title: Systematic reviews and knowledge translation.
abstract: Proven effective interventions exist that would enable all countries to meet the Millennium Development Goals. However, uptake and use of these interventions in the poorest populations is at least 50% less than in the richest populations within each country. Also, we have recently shown that community effectiveness of interventions is lower for the poorest populations due to a "staircase" effect of lower coverage/access, worse diagnostic accuracy, less provider compliance and less consumer adherence. We propose an evidence-based framework for equity-oriented knowledge translation to enhance community effectiveness and health equity. This framework is represented as a cascade of steps to assess and prioritize barriers and thus choose effective knowledge translation interventions that are tailored for relevant audiences (public, patient, practitioner, policy-maker, press and private sector), as well as the evaluation, monitoring and sharing of these strategies. We have used two examples of effective interventions (insecticide-treated bednets to prevent malaria and childhood immunization) to illustrate how this framework can provide a systematic method for decision-makers to ensure the application of evidence-based knowledge in disadvantaged populations. Future work to empirically validate and evaluate the usefulness of this framework is needed. We invite researchers and implementers to use the cascade for equity-oriented knowledge translation as a guide when planning implementation strategies for proven effective interventions. We also encourage policy-makers and health-care managers to use this framework when deciding how effective interventions can be implemented in their own settings.
authors.affiliation: Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell
authors.forename: Vivian
authors.initials: V
authors.lastname: Robinson
authors.forename: Jeremy
authors.initials: J
authors.lastname: Grimshaw
authors.forename: Nancy
authors.initials: N
authors.lastname: Santesso
mesh_terms: D019049:Developed Countries; D003906:Developing Countries; D014943:Global Health; D006291:Health Policy; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration; D033181:Information Dissemination / Q000379:methods*; D007306:Insecticides; D019359:Knowledge; D008288:Malaria / Q000517:prevention & control; D012196:Review Literature as Topic
chemical_list: D007306:Insecticides