The study was conducted as the second, qualitative phase of a sequential explanatory mixed-methods project. Twenty-one experts were recruited through snowball sampling from eleven Type I medical universities, the highest tier of Iran’s medical education system. The participant pool deliberately spanned the organizational hierarchy: faculty members who produce research, senior administrators who allocate resources and set strategy, and knowledge translation specialists who sit at the interface between the two worlds. Between February and August 2023, the researchers conducted semistructured interviews lasting between forty-five and ninety minutes, allowing participants to describe in their own words what helps and what hinders the movement of evidence into policy and practice within their institutions.

Analysis followed the inductive content analysis framework of Elo and Kyngäs, proceeding through open coding, categorization, and abstraction with the qualitative analysis software ATLAS.ti. Rigor was addressed through several established safeguards: member checking, in which participants reviewed the researchers’ interpretations; peer debriefing among the analytic team; and audit trails documenting how codes and categories evolved. Inter-coder reliability was quantified using Cohen’s Kappa, reaching a value of 0.82, which is conventionally interpreted as almost perfect agreement between independent coders. The study was conducted in accordance with the Declaration of Helsinki, with ethics approval from the Kerman University of Medical Sciences Ethics Committee and written informed consent from all participants.

From this analysis, five overarching dimensions of organizational readiness for knowledge translation emerged. The first is organizational culture and research climate, encompassing the norms, values, and informal expectations that determine whether evidence is genuinely valued or merely tolerated. The second is human resource development and training, the formal and informal structures through which staff acquire the skills to find, appraise, summarize, and communicate research findings. The third is knowledge production and sharing, the pipelines through which new evidence is generated, stored, and circulated inside and beyond the institution. The fourth is evidence-based policy and strategy, the extent to which institutional decision-making processes are explicitly designed around research findings. The fifth, and for the authors the most consequential, is monitoring and evaluation mechanisms, the systems that track whether knowledge translation efforts are actually functioning.

What elevates this study beyond a conventional checklist of readiness factors is its second-order analysis of how these five dimensions relate to one another. Rather than treating monitoring and evaluation as the final step of an implementation sequence, the researchers found that feedback loops function as the connective tissue of the entire system. In their formulation, feedback mechanisms act as the nervous system of knowledge translation readiness, continuously sensing what is happening across culture, training, production, and policy, and transmitting signals that allow the organization to learn and adapt. Without those loops, the other four dimensions operate in isolation; with them, the organization develops the dynamic capacity to correct course, reinforce what works, and abandon what does not.

This reframing carries real theoretical weight. Many existing knowledge translation frameworks, inherited from linear models of research uptake, position monitoring as a subsequent and largely administrative stage that occurs after the substantive work of translation is complete. The Iranian findings invert that logic: the feedback apparatus is not downstream of implementation but upstream of it, because organizations that cannot perceive the consequences of their own actions cannot become ready for anything. In systems terms, feedback converts a static bundle of resources into a learning system, and it is precisely that learning capacity, the authors argue, that distinguishes institutions where evidence routinely shapes decisions from institutions where reports accumulate unread.

The expert interviews also yielded a sobering catalogue of the barriers currently undermining this capacity in Iranian medical universities. Participants described siloed communication, in which departments, faculties, and administrative units exchange information poorly or not at all, fragmenting the very loops that the readiness model depends upon. They reported limited incentives for the use of evidence, meaning that career advancement, recognition, and reward structures do not encourage either researchers to engage with practice or managers to engage with research. They cited a lack of managerial commitment, insufficient capacity-building structures for developing the specialized skills that knowledge translation demands, and weak linkages between research units and the practice environments, such as hospitals and public health programs, that the evidence is meant to inform.

The authors conclude that enhancing organizational readiness for knowledge translation in this setting requires a multifaceted approach that strengthens cultural, structural, and leadership capacities simultaneously, rather than addressing any single factor in isolation. Most pointedly, they argue that establishing structured feedback mechanisms must be viewed as the core driver, not an afterthought, of sustainable knowledge translation implementation. In practical terms, that would mean designing deliberate channels through which evidence use is observed, questioned, and evaluated: routine forums where researchers and decision-makers exchange information, evaluation systems that generate usable information about how evidence flows, and leadership practices that treat feedback as a resource rather than a threat.

