Background: There are professional expectations for public health nurses to engage in and develop competencies in evidence-informed decision-making (EIDM). The purpose of this research study was to develop and psychometrically test a measure to assess competence in EIDM among public health nurses. Methods: Guided by the Standards for Educational and Psychological Testing (American Educational Research Association, American Psychological Association, & National Council on Measurement in Education, 2014), a three stage study was employed to develop and psychometrically evaluate the new self-report EIDM Competence Measure: 1) Stage one: a systematic review of existing measures assessing four EIDM competence attributes of knowledge, skills, attitudes/beliefs, and behaviours; 2) Stage two: item development for the EIDM Competence Measure comprised of four subscales (knowledge, skills, attitudes/beliefs, and behaviours); and 3) Stage three: psychometric testing (reliability, validity, acceptability) which included item reduction from an original 40-item to a final 27-item tool. Results: The EIDM Competence Measure consists of 27 items aligning with a four-factor model of EIDM knowledge, skills, attitudes/beliefs, and behaviours establishing internal structure validity. Cronbach’s alpha for these four factors was 0.96, 0.93, 0.80, and 0.94, respectively. Significant associations between EIDM competence subscale scores and education, EIDM training/project involvement, and organizational culture established validity based on relationships to other variables. For the original 40-item tool, missing data was minimal as 93% of participants completed all items and mean completion time was 7 minutes and 20 seconds. Conclusions: The EIDM Competence Measure is a conceptually and psychometrically robust instrument that has potential for use in public health nursing practice. / Dissertation / Doctor of Philosophy (PhD) / Nurses who work in public health have professional expectations to participate in evidence-informed decision-making (EIDM). Because of this, it is important to measure how competent they are in EIDM. The purpose of this study was to develop and test a tool that measures EIDM competence among public health nurses using a three-stage study. The first stage involved reviewing literature on existing tools that measure different components of EIDM competence including EIDM knowledge, skills, attitudes/beliefs, and behaviours among nurses. The second stage involved using existing tool items and developing new items for a new tool named the EIDM Competence Measure. In the third stage, the EIDM Competence Measure was tested to assess its validity, reliability, and acceptability among public health nurses in Ontario. The EIDM Competence Measure was found to have strong validity, reliability, and acceptability, showing that there is potential for its use in public health nursing practice.

Background. In order to deliver effective and efficient public health services, the best available research evidence should be considered when making public health decisions. The process of evidence-informed decision making (EIDM) involves searching for research evidence, appraising and synthesizing the high quality evidence, and adapting the evidence with consideration of local contextual factors and community preferences. For many public health departments achieving EIDM has been a challenge. Methods. This study aimed to learn how EIDM spread through interpersonal interactions within the health department of a provincial government in Canada. The health department was selected based on anecdotal evidence suggesting that ideas of EIDM had diffused within this department. Employees were invited to participate in an electronic survey about their interactions regarding EIDM. The data collected from this survey were analyzed using social network analysis methods. This helped to show how the interpersonal connections helped to spread the ideas of EIDM within the organization. Results. In this organization EIDM discussion occurred most often within the organizational divisions, whereas influence for EIDM often occurred both within and between divisions. The type of relationship that appeared most important in discussion of EIDM was colleague relationships, while supervisors were more important for encouraging use of EIDM. Furthermore, individuals in leadership positions within the organization were shown to have played an important role in the diffusion of EIDM. Limitations and Conclusions. Low participation resulted in a limited picture of the whole network of this organization. The use of social network analysis is a relatively novel approach for studying the diffusion of EIDM, and there are challenges to this approach that requires special consideration when working with organizations. / Thesis / Master of Science in Nursing (MSN)

Objective: To understand the use of evidence-informed decision-making within an interorganizational network, and identify the facilitators and barriers to achieving network goals. Design: Case study. Setting: Rural health district in Nova Scotia, Canada (2006 to 2011). Participants: Members from 4 organizations representing community and hospital groups participating in a regional Baby Friendly Initiative network. Methods: A descriptive mixed methods study using focus group and questionnaire methodology. Data were analyzed using framework analysis and social network analysis (SNA). Results: The SNA results highlighted the role that relationships have on the sharing of knowledge among network members. The findings highlight the need for leadership at multiple levels (community, network members, primary organizations, and the provincial government). A lack of resources to achieve the network’s goals was a key barrier. Conclusions: The role of multi-level leadership is important for future network development and community consideration. The case study methodology facilitated momentum towards the network’s goals.

Objective: To understand the use of evidence-informed decision-making within an interorganizational network, and identify the facilitators and barriers to achieving network goals. Design: Case study. Setting: Rural health district in Nova Scotia, Canada (2006 to 2011). Participants: Members from 4 organizations representing community and hospital groups participating in a regional Baby Friendly Initiative network. Methods: A descriptive mixed methods study using focus group and questionnaire methodology. Data were analyzed using framework analysis and social network analysis (SNA). Results: The SNA results highlighted the role that relationships have on the sharing of knowledge among network members. The findings highlight the need for leadership at multiple levels (community, network members, primary organizations, and the provincial government). A lack of resources to achieve the network’s goals was a key barrier. Conclusions: The role of multi-level leadership is important for future network development and community consideration. The case study methodology facilitated momentum towards the network’s goals.

Many strategies can be used to support the use of research evidence in decision-making. However, such strategies have been understudied in crisis zones, where decision-making may be particularly complex, many factors may influence decision-makers’ use of research evidence, and professional judgements may be particularly relied upon. Using synthesis and qualitative research methods, this dissertation examines the role of research evidence in crisis zones and strategies to support its use in decision-making. First, chapter 2 describes a critical interpretive synthesis, which drew upon a broad body of literature around evidence use in crisis zones to develop a new conceptual framework that outlines strategies that leverage the facilitators and address the barriers to evidence use in crisis zones in four systems, namely the political, health, international humanitarian aid, and health research systems. Second, in chapter 3, the focus narrows, and an embedded qualitative case study design was used to gain a deeper understanding into one of the four identified systems, the political system, and specifically the factors that influenced the use of research evidence in the governmental health policy-development processes for Syrian refugees in Lebanon and Ontario. Finally, in chapter 4, a user testing study design was used to zero-in on decision-makers’ experiences with a particular strategy within the health research system, namely an evidence website focused specifically on topics relevant in crisis zones. This dissertation provides a rich understanding of research evidence use by examining knowledge translation strategies in a setting that has been largely unexplored in the broader KT map: crisis zones. The findings from this thesis point to the need for comprehensive strategies to support evidence use in decision-making that draw upon the existing literature and are adapted for crisis zones, which can occur sequentially or simultaneously within or across the four identified systems. / Thesis / Doctor of Philosophy (PhD) / In humanitarian aid, and specifically in crisis zones, there are many different types of information decision-makers can draw from when making decisions. One specific type of information is research evidence; however, the use of research evidence, and the ways it can inform decision-making in crisis zones, has been understudied. This dissertation addresses this key gap in understanding by: 1) developing a new tool that can help decisions-makers use research evidence to inform their decisions in crisis zones within the political, health, humanitarian aid and health research systems; 2) examining the factors that influence the use of research evidence in the governmental health policy-development processes for Syrian refugees in Lebanon and Ontario; and 3) examining the perspectives of decisions-makers around using one way of supporting the use of research evidence — an evidence website — to support evidence-informed decision-making in crisis zones.