Obesity, a condition of excess body fat, is one of the most complex problems facing health systems. Lifestyle management programs that combine diet, physical activity, and intensive behavioral therapy have been shown by research to support a degree of weight loss that produces health benefits (i.e., at least a 3-5% initial body weight). However, it has been difficult for research-developed programs to be delivered in typical practice to have a meaningful impact. Integrated research-practice partnerships that involve the coming together of academic researchers, health system administrators, and program delivery staff may help overcome this gap, especially during this transformational time in the healthcare sector. This dissertation aimed to develop an understanding of how using the integrated research-practice approach would facilitate and sustain evidence-based lifestyle management strategies across a health system to treat obesity among patients and employees. An integrated research-practice partnership with Carilion Clinic, a health system in western Virginia, served as an example for the study. From 2013-2016, the Carilion Clinic integrated research-practice partnership conducted a series of trials testing different strategies for delivering weight loss and weight loss maintenance support. An evaluation guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was conducted to describe implementation processes and outcomes for each strategy. Lessons learned from the evaluation support the value of the integrated-research practice partnership approach as a solution for overcoming gaps in obesity care. A shared priority perspective between research and practice was identified as the powerful process for supporting facilitation and sustainability of strategies. In addition, findings from the evaluation produced evidence to inform the future development of a system for Carilion Clinic to help patients and employees lose weight and keep it off through lifestyle management. / Ph. D. / Obesity, a condition of excess body fat, is one of the most complex problems facing health systems. Lifestyle management programs that combine diet, physical activity, and intensive behavioral therapy have been shown by research to support a degree of weight loss that produces health benefits (i.e., at least a 3-5% initial body weight). However, it has been difficult for researchdeveloped programs to be delivered in typical practice to have a meaningful impact. Integrated research-practice partnerships that involve the coming together of academic researchers, health system administrators, and program delivery staff may help overcome this gap, especially during this transformational time in the healthcare sector. This dissertation aimed to develop an understanding of how using the integrated research-practice approach would facilitate and sustain evidence-based lifestyle management strategies across a health system to treat obesity among patients and employees. An integrated research-practice partnership with Carilion Clinic, a health system in western Virginia, served as an example for the study. From 2013-2016, the Carilion Clinic integrated research-practice partnership conducted a series of trials testing different strategies for delivering weight loss and weight loss maintenance support. An evaluation guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was conducted to describe implementation processes and outcomes for each strategy. Lessons learned from the evaluation support the value of the integrated-research practice partnership approach as a solution for overcoming gaps in obesity care. A <i>shared</i> priority perspective between research and practice was identified as the powerful process for supporting facilitation and sustainability of strategies. In addition, findings from the evaluation produced evidence to inform the future development of a system for Carilion Clinic to help patients and employees lose weight and keep it off through lifestyle management.

