The Gears of Knowledge Translation: Process Evaluation of the Dissemination and Implementation of a Patient Engagement Toolkit



Patient engagement is a key tenet of patient-centered care and is associated with many positive health outcomes. To improve resources for patient engagement, we created a web-based, interactive patient engagement toolkit to improve patient engagement in primary care across the Veterans Health Administration (VHA).


To use the knowledge translation (KT) framework to evaluate the dissemination and implementation of a patient engagement toolkit at facilities across one region in the VHA.


Using a mixed-methods approach, this process evaluation involved phone monitoring via semi-structured interviews and group meetings, during which we explored barriers and facilitators to KT. Outcomes were assessed using a structured rubric and existing patient satisfaction measures.


We enlisted implementers at 40 VHA facilities primarily serving Pennsylvania, New Jersey, and Delaware to implement patient engagement practices at their sites. Sites were randomly assigned into a high or low coaching group to assess whether external support influenced implementation.

Key Results

Sites with high rubric scores employed and possessed several elements across the KT trajectory from identification of the problem to sustainment of knowledge use. Key factors for successful implementation and dissemination included implementer engagement, organizational support, and strong collaborators. The most frequently cited barriers included short staffing, time availability, lack of buy-in, and issues with leadership. Successful implementers experienced just as many barriers, but leveraged facilitators to overcome obstacles. While sites that received more coaching did not have different outcomes, they were more likely to revisit the toolkit and indicated that they felt more accountable to local personnel.


Because leveraging available resources is a key component of successful implementation, future toolkits should highlight the type of facilitators necessary for successful implementation of toolkit content in healthcare settings. The ability to tailor interventions to local context is critical for overcoming barriers faced in most healthcare settings.

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The VISN 4 Center for Evaluation of PACT (CEPACT) Demonstration Laboratory is funded by the VA Office of Patient Care Services.

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Corresponding author

Correspondence to Shimrit Keddem PhD.

Ethics declarations

This project was reviewed by the Corporal Michael J. Crescenz VA Medical Center internal review board and considered a quality improvement project.

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The authors declare that they do not have a conflict of interest.


The views expressed here are those of the authors and do not represent those of the Department of Veterans Affairs or the United States Government.

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Keddem, S., Agha, A.Z., Long, J.A. et al. The Gears of Knowledge Translation: Process Evaluation of the Dissemination and Implementation of a Patient Engagement Toolkit. J GEN INTERN MED 35, 808–814 (2020).

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  • toolkit
  • patient engagement
  • knowledge translation
  • Veterans
  • primary care
  • implementation
  • frameworks
  • process evaluation
  • dissemination