Background: This thesis presents an empirical investigation into the efficacy, types, and performance of community health workers (CHWs)-trained lay people to whom simple medical procedures can be "task shifted" from doctors. It has three objectives: (1) assess the effects of CHW delivered interventions for primary health outcomes in low-and middle-income countries (LMICs), (2) develop a comprehensive taxonomy of CHW characteristics and programme design features, and (3) assess the relative efficacy of different types of CHW programme designs and how they can be used to optimise CHW performance. Structure and Methods: Following the logic of early stage intervention development, this thesis has an iterative and developmental structure in which each section flows out of and builds on the previous section. Objective one is addressed in Chapters 2-4: scoping review, systematic review, and meta-analytic methods are applied to establish the efficacy and effectiveness of CHW-led interventions in LMICs. Objective two is addressed in Chapter 5: inductive, thematic analysis of systematically identified trials, influential papers, and existing information classification systems is used to develop a formal CHW taxonomy for intervention reporting and coding. Objective three is addressed in Chapter 6: systematic review methods are employed to identify interventions for improving the performance of community health workers in LMICs. Results: Objective one: a systematic review of 155 papers reporting 86 trials found high quality evidence that CHW delivered interventions reduce perinatal mortality, improve child nutritional status, and improve tuberculosis completion rates versus facility-based care. There is also moderate quality evidence that CHW delivered interventions improve certain mental, infectious disease, paediatric, and maternal health outcomes. In undertaking this process, an additional, methodological contribution was made in the form of a tool to reduce risk of bias in overviews of reviews. This tool may facilitate early stage intervention development in the future. Objective two: 253 records were used to establish, in a faceted taxonomy, the definitional clarity required for theory building and knowledge accumulation. Two categories (CHW Characteristics and CHW Programme Features) and six dimensions (Integration, Recruitment, Training, Supervision, Incentives, and Equipment) emerged. Objective three: a systematic review of 14 trials identified moderate quality evidence of the efficacy of CHW performance interventions in improving certain behavioural outcomes for patients, utilisation of services, and CHW quality of care. There was no effect on the biological outcomes of interest. Conclusion: In bringing the tools of evidence based practice to bear on community health worker interventions, this dissertation has contributed to the theoretical, methodological, and empirical evidence base from which the field can continue to advance.

The results of a qualitative evaluation aimed at determining teacher’s perspectives on barriers to implementing based procedures will be presented. Data analysis revealed several highly pertinent barriers that teachers face in their attempts to implement evidence-based practices in the classroom. Discussion on minimizing these implementation barriers will be provided. Learner Outcomes: Participants will gain an understanding of the most prevalent barriers to implementing evidence-based practices as perceived by teachers. Participants will gain an understanding of the need for increased portability of evidence-based practices within classroom settings for ease and efficiency of use by teachers. Participants will understand strategies for minimizing barriers to implementing evidence-based practices within classrooms for students with developmental disabilities

Discharge instructions provided to patients discharged from the emergency department (ED) are often provided in a way that is neither clear nor concise. Patients are often discharged home without a clear understanding of their diagnosis, medications, reasons to return to the ED, follow-up instructions, or how to manage their care at home during their illness. Therefore, a guideline needed to be developed in order to help the ED staff provide clear and concise discharge instructions to patients discharged from the ED. The Ace Star Model of Knowledge Transformation was the foundation for the development of the evidence-based guideline. A formative group of 7 individuals was created to critique the initial draft of the guideline, and a final version of the guideline was then distributed to 10 medical professionals to aid in the approval and determination of the quality of the guideline. The data analysis from the formative group questionnaire, and the appraisal of guidelines for research and evaluation tool led to the recommendations for a guideline on the delivery of evidence-based discharge instructions. This project has implications for social change in practice by (a) increasing the awareness among medical professionals about the importance of their communication style on patient discharge and (b) allowing for more efficient communication to occur between them and their patients. The use of an evidence-based practice guideline for providing discharge instructions to patients discharged from the ED will allow improved quality of care to patients, efficient communication between the healthcare providers and patients, a positive impact for social change in practice, and a consistent and reliable method for patients to understand their discharge instructions in a way that is clear and concise.