Abstract This was a modified integrated mixed methods study of teachers’ perceptions of factors that influence transfer of research-based teaching strategies into classroom practice. Participants were made up of 66 respondents to a researcher made survey, “Survey of Teacher Attitudes toward Change and Classroom Implementation of Research–Based Strategies”. Respondents were divided into two groups based on participation in Louisiana Systemic Initiatives Programs (LaSIP): LaSIP, N= 39 and Non-LaSIP, N= 27. Answers to five research questions were based on analysis of quantitative data from a survey, recorded on a five-point Likert scale and qualitative data from analyses of transcripts of three personal interviews, two focus group discussions and five short-answer questions on the survey. SPSS software version 9 and Atlas.ti version 7 were used in quantitative and qualitative analyses, respectively. Concurrent quantitative and qualitative strands of data were integrated throughout the study. Findings from quantitative data included the following: (1) Teacher perceptions of features of the LaSIP were predictive of reported frequency of use of research-based teaching strategies (RBTS); (2) Reported frequency of use of RBTS was not significantly different in LaSIP versus non-LaSIP teachers, except in reported use of alternative assessments. (3) Both LaSIP and non-LaSIP teachers indicated that implementation of RBTS increased student achievement (4) LaSIP teachers identified factors such as opportunity to collaborate with colleagues, time to acquire content knowledge, practice with material and supplies as features of the LaSIP that influenced implementation of RBTS. (5) Perceived barriers to implementation of RBTS included lack of equipment and lack of teacher input into planning of professional development. and modeling of RBTS as factors that positively influence classroom implementation. Analyses of qualitative data supported many of the findings due to quantitative analyses. Additionally, qualitative data provided more in-depth information concerning teacher perceptions of barriers to implementation such as lack of teacher input into planning and implementation of professional development, and lack of time for in-depth learning during professional development activities. Key Words: Teacher Professional Development, Research-based Teaching Strategies, Classroom Implementation, Science Pedagogy, Mixed Methods, Student Achievement

Améliorer la qualité des soins à l'hôpital reste un enjeu. Mettre en place des interventions efficaces pour changer les pratiques cliniques et les évaluer avec une méthodologie adaptée est crucial. L'objectif de ce travail est de proposer une démarche d'évaluation des interventions complexes. Dans une première partie, nous présentons et discutons quatre études conduites en milieu hospitalier. Celles-ci ont permis de dégager les spécificités méthodologiques des évaluations des interventions complexes que nous développons dans une seconde partie. De ce travail, nous retenons les éléments suivants : la conception d'interventions efficaces repose sur la connaissance des freins au changement de pratique et des facteurs favorisants ; l'évaluation de l'impact dispose de différentes alternatives méthodologiques ; les approches sont pragmatiques, intégrées au contexte local. En contrepartie, la validité interne de l'étude est souvent affectée par l'absence de comparabilité initiale des groupes et l'absence d'insu des professionnels. Le processus d'implémentation et les facteurs contextuels doivent être compris pour interpréter les résultats des études et pour pouvoir transposer l'intervention. Nous proposons une démarche en 5 étapes pour l'élaboration et l'évaluation des interventions complexes : I. Conception de l'intervention, II. Déploiement, III. Evaluation de l'impact, IV. Transférabilité et V. Pérennité. Une grille est proposée pour guider la réalisation de chacune de ces étapes. Les perspectives de recherche sont de prendre en compte la préférence des professionnels dans les essais d'intervention, d'intégrer les connaissances en sciences humaines sur les changements de comportement pour concevoir les interventions et en comprendre les effets, et de développer des approches mixtes combinant des résultats qualitatifs et quantitatifs pour conclure sur l'impact des interventions / Improving the quality of hospital care remains a challenge. Setting up effective interventions to change clinical practices and evaluating them with an appropriate methodology is crucial. The objective of this work is to propose a process to evaluate complex interventions. In a first part, we discuss four studies conducted in hospitals. They allowed us to identify the methodological specificities of the evaluations of complex interventions that we develop in a second part. From this work, we take away the following items. Effective interventions are based on the knowledge of barriers and facilitators to change clinical practices. Various methodological approaches exist to evaluate the impact of complex interventions. These approaches are pragmatic, integrated into the local context. On the flip side, the internal validity of the study is often impacted by the lack of comparability of the original groups and the lack of blinding of the professionals; the implementation process and contextual factors need to be understood to interpret the results and to be able to transfer the intervention. We propose a 5-step approach for the development and the evaluation of complex interventions: I. Design II. Implementation, III. Impact assessment, IV. Transferability and V. Sustainability. A grid is provided in order to guide the completion of each of these steps. The research perspectives are: take into account the preference of professionals in intervention trials, integrate knowledge about behavior change to design interventions and understand the effects, and develop joint approaches combining qualitative and quantitative results to conclude on the impact of interventions

