Federal law mandates that transition plans and services be in effect for students with disabilities by the time they turn 16, in order to optimize students’ successful movement from high school into postsecondary areas including postsecondary education, competitive employment, independent living, and community participation. Despite currently available services, however, students with disabilities continue to exhibit worse outcomes than their peers in the aforementioned areas. Occupational therapists (OTs) have professional expertise and knowledge that may contribute to improved postsecondary outcomes for these students, yet the majority of school-based OTs do not work with transition age-youth or address goals related to transition planning. This may be due to OTs’ perceptions that other professionals handle transition services, lack of understanding of the role of OT by other team members, lack of funding within schools, and inadequate time on OTs' caseloads to address services not mandated in a student’s Individualized Education Program (IEP). Los Angeles Unified School District (LAUSD) is currently the second largest school district in the country and operates several Career and Transition Centers (CTCs) for students with disabilities aged 18–22. Following a literature review of OTs’ previous and potential role in transition, this paper proposes a model for an OT-led transition program for use within LAUSD. Supporting Opportunities for Adult Readiness (SOAR) is a multi-faceted and multipronged approach to team capacity building. It targets CTC staff and families, as well as district OTs, to maximize their skills and capabilities in supporting youth with disabilities as they transition into adulthood. The program is based on the Knowledge to Action framework (KTA), which posits that a deliberate and thoughtfully planned effort to disseminate knowledge with stakeholders will result in the more effective utilization of that knowledge. Using KTA as a road map, SOAR outlines a range of strategies, including trainings, consultations, publication of written materials, and models of ongoing support to best serve the target populations. SOAR presents a dynamic and evolving set of program activities that collectively can impact the perceptions and role of OTs within LAUSD. Methods for program evaluation and dissemination, as well as potential funding sources are discussed.

While holistic care is fundamental to occupational therapy (OT) practice, organizational and systemic factors often push for compartmentalized and specialist practice. Because services in many practice areas are compartmentalized, occupational therapy practitioners’ (OTPs) continuing professional development (CPD) efforts typically focus on one clinical specialty, and many often do not learn skills across different clinical areas. It is imperative that OTPs continue to learn and integrate knowledge across specialty areas so as to provide comprehensive and holistic care to all individuals who seek OT services. In addition to this, there is a known knowledge-to-practice gap that limits the implementation of research into practice. Numerous research studies (Summers et al. 2015; Stewart et al. 2020; Jones et al. 2015; Thomas et al. 2020) support the need for active engagement in CPD, implementing the most recent research into practice, and maintaining a holistic and integrated approach to healthcare. However, many clinicians experience barriers to the implementation of that knowledge, such as time, cost, staffing, and organizational influence. Healthcare organizations, on the other hand, must function in a competitive healthcare industry, by optimizing client outcomes while maintaining qualified and engaged staff. Occupational Therapists Fostering Unified Expertise and Learning (OT F.U.E.L.) was designed with these barriers in mind, and addresses them by creating a cost-effective, timely, and engaging platform for knowledge exchange across the profession of occupational therapy. OT F.U.E.L. is designed as an online community of practice, focusing on intra-professional social learning and knowledge implementation for OTPs working in the various siloed specialties of OT, including pediatrics, orthopedics/hand therapy, inpatient/outpatient rehabilitation, and mental health. The objective is to reconnect with the common roots and approaches of occupational therapy, and enhance practice skills and expertise — integrating clinical knowledge and skills from various clinical specialties across the profession. Overall group size will be limited to 16 participants, with subspecialty groups of approximately four members to ensure diversity of experience. The groups will be moderated by a “knowledge broker” who can facilitate interconnections between the specialty areas. There will be three phases to the piloting of this program. In the initial pilot (Phase 1), participants will be OTPs who are also fieldwork educators (FWEs), recruited using established affiliations with an entry-level Master of Occupational Therapy program. For the pilot, FWEs will be recruited through their employer in order to get organizational buy-in for their engagement in the program, as well as encouragement from management to participate. A secondary objective for this approach is to demonstrate the value of organizational support of professional development during established work hours. Phase 2 of piloting will involve running the program through other Universities in a variety of regions within the United States. Phase 3 will be potential dissemination through the American Occupational Therapy Association (AOTA). Ultimately, OT F.U.E.L is expected to result in several intermediate and long-term outcomes, including OTPs increased the confidence and competence with integrating skills and concepts across specialty areas in their practice. By reducing the barriers and facilitating the implementation of new knowledge, the clients will benefit, and likely demonstrate improved outcomes.

