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Int J Health Policy Manag. 2018;7(3): 231-243. doi: 10.15171/ijhpm.2017.79
PMID: 29524952        PMCID: PMC5890068

Original Article

Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation

Alison Kitson 1,2 * , Alan Brook 3,4, Gill Harvey 1,5, Zoe Jordan 6, Rhianon Marshall 1, Rebekah O’Shea 1, David Wilson 7

Cited by CrossRef:

1- Khatri R, Endalamaw A, Mengistu T, Erku D, Wolka E, Nigatu F, Zewdie A, Assefa Y. A scoping review of knowledge translation in strengthening health policy and practice: sources, platforms, tools, opportunities, and challenges. Arch Public Health. 2025;83(1) [Crossref]
2- Feo R, Urry K, Conroy T, Kitson A. Why reducing avoidable hospital readmissions is a ‘wicked’ problem for leaders: A qualitative exploration of nursing and allied health perceptions. Journal of Advanced Nursing. 2023;79(3):1031 [Crossref]
3- Perera S, Parkhurst J, Diaconu K, Bozzani F, Vassall A, Grant A, Kielmann K. Complexity and evidence in health sector decision-making: lessons from tuberculosis infection prevention in South Africa. 2022;37(9):1177 [Crossref]
4- Hitch D, Pepin G, Lhuede K, Rowan S, Giles S. Development of the Translating Allied Health Knowledge (TAHK) Framework. Int J Health Policy Manag. 2019;8(7):412 [Crossref]
5- Kitson A. Fundamentals of care: Methodologies, metrics and mobilisation. Journal of Clinical Nursing. 2020;29(11-12):1762 [Crossref]
6- Cassidy R, Singh N, Schiratti P, Semwanga A, Binyaruka P, Sachingongu N, Chama-Chiliba C, Chalabi Z, Borghi J, Blanchet K. Mathematical modelling for health systems research: a systematic review of system dynamics and agent-based models. BMC Health Serv Res. 2019;19(1) [Crossref]
7- Pinero de Plaza M, Yadav L, Kitson A. Co-designing, measuring, and optimizing innovations and solutions within complex adaptive health systems. Front Health Serv. 2023;3 [Crossref]
8- Healey A, Hartwick M, Downar J, Keenan S, Lalani J, Mohr J, Appleby A, Spring J, Delaney J, Wilson L, Shemie S. Improving quality of withdrawal of life-sustaining measures in organ donation: a framework and implementation toolkit. Can J Anesth/J Can Anesth. 2020;67(11):1549 [Crossref]
9- Champion C, Kuziemsky C, Affleck E, Alvarez G. A systems approach for modeling health information complexity. International Journal of Information Management. 2019;49:343 [Crossref]
10- Glegg S, Costello C, Barnaby S, Cassidy C, Sibley K, Russell K, Kingsnorth S, Pritchard L, de Camargo O, Andersen J, Bellefeuille S, Cross A, Curran J, Hesketh K, Layco J, Reynolds J, Robeson P, Straus S, Wittmeier K. Connecting for Care: a protocol for a mixed-method social network analysis to advance knowledge translation in the field of child development and rehabilitation. Implement Sci Commun. 2022;3(1) [Crossref]
11- Archibald M. Co-implementation: collaborative and concurrent approaches to advance embedded implementation in the health sciences. Front Health Serv. 2023;3 [Crossref]
12- Marshall M, Davies H, Ward V, Waring J, Fulop N, Mear L, O’Brien B, Parnell R, Kirk K, Reid B, Tooman T. Optimising the impact of health services research on the organisation and delivery of health services: a mixed-methods study. Health Soc Care Deliv Res. 2022;10(3):1 [Crossref]
13- Nociti F. Systems Integration: A Key Step Toward Strengthening Oral Health. Front Dent Med. 2021;2 [Crossref]
14- Zhao J, Bai W, Zhang Q, Su Y, Wang J, Du X, Zhou Y, Kong C, Qing Y, Gong S, Meng M, Wei C, Li D, Wu J, Li X, Chen W, Hu J. Evidence-based practice implementation in healthcare in China: a living scoping review. The Lancet Regional Health - Western Pacific. 2022;20:100355 [Crossref]
15- Hunter S, Kim B, Kitson A. Mobilising Implementation of i-PARIHS (Mi-PARIHS): development of a facilitation planning tool to accompany the Integrated Promoting Action on Research Implementation in Health Services framework. Implement Sci Commun. 2023;4(1) [Crossref]