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Digital technology has greatly revolutionized the field of health care and medical practices. Digitalization has significantly excelled the operational efficiency and standards of medical care enhancing the overall experience for both medical professionals and patients. Despite its overwhelming advantages, Health care sectors have been lagging in adopting and implementing new digital technology innovations. Deciding and shifting towards digitalization would require adopters to have a flexible and open mindset.  However, health care has a great shortage of pathologists, and implementation of digitalization seems to be very limited in this area of healthcare. Most of the pathologists today work with manual cancer diagnosing techniques indicating an acute need for digitalization. This thesis is aimed at identifying the barriers and facilitators for the implementation of a digital prostate cancer diagnostic innovation in health care. A literature review provides a detailed outline of various aspects related to prostate cancer diagnosis. It provides a detailed description of different frameworks and theories in relation to existing barriers and facilitators in implementing innovation in health care. The methodological approaches applied in this study have also been described in the methodology chapter. Based on the data gathered from semi-structured interviews and thematic analysis, three main themes were identified, and corresponding to these, possible barriers, and facilitators for implementing the digital cancer diagnostic innovation were developed.  Finally, the findings of this study concluded that implementation of digital cancer diagnostic innovation faces several barriers and facilitators. Some of the crucial barriers are financial barriers, time constraints, political conflicts, ethical policies, technology limitations, limited knowledge, skepticism towards new technology. Similarly, facilitators are Identifying key decision-makers, highly effective and cost-efficient technologies, high technical accuracy, openness in trying new technology.

Background: Public safety personnel (PSP) such as paramedics and police are exposed to traumatic situations which increases their risk for mental health issues. However, many PSP do not seek help in a timely manner. Peer support interventions have the potential to decrease stigma and increase treatment-seeking behaviours among PSP. However, little is known regarding how the organizational culture of public safety organizations (PSOs) may affect the implementation of a peer-based intervention. This study aims to understand the extent to which organizational culture, including masculinity contest cultures (MCC), within Canadian PSOs affects implementation of PeerOnCall, a new peer support app for PSP. Methods: A multiple case study design was adopted, integrating semi-structured interviews and a standardized MCC scale completed with organizational champions from three PSOs. Two to three champions from each PSO acted as key informants regarding their organizations. Interviews explored champions’ perceptions of how organizational culture might shape implementation. Interview data were analyzed using inductive thematic analysis. Interview data were also triangulated with MCC scale data to understand the extent to which an MCC exists and is important to consider when implementing this app-based intervention. Results: Interviews with champions resulted in the construction of four themes. The first theme focused on external drivers of organizational culture shift, while the second theme focused on internal drivers. The third theme focused on how culture can create resistance to implementation. The fourth theme emphasized that culturally competent implementation strategies could overcome this resistance Most participants perceived their organization to have low-to-moderate levels of MCC. Discussion/Conclusions: Each organization had a unique and changing culture, as evidenced through its cultural artifacts, beliefs, and values. Understanding how culture shapes implementation of PeerOnCall can guide the creation of contextually relevant strategies that optimize implementation of PeerOnCall within PSOs. Recommendations for strategies and further study are provided. / Thesis / Master of Public Health (MPH) / This multi-site case study explores how first responder culture influences implementation of the PeerOnCall peer support app. Interviews and surveys were conducted with seven workplace champions from one police and two paramedic organization(s). Interviews explored organizational culture in general while surveys focused on masculinity contest culture specifically. It was observed that: external and internal drivers of culture shift have created a window of opportunity for PeerOnCall implementation; cultures of mistrust, skepticism & apathy, and hegemonic masculinity can create resistance to implementation; and culturally competent implementation strategies can overcome this. Traditional norms of masculinity appeared to be changing within the organizations. While public safety organizations’ cultures have been studied, this study links culture to the implementation of a specific intervention and offers nuance to the issue of masculinity contest cultures. Findings can inform the creation of culturally competent strategies that optimize the implementation of resources such as PeerOnCall among first responders.

