<p><strong>Research objectives</strong>: 1) Develop an online repository of policy-relevant documents addressing healthcare renewal in Canada; and 2) describe the general contents of policy-relevant documents addressing healthcare renewal in Canada. <strong>Methods</strong>: The methods for this study were iteratively developed using an approach similar to a scoping review. Documents were identified through website hand-searches and sixteen Canadian health organizations that contributed to the development of the online repository. The majority of organizations are government health ministries/departments or government-supported health organizations. The focus of the analysis was to calculate general descriptive frequencies of the distribution of documents included in the online repository, specifically: 1) the general characteristics of the documents, such as document type, publication year and jurisdictional focus; 2) document themes by national priority areas; 3) document themes by health system topics; and 4) contributing organizations. <strong>Results</strong>: A total of 304 documents were coded for inclusion in the online repository<br />(<a href="http://eihrportal.org/">http://eihrportal.org</a>). The Health Council of Canada contributed the largest amount of documents (n=60, 19%). The top three types of documents are health and health system data (n=75, 25%), situation analysis (n=72, 24%) and jurisdictional review (n=49, 16%). The top three national priority areas addressed in the documents are health human resources (n=270, 89%), quality as a performance indicator (n=210, 69%) and information technology (n=183, 60%). The least commonly addressed national priority areas are technology assessment (n=19, 6%), prescription drug coverage (n=68, 22%) and Aboriginal health (n=87, 29%). <strong>Conclusion</strong>: The process of developing a systematic method for identifying policy-relevant documents and retrieving useful information from these documents can be reproduced by anyone interested in using this type of evidence to inform their health policymaking. A number of implications exist for policy and research, both in Canada and in low- and middle-income countries, which have to be considered in relation to the unique nature of this type of evidence.</p> / Master of Science (MSc)

<p><strong>Background:</strong> Despite strong evidence, strategies for improving bone health are underutilized. Knowledge translation (KT) interventions aim to improve uptake of evidence-based practices, however the feasibility and effectiveness of such strategies require further evaluation within Long-term Care (LTC). In this thesis, we examined the impacts of a province-wide osteoporosis strategy and a more intensive multifaceted KT strategy including expert-led educational meetings, audit/feed-back, and action planning for quality improvement. Both studies targeted interdisciplinary LTC teams (physicians, nurses, pharmacists, dietician, and other staff).</p> <p><strong>Methods: </strong>In the first thesis study, we examined the impact of the <em>Ontario Osteoporosis Strategy for LTC</em> by investigating changes in facility-level prescribing rates (vitamin D, calcium, osteoporosis medications) before and after its implementation (2007 versus 2012). The second study was a pilot cluster randomized trial evaluating the feasibility and effectiveness of a 12-month, multifaceted, interdisciplinary KT intervention [Vitamin D and Osteoporosis Study (ViDOS)]. Prescribing outcomes included: vitamin D ≥800 IU (primary), calcium ≥500 mg/day, and osteoporosis medications (high-risk residents only). Feasibility outcomes included recruitment, retention, data collection, intervention fidelity, and process changes. We analyzed resident level data using the generalized estimating equations (GEE) technique, adjusting for clustering.</p> <p><strong>Results:</strong></p> <p>In both studies, significant improvements were observed for vitamin D and calcium prescribing. In the first study, prescribing increased by 38% and 4%, respectively, between 2007 and 2012. In the ViDOS trial, the 12-month intervention resulted in an absolute improvement of 15% and 7%, respectively (intention to treat cohort). There was no significant effect for prescribing of osteoporosis medications in either study. In the ViDOS study, recruitment and retention rates were 22% and 63%, respectively; good intervention fidelity was achieved and intervention homes reported several process changes.</p> <p><strong>Conclusion:</strong></p> <p>This thesis study demonstrated that KT interventions targeting evidence-based osteoporosis and fracture prevention strategies were feasibly and effectively applied with interdisciplinary LTC teams.</p> / Doctor of Philosophy (PhD)

