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Roles and effectiveness of knowledge brokers for translating clinical practice guidelines in health-related settings: a systematic review
  1. Amanda J Cross1,
  2. Terry P Haines2,
  3. Choon Ean Ooi1,
  4. Adam La Caze3,
  5. Sara Karavesovska1,
  6. Eu Jin Lee1,
  7. Samuel Siu1,
  8. Sagar Sareen1,
  9. Carlos Jones1,
  10. Michelle Steeper1,
  11. John Simon Bell1
  1. 1 Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, Victoria, Australia
  2. 2 School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
  3. 3 School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
  1. Correspondence to Dr Amanda J Cross, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University - Parkville Campus, Parkville, VIC 3052, Australia; amanda.cross{at}


Background Poor translation of clinical practice guidelines (CPGs) into clinical practice is a barrier to the provision of consistent and high-quality evidence-based care. The objective was to systematically review the roles and effectiveness of knowledge brokers (KBs) for translating CPGs in health-related settings.

Methods MEDLINE, Embase, PsycINFO and CINAHL Plus were searched from 2014 to June 2022. Randomised controlled trials (RCTs), controlled and uncontrolled preintervention and postintervention studies involving KBs, either alone or as part of a multicomponent intervention, that reported quantitative postintervention changes in guideline implementation in a healthcare setting were included. A KB was defined as an intermediary who facilitated knowledge translation by acting in at least two of the following core roles: knowledge manager, linkage agent or capacity builder. Specific activities undertaken by KBs were deductively coded to the three core roles, then common activities were inductively grouped. Screening, data extraction, quality assessment and coding were performed independently by two authors.

Results 16 studies comprising 6 RCTs, 8 uncontrolled precomparisons–postcomparisons, 1 controlled precomparison–postcomparison and 1 interrupted time series were included. 14 studies (88%) were conducted in hospital settings. Knowledge manager roles included creating and distributing guideline material. Linkage agent roles involved engaging with internal and external stakeholders. Capacity builder roles involved audit and feedback and educating staff. KBs improved guideline adherence in 10 studies (63%), had mixed impact in 2 studies (13%) and no impact in 4 studies (25%). Half of the RCTs showed KBs had no impact on guideline adherence. KBs acted as knowledge managers in 15 (94%) studies, linkage agents in 11 (69%) studies and capacity builders in all studies.

Conclusion Knowledge manager and capacity builder roles were more frequently studied than linkage agent roles. KBs had mixed impact on translating CPGs into practice. Further RCTs, including those in non-hospital settings, are required.

PROSPERO registration number CRD42022340365.

  • Clinical practice guidelines
  • Health services research
  • Quality improvement

Data availability statement

Data sharing was not applicable as no datasets were generated and/or analysed for this study.

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Data availability statement

Data sharing was not applicable as no datasets were generated and/or analysed for this study.

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  • Contributors All authors meet all four ICMJE criteria for authorship. AJC is the guarantor.

  • Funding AJC was supported by a National Health and Medical Research Council Emerging Leadership 1 grant (APP2009633).

  • Competing interests AJC, ALC and JSB have received grant funding from the Medical Research Future Fund (GA187306). JSB has received grant funding or consulting funds from the National Health and Medical Research Council, Medical Research Future Fund, Victorian Government Department of Health and Human Services, Dementia Australia Research Foundation, Yulgilbar Foundation, Aged Care Quality and Safety Commission, Dementia Centre for Research Collaboration, Pharmaceutical Society of Australia, GlaxoSmithKline Supported Studies Programme, Amgen and several aged care provider organisations unrelated to this work. All grants and consulting funds were paid to the employing institution. TPH, CEO, SK, EJL, SSi, SSa, CJ and MS have no conflicts of interest to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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