Evidence-based policy and practice (EBPP) in population health in Australia has been promoted largely without sound research. In response, this thesis presents a series of studies undertaken to assess and inform enhancement of capacity for EBPP in Australia. It comprises linked studies designed to examine different yet complementary aspects of capacity for EBPP. Research was conducted at various levels of Australian health care system, from local to national, in order to better understand EBPP and to make a series of recommendations about effective and synergistic response.

Introduction The use of technology and Internet-based activities (IBAs) is increasing in society. However, seniors with limited experiences with the Internet can experience restricted participation in meaningful activities that are dependent on the Internet. Also, social transitions during aging might lead to reduced social activities and social contacts and to increased experiences of loneliness, all of which might have negative health implications. Therefore, there is a need to advance the knowledge of how occupational therapists can support seniors’ use of IBAs and create opportunities for social contacts and social activities during aging. Aim The overall aim of this thesis is to increase the knowledge of how Internet-based activities influence seniors’ participation in society, how seniors experience and are influenced by support from a social Internet-based occupational therapy intervention, and how different aspects of this intervention can contribute to healthy ageing. Methods In study I, seniors’ experiences of IBAs were explored and described through interviews with 10 seniors (66–82 years old) that were analyzed with the constant comparative method. In study II, a multiple case study with five seniors (65–85 years old) was used to explore the design of an Internet-based occupational therapy social intervention program and how it influenced social activities and social contacts among the participants. The qualitative and quantitative data from multiple sources were analyzed by pattern matching. In study III, an explorative randomized crossover study with an AB/BA design was conducted with 30 seniors (61–89 years old) who were vulnerable to loneliness and who participated in the intervention program. The quantitative data were analyzed with parametric and non-parametric statistics. In study IV, a qualitative interview study was conducted to collect the experiences of 15 seniors (66–87 years old) from the previous intervention process in study III. The interviews were analyzed with the constant comparative method. All participants in studies I–IV were community-dwelling, retired seniors without home-care services.   Results Complex interactions of different aspects influence seniors’ possibilities and preferences for taking part in IBAs. The performance of IBAs yielded different experiences of participation in society (study I). The initial explorative results indicated that the client-centered and individually adapted intervention program supports participation in social IBAs (SIBAs) and other social contexts (study II). After participation in the intervention program, the experiences of loneliness significantly decreased, and satisfaction with social contacts on the Internet increased for one group (study III). If an individual’s requirements are met during the intervention process, experiences of habitual SIBA usage, increased self-reliance, and enriched social contacts and social activities both on and off the Internet might be facilitated (study IV). Conclusion This thesis provides knowledge of how social support, experiences of and accessibility to technology, life-changing events, and identified meaningfulness with online activities influence the motivation to participate in social and Internet-based activities. The occupational therapist should address the individual’s perspective in the intervention program so as to adapt the intervention and to support experiences of satisfactory participation and enhanced social activities and social contacts for seniors. In addition, healthy aging might be supported by the intervention program due to the reduction in loneliness and increased participation in social activities and society. Further evaluation of the framework and content of the intervention program for seniors with restricted participation in IBAs and SIBAs and high levels of loneliness is suggested.

Studien syftade till att belysa arbetet med missbruksvården i Bosnien-Hercegovina. Det som har studerats är hur de yrkesverksamma ser på forskning, egen erfarenhet samt klientens erfarenheter och önskemål i valet av behandling. Den metodologiska utgångspunkten var en hermeneutisk kvalitativ ansats, där semistrukturerade intervjuer har genomförts och sedan studerats. Dessa intervjuer utfördes på ett behandlingshem i Bosnien-Hercegovinas huvudstad Sarajevo och antalet intervjupersoner var fem personer. Resultatet visade hur de arbetar på behandlingshem i Bosnien-Hercegovina. Resultatet visade även att Bosnien-Hercegovina använder sig utav evidensbaserad praktik. Vikten ligger i att få en trygg och verksam vård. Evidensbaserad praktik används utifrån tre olika källor, dessa är klientens erfarenhet, behov och önskemål, den professionellas erfarenhet och förmåga samt vetenskaplig kunskap. BosnienHercegovina tillämpar dessa tre olika källor i sitt behandlingsarbete.

