Background: There is strong level I evidence that in most patients, mechanical bowel preparation (MBP) is not required. Despite this, physician behaviour has been slow to change in favour of omitting preoperative MBP. Methods: A knowledge translation strategy including: guideline development, consensus, education by opinion leaders, audit and feedback and reminder cards, was used in this study. Results: Overall, 81.1% of patients in the “before” arm and 88.4% in the “after” arm received MBP in compliance with the guideline (p=0.038). Normal diet use was compliant with the guideline in 45.6% of the patients in the “before” arm and 55.8% in the “after” arm (p=0.080). The use of enemas was compliant with the guideline in 88.5% of “before” patients and 94.2% of “after” patients (p<0.001). Conclusions: The results of this study reveal that a tailored, multi-faceted knowledge translation strategy can be used to change surgeon behavior in this clinical scenario.

Background: There is strong level I evidence that in most patients, mechanical bowel preparation (MBP) is not required. Despite this, physician behaviour has been slow to change in favour of omitting preoperative MBP. Methods: A knowledge translation strategy including: guideline development, consensus, education by opinion leaders, audit and feedback and reminder cards, was used in this study. Results: Overall, 81.1% of patients in the “before” arm and 88.4% in the “after” arm received MBP in compliance with the guideline (p=0.038). Normal diet use was compliant with the guideline in 45.6% of the patients in the “before” arm and 55.8% in the “after” arm (p=0.080). The use of enemas was compliant with the guideline in 88.5% of “before” patients and 94.2% of “after” patients (p<0.001). Conclusions: The results of this study reveal that a tailored, multi-faceted knowledge translation strategy can be used to change surgeon behavior in this clinical scenario.

The translation of research findings, and the development of products, has been identified as a research priority that may improve health outcomes for Indigenous peoples. Although knowledge translation is relatively new and emerging area in Indigenous science, Indigenous scholars have already been critical of Western defined knowledge translation theories and approaches as neglectful of Indigenous ways of knowing, being and doing. Within Indigenous knowledge systems, the translation of research findings is best conceptualized as a ‘sharing what we know about living a good life.’ This dissertation explores and focuses on the use of Indigenous stories and storytelling as knowledge translation products that may be better equipped to share research findings with Indigenous peoples. Grounded in an earlier study exploring experiences and responses to depression among Indigenous peoples living with HIV, this dissertation reviewed the Indigenous knowledge translation literature, adapted narrative analysis to an Indigenous context using composite character development and a scared story (i.e., Animikii and Mishebeshu), and created an Indigenized research story titled “The Wisdom of Thunder.” Meant to inspire healing, this story was also meant to create space to rethink, reorder, and re-imagine a world where HIV-positive Indigenous people and experiencing depression can learn and understand through Indigenous eyes. In ways connected to an oral body of stories, Indigenous stories, as an artful research translation practice, may make the findings of research more culturally accessible for Indigenous communities thereby promoting healing and well-being. / Thesis / Doctor of Philosophy (PhD) / The sharing of research findings in cultural appropriate ways with Indigenous community stakeholders is an important endeavour. Guided by the Indigenous principle of "sharing what we know about living the good life," it is equally important that such activity be done so in ways that respect Indigenous ways of knowing, being, and doing. This dissertation explores and focuses on the use of Indigenous stories and storytelling as knowledge translation products that may be better equipped to share research findings with Indigenous peoples.

In the emerging field of knowledge translation (KT) evaluation is typically assigned the role of quality control, constructing judgments about the merit and worth of knowledge translation activities. To date however, there has been little, if any, record of attempts to use evaluation to facilitate knowledge translation. The purpose of this research was to examine the potential role of evaluation as a mechanism for integrated knowledge translation (IKT). This study was completed in two phases and employed a prospective multiple methods case study design. Phase one explored the context of primary care, the setting in which phase two was conducted. Phase two involved the implementation of an evaluation designed to facilitate knowledge translation; an evaluation of a Memory Clinic within a primary care setting in Ontario, Canada served as the case. The evaluation was participatory and used intentional strategies to support knowledge translation. A framework from the evaluation literature, Pathways of Influence, was used to examine the influence of the evaluation at the level of the individual, interpersonal and collective. This research provides the first known description of a KT-informed evaluation. At the level of the individual, a KT-informed evaluation influenced the individuals’ knowledge about the program, attitudes towards practice-based knowledge and clinical practices and processes. At the team/interpersonal level the evaluation was seen to influence the team’s social norms, supporting the team in thinking beyond their disciplinary boundaries and to develop a shared vision and common language. The evaluation did not have influence at the level of the broader organization, however had diffuse impact on two external organizations. Results of this study suggest that adding knowledge translation to the repertoire of evaluation purposes is a natural extension of the field. Integrated knowledge translation is designed to engage individuals in the synthesis, exchange and ethically sound application of knowledge and the results of this study demonstrate that a collaborative evaluation approach promotes this interest in a potentially powerful way. / Thesis (Ph.D, Education) -- Queen's University, 2013-08-30 16:48:36.698