16- García-Cruz J, Oliveira Vera-Cruz J. Knowledge mobilization in Type 2 Diabetes Mellitus (T2DM) researchers: an approach to the Mexican national health system. Tapuya: Latin American Science, Technology and Society. 2023;6(1) [Crossref]
17- Heinsch M, Cootes H, Tickner C. Another implementation science is possible: engaging an ‘intelligent public’ in knowledge translation. Health Sociology Review. 2023;32(1):5 [Crossref]
18- Robinson T, Bailey C, Morris H, Burns P, Melder A, Croft C, Spyridonidis D, Bismantara H, Skouteris H, Teede H. Bridging the research–practice gap in healthcare: a rapid review of research translation centres in England and Australia. Health Res Policy Sys. 2020;18(1) [Crossref]
19- Augustsson H, Churruca K, Braithwaite J. Re-energising the way we manage change in healthcare: the case for soft systems methodology and its application to evidence-based practice. BMC Health Serv Res. 2019;19(1) [Crossref]
20- Baixinho C, Ferreira Ó, Medeiros M, de Oliveira E. Participation of Nursing Students in Evidence-Based Practice Projects: Results of Two Focus Groups. IJERPH. 2022;19(11):6784 [Crossref]
21- Ritchie M, Drummond K, Smith B, Sullivan J, Landes S. Development of a qualitative data analysis codebook informed by the i-PARIHS framework. Implement Sci Commun. 2022;3(1) [Crossref]
22- Kothari A, Sibbald S. Using Complexity to Simplify Knowledge Translation Comment on "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation". Int J Health Policy Manag. 2017;7(6):563 [Crossref]
23- Augustsson H, Churruca K, Braithwaite J. Change and improvement 50 years in the making: a scoping review of the use of soft systems methodology in healthcare. BMC Health Serv Res. 2020;20(1) [Crossref]
24- Galkina T, Atkova I. Effectual Networks as Complex Adaptive Systems: Exploring Dynamic and Structural Factors of Emergence. Entrepreneurship Theory and Practice. 2020;44(5):964 [Crossref]
25- Zhao J, Harvey G, Vandyk A, Gifford W. Social Media for ImpLementing Evidence (SMILE): Conceptual Framework. JMIR Form Res. 2022;6(3):e29891 [Crossref]
26- Kitson A, O’Shea R, Brook A, Harvey G, Jordan Z, Marshall R, Wilson D. The Knowledge Translation Complexity Network (KTCN) Model: The Whole Is Greater Than the Sum of the Parts - A Response to Recent Commentaries. Int J Health Policy Manag. 2018;7(8):768 [Crossref]
27- Heinsch M, Cribb A. ‘Just Knowledge’: Can Social Work’s ‘Guilty Knowledge’ Help Build a More Inclusive Knowledge Society?. 2018; [Crossref]
28- Blanken M, Mathijssen J, van Nieuwenhuizen C, Raab J, van Oers H. Examining preconditions for integrated care: a comparative social network analysis of the structure and dynamics of strong relations in child service networks. BMC Health Serv Res. 2023;23(1) [Crossref]
29- Bowen S, Botting I, Graham I, MacLeod M, Moissac D, Harlos K, Leduc B, Ulrich C, Knox J. Experience of Health Leadership in Partnering With University-Based Researchers in Canada – A Call to "Reimagine" Research. Int J Health Policy Manag. 2019;8(12):684 [Crossref]
30- Bell J, La Caze A, Steeper M, Haines T, Hilmer S, Troeung L, Quirke L, Wesson J, Pond C, Buys L, Ghahreman-Falconer N, Lawless M, Shrestha S, Martini A, Ochieng N, Glamorgan F, Lagasca C, Walton R, Cenin D, Kitson A, Jung M, Bennett A, Cross A. Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE): protocol for a helix-counterbalanced randomised controlled trial. Implementation Sci. 2024;19(1) [Crossref]
31- Vincenten J, MacKay J, Schröder-Bäck P, Schloemer T, Brand H. Factors influencing implementation of evidence-based interventions in public health systems - a model. Cent Eur J Public Health. 2019;27(3):198 [Crossref]
32- Harvey G, Dollard J, Marshall A, Mittinty M. Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight For the Future?. Int J Health Policy Manag. 2018;7(4):290 [Crossref]
