Systematic synthesis of intersectional best practices: knowledge translation for circumpolar indigenous disability

Figures & data

Table 1. Nine-step process for systematic collation of best practices, emphasising existing tailored-database and peer-reviewed syntheses of evidence.

Step	Action
Phase I Search: Tailored-Databases
1	Focus: Identify the focus of the TMF synthesis
2	Explore: Search for any existing tailored-databases to inform the focus
3	Collate: List all constructs, if any, presented by the tailored-database(s) retrieved in step 2
Phase II Search: Existing Syntheses in Peer-reviewed Literature
4	Assess: Conduct a systematic search for a) quantity and b) level of evidence that is already synthesized in peer-reviewed literature
5	Combine: Identify TMF-syntheses and reviews as a starting point to collate best practices/constructs, combining with those retrieved in step 3
Synthesis of Best Practices Retrieved in Phase I and Phase II Search
6	Evaluate: Transferability: Prior to removing best practices with limited relevance, consider if they may present transferable insight in terms of principles Heterogeneity: Consider if best practices repeat - or are different from, inform, and add-value to constructs collated from tailored-databases Potential-for-Action: Consider if best practices are principles only - or guide on-the-ground action Specificity: Consider if best practices have explicit connection to the focus identified in step 1 - or instead can be drawn from any general TMF Outliers: Consider if best practices appear frequently across different sources - or, are unique outliers due to innovative thought; inequitable power relations; historic marginalisation; or delegitimisation of marginalised perspectives
7	Assess Quantity: Consider if final list of best practices contribute to feasibility
8	Reflect: Consider if the list of best practices sufficiently meets the focus and objective of synthesis identified in step 1
9	Reiterate: Return to step 5, moving up or down the levels of evidence as needed

Table 2. KT strategies and target groups as collated by KTDRR.

Type of KT Strategy

Target Group

Audit and Feedback Briefing Notes Case Study Checklist Clinical Practice Guidelines Community of Practice Computer-Based Model Continuous Quality Improvement/Total Quality Management Critical Appraisal Decision Aids Discussion Board Educational Meetings Educational Outreach/Person to Person TA Evidence-based Activism Facilitation Financial Incentives Focus Group Group Training Handbooks In Service Training Infographic Informal Interviews Institutional Strengthening Knowledge Broker Knowledge Cafe Logic Models Motivational Interviewing Multi-Professional Collaboration Multifaceted Interventions Narrative Summary Online Resources Opinion Leader/Champion Organizational Readiness Policy Brief Printed Educational Materials Questionnaires Reminders Scoping Review Methodology Social Media Social Network Analysis Stakeholder Collaboration Survey Systematic Review Synthesis/Framework Targeted Messages Templates Toolkits Web-based Training Wiki Working Groups

Administrator Business/Employer/ Industry Decision Maker Educator Healthcare Professional Person with disability/Family/Advocate Policymaker/Legislator Research Funders Researchers Service Provider VR Professional

Table 3. Forty-six KT TMF constructscollated from 114 TMFs on D&I modelswebtool.

Acceptability/feasibility Adaptation and evolution Adopter/implementer/decision-maker characteristics Adoption Awareness Barriers and facilitators Champion/field agent Communication Communication channels Compatibility Complexity Context Inner setting Context – Outer setting Cost Development of an Intervention Dissemination Dose Engagement Evaluation External Validity/Generalizability Fidelity Fit Goals Health Equity Identification Implementation Innovation characteristics Knowledge andKnowledge Synthesis Knowledge Transferand Utilization Maintenance and Sustainability Observability Outcomes Outcomes –Health/QOL/Satisfaction/Clinical Outcomes –Implementation Outcomes –Quality Improvement/Practiceor Policy Change Patient/target audience characteristicsand needs Pre-implementation Process Reach Readiness Relative advantage Stakeholders Strategies Translation Trialability

Table 4. Search terms for 3 intersectional themes and 6 levels of evidence-synthesis.

Desired Output	Search Terms
Identifying Themes
Circumpolar Health	Circumpolar OR arctic OR northern
Indigenous	Indigen* OR aborigin* OR coloniali* OR postcolonial* Or post-colonial
Disability	Disab* OR “occupational therap*” OR “physical therap*” OR neurodivers* OR ableis* OR rehabilit*OR “differently able*”
Identifying Existing Syntheses
Level 1 evidence: studies	(none)
Level 2 evidence: reviews	Review
Level 3 evidence: meta-analyses	“Meta review” OR “meta analys*” OR “umbrella” OR “review of systematic” OR “review of review*” OR “review of scoping” OR “review of narrative review*”
Level 4 evidence: Theories, Models, and Frameworks	Theor* OR model* OR framework* OR “best practice*” Or guidelines OR recommendations OR strategies OR toolkit OR tools OR instrument
Level 5 evidence TMF reviews	Theor* OR model* OR framework* OR “best practice*” Or guidelines OR recommendations OR strategies OR toolkit OR tools OR instrument AND review
Level 6 evidence TMF syntheses	Theor* AND model* AND framework* AND TMF*

Table 5. Web of science “all fields” search results, with high-quantity fields bolded.

