Tuberculosis (TB) is a major public health problem in many parts of the world. Nigeria is one of the 30 countries in the world that has the highest burden of TB. Private medical practitioners in Nigeria play an important role in health care delivery. Motivating them to adhere to TB treatment guidelines in managing persons suspected of having TB or diagnosed with the disease is one of the strategies employed by the National Tuberculosis Program to Reduce the Burden of TB. Few studies were identified which used qualitative study approaches to study the perceptions of these practitioners towards the TB treatment guidelines. The overarching question asked the study participants centered on eliciting their perceptions towards the guidelines. Guided by the theory of planned behavior, this qualitative narrative study explored the perceptions of private medical practitioners in Anambra State, Nigeria towards the Nigerian National TB Treatment Guidelines. To elicit these perceptions, in-depth interviews were conducted on 11 purposefully selected practitioners. Data analysis comprised coding of data obtained and extracting themes from them. The QSR Nvivo 11 helped to manage data. The main finding of the study was that the practitioners perceived the treatment guidelines to be adequate to meet most of their needs in the diagnosis and treatment of TB patients. Other key findings were that provision of financial incentives and regular training will motivate collaboration with the TB program and adherence to the guidelines. Positive social change may occur by insight being gained into how private medical practitioners view the treatment guidelines and how this knowledge will lead to improved management of TB patients. This may in turn result in the reduction in the morbidity and mortality associated with TB in Nigeria.

The high prevalence of back and neck pain results in enormous social, psychological, and economic burden. Most seeking help for back or neck pain consult general practitioners or chiropractors. Chiropractic is a regulated health profession (serving approximately 10 – 15% of the population) that has contributed to the health and well-being of North Americans for over a century. Despite available evidence for optimal management of back and neck pain, poor adherences to guidelines and wide variations in services have been noted. For instance, overuse and misuse of imaging services have been reported in the chiropractic literature. Inappropriate use of spine imaging has a number of potential adverse outcomes, including inefficient and potentially inappropriate invasive diagnosis and subsequent treatment, and unnecessary patient exposure to ionizing radiation. Although evidence-based diagnostic imaging guidelines for spinal disorders are available, chiropractors are divided on whether these guidelines apply to them. While guidelines can encourage practitioners to conform to best practices and lead to improvements in care, reviews have demonstrated that dissemination of guidelines alone is rarely sufficient to optimise care. Evidence regarding effective methods to promote the uptake of guidelines is still lacking. There is growing acceptance that problem analysis and development of interventions to change practice should be guided by relevant theories and tailored to the target audience. To date, very little knowledge translation research has addressed research-practice gaps in chiropractic. This thesis reports rigorous methods to: (1) assess practice and providers’ characteristics, (2) determine baseline rates and variations in spine x-ray ordering, (3) evaluate the impact of disseminating guidelines to optimise spine x-ray ordering, and (4) assess determinants of spine x-ray ordering and potential targets for change prior to the design of a tailored intervention. A mixed method using two disciplinary perspectives (epidemiology and psychology) was undertaken. A cross-sectional analysis of administrative claims data was carried out on a sample of chiropractors enlisted in a large American provider network. Despite available clinical practice guidelines, wide geographical variations in x-ray use persist. Higher x-ray ordering rates were associated with practice location (Midwest and South US census regions), setting (urban, suburban), chiropractic school attended, male provider, employment, and years in practice. The impact of web-based guideline dissemination was evaluated over a five year period using interrupted time series and demonstrated a stepwise relative reduction of 5.3% in the use of x-rays. Passive guidelines dissemination appeared to be a simple, cost effective strategy in this setting to improve but not optimise x-ray ordering rates. Focus groups using the theoretical domains framework were conducted among Canadian and US chiropractors to explore their beliefs about managing back pain without x-rays. Findings were used to develop a theory-based survey to identify theoretical constructs predicting spine x-ray ordering practice. Psychological theories and theoretical constructs explained a significant portion of the variance in both behavioural simulation and intention. Results from this thesis provide an empirically-supported, theoretical basis to design quality improvement strategies to increase guidelines adherence and promote behaviour change in chiropractic. Other researchers interested in improving uptake of evidenced-based information could use this method in their own setting to investigate determinants of behaviour among other professional groups. Future research may use knowledge gained to inform the development and evaluation of a theory-based tailored intervention to improve guideline adherence and reduce the use of spine x-rays among targeted providers.

