6.2. The action cycle
The seven action phases can occur sequentially or simultaneously and the knowledge phases can influence the action phases at any point in the cycle. The action parts of the cycle
are based on planned action theories that focus on deliberately engineering change in health care systems and groups. Included are the processes needed to implement knowledge in health care settings specifically identification of the problem; identifying, reviewing, and selecting the knowledge to implement; adapting or customizing the knowledge to the local context; assessing the determinants of knowledge use; selecting, tailoring, implementing, and
monitoring knowledge translation interventions and knowledge uptake; evaluating outcomes or impact of using the knowledge; and determining strategies for ensuring sustained
knowledge use. Integral to the framework is the need to consider the various stakeholders who are the end users of the knowledge that is being implemented.