	Focus
Level of Evidence- Synthesis	Intersectional	Two Themes			Single Theme
	Circumpolar, Indigenous, Disability	Circum polar AND Indigenous	Indigenous AND Disability	Circumpolar AND Disability	Circumpolar	Indigenous	Disability
6 TMF syntheses	0	0	0	0	0	1*	2*
5 Theory/Model/Framework reviews	6*	764	68	11	10k	2.6k	16.8k
4 Theory/Model/Framework	64	5.8k	901	2.8k	312k	86k	196k
3 Meta-Analyses	0	67	19	126	4.4k	766	9.8k
2 Reviews	11	764	136	436	37k	8.6k	104k
1 Studies	140	16k	1.9k	6.7k	1356k	435k	1165k

Table 6. Seven articles informing basis of of synthesis.

Author(s)	Title	Studies screened	Studies included	Highlights
[28]	Advancing health equity through a theoretically critical implementation science	NA	NA	3 theories presented, with 1 explicitly centred on postcolonialism
[29]	Implementation strategies and outcomes for occupational therapy in adult stroke rehabilitation: a scoping review	1219	26	73 implementation strategies collated 26 TMFs collated Best practices include: “distribute educational materials” (n = 11), “assess for readiness and identify barriers and facilitators” (n = 11), and “conduct educational outreach visits” (n = 10)
[30]	Knowledge Translation Research to Promote Behavior Changes in Rehabilitation	2744	22	16 process models 4 barrier-assessment frameworks 7 intervention-design frameworks 2 evaluation frameworks 12 classic theories 1 implementation framework
[31]	Northern philosophies and professional neocolonialism in occupational therapy: a historical review and critique	NA	NA	13 recommendations
[32]	Work disability prevention in rural areas: a focus on healthcare workers	860	30	Emphasis on documenting greater risk of disability for rural workers
[33]	A Critical Systematic Literature Review of Global Inclusive Education Using an Affective, Intersectional, Discursive, Emotive and Material Lens	Unreported	64	9 theories collated
[34]	A pharmacist-led medicines review intervention in community-dwelling Māori older adults – a feasibility study protocol	NA	NA	Emphasis on outlining process to localise existing pharmaceutical intervention to indigenous community
[35]	Neotropical ornithology: Reckoning with historical assumptions, removing systemic barriers, and reimagining the future	NA	NA	15 best practices

Table 7. Illustration of evaluating transferability of two seemingly-irrelevant best practices.

Seemingly-Irrelevant Best Practice	Principle(s)	Possible Generalized Transfer	Possible Decision for Purging from Collation
Item 2: “Institutions explicitly acknowledge the colonial legacy of ornithology in the Neotropics, including the historical exclusivity of field stations and expeditions embedded in systems of hierarchy and segregation” [35]	Colonial legacy exist in marginalized geographies Historical practices can become embedded in hierarchical power-relations	Institutions should explicitly acknowledge the colonial legacy of health practices in circumpolar regions, including the historical exclusivity of practices embedded in systems of hierarchy and segregation	No
Item 16: “Organizations support visits of ornithologists from the Neotropics to museum collections in the Neotropics and in the Global North”. [35]	Supporting travel	Organizations support travel-needs of indigenous people living with disabilities in circumpolar regions (for access to knowledge)	Yes

Table 8. Examples of varying degrees of heterogeneity in recommendations.

Constructs Collated from Systematic Search (Step 5)	Constructs Already Known in Databases (Step 3)	Degree of Heterogeneity
Item 100: “Assess for readiness and identify barriers and facilitators” [29]	“Readiness” “Barriers and Facilitators” (D&I Models Webtool)	Very Low
Item 57: “Interventions must be adapted to be culturally acceptable and appropriate” [28]	“Acceptability/feasibility” (D&I Models Webtool)	Moderate
Item 44: “What is the history of health development in the region and whose perspectives have been excluded?” [28]	(no equivalent)	High

Table 9. Examples of varying degrees of potential-for-action and performativity.