Purpose: The purpose of this study was to increase the efficiency of the planning stages in the building industry. The goal was to produce valuable information that will be useful in the future development of Swedish national BIM guidelines. Method: The study has been conducted by following the principles of content analysis. “Content analysis is a research method that uses a set of procedures to make valid inferences from text”. By searching for and analysing the content of national BIM guidelines, valuable information for future development of Swedish national BIM guidelines would be produced. The BIM guidelines had to fulfil two criteria in order to qualify for the study: Be a national BIM guideline. Have a version in English. Once selected, the guidelines were analysed using 11 topics, namely BIM execution plan, Level of Development, Format standards and their application – interoperability, accountability, filing, archiving, modes of collaboration, operations and maintenance, simulations, pre-qualifications, BIM functions through project phases. These were chosen based on works by R. Sacks, Gurevich, & Shrestha and Hooper. Findings: Out of the 81 BIM guidelines listed in the BIM guides project by BuildingSMART, 10 national BIM guidelines from 10 different countries were chosen for further study. NATSPEC from Australia, Belgian guide for the construction industry, CanBIM from Canada, COBIM from Finland, HKIBIM BIM project specification from Hong Kong, New Zealand BIM handbook, Statsbygg BIM manual from Norway, Singapore BIM guide, Level 2 PAS from the UK and NBIMS from the USA. All topics have a high level of inclusion, pointing to that the topics from Hooper and Sacks are relevant on a global scale. Pre-qualifications scored the lowest, and BIM functions through project phases scored the highest. Implications: Cover all 11 topics reviewed in this study. Avoid strict protocols with excessive level of detail, but rather formulate guidelines as frameworks, thus making them user-friendly and usable. Formulate guidelines so details may easily and logically be worked out in a BIM execution plan. Make a plan to keep the documents up to date. Limitations: This study only includes national BIM guidelines with English versions available. It has solely been conducted by document analysis and does therefore not provide much information on what current users of national BIM guidelines think of the guidelines reviewed, apart from what is mentioned from Hooper’s work. The score of each guideline indicate how much information it contains, and a high score may therefore not necessarily indicate it is the most user-friendly and readable guideline. Keywords: BIM guidelines, national BIM guidelines, BIM implementation / Sammanfattning Syfte: Syftet med denna studie var att öka effektiviteten i planeringsstadiet inom byggbranschen. Målet var att producera värdefull information som kommer att vara användbar vid den framtida utvecklingen av svenska nationella BIM-riktlinjer. Metod: Studien har genomförts genom att följa principerna för innehållsanalys. Innehållsanalys är en forskningsmetod som använder en rad tillvägagångssätt för att dra giltiga slutsatser från text. Genom att leta efter och analysera innehållet i nationella BIM-riktlinjer, bör värdefull information för framtida utveckling av svenska nationella BIM-riktlinjer kunna frambringas. BIM-riktlinjerna behövde uppfylla två kriterier för att kvalificera sig till studien: 1. Vara en nationell BIM-riktlinje. 