Table 1 Process Level Factors Influencing the Implementation of the Co-Creating Knowledge Translation (Co-KT) Framework in the LINKIN study

Insight into the working process

• Use of the Co-KT framework by researchers allowed the collation of locally generated knowledge, including identifying opportunities for better health integration and improvement.

• Researchers were not fully aware of the on-the-ground policy process of stakeholders in Port Lincoln—the CATI and health census data did not identify on-the-ground issues to the working processes.

• The working process in Port Lincoln changed early in the intervention, with key stakeholders changing.

• The local infrastructure was lacking with regards to health services:

  o There was a shortage of physiotherapists.

  o There were no accredited Exercise Physiologists, resulting in a lack of expertise in clinical exercise interventions for people with chronic and/or complex medical conditions or injuries.

o There were limited networks between local Allied Health and GP services, which in turn, inhibited patient referrals.

Study Design

• The longitudinal nature of the study meant that it was possible to compare participant outcomes in the intervention and wait-list groups.

• Referral forms were implemented to aid patient referral:

  o For GPs to refer to physical activity and/or physiotherapist treatment.

o For physiotherapists to refer to Physical Activity centres.

• Due to the longitudinal nature of the study design, and over 6 months between patient identification and re-contact, many participants no longer had musculoskeletal problems when recontacted by researchers to take part in the intervention phase of the project.

• With the high number of co-morbidities of LINKIN participants, the majority of participants required a GP clearance prior to their physical activity/physiotherapy participation. Given that the waiting list for GPs was up to 8 weeks during our study period, there was a considerable delay in implementing our study intervention.

Policy Process

• There are some policies for people with musculoskeletal conditions in Port Lincoln, but these were for people with Health Care Cards (low income earners) only.

• Mid-intervention saw both the state and federal government changes in health policy, affecting health service usage in Port Lincoln—including closing Medicare Locals and re-shuffling Country Health South Australia infrastructure.

• Musculoskeletal problems were identified as the main problem in Port Lincoln, but this was not a priority are in the State Government’s 10 Year Local Health Service Plan for Port Lincoln.

Degree of Uncertainty

• We employed a physiotherapist to run our intervention “on-the-ground” who was able to provide us with proactive information, which reduced the level of uncertainty in the project.

• The fitness centre climate in Port Lincoln is continually evolving: during the year-long intervention, 2 fitness centres had changed owners, and a further 2 were established.

 Timetable

• The project was flexible, so we were able to implement the study within the 12-month timeframe.

• The local football season coincided with the middle of our intervention study, resulting in long waiting lists of study participants to see physiotherapists.

• The changes in study design, due to an abrupt change of location and stakeholder needed, meant a 2-month delay in recruiting participants.

• There were many attendance disruptions as many participants were retirees and often travelling frequently for long periods.

Media

• Researchers publicised the LINKIN study, through regular newsletters to the community /stakeholders as well as newspaper articles. A “LINKIN” logo was present on all media to improve the credibility and recognitition of the research project.

• The website for the project was not permanent.