Examining the conceptual and instrumental use of the knowledge-to-action framework: a citation analysis and scoping review

Implementation science theories, models, and frameworks provide structure and guidance when translating evidence into practice and policy. The Knowledge-to-Action (KTA) Framework, published by Graham and colleagues in 2006, is among the most highly cited frameworks for guiding implementation efforts. However, after nearly 20 years of use, little is known about how the KTA Framework has been applied over time or whether more recent implementation science priorities, such as application of multiple theories, models, and frameworks, knowledge user engagement, and equity considerations are reflected in its use. The purpose of this citation analysis and scoping review was to explore how the KTA Framework has been used as reported in the published literature. We conducted a citation analysis and scoping review following the JBI Scoping Review Methodology. Papers were eligible if they cited one of two core KTA Framework references. Forward citation searches were conducted in Scopus, Web of Science, and Google Scholar on April 16, 2024. We categorized included papers, based on application of the framework, into three use levels: referenced (citation only), conceptual (informing or guiding the approach), and instrumental (guiding implementation activities). An independent reviewer extracted data from conceptual and instrumental papers and all extracted data were verified by a second reviewer. We analyzed data using descriptive statistics and qualitative content analysis. Of 8,671 sources retrieved, 4,208 underwent full-text screening; 3,258 referenced the KTA Framework only, and 825 used it conceptually ( n = 438) or instrumentally ( n = 387). Citation and use of the KTA framework has increased steadily over time, growing from 1787 citations by 2013 to 4285 citations by April 2024. The largest number of included papers were from Canada ( n = 405, 49.1%), the United States ( n = 132, 16.0%), and Australia ( n = 113, 13.7%). The KTA Framework was used across disciplines, with healthcare being the most common (77%). The most used KTA phase was Assess Barriers and Facilitators (73.6%), while Sustain Knowledge Use was least often applied (41.9%). Knowledge user engagement was reported in 44.6% of papers, while equity, diversity, inclusion, and accessibility (EDIA) considerations appeared in only 11.9% of included papers. The use of the KTA Framework continues to grow, with applications varying across implementation phases. More recent years have seen the integration of companion theories, models, and frameworks, knowledge user engagement, and some limited EDIA considerations. These findings are informing future refinements to the KTA Framework to support the translation of evidence into practice.