The study’s authors are careful to specify the limits of their claims. The findings identify enabling conditions for knowledge translation rather than providing direct evidence that strengthening these conditions improves health outcomes, a distinction that matters for anyone tempted to treat the five-dimension model as a guaranteed prescription. The research is also confined to Type I medical universities in one national context, and organizational readiness in smaller institutions or different health systems may depend on a different balance of factors. Nevertheless, the implications travel beyond Iran. Knowledge translation challenges are well documented across low- and middle-income countries, where research production has often expanded faster than the organizational machinery needed to apply it. By proposing feedback as the organizing principle of readiness, the study offers a testable hypothesis for implementation science: that the first question any research institution should ask is not how much evidence it produces, but how effectively it hears the signal of its own experience. By addressing these readiness factors, the authors suggest, medical universities can strengthen their role in evidence-informed policy and practice, turning the institutional pyramid of training, production, and strategy into a genuinely self-correcting system.

Subject of Research: Organizational readiness for knowledge translation and feedback loops in Iranian medical universities

Article Title: Feedback loops as a core driver: rethinking organizational readiness for knowledge translation in Iranian medical universities

Article References: Rezaei, F., Saberian, M., Ghasemi, S., Gharibi, Z., & Hosseinzadeh, H. (2026). Feedback loops as a core driver: rethinking organizational readiness for knowledge translation in Iranian medical universities. Health Research Policy and Systems. https://doi.org/10.1186/s12961-026-01537-7

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01537-7

Keywords: knowledge translation, organizational readiness, feedback loops, implementation science, medical universities, Iran, qualitative study, evidence-based policy, monitoring and evaluation, organizational learning, health policy, Feedback

The context for the study is a demographic and policy pressure cooker. Societies and healthcare systems worldwide are confronting the demands of an aging population, and the European Commission has emphasized cross-sector collaboration to build sustainable, health-promoting solutions that support active and healthy ageing. In Sweden, healthcare is undergoing a deliberate transition toward person-centered and integrated care, with proactive, health-promoting approaches and digital solutions intended to deliver more equal, efficient, and accessible services. Municipal healthcare, provided in people’s homes or in specialized housing, serves a population in which up to 83 percent of recipients in 2023 were aged 65 or older, and many of these individuals also receive municipal social services such as home care. Staff in these services frequently perform delegated healthcare tasks, blurring the boundaries between sectors and making shared, collaborative perspectives essential to any preventive shift.

The scientific rationale is compelling. Cohort studies suggest that today’s older adults generally show higher levels of physical and mental functioning than previous generations, and Swedish data report improvements in health, longevity, and activity performance among people up to 80 years of age. Health promotion, defined as the process of enabling people to increase control over the determinants of their health, offers a way to consolidate those gains. Interventions that target key health determinants among community-dwelling older adults before they enter municipal care could help maintain health, delay the onset of care needs, and reduce future demand on strained health and social care systems. Within occupational therapy, engagement in meaningful everyday activities is considered a key determinant of health, and prior evidence supports both group-based formats and digital delivery, suggesting that combining the two could offer promising, resource-efficient routes to supporting healthy ageing.

To understand the organizational ground truth before any large-scale implementation, the researchers turned to the people who run and staff municipal services. Using a qualitative focus group design, they recruited 22 participants from seven municipalities in northern Sweden, including occupational therapists, development managers, area managers, operations managers, and case managers. The participants were purposively sampled across professional roles and organizational levels, and grouped with others in similar positions to reduce the distorting effects of hierarchy on candid discussion. Five focus groups were held over five months, three digitally because of the long distances between workplaces and two in person. To anchor the conversation, the researchers presented a shared case: a web-based, group-delivered occupational therapy intervention called Health Web, which their team had previously developed and piloted. The case was not being evaluated; it served as a concrete stimulus for broader reflection on what health-promoting work would demand of the organization. Discussions, lasting between 56 minutes and one hour and 50 minutes, were audio recorded, verbatim transcribed, and analyzed inductively using a structured focus group analysis approach.

