Table 1.

Multi-level community knowledge translation actions

Level of intervention	Knowledge translation (KT) actions
Project planning
Community-based quality improvement project approach	Established a multidisciplinary community advisory group
	Collaboratively created a community plan the Essex County Community Asthma Care Strategy
	Identified key barriers to the implementation of asthma guidelines
	Identified key guideline interventions for implementation within the project
	Collaboratively developed infrastructure tools and a healthcare model to address the identified barriers
	Pilot testing of project tools and program operations with tool refinement
Health system level	Organizational
Barrier: Primary care without a common organizational structure, standardized KT tools and sufficient human resources	Asthma Research Group (Windsor Essex County Inc.) is registered as a community non-profit corporation to lead the initiative
	Community organizations (6) sign an operating agreement
	A project coordinator is hired. Healthcare professionals from a variety of backgrounds are trained as asthma educators
Solution: infrastructure innovation focused on asthma KT, professional training and developing standardized tools	Electronic
	An electronic infrastructure is created collaboratively with the University of Windsor including: (i) a web-based communication and scheduling tool to support project administration, (ii) an educator software program for patient assessment, education and decision support and (iii) an automated recall appointment reminder system
Practice level
Barrier: no common model for implementing guidelines, quality improvement, sharing human resources and sharing knowledge tools	Accepted the Global Initiative for Asthma and Canadian Asthma Consensus guidelines as the guiding document for best practices
	Guideline objectives (6) were incorporated into the care model.
	The asthma educator is placed centrally in an inter-disciplinary care model as a guideline content expert.
Solution: creating an asthma management program and asthma care days	Care is integrated into the primary care practice with all elements delivered on-site where the patient normally receives care
	The educator uses the software program created for the project to standardize the intervention, track performance indicators and for action plan decision support
	Self-management education is a key element of the care model
	Automated recall notices for follow-up appointments
Individual patient level
Barrier: practitioner resources limit access	Regular physician review of controller medication and asthma control
Solution: inter-disciplinary care based on six guideline recommendations	Self-management education including a written action plan
	Objective measurement of lung function with spirometry
	Education on environmental control
	Education on role of medications
	Review and instruction on inhaler device technique