Universal school-wide social-emotional screeners identify at-risk students with social-emotional behavior problems (Romer et al., 2020). Identifying such students alone cannot prevent these social, emotional, and behavioral concerns from becoming problematic. However, data gathered from social-emotional screening can guide the development of strategies, supports, interventions, and progress monitoring students at risk across all tiers (Yates et al., 2008), leading to the prevention of social-emotional and behavioral problems from turning maladaptive (Humphrey & Wigelsworth, 2016; Walker et al., 2004). A school district in the Mountain West area of the United States developed a screening survey that addresses school climate, culture, and connectedness to administer to their student body. Their survey aims to identify students' needs in the following character social-emotional learning (SEL) skills that contribute to student well-being: self-awareness, compassion, resilience, and respect. Their screening survey can potentially identify the general student body's social-emotional behavioral needs. The data gathered may be used to create tiered supports that address students' needs. In this study, we conducted two focus groups that provided a forum for school psychologists in this Mountain West school district who work in an elementary school to discuss what tiered supports may be appropriate to implement in response to needs identified by the survey. The discussion also included professional development topics the participants perceived necessary for school teams responding to the survey data. The findings from this study contribute to the existing literature by recognizing that school psychologists may understand implementation science and can help lay the needed groundwork before implementing social-emotional screeners so that the process can be more efficient and effective. The findings emphasize the understanding that from the perspective of school psychologists, social-emotional learning should be applied universally and collaboratively at school and at home. School teams need to allocate time to teach social-emotional learning at school. The findings also suggest that school psychologists can determine appropriate interventions if screening data suggest a weakness in social-emotional and behavioral areas and that data collected from the screener can be used to guide topics for professional development.

Yes / Pharmacogenomic (PGx) testing can help personalise psychiatric prescribing and improve on the currently adopted trial-and-error prescribing approach. However, widespread implementation is yet to occur. Understanding factors influencing implementation is pertinent to the psychiatric PGx field. Normalisation Process Theory (NPT) seeks to understand the work involved during intervention implementation and is used by this review (PROSPERO: CRD42023399926) to explore factors influencing PGx implementation in psychiatry. Four databases were systematically searched for relevant records and assessed for eligibility following PRISMA guidance. The QuADS tool was applied during quality assessment of included records. Using an abductive approach to codebook thematic analysis, barrier and facilitator themes were developed using NPT as a theoretical framework. Twenty-nine records were included in the data synthesis. Key barrier themes included a PGx knowledge gap, a lack of consensus in policy and guidance, and uncertainty towards the use of PGx. Facilitator themes included an interest in PGx use as a new and improved approach to prescribing, a desire for a multidisciplinary approach to PGx implementation, and the importance of fostering a climate for PGx implementation. Using NPT, this novel review systematically summarises the literature in the psychiatric PGx implementation field. The findings highlight a need to develop national policies on using PGx, and an education and training workforce plan for mental health professionals. By understanding factors influencing implementation, the findings help to address the psychiatric PGx implementation gap. This helps move clinical practice closer towards a personalised psychotropic prescribing approach and associated improvements in patient outcomes. Future policy and research should focus on the appraisal of PGx implementation in psychiatry and the role of pharmacists in PGx service design, implementation, and delivery.