33- Kitson A, Harvey G, Gifford W, Hunter S, Kelly J, Cummings G, Ehrenberg A, Kislov R, Pettersson L, Wallin L, Wilson P. How nursing leaders promote evidence‐based practice implementation at point‐of‐care: A four‐country exploratory study. Journal of Advanced Nursing. 2021;77(5):2447 [Crossref]
34- Strachan D, Teague K, Asefa A, Annear P, Ghaffar A, Shroff Z, McPake B. Using health policy and systems research to influence national health policies: lessons from Mexico, Cambodia and Ghana. 2023;38(1):3 [Crossref]
35- Donetto S, Desai A, Zoccatelli G, Allen D, Brearley S, Rafferty A, Robert G. Patient experience data as enacted: Sociomaterial perspectives and ‘singular‐multiples’ in health care quality improvement research. Sociology Health & Illness. 2021;43(4):1032 [Crossref]
36- Lawless M, Tieu M, Archibald M, Pinero De Plaza M, Kitson A. From Promise to Practice: How Health Researchers Understand and Promote Transdisciplinary Collaboration. Qual Health Res. 2025;35(1):3 [Crossref]
37- Heinsch M, Cribb A. ‘Just Knowledge’: Can Social Work’s ‘Guilty Knowledge’ Help Build a More Inclusive Knowledge Society?. 2018; [Crossref]
38- Kirchner J, Landes S, Eagan A. Applying KT Network Complexity to a Highly-Partnered Knowledge Transfer Effort Comment on "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation". Int J Health Policy Manag. 2017;7(6):560 [Crossref]
39- Ferreira Ó, Baixinho C, Medeiros M, Oliveira E. Learning to use evidence at nursing undergraduation: a contribution to collective health. Ciênc saúde coletiva. 2022;27(5):1723 [Crossref]
40- Isett K, Hicks D. Pathways From Research Into Public Decision Making: Intermediaries as the Third Community. 2020;3(1):45 [Crossref]
41- Flenady T, Dwyer T, Kahl J, Sobolewska A, Reid-Searl K, Signal T. Research Ready Grant Program (RRGP) protocol: a model for collaborative multidisciplinary practice–research partnerships. Health Res Policy Sys. 2022;20(1) [Crossref]
42- Kauffeldt K, Latimer-Cheung A, Faulkner G, Brouwers M, Jones R, Lane K, Weston Z, Morgan T, Varkul O, Tomasone J. The longitudinal evaluation of the Canadian 24-Hour Movement Guidelines for Adults: lessons learned and considerations for future research. Appl Physiol Nutr Metab. 2025;50:1 [Crossref]
43- Sehgal A, Kennedy A, McGowan K, Crowshoe L. Parallel systems in healthcare: Addressing Indigenous health equity in Canada. Global Public Health. 2025;20(1) [Crossref]
44- Ferraz L, Pereira R, Pereira A. Tradução do Conhecimento e os desafios contemporâneos na área da saúde: uma revisão de escopo. Saúde debate. 2019;43(spe2):200 [Crossref]
45- Chandler J. The Paradox of Intervening in Complex Adaptive Systems Comment on "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation". Int J Health Policy Manag. 2018;7(6):569 [Crossref]
46- Xue Y, Liu G, Feng Y, Xu M, Jiang L, Lin Y, Xu J. Mediating effect of health consciousness in the relationship of lifestyle and suboptimal health status: a cross-sectional study involving Chinese urban residents. BMJ Open. 2020;10(10):e039701 [Crossref]
47- Elmberger A, Blitz J, Björck E, Nieminen J, Bolander Laksov K. Faculty development participants' experiences of working with change in clinical settings. Medical Education. 2023;57(7):679 [Crossref]
48- Harvey G, Rycroft-Malone J, Seers K, Wilson P, Cassidy C, Embrett M, Hu J, Pearson M, Semenic S, Zhao J, Graham I. Connecting the science and practice of implementation – applying the lens of context to inform study design in implementation research. Front Health Serv. 2023;3 [Crossref]
49- Romera A, Bratman E, Pinero de Plaza M, Descalzo A, Ghneim-Herrera T. Freeing transdisciplinarity from the project straightjacket: reframing the problem. Social Sciences & Humanities Open. 2025;11:101483 [Crossref]
50- Tieu M, Lawless M, Hunter S, Pinero de Plaza M, Darko F, Mudd A, Yadav L, Kitson A. Wicked problems in a post-truth political economy: a dilemma for knowledge translation. Humanit Soc Sci Commun. 2023;10(1) [Crossref]