Introduction: In a mixed-methods study I assessed the role of social networks as predictors and outcomes of the implementation of an intervention to promote evidence-informed decision-making (EIDM) in three public health departments in Ontario, Canada. The quantitative strand included the analysis of the role of staff’s position in networks on the adoption of EIDM, the longitudinal evolution of networks, and the association between the name generators’ position in surveys and respondents’ motivation to answer survey questions. The qualitative strand aimed to explain and contextualize the quantitative findings. Methods: A tailored intervention was implemented in the public health departments, including the mentoring of staff through the EIDM process by a knowledge broker. The staff participated in three online surveys before and after the 22-month intervention, providing the names of peers to whom they turned to seek information, whom they considered as experts, and their friends. I assessed the dynamic evolution of social networks, and the role of local opinion leaders (OL) in promoting the adoption of EIDM. I interviewed key network actors about their interpretation and experience regarding the quantitative findings. Results: Overall, there was no statistically significant impact on EIDM behavior and skill in health departments. However, the analysis of the role of OLs in behaviour change showed that non-engaged staff who were connected to highly engaged OLs, and those OLs who communicated with each other improved their EIDM behavior. Social networks became more centralized around already popular staff due to selective training of recognized experts. Highly engaged staff tended to connect to each other, and to limit their connections within organizational divisions over time. In the department where multiple activities were being implemented to support EIDM, the highly engaged staff became more popular due to department-wise presentations and informal information spread. I also found that when name generator questions are asked later in surveys then respondents are more likely to refuse, indicate they do not know anyone, or provide fewer names than when these questions are asked earlier Conclusion: Social network analysis showed the structure of information-seeking relations, the impact of opinion leaders on the EIDM behavior of their peers, and underlying social changes through implementing an EIDM intervention. These findings can inform the design and tailoring of EIDM interventions in public health organizations. / Thesis / Doctor of Philosophy (PhD) / In three public health departments in Ontario, where we offered an intervention to a group of staff on how to use more research evidence in practice, I studied how the pattern of communication among staff influenced their use of evidence, how those communications changed over time, and how the staff themselves viewed those changes. In the department that largely promoted staff engagement in the intervention, the staff who were engaged became more popular over time. In all departments, already popular staff became more popular. The staff who sought information from popular people engaged in the intervention, and those popular people who communicated with each other used more research evidence over time. Network analysis helped reveal the social structure and identify popular staff and could be used to inform similar interventions. It also showed how selecting and training a group of staff can change the way people communicate in health departments.