2. Ha en version på engelska. Riktlinjerna som valdes ut analyserades utifrån 11 ämnen, nämligen BIM:s genomförandeplan, utvecklingsnivå (LoD), formatstandarder och deras tillämpning - driftskompatibilitet, ansvarsskyldighet, register och mapphantering, arkivering, samarbetsformer, drift och underhåll, simuleringar, förkvalifikationer, BIM-funktioner genom projektfaser. Dessa valdes utifrån verk av R. Sacks, Gurevich, & Shrestha och Hooper. Resultat: Av de 81 BIM-riktlinjerna som listades i BIM-guideprojektet av BuildingSMART valdes 10 nationella BIM-riktlinjer från 10 olika länder för vidare studier. NATSPEC från Australien, Belgian guide for the construction industry, CanBIM från Kanada, COBIM från Finland, HKIBIM BIM project specification från Hong Kong, New Zealand BIM Handbook, Statsbygg BIM-handbok från Norge, Singapore BIM-guide, Level 2 PAS från Storbritannien och NBIMS från USA. Alla ämnen är inkluderade till hög grad och pekar på att ämnena från Hooper och Sacks är relevanta på global nivå. Förkvalifikationer fick lägst poäng, och BIM-funktioner genom projektfaser fick högst. Slutsats: Inkludera alla 11 ämnen som ses över i denna studie. Undvik strikta protokoll med överdriven detaljnivå och formulera riktlinjer som ramverk, vilket gör dem användarvänliga och användbara. Formulera riktlinjer så att detaljer enkelt och logiskt kan utarbetas i en BIM-genomförandeplan. Gör en plan för att hålla dokumenten uppdaterade. Begränsningar: Denna studie innehåller endast nationella BIM-riktlinjer med engelska versioner tillgängliga. Den har enbart genomförts med dokumentanalys och ger därför inte information om vad nuvarande användare av nationella BIM-riktlinjer tycker om de riktlinjer som granskats, förutom vad som nämns från Hooper-arbetet. Antalet poäng för varje riktlinje anger hur mycket information den innehåller, och ett högt betyg behöver därmed inte nödvändigtvis indikera att det är den mest användarvänliga och läsbara riktlinjen. Nyckelord: BIM-riktlinjer, nationella BIM-riktlinjer, BIM-implementering

Electronic communication is becoming an integral part of the communication structure within organisations, but the costs and benefits are not being assessed. Communication by email is usually assumed to be an efficient and effective means of sending messages. However, on analysis the process is seen to be much more complex and much less efficient than is normally assumed. Communication is carried out in many different forms, but the common underlying motive of communication is to improve working practices and to increase productivity. As communication pervades nearly everything we do, even small improvements in the effectiveness and cost of our communication processes can have significant benefits. The aim of this research was to analyse the cost effectiveness of using email and to suggest ways in which the cost effectiveness can be improved. A number of studies have been conducted into the cost effectiveness of email within organisations. The studies were carried out mainly at the Danwood Group, the company sponsoring the author's PhD research. The Danwood Group has just over 500 employees at 19 sites around the UK and its head office is based in Lincoln, where all of the email case studies in this thesis where undertaken. The Danwood Group retails office equipment, predominately photocopiers. Email behaviour was monitored by the use of software at the Danwood Group. This raised a number of questions on the ethical issues of electronic monitoring. This thesis explores these issues and proposes a set of guidelines to allow electronic monitoring within strict professional and ethical guidelines. The Danwood Group studies examined how and when email was used. It was found that, when the company first started using email, over two thirds of messages were non-business-related, though this dropped to less than half in a few months. It was also found that many messages could be delivered in one line of text. A one-line message service was introduced and this was found to save employee time for both senders and receivers of the messages. A costing formula was developed measuring the human cost of operating email messaging. The final study was to determine how long it took employees to recover and return to normal work after an email interruption and this was compared with published data for telephone interrupts. From these results a set of guidelines were developed to enable companies to make the most efficient use of email. The thesis concludes by identifying further areas of research into email usage that would help give a better understanding of methods to enable email to become even more cost effective.

