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.

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.

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.

This thesis uses a constructivist grounded theory approach to investigate nonprofit corporate governance in the UK; using data obtained from participatory observations of board and associated meetings, workshops, and unstructured elite interviews. Open codes are generated and brought together as concepts, which are then iteratively compared and grouped in open categories. These categories are then reassembled using the paradigm model into five axial codes: the clash of orthodoxies; clash of motivations; regulator versus board power; clash of rationalities; and effective board duality. A dialectical approach is then used to create the core category of the ‘clash of neoliberal and public service world views which exists at every level of the nonprofit sector’. This core category is analysed in terms of the subordinate contradictions: at an environmental level - regulatory power versus sector power; at board level - accountability; the SMT; board practices and rituals (professionalism, actual and symbolic authority, boards meetings as theatre, and ethical standards); the concept of challenge as an expression of power relations; and rationality and decision making; and at the individual level - motivations of directors, moral duty and social purpose, social group membership, identification, credibility and trust. The substantive theory is then situated within psychology, governance, and corporate governance theories. The contribution made by the thesis are identified as the: use of ethnography to describe the inner workings of the board; creation of a model of nonprofit corporate governance; identification of the importance of political, ideological, regulatory, and ethical contexts; and concept of power, and the senior management team as a component of the board. Further research is suggested into: (i) a comparison of corporate governance in the for-profit and nonprofit sectors; (ii) challenge within the nonprofit culture; and (iii) the SMT as a major player in governance.

Informationssäkerhet är ett område som kommit att sättas alltmer i fokus hos organisationer. Tidigare har främst tekniska lösningar för att skydda viktig information fått uppmärksamhet, det är först på senare tid som informationssäkerhet har börjat uppfattas som ett komplext område som innefattar såväl tekniska, som organisatoriska och mänskliga faktorer. För att eftersträva en god informationssäkerhet inom organisationen bör ett grundligt arbete läggas på att utveckla informationssäkerhetspolicys och säkerhetsansvariga måste kontinuerligt utbilda och skapa medvetenhet hos anställda kring vilka hot som finns mot organisationen ifall informationssäkerhetsbestämmelser inte efterlevs. Huvudsyftet i föreliggande studie har varit att undersöka vilka faktorer som styr anställdas efterlevnad av informationssäkerhetspolicys. Ytterligare delsyfte har varit att undersöka hur den faktiska efterlevnaden av informationssäkerhetsbestämmelser avspeglar sig inom två vårdverksamheter i Landstinget i Östergötland. För att uppfylla studiens syfte har fallstudier genomförts där såväl observationer som intervjuer med personal legat till grund för datainsamlingen. Resultatet visar att säkerhetsmedvetandet och efterlevnaden av säkerhetsbestämmelser inom de undersökta organisationerna är tämligen god, men det finns skillnader i graden av efterlevnad. Resultaten visar att anställda i viss mån hoppar över säkerhetsbestämmelser för att effektivisera sitt arbete. Den vanligaste säkerhetsbestämmelsen som visade på bristande efterlevnad var att en del anställda slarvade med att logga ut eller låsa datorn då denna lämnades oövervakad. Faktorer som visat sig vara avgörande för ifall säkerhetsbestämmelser efterlevs eller inte är bland annat ifall den anställde anser att beteendet övervakas, hur väl medveten man är kring konsekvensen av att säkerhetsbestämmelser inte efterlevs, samt hur stor sannolikhet man anser det vara att hotet realiseras. Ytterligare faktorer som visat sig spela roll är ifall den anställde anser att säkerhetsbestämmelsen ligger i konflikt med andra intressen, såsom effektivitet eller bekvämlighet. För att kunna införa effektiva policyåtgärder krävs det därmed att policyutvecklare förstår vad som motiverar anställda till att följa säkerhetsbestämmelser och vilka värderingar som ligger bakom deras beteende. / Information security has grown into a field of study that has gained increasingly attention within organizations. In the early days focus of the field has primerly been on technical solutions in order to protect information. Only recently information security has come to be seen as a complex area including both technical, organizational and human factors. In order to strive for a high degree of information security within the organization, emphasis has to be placed on developing a functional information security policy. Just as important is that security managers continually educate and create awareness amongst employees with regards to existing threats if information security rules are not respected. The main purpose in regards to this study has been to investigate the determinants of employees' compliance with information security policies. A further aim of the study has been to examine how the actual compliance of information security regulations is reflected in two healthcare clinics in the county council of Östergötland. In order to fulfill the purpose of the study, case studies were carried out in the clinics, where both filed studies and interviews with staff members formed the basis for data collection. The results show that security awareness and compliance with safety regulations within the surveyed organizations are fairly good, but there are differences in the level of compliance. The results show that employees to some degree overlook safety rules in order to make their work more efficient. The most common security rule that showed non-compliance was where employees occasionally did not logg off or lock the computer as it was left unattended. Determinants that showed to have an influence on whether or not employees comply with information security policys are among other factors to what extent the employee belives that the behavior is being monitored, awareness about conseqences from not complying with the security rules, as well as to what extent one belives that the actual threat occurs. Additional determinants that were found to have an influence on the actual behavior with regards to compliance is to what extent the employee considers the regulations to be in conflict with other interests, such as efficiency or convenience. In order to introduce effective policy measures knowledge is needed where policy makers understand what motivates employees to comply with safety rules, as well as the values that underlie their behavior.