This dissertation presents a body of research consisting of 5 scientific papers with an overarching objective to develop and test interventions that can enhance the dissemination, access and use of current best evidence at the point of care. Questions constantly arise from clinicians’ interactions with their patients, but more than 60% remain unanswered. The first 4 papers therefore focused on evidence dissemination to clinicians and trainees looking for answers and trying to stay alert to new evidence. We used as our “laboratory” an online tool developed at McMaster University’s Health Information Research Unit, the MacPLUS Federated Search (MacPLUS FS), which allows busy clinicians to search multiple top high quality resources simultaneously and display a 1-page output with the most clinically useful results at the top. Guided by effective models for the teaching of clinical skills at the point of care, we designed 3 web-based interventions addressing logistical and educational barriers to increase the quantity and quality of searching for current best evidence. These interventions were: (A) a web-based Clinical Questions Recorder and Reminder; (B) an Evidence Retrieval Coach composed of 8 short videos embedded in MacPLUS; (C) and a Gamified Audit & Feedback based on the allocation of “badges” and “reputation scores” for evidence searching. We tested these interventions in 4 factorial randomized-controlled trials among 1,868 heath care professionals and students currently registered in MacPLUS FS, namely: 477 medical faculty members, 431 postgraduate medical trainees, 725 nursing students and 235 medical students. Results showed that these target populations substantially differed both in their baseline frequency of search and access to alerts, as in their responsiveness to the 3 web-based interventions on evidence utilization. Evidence summaries have traditionally been tailored to meet the educational needs of clinicians, but are seldom provided in a format that supports shared decision-making. Our fifth paper explored a potential solution, which constitutes another route for evidence dissemination and use. In a project called SHARE-IT, we developed a new framework and online prototype for the generic production of decision aids, which allow physicians and patients to discuss the evidence together in the clinical encounter. We present the framework, design methods and early testing of this generic approach, which showed promising results for the translation of evidence summaries into useful tools for shared decision-making. / Thesis / Doctor of Philosophy (PhD)

Background: Although research in healthcare transition is not novel, youth with chronic health conditions (YCHC) and parents still struggle with this complex process. Currently, there is limited theoretically-driven studies to inform transition research. The key foundation of this thesis is on the integration and application of theories and conceptual frameworks to studying the complexities of the transition process to inform research on a conceptual level. Purpose: Three study objectives were: 1) to gain a better understanding of the experiences of YCHC, parents, and healthcare providers with self-management during the transition process; 2) explore theoretical frameworks to guide research in transition and inform the planning and delivery of holistic transition services that is developmentally appropriate and culturally sensitive; and 3) to identify strategies to facilitate knowledge mobilization in transition. Methods: This “sandwich thesis” includes four individual scholarly works (Chapters 2-5) positioned between the introduction (Chapter 1) and the conclusions (Chapter 6). The Knowledge to Action (KTA) framework was used to framed all of my four scholarly works together. Chapter 2 was a qualitative study to examine the collective experiences YCHC, parents, and healthcare providers with self-management during transition. Chapter 3 was a critical appraisal of the literature to explored the potential application of acculturation theory in transition through the use of a clinical vignette. Chapter 4 was a scoping review about the current use of the ICF and transition research and practice. Chapter 5 was a demonstration project with the primary aim of working with youth (i.e. university students with and without a disability) and researchers to identify engagement strategies in research to develop partnerships to facilitate knowledge mobilization. Results: Key findings of Chapter 2: i) the process of self-management is interconnected and interdependent between YCHC, parents, and healthcare providers, and ii) results began to uncover cultural nuances between pediatric and adult healthcare. Key findings of Chapter 3: i) acculturation theory provides a concrete conceptual framework to guide thinking about the process of change within an individual with a change in culture to another; and ii) acculturation can become a natural framework for health systems practitioners when integrated into clinical practice frameworks. Key findings of Chapter 4: i) the ICF broadens our view on health to include personal and environment factors, and ii) the ICF enhances multidisciplinary communication and collaboration. However, the ICF is not without limitation. Specifically, there are limited descriptions around personal and environmental factors and the underlying processes, defining differences between the domains of activity and participation, and the ICF’s static