This study examines how school psychology professors are preparing graduate students to evaluate research and seeks their views on problematic assessment and intervention practices. School psychology faculty members’ e-mails were identified based on the National Association of School Psychologists’ (NASP) list of Approved Programs (NASP, 2017) and a total of 127 professors responded. Each participant completed a survey that included 22 Likert scale items and three free listing items. Three research questions were proposed: What percentage of school psychology faculty members are using each of the strategies recommended by Lilienfeld et al. (2012)? What school-based assessment practices do school psychology faculty members identify as the most problematic? What school-based intervention practices do school psychology faculty members identify as the most problematic? The researcher found that the majority of programs are using the recommendations suggested by Lilienfeld and colleagues (2012), although there is room for improvement in the amount of usage for multiple recommendations. School psychology faculty members frequently listed cognitive profile analysis (CPA), projective testing, and inappropriate use of assessments as problematic assessment practices, and inappropriate use of interventions and eclectic counseling as problematic intervention practices. Implications for the use of evidence-based practices (EBP) were provided. Limitations of the study were discussed.

The primary purpose of this longitudinal, quasi-experimental study was to investigate the effects of a bipartite, standardized case conceptualization training among participants in comparison to those who were exposed to both the training and deliberate practice coaching. The secondary purpose of this study was to examine the relationship of the training and aspects of deliberate practice, along with participants’ attitudes toward evidence-based practice (EBP). A total of 84 counselor trainees were recruited from two South Florida universities. Participants in both the experimental group (n = 35) and comparison group (n = 49) received two, three-hour training lectures, which explained the integrative case conceptualization model developed by Dr. Len Sperry in 1989. Over a period of eight weeks, the lectures were separated by approximately four weeks in order to assess whether the training effects persist over time. As measured by the Views About Case Conceptualization (VACC) instrument, the first training lecture effectively reduced case conceptualization myths for both groups by approximately 4 points (out of 25), t (83) = -8.53, p < .001. Repeated measures MANOVA showed that the training had a significant impact on the entire sample. As measured by the Case Conceptualization Evaluation Form (CCEF) 2.0, the comparison group’s overall mean score improvement was approximately 40 points (out of 100) and the experimental group’s overall mean score improvement was approximately 63 points (out of 100), F (4.256, 348.974) = 32.102, p < .001. The results reveal that the training and coaching had a significant effect on counselor trainees’ ability to write effective case conceptualizations with a partial eta-squared effect size of .281. Using both the Evidence-Based Practice Attitude Scale (EBPAS) and Moulaert Questionnaire, this study also examined the influence of attitudes toward EBP and aspects of deliberate practice on trainees' case conceptualization competence. Paired samples t-tests and correlation analysis revealed that participants became more “open” to EBP, t (83) = -5.280, p < .001. However, it was determined that coaching did not act as a mediating or moderating variable. Overall, the findings support that case conceptualization training and deliberate practice coaching increase counselor competence, and that the effects persist over time. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

In this project, I sought to understand how evidence-based practices are understood and implemented by individuals who work within the criminal justice system, with specific focus on the Iowa Correctional Institution for Women (ICIW). I collected interviews in the summer and fall of 2016 and observations at local criminal justice agencies from summer 2016 to summer 2017. Thirty-eight individuals agreed to be interviewed, including ICIW staff, Department of Corrections (DOC) staff, prison volunteers, and prisoner advocates. I found that how individuals understand “what works” in prison policy and practice is shaped by three main factors. First, their ideological standpoints on what purpose prison ought to serve influenced how they thought evidence should be used to inform policy, whether they believed it should achieve humanitarian goals of giving offenders second chances, utilitarian goals of keeping the community safe, or bureaucratic goals of ensuring that prisons are run efficiently and rationally. Second, their experiences with prisoners shaped their acceptance or skepticism of certain types of evidence, and respondents placed more value in experiential and anecdotal evidence in the case of women-centered policies. Third, the respondents’ stereotypes about who women are and what their place is in the larger correctional system contributed to more ready acceptance of women-centered practices, and more skepticism of statewide or uniform evidence-based practices. In turn, these different interpretations of evidence and the policies based upon it contributed to conflict and resistance to statewide DOC policy, as well as greater feelings of frustration and disenchantment among correctional stakeholders.