Background and Purpose: Dental hygienists are targeted for practice expansion to improve public access to oral health care and, therefore, must demonstrate decision making capacity. This study aimed to identify and test the impact of factors influential in dental hygiene decision making. Organizational and gender factors were hypothesized to be most influential. Methods: A phased mixed methods approach was used. Phase I: A series of focus groups were conducted to inform a dental hygiene decision making model, which included key predictor variables and the outcome variable: decision making capacity. Phase II: Aspects of the model were tested via an electronic questionnaire and key informant interviews. Statistical and qualitative thematic analyses were conducted and then findings were merged for interpretation. Results and Interpretation: Focus groups yielded over 75 codes and 6 themes (+ 1 theme from the literature) comprising the model and guiding the survey. The survey had a 38% response rate, and moderate to weak correlations between predictors and the outcome measure were shown. The final statistical model demonstrated Individual Characteristics and graduating from a 3-year program together significantly predicted decision making capacity. When merged with the key informant qualitative data, Individual Characteristics were shown to be a product of broad environmental factors and educational preparation had a particularly strong influence. Conclusions: Individual characteristics and education are predictive of decision making capacity but are outcomes of broad structural influences. Thus, it is recommended that modifications are made to these structures to support dental hygiene decision making in expanded practice.

Background and Purpose: Dental hygienists are targeted for practice expansion to improve public access to oral health care and, therefore, must demonstrate decision making capacity. This study aimed to identify and test the impact of factors influential in dental hygiene decision making. Organizational and gender factors were hypothesized to be most influential. Methods: A phased mixed methods approach was used. Phase I: A series of focus groups were conducted to inform a dental hygiene decision making model, which included key predictor variables and the outcome variable: decision making capacity. Phase II: Aspects of the model were tested via an electronic questionnaire and key informant interviews. Statistical and qualitative thematic analyses were conducted and then findings were merged for interpretation. Results and Interpretation: Focus groups yielded over 75 codes and 6 themes (+ 1 theme from the literature) comprising the model and guiding the survey. The survey had a 38% response rate, and moderate to weak correlations between predictors and the outcome measure were shown. The final statistical model demonstrated Individual Characteristics and graduating from a 3-year program together significantly predicted decision making capacity. When merged with the key informant qualitative data, Individual Characteristics were shown to be a product of broad environmental factors and educational preparation had a particularly strong influence. Conclusions: Individual characteristics and education are predictive of decision making capacity but are outcomes of broad structural influences. Thus, it is recommended that modifications are made to these structures to support dental hygiene decision making in expanded practice.

Background: Task shifting provision of basic health care services to lay health workers (LHWs) is increasingly employed to combat the global shortage of skilled health workers, particularly in low and middle income countries, where the shortage is greatest. Despite evidence for the effectiveness of LHWs in improving access to basic health services and positively impacting a variety of health outcomes, questions remain as to how recognized weaknesses in training and supervision are best addressed. This thesis employed a sequential-concurrent mixed-methods design and is composed of 3 studies with the objective of designing and rigorously evaluating a knowledge translation (KT) intervention tailored to address identified barriers to LHWs ability to function optimally as TB adherence supporters in Zomba district, Malawi. Methods & Findings: The first study utilized the qualitative methods of focus groups and interviews conducted with LHWs routinely involved in provision of care to TB patients. Lack of TB knowledge and job-specific training were identified as the key barriers to LHWs in their role as TB adherence supporters. Based on these findings, a KT intervention was developed and tailored to the identified training gaps. The second study, evaluated the effectiveness of the intervention in improving TB treatment adherence in a cluster randomized controlled trial, which showed no evidence for effectiveness of the intervention. The third study, conducted concurrently with the cluster trial, employed qualitative interviews to explore LHWs experiences with the intervention to identify ii aspects of the intervention found to be helpful and areas in need of improvement. Study 3 found that the intervention was well received and valued, with reported benefits to LHWs through improved knowledge and skills, and increased confidence. Suggestions for improvement varied considerably, with an anticipated concern with the lack of stipends and conduct of training on-site, raised as an issue by a minority of participants. Conclusion: This thesis suggests that a multi-component KT strategy tailored to address local barriers, was well received and valued by LHWs, and may represent a cost-effective approach to LHW training. However, given the trend for effectiveness did not reach significance in this underpowered study, further research is needed.