The high prevalence of back and neck pain results in enormous social, psychological, and economic burden. Most seeking help for back or neck pain consult general practitioners or chiropractors. Chiropractic is a regulated health profession (serving approximately 10 – 15% of the population) that has contributed to the health and well-being of North Americans for over a century. Despite available evidence for optimal management of back and neck pain, poor adherences to guidelines and wide variations in services have been noted. For instance, overuse and misuse of imaging services have been reported in the chiropractic literature. Inappropriate use of spine imaging has a number of potential adverse outcomes, including inefficient and potentially inappropriate invasive diagnosis and subsequent treatment, and unnecessary patient exposure to ionizing radiation. Although evidence-based diagnostic imaging guidelines for spinal disorders are available, chiropractors are divided on whether these guidelines apply to them. While guidelines can encourage practitioners to conform to best practices and lead to improvements in care, reviews have demonstrated that dissemination of guidelines alone is rarely sufficient to optimise care. Evidence regarding effective methods to promote the uptake of guidelines is still lacking. There is growing acceptance that problem analysis and development of interventions to change practice should be guided by relevant theories and tailored to the target audience. To date, very little knowledge translation research has addressed research-practice gaps in chiropractic. This thesis reports rigorous methods to: (1) assess practice and providers’ characteristics, (2) determine baseline rates and variations in spine x-ray ordering, (3) evaluate the impact of disseminating guidelines to optimise spine x-ray ordering, and (4) assess determinants of spine x-ray ordering and potential targets for change prior to the design of a tailored intervention. A mixed method using two disciplinary perspectives (epidemiology and psychology) was undertaken. A cross-sectional analysis of administrative claims data was carried out on a sample of chiropractors enlisted in a large American provider network. Despite available clinical practice guidelines, wide geographical variations in x-ray use persist. Higher x-ray ordering rates were associated with practice location (Midwest and South US census regions), setting (urban, suburban), chiropractic school attended, male provider, employment, and years in practice. The impact of web-based guideline dissemination was evaluated over a five year period using interrupted time series and demonstrated a stepwise relative reduction of 5.3% in the use of x-rays. Passive guidelines dissemination appeared to be a simple, cost effective strategy in this setting to improve but not optimise x-ray ordering rates. Focus groups using the theoretical domains framework were conducted among Canadian and US chiropractors to explore their beliefs about managing back pain without x-rays. Findings were used to develop a theory-based survey to identify theoretical constructs predicting spine x-ray ordering practice. Psychological theories and theoretical constructs explained a significant portion of the variance in both behavioural simulation and intention. Results from this thesis provide an empirically-supported, theoretical basis to design quality improvement strategies to increase guidelines adherence and promote behaviour change in chiropractic. Other researchers interested in improving uptake of evidenced-based information could use this method in their own setting to investigate determinants of behaviour among other professional groups. Future research may use knowledge gained to inform the development and evaluation of a theory-based tailored intervention to improve guideline adherence and reduce the use of spine x-rays among targeted providers.

Physical activity guidelines have become a focal point of mass media messages promoting physical activity to the adult population. Messages regarding sedentary behaviour have also emerged. Further, Chapter 3 identified knowledge of just 18% within a large sample of highly educated and employed UK adults. Of concern is the further finding that knowledge is likely to be higher within this group than within the general population and many groups within society may therefore have even lower knowledge. As many individuals are seemingly not likely to know the current physical activity guidelines, disseminating messages to promote them appears to be a reasonable strategy. However, Chapter 1 of this thesis highlighted the lack of research investigating the efficacy of messages designed around physical activity guidelines. Chapters 4, 5 and 6 began to explore some of the possible motivational implications of messages prominent in mass media campaigns promoting physical activity guidelines. Chapter 4 describes a cross-sectional study which compared the effects of messages using the threshold of 150 minutes a week with a generic message on perceived benefits of physical activity. Messages were representative of those found in mass media campaigns. Those receiving a threshold message held significantly less positive views of the benefits of physical activity at durations below 150 minutes a week. While a threshold message may be motivationally damaging in certain