nature which does not address change over time. Key findings of Chapter 5: five engagement strategies: 1) creating a physical or virtual hub with updated information or updating current websites to ensure usability and accessibility (e.g. for course selection), 2) hosting “speed dating” events between students and faculty/researchers to enhance communication and knowledge exchange, 3) hosting monthly lectures/workshops/webinars, 4) capacity building via emailing lists for new opportunities, and 5) peer mentoring to connect stakeholders within the University and Hamilton communities. Conclusions: Synthesis of the knowledge from this thesis contributes to the thinking and doing of transition research. Specifically, acculturation theory (a social science and psychology theory) and the International Classification of Functioning, Disability, and Health (ICF) (a bio-psycho-social theory) are offered as complementary conceptual frameworks to inform transition research. Stakeholder involvement in transition research is critical in facilitating knowledge mobilization, however, researchers need to consider the challenges of research partnership with YCHC. It is recommended to explore and assess opportunities for YCHC to have experiences starting in childhood and through adolescence; these experiences can assist in building YCHC’s capacity to assume adult roles and responsibilities for self-management. / Thesis / Doctor of Philosophy (PhD) / Today, one in five Canadian children, adolescents, and young adults live with a chronic physical, developmental, behavioural or emotional condition that impact their developmental trajectories. Youth with chronic health conditions (YCHC) and their families find it difficult to go from pediatric to adult healthcare. Although the topic of transition is not new, YCHC and parents continue to experience barriers in the adult system for meeting their needs (e.g. fragmented services, accessibility to available services, and biomedical focus of healthcare to name a few). Moreover, research evidence is not reaching the people who need it most, YCHC and their parents, and they are not benefitting optimally from advances in research. Thus, research is needed to carefully examine the process of transition to better understand the underlying processes, to identify current knowledge gaps, and to facilitate knowledge mobilization. The overall aim of this thesis is on the application of theories (acculturation theory) and frameworks (International Classification of Functioning, Disability, and Health-ICF) to provide a new outlook and lens to unraveling the complexities and underlying processes of transition, which has not been examined before. The Knowledge to Action (KTA) framework is used to inform the research process and stakeholder consultation to facilitate knowledge mobilization. The goal is to ultimately produce meaningful and relevant outcomes for YCHC and those involved in the transition process. YCHC and other stakeholders (parents, healthcare providers, community partners, and policymakers) were consulted throughout all of the components of the thesis ensure their voices and needs were heard. Results from this thesis will bring new insights and knowledge to those involved in transition research and practice.

In just over a decade, exome sequencing and genome sequencing (ES/GS) has transitioned from a research method to an implemented test for patients with suspected rare genetic diseases (RGDs) worldwide, and healthcare systems are challenged to optimize its use within their jurisdictions. This thesis aimed to examine the rapidly evolving scientific evidence base related to ES/GS and how it has been translated into diagnostic care for families with RGDs to inform practice and policy in the future. Guided by the Knowledge-to-Action (KTA) conceptual framework, I designed and conducted three original studies: two aimed to generate evidence related to the KTA concept of Knowledge Creation, and the third studied the Action Cycle. In Article 1, we examined the knowledge base and determined that evidence related to the etiologies of RGDs and analytical processes related to ES/GS testing are progressing at a pace that has diagnostic implications. Next, in Article 2, we examined knowledge refinement and found that one knowledge user, organizations representing genetics professionals, have produced clinical recommendations related to a broad range of topics connected to ES/GS for RGD diagnosis, but the quality of clinical guidance documents is low, overall, and with specific reference to the rigour of the methods developers used. Finally, in Article 3, we studied the Action Cycle and found that implementing publicly-funded ES/GS using a set of clinical eligibility criteria in the Ontario healthcare system resulted in clinically-valid diagnoses for patients that met provincial benchmarks for diagnostic yield. Together, the results of these studies informed eight considerations for optimizing ES/GS testing with implications for healthcare practitioners, patients, guidance developers, payers, and researchers. Importantly, this thesis provides evidence of the necessity for continued evaluation and improved guidance development related to ES/GS to optimize this testing. It offers a foundation for future studies that may investigate knowledge translation into policy and practice in this and other rapidly evolving fields. Ultimately, these findings will enable better diagnostic care for families with RGDs.