<p>This thesis consists of three related studies presented as three separate manuscripts. The first two comprise part of a larger sequential mixed-methods study with a qualitative and subsequent quantitative (survey) component. The overarching goal of this study was to understand the factors that influence the use of home dialysis, from the perspectives of Canadian nephrologists. The third study was a methodological study (a clinical trial) embedded in the survey, evaluating a novel strategy to incentivize survey responses.</p> <p>In the first paper, we aimed to develop a theoretical framework describing determinants of dialysis modality choice. We selected informants using a maximum-variation sampling strategy, and used in-depth interviews to explore their perspectives. We used a grounded theory-informed analytical approach to construct a taxonomy of barriers and related facilitators to home dialysis use. We triangulated our findings against related published studies and qualitative results from our survey study. This study informed the development of the questionnaire that is the focus of the second study.</p> <p>The second paper describes the development, administration, and results of a 47-item survey measuring Canadian nephrologist perspectives on the relevance of barriers to home dialysis use, and the utility of candidate interventions to overcome them. We used factor analysis to aggregate items into domains, and examined the relationships between respondent and practice characteristics with domain-level scores. Respondents expressed enthusiasm and reluctance towards a number of strategies to optimize home dialysis use. Our findings will guide policy development and further research directed at managing barriers to home dialysis use.</p> <p>The third and final study tests the effectiveness of a promised donation as an incentive for survey completion. We randomized survey recipients to receive standard notifications versus notifications that offered a charitable donation of $40 CAD to the Kidney Foundation of Canada in exchange for returning a completed survey. Contrary to our hypothesis, the intervention was not effective, thus adding to the cumulative evidence that such incentives do not impact on physician response rates.</p> / Master of Science (MSc)

Background: Moving knowledge into healthcare practice and the implementation of innovations in healthcare organizations remain significant challenges. The objective of this study was to examine the key interpersonal-, organizational-, and system-level factors that influenced the implementation and use of an innovation – synoptic reporting tools – in three specific cases of cancer care. Methods: Using case study methodology, this study examined three cases in Nova Scotia, Canada, wherein synoptic reporting tools were implemented within clinical departments/programs. Three theoretical perspectives guided the design, analysis, and interpretation of the study. Data were collected through semi-structured interviews with key informants across four units of analysis (individual user, implementation team, organization, and larger system), document analysis, nonparticipant observation, and examination/use of the synoptic reporting tools. Analysis involved production of case histories, an in-depth analysis of each case, and a cross-case analysis. Results: Numerous factors – which existed at multiple levels of the system and which were often related – were important to the implementation and use of synoptic reporting tools. The cross case analysis revealed five common factors that were particularly influential to implementation and use across the three cases studied: stakeholder involvement, managing the change process, administrative and managerial support, the presence of clinical champions, and attributes of the tools themselves. Key factors distinct to one or two of the cases were: implementation approach, project management, resources, culture, leadership, monitoring and feedback mechanisms, and components of the healthcare system (e.g., care delivery structures, system infrastructure, and socio-historical context). The analyses suggested that several contextual factors, including the timing of implementation and technical requirements of the tool, contributed to the differences across cases. Discussion: This study contributes to our knowledge base on the multi-level factors, and the relationships amongst factors in specific contexts, that influence implementation and use of innovations such as synoptic reporting tools in health care. Importantly, the findings add to our understanding of several important issues that are under-developed in the existing literature in this area: organizational management; healthcare system components; interpersonal aspects of implementation, including stakeholder involvement; and the complex nature of implementation processes.

Upstream social determinants of health (SDH) have become widely acknowledged as lying at the root of poor health outcomes in Canada and globally. Conditions of social disadvantage restrict access to both social and physical resources, limiting the opportunity to actively pursue a healthy lifestyle. The Commission on the Social Determinants of Health maintains that educating the public about the SDH is a key step towards population health equity. Educating adolescents may be the most efficient and effective route of SDH knowledge dissemination, as youth are in a stage of peak learning, and are also easily reached through health education curriculum delivered in secondary school. However, health curriculum in Ontario is lacking in SDH content, placing a much greater emphasis on individual, lifestyle behaviors, such as diet, physical activity, and sax sex practices. Identifying a gap in SDH knowledge within this population, and evaluating the benefits of SDH education, is required to advocate for health curriculum revision to include SDH material. This project is designed as both a research study and SDH educational intervention. Concept mapping exercises were used to determine students’ knowledge of the determinants of health and the SDH. The impact of short term SDH education on student retention of SDH material was also evaluated. Student concept maps indicated that students attributed their health primarily to physical determinants versus social determinants; 44% of maps contained no SDH content. Statistical analyses prior to delivering the SDH lessons indicated that students’ SDH knowledge varied by their relative socioeconomic status (SES). Post-lesson analyses indicated however that student SDH knowledge increased significantly, and final levels of SDH knowledge following the SDH lessons was unaffected by socio-demographic variables. Findings suggest that 1) there is an SDH knowledge gap in the adolescent population, 2) an inequity in adolescent SDH knowledge exists across socio-economic factors, and 3) that SDH education can potentially eliminate the inequity in SDH knowledge. Current Ontario health curriculum requires revision to include SDH material. Designing curricula to have an optimal influence on both student learning and adolescent health requires greater communication and collaboration from both educational institutions and health agencies in Canada / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2012-09-27 08:49:09.739