contexts, they tend not to be provided in isolation. Intensity of physical activity i.e. moderate-to-vigorous (MVPA) is another key aspect of physical activity guidelines featured in mass media campaigns. Subsequently, Chapter 5 employed an online survey of highly educated adults to investigate associations between threshold and generic messages describing MVPA as either walking or using a physiological description, with motivational constructs. Interestingly, the message incorporating a threshold was motivationally advantageous when MVPA was described as walking. On the other hand, inactive adults tend to overestimate their physical activity with walking behaviour being serially overestimated. This could result in reduced motivation to engage in MVPA. The influence of regular walking speed on misperceptions was therefore investigated in Chapter 6. Further, accurate knowledge of physical activity requirements has been theorised to reduce misperceptions. Chapter 6 reports findings that regularly slow walkers are more likely to overestimate their physical activity levels while knowledge of guidelines has no effect. This leaves a complex picture of the motivational qualities of messages promoting physical activity guidelines. Finally, Chapter 7 describes a content analysis which broadens the investigation of mass media messages by scrutinising the introduction of messages promoting reductions in sedentary behaviour. Sticking closely to guidelines, combining messages on sedentary behaviour with those on physical activity, the relative omission of standing and the demonisation of sitting emerged as common themes. This thesis highlights the problem of low knowledge of physical activity guidelines within a sample of UK adults and points towards a lack of evidence-based messaging. With knowledge being low, the provision of a threshold is desirable on an informational level. The provision of walking as an exemplar appears to make the threshold more amenable, however, for inactive adults the use of this exemplar in messages may lead to overestimation of physical activity and decrease motivation. Clearly, the motivational implications of these messages are complex and require further investigation.

Objective: New Mexico nurse practitioners contribute to the prevention and management of pediatric obesity. This study aimed to assess nurse practitioners' knowledge, attitudes, and behaviors, which were unknown in New Mexico, to counseling frequency in the assessment and management of overweight and obese pediatric patients. This was done using clinical practice guidelines (CPG). The study also sought to learn nurse practitioners' insights on needed resources for clinical practice. Rural and urban nurse practitioners' responses were then compared to the study aims. Methods: This descriptive pilot study surveyed members of the New Mexico Nurse Practitioner Council (NMNPC) to evaluate their knowledge, attitudes, and behaviors, in addition to the counseling frequencies expected to result in patient change. The survey used the platform Qualtrics and measured answers using a four-point Likert scale. Rural and urban comparisons were evaluated for each variable (knowledge, attitudes, and behaviors) in order to investigate relationships. Despite the underpowered sample size, data were analyzed for feasibility of future studies using descriptive statistics, Spearman's Rho Correlation, and Mann-Whitney U testing. Results: Fifteen nurse practitioners were included in the statistical analysis. The data found the nurse practitioners' self-reported responses exhibited knowledge, positive attitudes, and confident behaviors using pediatric obesity CPGs. The increases in these parameters correlated reported needing a quick CPG tool that can be used in practice. In all, rural nurse practitioners reported a slightly higher usage of pediatric obesity CPGs than urban nurse practitioners. Conclusion: The feasibility of this study's assessment of nurse practitioners' knowledge, attitudes, and behaviors using CPGs will assist in developing interventions to impact patient outcomes. The study also found that resources needed by New Mexico nurse practitioners were similar to those desired by other providers throughout literature. Rural compared to urban nurse practitioners findings indicated the need for further research. Future studies should include all health care providers in New Mexico in order to further explore aims of this study and development of interventions on overweight and obese pediatric CPGs to positively impact practice.

International Telemetering Conference Proceedings / October 22-25, 2001 / Riviera Hotel and Convention Center, Las Vegas, Nevada / The technicalities of sharing telemetry bandwidth have been addressed in design and specification for the builders of the International Space Station. But success in sharing bandwidth comes from building relationships, documenting guidelines, negotiating, understanding human nature, peer review and willingness to participate in an evolving process. The station, 240 miles above Earth, moves through space at 17,000 mph, has its mass added to by humans and machines, regularly docks with visiting spacecraft, has year-round residents, and communicates with space agencies around the globe. Each new module -- with associated computers, multiplexers, and communications buses -- creates additional telemetry demands.