Best Practice	Potential to Remain as Principle Only	Potential to Accommodate Performative Action	Total Potential to Guide Practice
Item 8. “Promote diversity through justice, equity, and inclusion “ [35]	High	High	Low
Item 42: “Reflexivity: researchers’ critical[ly] reflect on their power” (Snell-Rood et al., 2023) [28]	Low	Moderate	Moderate
Item 48”:What effects does intervention scale-up in global settings have on indigenous treatment providers?” (Snell-Rood et al., 2023) [28]	Low	Low	High

Table 10. Examples of varying degrees of specificity to inform the intended focus.

Construct or Best Practice	Potential for this Construct/Best Practice be Found in Out-of-Scope TMFs	Degree of Specificity to Inform Circumpolar Indigenous Disability	Possible Transferred Version of Construct/Best Practice
“Communication” (Step 3, D&I Models Webtool)	High	Low	Communicate to indigenous people living with disabilities in circumpolar regions
Item 103: “Audit & provide feedback” [29]	High	Low	Allow indigenous people living with disabilities in circumpolar regions to audit and provide feedback
Item 35”:[Acknowledge] the unique needs of aboriginal health workers … ” [32]	Low	High	Acknowledge the unique needs of aboriginal health workers in circumpolar regions, particularly those who live with disabilities or work with people living with disabilities

Table 11. Examples of outlier evaluation to guide synthesis.

Best Practices/Constructs	Question 1: Is it an Outlier?	Question 2: If so, is it Relevant to the Focus?	Question 3: If so, does it Contribute to Innovation or Amplify Marginalized Experiences, Voices, & Perspectives?
Item 33: Prioritise our duty to address social injustices at community and population levels … ” [32]	No: See Item 8. “Promote diversity through justice, equity, and inclusion “ [35] “Health Equity” (D&I Models Webtool)	–	–
Item 3: “Journals and funding agencies add requirements for researchers to reflect on how they promoted/will promote equity and inclusion of local ornithologists in research leadership” [35]	Yes	No	–
Item 39. “Health interventions can also be used to control and gain power”. (Snood-Rell et al., 2023) [28]	Yes	Yes	Yes; it cannot be assumed that access to health interventions does not place marginalised individuals under new power imbalance

Table 12. Output of initial synthesis for intersectional best practices, drawn upon recommendations in peer-reviewed syntheses.

For indigenous people living with disabilities in circumpolar regions:
KT can explicitly connect the accountability of stakeholders to the wellbeing of the people they serve	KT can recognize entanglement with existing neoliberal systems: consider how cost, incentivization, and reimbursement impact outcomes of interest
Assess impacts of KT on indigenous treatment providers	KT can employ personal outreach visits
KT can rectify longstanding delegitimization: acknowledge that the target group has historically been denied acceptance and acknowledgement of legitimacy in dominant biomedical systems; address these imbalances to build trust in a KT relationship	KT can avoid assuming the target group to be homogeneous, and critically examine inequitable distribution of benefits and risks: between various indigenous peoples living with disabilities in circumpolar regions
Consider how emphasis on a KT initiative can distract from historical and systemic inequalities: and how health behavior change can be informed by knowledge of historical inequalities	KT can target inequitable, systemic social and economic forces: which lead to lack of wellbeing, and consider if specific forms of KT are better suited to address such forces
Consider how KT can also be mobilized to gain power and control, including for governments and businesses intending to manage populations deliberately: assess what is selected for KT, and how it intersects with power position of external stakeholders and internal champions	KT can allow people access-to-knowledge which changes inequitable systems: as opposed to knowledge which can only be applied under existing inequitable systems

Table 13. Strengthening potential for execution based on existing knowledge retrieved through the Nine-Step Process.

Recommendation	Who should be engaged in visits?	With what?	With what guidelines?
From Table 11. Ten Best Practices “Employ personal outreach visits”	From Table 3 (KTDRR Constructs): Educator Healthcare Professional Person with disability Family Advocate Service Provider	From Table 3 (KTDRR Constructs): Checklist Financial Incentives Knowledge Cafe Interventions Narrative Summary Online Resources Educational Materials Social Media Targeted Messages Toolkits Web-based Training	From Table 11. Ten Best Practices Allow people access to knowledge which changes inequitable systems Avoid gaining power and control over individuals through the process Consider if any costs are imposed upon the individuals

Snell-Rood C, Jaramillo ET, Hamilton AB, et al. Advancing health equity through a theoretically critical implementation science. Transl Behav Med. 2021;11(8):1617–1625. doi: 10.1093/tbm/ibab008

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Hernández-Saca DI, Voulgarides CK, Etscheidt SL. A critical systematic literature review of global inclusive education using an affective, intersectional, discursive, emotive and material lens. Educ Sci. 2023;13(12):1212, Article 12. doi: 10.3390/educsci13121212.

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