This finding from this study is not consistent with prior research and theory. The use of the intervention of the combined use of educational materials. educa- tional meetings, reminders, and audit and feedback in studies with diverse patient populations has been shown to be effective in improving patient outcomes. Only two studies were located that used the combined use of the same four translation strategies(Abbott, Dremsa. Stewart Mark, & Swift, 2006; Berenholtz et al. 2004). Unlike the current study. findings from both of these previous studies support Greenhalgh et al. demonstrating that patient outcomes can significantly improve with the appropriate implementation process