The aims of this dissertation study are 1) to examine how the interplay of motivation, artifacts, and task interconnectedness affect users' flow experience, 2) to understand users' multitasking patterns by analyzing approaches and strategies in multitasking environments through a participatory design session, and 3) to come up with design insights and implications for desired multitasking environments based on findings from the quantitative and qualitative data analysis and synthesis. This dissertation employed the PAT (Person-Artifact-Task) model to examine factors that affect users' flow experience in computer-mediated multitasking environments. Particularly, this study focused on users' flow experience - sense of control, focused attention, curiosity, intrinsic interest and interactivity - in the context of multitasking. The dissertation begins with perspectives on human multitasking research from various disciplines. Emphasis is placed on how researchers have defined the term multitasking and the scope of previous multitasking research. In addition, this study provides definitions of the term task switching, which also has been used to describe human multitasking. The second section of this dissertation focuses on the literature, which characterizes factors and theoretical frameworks of human multitasking research. In this section, human multitasking factors were classified into internal and external factors to analyze factors from the micro to the macro perspective. More detailed definitions and comparisons are also addressed. To summarize and conclude the literature review, this study provides a synthesis framework of internal and external factors of human multitasking contexts. In section III, this dissertation introduces theoretical frameworks that include the constructs of the PAT (Person-Artifact-Task) model and flow model. The next three sections present the research design and two research methods - the experiment and participatory design. The results and discussion section includes the implications of interpreting people's flow experience with motivation, artifact (technology affordance type), and task interconnectedness through the PAT model. The study findings and implications should extend our understanding of multitasking behaviors and contexts and how the interplay of person, artifact, and task factors affects humans' flow experience. A concluding chapter explores future work and design implications on how researchers and designers can take contextual factors into consideration to identify the most effective multitasking in computer-mediated environments. / text

The purpose of this thesis was to determine the feasibility of implementing an intervention tailored to overcome barriers to adherence to recommendations of critical care nutrition guidelines in the Intensive Care Unit (ICU). The thesis is comprised of four manuscripts. The first manuscript described the development of a 26 item questionnaire rating the importance of potential barriers as impediments to the provision of enteral nutrition (EN) in the ICU. Preliminary evaluation demonstrated acceptable face and content validity and internal reliability, but the test retest reliability and within group reliability were poor for some items. The second manuscript provided evidence to support the construct validity of the developed questionnaire by reporting the results of a multilevel multivariate regression analysis of cross-sectional data from 55 ICUs that demonstrated that a 10 point increase in the overall barrier score was associated with a statistically significant 3.5% (Standard Error (SE) 1.3) decrease in prescribed calories received from EN. The third manuscript provided data to inform whether the intervention should be tailored to site specific barriers by describing the barriers to enterally feeding critically ill patients identified by 138 nurses, and evaluating whether these barriers differed across the 5 participating sites. Statistically significant differences were found among ICUs for 4 out of the 22 potential barriers. The fourth manuscript described the results of a pretest posttest study involving 5 ICUs in North America and determined that all participating sites successfully developed the tailored intervention. A statistically significant 10% (Site range -4.3 to -26.0%) decrease in overall barriers score, and a non-significant 6% (Site range -1.5 to17.9%) change in prescribed calories received was observed following the intervention. However, there was variability in the degree of implementation achieved by each site. Taken together, the results of this thesis demonstrated that adopting a tailored approach to improving nutrition practice is feasible. However, the findings also resulted in revisions to the barriers questionnaire and modifications to the design of the tailored intervention. Thus, the next step is to formally test the hypothesis that a tailored intervention designed to address barriers to feeding critically ill patients will improve nutrition performance. / Thesis (Ph.D, Community Health & Epidemiology) -- Queen's University, 2013-04-28 21:37:54.695