Objective: The primary goal of this study is to understand what factors contribute to teachers and administrators involved in these projects viewing the YSS feedback reports as effective and useable in order to continue improving the design and content of the reports to encourage knowledge utilization and integration at the school level. Methods: This study employed a mixed methods approach that included both qualitative and quantitative methods of data analysis. Specifically this study employed a concurrent nested design wherein quantitative data analysis was performed concurrently within a predominantly qualitative study. The qualitative portion consisted of telephone interviews with YSS participants that had viewed their School Profile. The quantitative portion was a secondary data analysis that examined the relationship between a downloading behaviour outcome and various school characteristics and contextual factors. Results: Of the 57 eligible participants that were identified from the 2010-11 YSS sample, 8 participated in telephone interviews; in the quantitative analysis data from 448 of the schools that participated in the 2010-11 YSS were used. Overall interview respondents rated the School Profile as a valuable and utile KTA tool for them and their school communities. Aspects of the profile that contributed to its value were the tailored and quantitative information it provides; the clarity and readability of its design; the ease of accessing and sharing the profile in an electronic format; and the broad range of health topics covered in the Profile. Participants were also asked to discuss their use and sharing of the profile with almost all respondents indicating that they had shared the profile within their school and/or community. Instrumental and conceptual knowledge use were the most common forms described by participants. Participants also commonly expressed a desire for more resources to support the continued use and uptake of the Profile in their school and community. The quantitative analysis revealed a statistical relationship between location in certain provinces and downloading behaviour but no other predictor variables proved significant in the full logistic model. Conclusion: The findings have contributed to understanding what facets of the School Profile contribute to its value as perceived by the individuals using it and point to a few avenues of further investigation regarding the Profile and its function within the YSS. The positive response by interview participants indicates that the Profile in its current state is a valuable and useful tool, however the use of additional strategies to support its uptake and utilization could be improved. The findings that location in certain provinces, some of which have collaborative projects with the YSS, may influence Profile downloading and health outcomes within schools is a potentially important avenue for further investigation and refinement of YSS KE systems.

Thesis advisor: Jean M. Bartunek / This dissertation examines the knowledge translation from one professional community to another that has distinct priorities, values, and commutation styles: management academia to practice. More specifically, I examined knowledge translation in the form of converting peer-reviewed management research papers into practitioner-oriented research highlights. Drawing from archival and interview data, I conducted three interrelated empirical studies to investigate this phenomenon. In the first study, using the framework of Gatekeeping Theory (Lewin, 1947; Shoemaker, 1991), I examine the process and norms of how knowledge translators select from the vast amount of management research and decide which ones deserve to be translated toward practitioners. In the second study, I build on Communication Accommodation Theory (Giles, Coupland, & Coupland, 1991) to examine the processes, underlying motivations, and translation strategies of how knowledge translators conduct the knowledge conversion, especially how they manage the often conflicting demands between source knowledge producers and recipients of translated knowledge. In the third study, drawing on insights from the cross-cultural psychology literature, I examine how knowledge translators’ strategies may differ systematically when they write in two different languages toward audiences in two different cultures. This dissertation contributes to the knowledge translation literature, the academic-practitioner knowledge transfer literature, and the communication literature with insights on the micro-processes and strategies underlying knowledge translation, the generative tensions in this multi-party process, and the perceptions of and relationships between the academic and practitioner communities. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Carroll School of Management. / Discipline: Management and Organization.

Introduction: Applied occupational health research is complex and requires transparent communication between stakeholders to facilitate development and implementation of injury management strategies. Firefighting as a physically demanding, male-dominant occupation provides a unique context to develop and implement injury management strategies. Thesis Objectives: To investigate how individuals perform occupational tasks within a physically demanding occupational context considering the interrelationship between personal, task and environmental factors. A secondary objective was to evaluate the research partnership as integrated knowledge translation using the Knowledge-to-Action (KTA) Framework. Methods. A qualitative study was used to identify barriers and facilitators experienced by female firefighters. Dartfish movement analysis software was adapted to analyze kinematics associated with firefighter tasks. Relative and absolute reliability was used to establish measurement properties of Dartfish methods. Regression models identified the relative importance of individual factors on firefighter task performance. A case study of the research partnership using knowledge translation (KT) theory identified critical phases in developing occupational health research partnerships. Results. The qualitative study identified sex/gender and task/environment effects on firefighter task performance and injury risk. Tracking positional co-ordinate data using Dartfish demonstrated excellent relative reliability (ICC2,1 = 0.84-0.99) and lowest absolute reliability (SEM = 0.01m-0.11m). Strength was the strongest independent predictor of firefighter task performance time where increasing strength was associated with faster time. The case study identified components of the KTA Action Cycle that supported and described collaborative occupational health research. Conclusions. Although female firefighters share commonalities with their male counterparts, unique personal attributes and social experiences affect how they experience firefighting. Dartfish provides a reliable tool to measure kinematics in an applied context. Although refinements are required, recommendations for data collection and extraction using Dartfish in occupational contexts are provided. Occupational health research imbedded in KTA cycle confirms the importance of partnership with stakeholders to ensure the feasibility and relevance of the research. / Thesis / Candidate in Philosophy