The presence of challenging and violent behaviors that pose risks to the overall safety and the educational learning experience in the public education setting have been on the rise in recent years. Traditional reactive, coercive, and punitive measures to address these behaviors have been futile. Congress responded to the national increase in violent behaviors by implementing several acts, including zero tolerance policies, in an effort to diminish the rise in violent behaviors. Of significance to this study was the inclusion of Functional Behavior Assessment in the reauthorization of the Individuals with Disabilities Education Act in 1997. Unfortunately, FBA has the least legal grounding of all the disciplinary provisions of IDEA and has been questioned by experts in the field if sufficient empirical support exists for the generalization of the technology to all students and whether or not school personnel have the skills required to conduct FBA with integrity (Drasgow, Yell, Bradley, & Shriner 1999; Quinn, 2000; Scott et al., 2005; Skiba, 2002). The purpose of this research study was to obtain and analyze information regarding the perceptions of special education teachers in the Commonwealth of Virginia on the use of Functional Behavior Assessment with students with high incidence disabilities in public schools. A nonexperimental survey design using an online self-report survey was conducted with special education teachers in the eight superintendent regions in the Commonwealth of Virginia. The study examined the behaviors that most frequently prompt a FBA, if a relationship exists between the type and frequency of training and the perceived effectiveness of FBA, the relationship between teacher attributes of beliefs and self-efficacy and the overall perceived effectiveness of FBA, and how teachers perceive the overall FBA/BIP process in public schools. The survey was distributed electronically to special education teachers through the office of the special education director in each of the 132 school divisions in Virginia. A total of 373 special education teachers responded to the survey. Respondents perceive the extent to which FBA contributes to the effectiveness of interventions that reduce challenging behaviors of students and the effectiveness of current FBA methods in increasing positive replacement behaviors and improving learning/academic achievement in public schools moderately effective. Congruent with the literature, special education teachers reported that chronic problem behaviors and physically aggressive behaviors were most likely to prompt an FBA. Respondents indicated their knowledge base, training experiences, and background in FBA. Overall, the majority of special education teachers reported that the training that they have received in FBA was moderately to very effective. Respondents indicated that further training in all areas of FBA was needed using a dynamic team based process with post training support. The most frequently reported area of FBA that requires more training was developing function-based interventions while the least reported area of need was developing hypotheses about the functions of the behavior. Teacher beliefs and self-efficacy were examined to determine if these attributes predict a special educator’s perceived effectiveness of FBA. High levels of teacher self-efficacy were associated with increased views of perceived effectiveness of FBA in public schools. Two belief items were found to correlate with the perceived effectiveness of FBA. The results of this study have important implications for personnel development and training for future and current special educators as well as information that can be applied to the exploration of a standardized process for conducting FBA in public schools in Virginia.

Pulse oximeters are low-cost, easy to use, and effective at detecting hypoxemia (low blood oxygen levels), a common complication of bronchiolitis, asthma, and pneumonia, the leading infectious cause of death in children worldwide. However, pulse oximeters are often unavailable in lowincome settings, and if available, often underused, yet little research investigates why. In this thesis, I examine pulse oximeter implementation in low-income settings, focusing on Kenyan hospitals as a case study, and using a mixed-methods approach. I conducted a systematic literature review, examining how pulse oximeter use with children at admission to hospital impacts health outcomes; I then conducted quantitative analyses of 28,000 children admitted to seven Kenyan hospitals to determine with which children pulse oximeters are used, and pulse oximetry's impact on treatment provision; these analyses informed the qualitative research component, for which I conducted interviews with 30 healthcare workers (HCWs) and staff in 14 Kenyan hospitals and employed theoretical frameworks to determine how HCWs decide whether to use pulse oximeters, and the barriers to pulse oximetry. I found that pulse oximeter use varies substantially between and within Kenyan hospitals over time. After adjusting for case-mix and signs of illness severity, HCWs were most likely to use pulse oximeters with children with a very high respiratory rate, indrawing and/or who were not alert; children who obtained a pulse oximeter reading were more likely to be prescribed oxygen than if a pulse oximeter was not used; and children with a reading below 90% were more likely to be prescribed oxygen than those with higher readings, suggesting that HCW decision-making is influenced by international and national guidelines. However, HCWs sometimes cannot use pulse oximeters when they intend to, because of insufficient pulse oximeter availability, largely due to inefficient and confusing procurement processes and repair delays. Furthermore, HCWs sometimes use pulse oximeters incorrectly or misinterpret their results, because of insufficient training. Pulse oximeter promotion programme planners can use the recommendations I provide to effectively target barriers to pulse oximeter uptake in low-income settings. Increased pulse oximetry implementation could enable early detection of hypoxemia, improving accurate diagnosis, and supporting prompt, effective treatment, which could help reduce mortality in children needing oxygen, in line with Sustainable Development Goal 3.