51- Tuolong J, Alatinga K, Yendaw E. Supply-side factors influencing national health insurance uptake, access and use of primary health care: Evidence from the Upper West Region, Ghana. SSM - Health Systems. 2024;3:100036 [Crossref]
52- Harvey G, Pham C, Inacio M, Laver K, Lynch E, Jorissen R, Karnon J, Bourke A, Forward J, Maddison J, Whitehead C, Rupa J, McNamara C, Crotty M. An integrated knowledge translation approach to address avoidable rehospitalisations and unplanned admissions for older people in South Australia: implementation and evaluation program plan. Implement Sci Commun. 2021;2(1) [Crossref]
53- Mayanja S, Omeke M, Mutebi H, Zombeire R. Nexus of generative influence and entrepreneurial networking: the mediating role of informational differences and opportunity identification among small and medium enterprises in Uganda. J Glob Entrepr Res. 2024;14(1) [Crossref]
54- Kaehne A. Sharing a vision. Do participants in integrated care programmes have the same goals and objectives?. Health Serv Manage Res. 2020;33(3):122 [Crossref]
55- Archibald M, Lawless M, de Plaza M, Kitson A. How transdisciplinary research teams learn to do knowledge translation (KT), and how KT in turn impacts transdisciplinary research: a realist evaluation and longitudinal case study. Health Res Policy Sys. 2023;21(1) [Crossref]
56- Brocklehurst P, Baker S, Langley J. Context and the evidence‐based paradigm: The potential for participatory research and systems thinking in oral health. Comm Dent Oral Epid. 2021;49(1):1 [Crossref]
57- Gamal Y, Heppenstall A, Strachan W, Colasanti R, Zia K. An analysis of spatial and temporal uncertainty propagation in agent-based models. Phil Trans R Soc A. 2025;383(2293) [Crossref]
58- TOPAL KOÇ D. SAĞLIK HİZMETLERİ PİYASASI VE KOMPÜTASYONEL MODELLEME. 2020;6(2):238 [Crossref]
59- Boersema G. Perspectives on wound care in nursing homes: an agenda for knowledge translation in the South African context. Wound Healing Southern Africa. 2024;17(1):22 [Crossref]
60- Ferreira Ó, Baixinho C, Medeiros M, Oliveira E. Aprender a usar evidência na graduação em enfermagem: um contributo para a saúde coletiva. Ciênc saúde coletiva. 2022;27(5):1723 [Crossref]
61- Walker A, Dale C, Curran N, Boaz A, Hurley M. Leading the spread and adoption of innovation at scale: an Academic Health Science Network’s perspective. leader. 2021;5(3):155 [Crossref]
62- Archibald M, Wiebe S, Rieger K, Linton J, Woodgate R. Protocol for a systematic review of living labs in healthcare. BMJ Open. 2021;11(2):e039246 [Crossref]
63- Farley-Ripple E, MacGregor S. A mixed methods study of education researchers’ knowledge mobilization approaches. J Educ Change. 2024;25(4):825 [Crossref]
64- Crosschild C, Huynh N, De Sousa I, Bawafaa E, Brown H. Where is critical analysis of power and positionality in knowledge translation?. Health Res Policy Sys. 2021;19(1) [Crossref]
65- Francis T, Davidson M, Senese L, Jeffs L, Yousefi-Nooraie R, Ouimet M, Rac V, Trbovich P. Exploring the use of social network analysis methods in process improvement within healthcare organizations: a scoping review. BMC Health Serv Res. 2024;24(1) [Crossref]
66- Carlson M, Morris S, Day F, Dadich A, Ryan A, Fradgley E, Paul C. Psychometric properties of leadership scales for health professionals: a systematic review. Implementation Sci. 2021;16(1) [Crossref]
67- Bühler F, Leinen A, Schneider-Schelte H, Meyer G, Dichter M, Köpke S, Wilm S, Bieber A. Exploring stakeholders’ perspectives on the adaptation of the Living Lab approach to dementia care: A qualitative study. Geriatric Nursing. 2023;54:184 [Crossref]
68- Colvin M, Miller S. The role of complexity theory and network analysis for examining child welfare service delivery systems. Child & Youth Services. 2020;41(2):160 [Crossref]
69- Baixinho C, Ferreira Ó, Medeiros M, Oliveira E. Sense of Belonging and Evidence Learning: A Focus Group Study. Sustainability. 2022;14(10):5793 [Crossref]