Introduction: Cerebral Palsy (CP) is the most common cause of disability in children. Healthcare providers aim to facilitate optimal function and participation by working with children and their families. The success of this endeavor depends on shared understanding, collaboration, and contextual factors that affect resource availability. The aim of this thesis was to understand parents’ perspectives in Indian and North American cultures towards management of CP using an ICF lens, to evaluate the extent to which this lens is evident in literature conducted in an Indian context and to evaluate a Knowledge Translation (KT) resource to inform parents and healthcare professionals (HCP). Methods: In the five thesis papers: study 1 explored parents’ perspectives towards the management of their children with CP (qualitative design); study 2 described the contextual factors shaping parents’ perspective in India (reflective design); study 3 and 4, described the research trends in the management of CP in India (scoping review); and study 5 describes the development and evaluation of a KT resource created to inform parents about incorporating the ICFconcepts into management of CP. Results: The qualitative study identified that Indian parents focus more on Body Structure and Function (BSF) challenges and have more resource limitations, as compared to the Canadian context. The scoping review identified that research also focuses on BSF, with less research addressing activity and participation, or its environmental determinants. KT resources showing the application of the ICF concepts into CP management received widespread uptake and were perceived as helpful by parents and HCP. Discussion and Conclusion: ICF was useful for understanding and informing parents and HCP about management of CP. Despite the importance of environmental considerations and contextual factors, these were insufficiently addressed in the literature and in stakeholder perspectives. To optimize CP management across contexts, further research and KT is needed. / Thesis / Doctor of Philosophy (PhD) / Cerebral Palsy (CP) is the most common cause of physical disability in children. Parents and professionals from multiple disciplines work together to provide developmental support for children with CP. This thesis explored parents’ views about management of CP in India and Canada; assessed the scope of the scientific literature from India addressing CP; and developed and evaluated educational videos to inform parents and professionals about the use of the International Classification of Functioning, Disability and Health (ICF) in the management of CP. Parents’ views towards their children in both countries are influenced by the availability of resources, professional attitudes, and cultural beliefs. Research in India focuses on ‘fixing’ the child’s impairments. The videos developed to encourage parents and doctors to focus on increasing activity and participation in children, were judged to be useful in creating awareness about the use of the ICF in the management of CP.

<p>Hospitals are complex socio-technical systems where health professionals from varied backgrounds interact with each other and technology for the wellbeing of patients. Effective communication among the members of the care team is vital for optimal care; poor communication can result in suboptimal care and in many cases, lead to adverse events (AEs) and even death. More than a decade after the US Institute of Medicine report which catalyzed patient safety improvement measures, patient safety remains a major concern. Two-thirds of AEs in hospitals are still linked to communication errors. Hospitals are trying to improve communication by introducing new communication devices like smart phones and tablet computers for professional use. However, they are being deployed without adequate study of the mechanics of communication in hospitals or their use affects inter-professional communication. High risk organizations such as nuclear power plants, aviation and the military have achieved better safety records than healthcare. This is likely because they have studied their communication challenges and based their assessments on a firm theoretical foundation before implementing customized solutions. This approach in healthcare is lacking. Therefore a scoping review was conducted to collect communication theories, models, frameworks, and methods applicable to new information and communication technology used in hospitals. Literature from basic and applied science domains such as cognitive psychology, human factors engineering, organizational behavior, sociology, communication sciences and from high risk organizations like aviation, nuclear power generation and defense was reviewed. 14 theories, 12 models and 12 communication analysis methods were identified. One of the selected methods was employed to conduct a case study of a case of faulty communication reported in the AHRQ web M&M. It is not known how well those theories, models and analysis methods can be adapted to medicine. Future research may be able to address the issue and adopt theories and models to hospital communication research, modifying existing theories and models to suit the unique requirements of hospitals or by developing a strategy to design them de-novo.</p> / Master of Science (MSc)