Abstract
PROACTIVE (Pediatric Oncology Capacity Assessment Tool for Intensive Care) is a quality improvement (QI) intervention that assist pediatric onco-critical care teams identify institutional strengths and gaps, but language barriers have limited its global uptake. This study aimed to evaluate the translation, refinement, and dissemination of Spanish-PROACTIVE guided by an integrated knowledge translation (IKT) approach. We conducted a four-phase mixed-methods study including: (1) translating and piloting Spanish-PROACTIVE in 22 centers across 12 countries in Latin America and Spain, (2) identifying institutional and regional pediatric onco-critical care challenges and QI priorities, (3) assessing barriers to disseminating results, and (4) co-developing dissemination tools. The professionally translated and refined Spanish-PROACTIVE identified key institutional and common regional pediatric onco-critical care challenges including lack of multidisciplinary rounds (only 14% availability). Institutional barriers to disseminating results included limited time and resources, gaps in dissemination knowledge and skill, and lack of mentorship. These findings informed the co-development of tailored dissemination tools, including a leadership-focused slide deck and a clinical-staff-targeted infographic to support internal dissemination. Applying an IKT approach effectively addressed language and dissemination barriers, and improved accessibility and local relevance of PROACTIVE. Spanish-PROACTIVE supports consistent multilingual data collection, and its contextually tailored dissemination tools may enhance internal communication and uptake of findings across Spanish-speaking institutions. This approach offers a practical model for strengthening dissemination and accelerating uptake of intervention results in linguistically diverse, resource-constrained settings, supporting global efforts to improve outcomes for children with cancer.