of later referrals, resulting in a decrease time to treatment and the number of therapy visits needed 

Although there are many models of Knowledge Transfer (Process, Theories, Evaluation), Knowledge to Action (KTA), a process model, focuses on steps needed for successful transfer of information into clinical practice. Seven stages of action, (identify the problem, adapt to current context, assess barriers, select and tailor the intervention, monitor, evaluate and sustain practice) were created for this project. The stakeholders included therapists, community health nurses, the team leader and the families referred in this rural health district.

1. Identify the Problem: Late referrals decreased leading to less severe head asymmetry when treatment began
2. Adapt to current Context: A rural health service comprising therapists, nurses, team leader and families
3. Assess Barriers: Fifteen people attended three education sessions which covered preventative intervention.
4. Select and tailor intervention: The best available evidence (including Australian and USA Clinical Practice Guidelines) were reviewed to create preventative intervention guidelines for 2 weeks, 6-8 weeks, 3- and 4-month age ranges.
5. Monitor: Regular check-ins with team members
6. Evaluate: Six monthly monitoring of referrals, time to treatment and # of visits is ongoing
7. Sustain the knowledge. Continuous six-monthly checks and training new staff is ongoing.

All stakeholders reported that the changes in earlier referral assisted families to spend less sessions in treatment. Average change in number of treatment visits from 8 visits to 2.1 visits per infant at the time of the first evaluation.

This project resulted in quality improvement for a rural team of community health practitioners, resulting in a decrease in late referrals of infants, a decrease in the time the staff needed to assist each referred infant and overall satisfaction of both staff and families. Continued monitoring, evaluating referrals every six months and repeated training will need to be done to sustain the results over time. 

Using a KTA framework could assist rural community health teams to put evidence into practice focusing on preventative intervention and care for infants referred for altered head shape.