Implementing evidence in residential aged care facilities: a longitudinal multi-method evaluation of knowledge broker...

Knowledge brokers act as intermediaries to bridge evidence-to-practice gaps. Limited evidence describes how the knowledge broker role in health settings evolves over time. This study aimed to (a) examine the evolution of knowledge broker activities over a 12-month implementation trial and (b) identify enablers necessary to strengthen and support the role.

This longitudinal multi-method study is nested within the 12-month Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) trial. The EMBRACE intervention involved knowledge brokers working in 19 residential aged care facilities (RACFs) to support implementation of Australia's Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia in Residential Aged Care. Seventy-six knowledge broker local action plans, representing 19 RACFs at four time points, were analysed to characterise core knowledge broker functions and the frequency of planned quality improvement activities targeting seven pre-defined sub-indicators of psychotropic appropriateness. The Consolidated Framework for Implementation Research informed thematic analysis of 76 separate quarterly written reflections and 28 semistructured interviews with knowledge brokers.

The number and breadth of knowledge broker activities increased over time. At baseline, six RACF local action plans included activities targeted towards at least one sub-indicator, increasing to all 19 local action plans from the 3-month timepoint onwards. Knowledge brokers enacted overlapping functions as knowledge managers, linkage agents and capacity builders, although the timing and extent of role progression varied across RACFs and individuals. Evolution of activities was shaped by individual (clinical leaders, implementation facilitators, peer support) organisational (culture, governance pathways, digital integration) and outer setting factors (COVID-19 disruptions, national policy directives).

The knowledge broker role fundamentally evolved from assessing local context and establishing foundational rapport to driving systemic change. Effective translation of guidelines into practice requires future implementation programmes to support this role with a strong organisational culture, robust infrastructure and strategic alignment with RACFs and national priorities.