The analysis converged on a single overarching theme: creating organizational readiness for health-promoting interventions. This theme was supported by three interrelated subthemes: supportive structures for health-promoting work are needed within the organization; a shared health-promoting focus and new collaborations are required; and new working methods are necessary to facilitate health promotion. The researchers found that these subthemes do not operate as isolated barriers or facilitators but interact dynamically in everyday practice, collectively shaping whether preventive ambitions can actually be realized. Every focus group judged current readiness to be insufficient, yet participants also expressed a clear sense that health-promoting interventions are essential as the organization aligns with person-centered and integrated care.

The first subtheme exposed a structural paradox. Participants described legal agreements, frameworks, and priority orders that govern municipal work as failing to stipulate health-promoting activity. Development managers explained that the home care agreement, for example, directs effort almost entirely toward technical aids and reactive, treatment-focused care, leaving professionals who are trained to work preventively feeling actively hindered. In their words, staff are left to put out fires without ever being able to prevent the fires from starting. The absence of supportive structures led to a shared perception of health promotion as optional work, something to be attempted only when time and resources allowed. Participants called for revised agreements, clearer interpretation of the new social services act, explicit direction on resource allocation and competence use, and political and managerial leadership to initiate the change, emphasizing that long-term sustainability requires extra resources during a transition period rather than short-term projects vulnerable to annual budget cuts.

The second subtheme revealed a cultural trap: daily practice is dominated by reactive, compensatory interventions. Occupational therapists are mainly contacted for acute needs following hospital discharge and are often perceived as an overburdened group with few staff, so managers hesitate to add anything beyond ordinary tasks. Interventions in older adults’ daily activities are frequently delegated to home care staff who lack formal competence and face language barriers, leading to deprioritization in favor of basic care. Collaboration between health and social care typically emerges only late, when complex needs have already arisen, and is further restricted by secrecy regulations. Participants proposed earlier, closer collaboration, tools such as life story forms used proactively to map health determinants, and outreach into society, including associations, libraries, and digital platforms, to reach resourceful older adults whose changing life circumstances make them ideal candidates for preventive intervention before poor health takes hold.

The third subtheme highlighted new working methods, particularly digital and group-based formats. Participants viewed digital solutions as a way to reach older adults who have difficulty leaving home, including informal caregivers and those with limited energy or mobility, and to build digital competence, itself a health-promoting skill in modern society. Yet current municipal digital use is largely one-way, covering security alarms and camera surveillance rather than mutual communication. Group formats were judged inherently health-promoting: shared activities foster mutual encouragement, social learning, empowerment, cognitive and physical stimulation, and a sense of purpose, right down to the motivation to look presentable for a meeting. Flexible design was seen as important, since combining an initial physical meeting with later digital sessions could lower the threshold for isolated older adults, while for others a screen feels safer as a first step out of isolation.

Interpreted through Weiner’s theory of organizational readiness for change and the Consolidated Framework for Implementation Research, the findings suggest low change efficacy and fragmented change commitment among staff, but also extend those frameworks by showing that readiness is continuously negotiated through structural conditions, shared views, and everyday collaborative practices rather than being a static psychological state. The authors argue that the study provides a foundation for structured dialogue between policymakers, managers, and professionals, ideally within collaborative co-creation processes, and call on the occupational therapy profession to engage across organizational levels in deciding how its competencies can shift from reactive, compensatory roles toward proactive, health-promoting practice. For a system facing an ever-growing older population, the message is stark but constructive: the potential for prevention already exists within municipal organizations, but it must be deliberately built, resourced, and led from the top if health promotion is ever to move from aspiration to everyday routine.

Subject of Research: A qualitative focus group study exploring organizational opportunities and challenges for delivering health-promoting interventions to older adults within municipal health and social care in Sweden.

Article Title: Opportunities and Challenges for Health-Promoting Interventions for Older Adults: A Focus Group Study with Professionals in Municipal Health and Social Care

Article References: Körlof, L., Nyman, A., Larsson, E., & Isaksson, G. (2026). Opportunities and Challenges for Health-Promoting Interventions for Older Adults: A Focus Group Study with Professionals in Municipal Health and Social Care. Scandinavian Journal of Occupational Therapy, 33(1), Article 6. https://doi.org/10.1007/s44474-026-00008-0

Image Credits: AI Generated

DOI: 10.1007/s44474-026-00008-0

Keywords: health promotion, older adults, occupational therapy, organizational readiness, municipal health care, social care, person-centered care, integrated care, digital interventions, group-based interventions, healthy ageing, qualitative research