Background: Task shifting provision of basic health care services to lay health workers (LHWs) is increasingly employed to combat the global shortage of skilled health workers, particularly in low and middle income countries, where the shortage is greatest. Despite evidence for the effectiveness of LHWs in improving access to basic health services and positively impacting a variety of health outcomes, questions remain as to how recognized weaknesses in training and supervision are best addressed. This thesis employed a sequential-concurrent mixed-methods design and is composed of 3 studies with the objective of designing and rigorously evaluating a knowledge translation (KT) intervention tailored to address identified barriers to LHWs ability to function optimally as TB adherence supporters in Zomba district, Malawi. Methods & Findings: The first study utilized the qualitative methods of focus groups and interviews conducted with LHWs routinely involved in provision of care to TB patients. Lack of TB knowledge and job-specific training were identified as the key barriers to LHWs in their role as TB adherence supporters. Based on these findings, a KT intervention was developed and tailored to the identified training gaps. The second study, evaluated the effectiveness of the intervention in improving TB treatment adherence in a cluster randomized controlled trial, which showed no evidence for effectiveness of the intervention. The third study, conducted concurrently with the cluster trial, employed qualitative interviews to explore LHWs experiences with the intervention to identify ii aspects of the intervention found to be helpful and areas in need of improvement. Study 3 found that the intervention was well received and valued, with reported benefits to LHWs through improved knowledge and skills, and increased confidence. Suggestions for improvement varied considerably, with an anticipated concern with the lack of stipends and conduct of training on-site, raised as an issue by a minority of participants. Conclusion: This thesis suggests that a multi-component KT strategy tailored to address local barriers, was well received and valued by LHWs, and may represent a cost-effective approach to LHW training. However, given the trend for effectiveness did not reach significance in this underpowered study, further research is needed.

The systemic environment in children is characterized by factors that facilitate muscle and bone development. These systemic factors may help to regulate the growth of these tissues particularly when mechanical loading is minimal, as observed with low-impact exercise. Low-impact exercise induces an alteration in the systemic environment in children and adults, however the direct implications of these changes on muscle and bone development are unclear. The focus of this thesis was to examine the effects of exercise on systemic regulators of muscle and bone growth in prepubertal girls and women, and to determine whether changes in these systemic regulators can influence osteoblast and myoblast proliferation and differentiation. In addition, this thesis will also highlight the importance of translating knowledge in the form of an animation video about the effects of exercise on bone health. Our first study demonstrated that an acute bout of moderate intensity exercise elicits similar responses in systemic regulators (CX3CL1, FGF-2, and IGF-1) of muscle and bone growth in prepubertal girls and women, with exception of a higher inflammatory response (IL-6) in women. In our second study, we show that exercise does not elicit a proliferative response myoblasts and osteoblasts in vitro after treatment with serum collected from prepubertal girls and women. However, proliferation of osteoblasts and myoblasts was higher in women post- exercise relative to prepubertal girls. Moreover, there was no exercise effect on myotube formation in prepubertal girls and women, however mineralization decreased post-exercise in both groups. In our final study, we developed an animation video that summarizes the findings of this thesis to school-age children and explored the educational utility of this knowledge translation tool. Four salient viewpoints were identified in our cohort of children, each with varying degrees of engagement and attitudes towards the video. All participants expressed an improved understanding how exercise influences bone as evidenced by their consensus statement. Altogether, our data suggests that inflammatory responses induced by exercise are attenuated in children relative to adults, which can have an effect on myoblast and osteoblast proliferation. The decrease in mineralization observed after exercise may be indicative of increased bone remodeling followed by an anabolic bone response. Finally, the development of a knowledge translation tool proved to be feasible and beneficial in promoting awareness about the benefits of exercise on bone health. / Thesis / Doctor of Philosophy (PhD)

<p><em>Background:</em> Hospitalization is stressful, and anxiety is a common experience among hospital inpatients. Nurses who use a standardized patient anxiety assessment tool can improve their recognition of patient anxiety and its management. Implementing evidence-informed practice changes among nurses is a challenge, and there is little compelling evidence on how best to proceed with such implementations. Two theoretical frameworks that have shown promise for designing effective interventions among nurses are the Theory of Planned Behaviour (TPB), which focuses on individual determinants of behaviour, and Promoting Action on Research in Health Services (PARiHS), which focuses on the nature of the evidence, the context in which change is to take place, and the type of facilitation used to induce change. The current study attempts to fill a gap in our understanding of the relationship between the context of practice and nurses’ intention to adopt evidence-informed practices.</p> <p><em>Objective: </em>The purpose of this study was to investigate whether adding context among those variables derived from the TPB enhances prediction of nurses’ behavioural intentions to adopt an evidence-informed practice change.</p> <p><em>Methods: </em>Following an educational intervention aimed at teaching nurses the use of a tool for assessing patient anxiety, 174 participants (70% of those attending the educational classes) completed a survey measuring (1) attitude, ( 2) subjective norm, (3) perceived behavioural control, (4) context, and (5) intention to perform anxiety assessments. <em></em></p> <p><em>Results:</em> Intention to perform anxiety assessments on patients was greater for nurses who (a) perceived that they had control over performing anxiety assessments, (b) had a positive attitude toward providing such assessments, and (c) perceived their work context to be positive.</p> <p><em>Conclusion:</em> This study adds to our understanding of the variables influencing nurses’ adoption of evidence-informed practices. Context, defined in terms of leadership, culture, and evaluation, appears to influence individual adoption of evidence-based practices. These results suggest that the success of attempts to encourage health professionals to adopt evidence-based practices will be enhanced when contextual variables important to the success of the change intervention are put into place. Future research can build on the current study by seeking to replicate the findings reported here and expanding the list of contextual variables investigated.</p> / Doctor of Philosophy (PhD)