70- Haynes A, Rychetnik L, Finegood D, Irving M, Freebairn L, Hawe P. Applying systems thinking to knowledge mobilisation in public health. Health Res Policy Sys. 2020;18(1) [Crossref]
71- Archibald M, Wittmeier K, Gale M, Ricci F, Russell K, Woodgate R. Living labs for patient engagement and knowledge exchange: an exploratory sequential mixed methods study to develop a living lab in paediatric rehabilitation. BMJ Open. 2021;11(5):e041530 [Crossref]
72- Colnar S, Radević I, Martinović N, Lojpur A, Dimovski V, Pamucar D. The role of information communication technologies as a moderator of knowledge creation and knowledge sharing in improving the quality of healthcare services. PLoS ONE. 2022;17(8):e0272346 [Crossref]
73- Situated Precision Healthcare in the Smart Medical Home: Bringing NASA’s Research Strategy down to Earth. Adv Geriatr Med Res. 2020; [Crossref]
74- Murray J, Hunter S, Conroy T, Kitson A, Splawinski Z, Block H, Lewis A. REDUCE missed oral healthcare: The outcomes of and learnings from an implementation project in an acute geriatric unit. Research in Nursing & Health. 2024;47(5):551 [Crossref]
75- Bucknall T, Hitch D. Connections, Communication and Collaboration in Healthcare’s Complex Adaptive Systems Comment on "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation". Int J Health Policy Manag. 2017;7(6):556 [Crossref]
76- Gear C, Koziol-McLain J, Eppel E, Hape H, Rolleston A, Manuel C, Timutimu N, Ahomiro H, Healy C, Isham C. Capturing the emergence of change in complex systems: The ‘Atawhai’ study in Aotearoa, New Zealand. Evaluation. 2025; [Crossref]
77- Massuard M, Lane J, Manceau L, Castonguay P, Proulx R. Analyse d’une infrastructure québécoise de transfert de connaissances en autisme : le RNETSA. 2024;vol. 36(3):21 [Crossref]
78- Dadich A, Piper A, Coates D. Implementation science in maternity care: a scoping review. Implementation Sci. 2021;16(1) [Crossref]
79- Jesus T, Landry M, Jacobs K. A ‘new normal’ following COVID-19 and the economic crisis: Using systems thinking to identify challenges and opportunities in disability, telework, and rehabilitation. WOR. 2020;67(1):37 [Crossref]
80- Munn Z, McArthur A, Mander G, Steffensen C, Jordan Z. Evidence-based healthcare, knowledge translation, implementation science and radiography: What does it all mean?. Radiography. 2020;26:S8 [Crossref]
81- Maltby S, Gibson P, Reddel H, Smith L, Wark P, King G, Upham J, Clark V, Hew M, Owens L, Oo S, James A, Thompson B, Marks G, McDonald V. Severe Asthma Toolkit: an online resource for multidisciplinary health professionals—needs assessment, development process and user analytics with survey feedback. BMJ Open. 2020;10(3):e032877 [Crossref]
82- Franklin P, Montgomery K, Dorr P, Trandel D. Building Maryland's health care leadership capacity: The Nurse Leadership Institute at the University of Maryland School of Nursing. Nursing Outlook. 2020;68(5):657 [Crossref]
83- Braithwaite J. Changing how we think about healthcare improvement. BMJ. 2018;:k2014 [Crossref]
84- Chan R, Knowles R, Hunter S, Conroy T, Tieu M, Kitson A. From Evidence-Based Practice to Knowledge Translation: What Is the Difference? What Are the Roles of Nurse Leaders?. Seminars in Oncology Nursing. 2023;39(1):151363 [Crossref]
85- Kauffeldt K, McFadyen I, Latimer-Cheung A, Faulkner G, Tomasone J. Barriers and facilitators to the dissemination of national movement behavior guidelines among health-promoting organizations: a qualitative study. Front Public Health. 2024;12 [Crossref]
86- Craike M, Klepac B, Mowle A, Riley T. Theory of systems change: An initial, middle-range theory of public health research impact. 2023;32(3):603 [Crossref]
87- Harvey G, Gifford W, Cummings G, Kelly J, Kislov R, Kitson A, Pettersson L, Wallin L, Wilson P, Ehrenberg A. Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries. International Journal of Nursing Studies. 2019;90:21 [Crossref]