The uptake of evidence in practice remains a challenge for healthcare professionals including nurses and providers. Increased use of evidence-based practices in healthcare settings may improve patient conditions such as pain and decrease the cost of healthcare. A wealth of literature can be found describing barriers and facilitators of evidence-based practice (EBP), and a movement in research has begun to focus on what influences the use of EBP. This study explored the relationships of context including the elements of individual, unit, and hospital and the use of evidence-based nonpharmacological pediatric pain management practices (EBNPP) using an existing data set of nurses and providers caring for children in the Emergency Department. Initial analysis found several significant correlations with individual, unit, and hospital context elements and EBNPP. A significant correlation was not found between evaluation and EBNPP and Magnet Status and EBNPP for nurse or providers. Nurse regression analyses showed knowledge and continuing education were significant predictors of EBNPP. Overall context was a significant predictor of EBNPP for both the nurse and provider models. A pooled regression analysis with Registered Nurses and Providers found nurses had a significant increased use of EBNPP when compared to providers. Regression analyses found that while overall context is a significant predictor of EBNPP, no single element was significant when all three were added to the model. The effect of context on EBNPP did not differ by profession in this sample. Results of this study indicate that while context is important in the uptake of EBNPP, one area does not have more influence than another. The variables explored in this study account for 13% of the variance in EBNPP. Future research should focus on the overall influence of context on EBP and consider other factors that may play a role in the uptake of EBP.

Research Doctorate - Doctor of Philosophy (PhD) / The Equity Assessment Cardiac Rehabilitation (EACR) study uses a hospital outpatient cardiac rehabilitation (CR) program as the vehicle for demonstrating ways of using evidence to inform equity assessment in health services. This is achieved by demonstrating methods which policy and decision-makers can use to measure, deconstruct and interpret inequalities in service access, defined by selection and utilisation. Some of these methods are familiar in epidemiology and health services research and others less so. Chapter 1 defines equity and equality in health, and introduces the conceptual classification used here to analyse socio-behavioural factors that impact upon utilisation of the hospital outpatient CR program. Chapter 2 reports the results of a search of the international literature on ways of similarly addressing inequalities and inequities in healthcare services and programs, and also factors associated with the recruitment and retention of patients to hospital outpatient CR programs. Chapter 3 describes the methods used in the development and construction of the EACR patient cohort. Chapter 4 explains the theoretical basis for the statistical applications demonstrated in this dissertation. Analyses are conducted on the cohort in accordance with patients’ index hospitalisation. Chapter 5 applies multi-variable logistic regression to analyse factors associated with CR invitation and Chapter 6 uses similar methods to analyse factors associated with attendance for invited patients and Chapter 7 tests the effects of invitation and attendance on survival in accordance with age and gender. Using the results of the regression models presented in Chapter 5, Chapter 8 demonstrates post-estimation non-linear decomposition of gender-based inequalities in invitation to CR. This is a novel application in health services research. Chapter 9 concludes this body of work.

Evidence Based Practice (EBP) is a relatively new approach that professionals are using to cope with the ever-growing body of literature in their fields. The goal of EBP is to effectively use this body of literature to improve professional practice, thus improving the quality of services. A major component of EBP is asking a focused, well-built question, referred to in this paper as an Evidence Based Practice Question (EBPQ). This paper reports the findings of an exploratory study that examines the use an EBPQ to respond to reference questions emailed to a university library reference desk. A purposive sample of 30 randomly selected reference emails was divided into two groups, the EBPQ group and the control group. The professional searcher who conducted the searches used the same approach in responding to each emailed reference question, except that the EBPQ group searches were guided by EBPQs, and the control group’s responses were not. The results indicate that searches guided by using EBPQs are more focused, apply more resources to the search process, and take less time than searches not guided by using EBPQs. These conclusions suggest that EBPQs appear to be useful for improving that search process and that further research is warranted.

<p>This was a cross-sectional study done in Lagos, Nigeria on 114 dentists. The aim of the study was to describe the knowledge and attitudes of dentists towards the concept of evidence-based dentistry (EBD). This study also attempted to create an awareness of this concept in the minds of previously uninformed dentists as well as demonstrate its need in continuous professional education via seminars, updates, lectures and short-term courses in Lagos, Nigeria.</p>