Cultural factors affecting the development of an evidence-based information service in a third sector provider of complementary cancer care Matthew Breckons Introduction Many people with cancer access complementary and alternative medicine (CAM) and a need for high quality information was emphasised in reports by the House of Lords and the National Institute for Health and Clinical Excellence. Organisational culture, incorporating people’s underlying assumptions, values and actions, has been highlighted as an important factor when attempting to introduce evidence-based practices. Opinion is divided over the relevance of evidence to CAM practice, although the influence that this has on the cultural context of a CAM organisation is not understood. Aims To identify cultural factors affecting the introduction of an evidence-based information service in a third-sector CAM organisation and, in light of factors identified, to suggest feasible innovations to achieve a more evidenced-based approach. Methods Access to the charity was gained through a Knowledge Transfer Partnership. Soft Systems Methodology, a form of action research, was used to carry out four ‘learning cycles’ in which data was collected and fed back to staff at the organisation to prompt discussion on what could be improved. Learning cycles focused on improving the quality of web-based and printed information and gaining an understanding of how the information service could be improved from staff and service-user perspectives. Results Results suggested that a lack of time and emphasis on marketing values led to difficulties feeding back results and making changes that were perceived to reduce demand for the charity’s services. A lack of management support and a reluctance to implement rules made introducing any form of information policy problematic. Additionally, structural factors such as a large team of part-time staff and a lack of financial resources led to communication difficulties as well as limiting the opportunity for staff development. Conclusions This is the first study to document systematic attempts to make evidence-based changes in a third sector CAM organisation. As such, this study has generated results demonstrating how cultural and structural constraints in this type of organisation may influence attempts to make evidence-based changes. Introduction of an initiative such as the Information Accreditation Scheme (IAS) may provide benefits to an organisation of this type by guiding the development of information production systems at the same time as raising the profile of the organisation. The findings of this study strongly suggest that, despite demands from policy makers for the provision of evidence-based CAM information, there may be systematic difficulties experienced by organisations responsible for the production of this information. Further research is needed to understand how producers of CAM information can be supported in providing high quality, evidence-based materials.

Background: It has been proven to be a challenge for physiotherapists to utilize evidence within their practice. Conducting evidence-based care is a requirement for providing good care and a requirement in the legitimation for Swedish physiotherapists. Aim: To explore physiotherapists experiences of their possibilities and challenges in implementing prevailing evidence in their practice. Method: A qualitative method was applied with a semi-structured interview guide. A choice of convenience sampling was made with 5 physiotherapists from a region in Sweden with the aim of getting as wide a sample as possible. The analysis of the data was done through a qualitative content analysis. Results: Physiotherapists felt that the challenges were based on their work environment and that the Swedish care structure  measures quantity over quality. Other contributing challenging factors mentioned where lack of time, low interest from managers, lack of training and difficulties in understanding and evaluating the different parts of the evidence model. Opportunities that were raised were the mutual learning among colleagues in the workplace and that research is easily accessible with today's technology. Conclusion: This study shows that in order for physiotherapists to feel that they have good opportunities to implement evidence, one needs to try to eliminate the various challenges that arise within their work environment. This can enable organizations in which physiotherapists work to gain an understanding of what needs to be focused on and improved in order for physiotherapists to be able to implement evidence-based care and therefore increase the quality of care for patients. / Bakgrund: Det har visat sig vara en utmaning för fysioterapeuter att använda sig av evidens inom sitt verksamhetsområde. Att bedriva en evidensbaserad vård är en nödvändighet för att bedriva en god vård och ett krav i legitimationen för svenska fysioterapeuter. Syfte: Att utforska fysioterapeuters upplevelser av sina möjligheter och utmaningar med att implementera rådande evidens inom sitt verksamhetsområde. Metod: En kvalitativ metod tillämpades med en semistrukturerad intervjuguide. Ett bekvämlighetsval användes där 5 fysioterapeuter valdes från en region i Sverige och med syfte att få så brett urval som möjligt. Analysen av data gjordes genom en kvalitativ innehållsanalys. Resultat: Fysioterapeuterna upplevde att utmaningarna främst grundade sig i deras arbetsmiljö och att den svenska vårdstrukturen är mer uppbyggd för att mäta kvantitet och inte kvalité. Andra nämnda bidragande utmanande faktorer var tidsbrist, lågt intresse från chefer, brist på utbildning och svårigheter med att förstå och värdera evidensmodellens olika delar. Möjligheter som togs upp var det gemensamma lärandet bland kollegor på arbetsplatsen och att forskningen är lättillgänglig med dagens teknik. Konklusion: Den här studien visar att om fysioterapeuter ska uppleva att de har goda möjligheter att implementera evidens så behöver man försöka eliminera de olika utmaningar som finns inom deras arbetsmiljö. Detta kan möjliggöra att organisationer som fysioterapeuter jobbar inom kan få en förståelse för vad man behöver fokusera på och förbättra för att fysioterapeuter ska kunna implementera en evidensbaserad vård och därmed öka vårdkvalitén för patienter.

The implementation of evidence-based practices has great potential to improve the quality of children’s services; however, with a large variety of available practices, it can be challenging to select targets for quality improvement in community-based treatment. This study used a method called relevance mapping to identify how thoroughly evidence-based programs could cover a specific population of children seeking services at a large public agency and identify practice elements relevant to these clients. A therapist survey was used to examine current practice at the agency. Eight therapists at the agency reported on their practice delivery for 141 clients. Results from relevance mapping and therapist surveys were combined to create practice profiles for two predominant diagnostic categories seen at the agency: substance use and depression. These practice profiles were used to identify three areas of interest for agency quality improvement with regard to practice element delivery: Agency Strengths, Opportunities, and Weaknesses. Results demonstrate a potential blueprint for tailoring specific feedback to an agency for use in quality improvement efforts.

This study was undertaken to determine adherence rates to side effect monitoring guidelines of second-generation antipsychotics (SGAs) approximately 10 years after their publication to assess the quality of care being provided to patients with mental illness at an urban community mental health center located in the Southeast United States. Results indicated an initial combined collection of fasting blood glucose (FBG) and fasting lipid profile (FLP) of 30%. At the 3-month time point, 20% of FBG and FLP were checked and at 1 year 14%. Study results suggest there is a need for practice improvements to increase quality of care.

The Long March is a review of the origins and development of the Physical Therapy profession in the United States since the beginning of the 20th century. It shows the evolution experienced since that time of its professional profile, name and academic training received. It is shown how the relationship between the physical therapist and physician has grown and evolved into a relationship of mutual respect and of improvement in the professional practice.On the other hand, the principal milestones in the long march of the physical therapy profession from the time of its birth as a profession that was totally dependent on the physician to its current status as a profession with professionals having a deep science base and high university level training who are able to practice and freely govern their profession without external control are presented.

At the project site in New Jersey, eligible patients were leaving the hospital without receiving the influenza or pneumococcal vaccine. The field site has an established, evidence-based, nurse-driven protocol. The purpose of this project was to increase adherence to the current influenza and pneumococcal nurse-driven protocol on one medical-surgical unit. This unit had experienced low adherence rates to the nurse-driven protocol for vaccines, not reaching the New Jersey state target of 96% administration prior to discharge. The practice-focused question was: Will increasing awareness of evidence-based practice increase adherence to the influenza and pneumococcal vaccine protocol? A quality improvement plan was developed to address a gap in practice using the plan-do-study-act model. Internal vaccination data was the source of evidence used to drive this project. Baseline data was used from 2 months prior to the December 2017 start of the project. Once the quality improvement plan was implemented, data were collected and analyzed weekly with the quality improvement team. Findings for the pneumococcal vaccine demonstrated reaching 96% or higher while the influenza vaccine exceeded the state target reaching 100% of discharged patients being vaccinated. Implementing large surveillance boards into clinical rounds promoted increased adherence to the protocol, achieving a positive social change. Leadership worked directly with the staff to use evidence-based practice and promote nursing autonomy to administer the vaccines. An increased number of vaccinated patients leaving the medical-surgical unit was achieved.

Monitoring results is the final step that determines the impact of an evidencebased practice (EBP) decision. A variety of health outcomes can be expected to change following rehabilitation; therefore, outcome measures (OMs) are a major focus of EBP in rehabilitation. For instance, in patients with hand injuries, physiotherapy (PT) services focus on enabling patients to improve their functional use of the traumatized hand. Examining current practice of physiotherapists (PTs) in Saudi Arabia with respect to use of EBP and OMs can serve as a basis for understanding any identified gaps in knowledge before the full effect of translation and adoption of new patient self-reported outcomes (PROs) instruments can be seen in clinical practice. Therefore, this thesis was designed in two phases, incorporating two papers, to address EBP and PROs and their adoption in the evolving PT practice in Saudi. The first paper is a survey that aimed to determine the current self-reported attitudes, skills, and knowledge of PTs in Saudi Arabia toward EBP and outcome measures, including PROs. The second paper describes the process of crosscultural Arabic translation and adaptation of the Patient-Rated Wrist and Hand Evaluation (PRWHE) and reports estimates of the psychometrics properties of the translated measure. Finally, the thesis addresses overall areas of limitations and includes suggestions for future refinement and research in order to foster and facilitate EBP implementation in the cultural context of the evolving physiotherapy profession in the health systems of Saudi Arabia. / Thesis / Master of Science Rehabilitation Science (MSc)