In many academic disciplines, there are promising discoveries and valuable information, which have the potential to improve lives but have not been transferred to or taken up in ‘real world’ practice. There are multiple, complex reasons for this divide between theory and practice—sometimes referred to as the ‘know-do’ gap—and there are a number of disciplines and research fields that have grown out of the perceived need to close these gaps. In the field of health, Knowledge Translation (KT) and its related research field, Implementation Science (IS) aim to shorten the time between discovery and implementation to save and improve lives. In the field of humanitarian development, the discipline of Communication for Development (ComDev) arose from a belief that communication methods could help close the perceived gap in development between high- and low-income societies. While Implementation Science and Communication for Development share some historical roots and key characteristics and IS is being increasingly applied in development contexts, there has been limited knowledge exchange between these fields. The aim of this paper is to provide an overview of the characteristics of IS and ComDev, analyze some key similarities and differences between them and discuss how knowledge from each could help inform the other to more effectively achieve their common goals.

<p><strong> Objective:</strong> The purpose of this systematic review is to identify the effectiveness of KT strategies used to promote evidence-informed decision making (EIDM) among public health decision makers.</p> <p><strong> Methods: </strong>A search strategy was developed to identify primary studies published between 2000-2010.<strong> </strong>Studies were obtained from multiple electronic databases, supplemented by checking the reference lists of included articles and background papers. Two independent reviewers screened studies for relevance, assessed methodological quality and extracted data from relevant studies using standardized tools. Disagreements were resolved through consensus.</p> <p><strong> Results: </strong>The search identified 92, 548 titles related to KT interventions. After duplicate articles were removed 64, 391 were imported into Distiller SR of which 345 articles were deemed potentially relevant on double title and abstract review. Of the 345 articles, 30 met all relevance criteria on full text screen and after revisions to the inclusion criteria, 6 studies of moderate quality were included in this review.</p> <p>KT interventions tested in the systematic review included organization change, provider reminders, education, financial incentives and feedback. Interventions tested in the five primary studies ranged from; educational sessions; dissemination channels including print, CD-ROM and Internet; technical assistance and staff training; and web-based services such as databases, information services, registries of pre-processed research evidence and tailored targeted messaging.</p> <p>KT strategies shown to be less effective included access to registries of pre-processed research evidence or print materials. Simple or single KT interventions were shown in some circumstances to be as effective as multifaceted ones including organizational change, provider reminders and tailored targeted messaging. While knowledge brokering did not have a significant effect generally, results suggest that it did have a positive effect on organizations with low research culture.</p> <p><strong> Conclusion:</strong> KT research in public health is in early stages. Single interventions can be effective. Researchers and practitioners must pay attention to contextual factors.</p> / Master of Science in Nursing (MSN)

The purpose of this dissertation was to test the utility of theories across the development, implementation, and evaluation of three nationwide knowledge translation (KT) interventions in the physical disability community. Using a theory-based evaluation guided by the Theory of Planned Behaviour (TPB), Study 1 evaluates the effectiveness of an evidence-based, continuing education module designed to increase emergency health care professionals’ (HCPs) knowledge and use of clinical practice guidelines for managing patients with spinal cord injury (SCI) who present with autonomic dysrefexia. Findings suggest that behaviour change theory should be integrated into the intervention to change theory-based determinants of behaviour, and that information about intervention implementation may help explain observed outcomes. Study 2 examined the use of theory across three phases of research in the Canadian Paralympic Committee’s Changing Minds, Changing Lives (CMCL) intervention. Study 2.1 describes the restructuring of the CMCL curriculum to include research evidence and theory. Study 2.2 evaluates the short- and long-term effects of the CMCL intervention on HCPs’ social cognitions for discussing leisure-time physical activity (LTPA), and explores key implementation variables that predict changes in HCPs’ social cognitions. Overall Study 2 results suggest that: (1) using a KT framework and integrating stakeholders throughout intervention development increases the likelihood that interventionists will adopt and implement the intervention, and (2) real-world implementation is important to understanding intervention effectiveness. Study 3 examines the effectiveness, and its implementation correlates, of Get in Motion (GIM), a nationwide, LTPA-enhancing telephone counseling service for adults with SCI. Study 3 furthers our understanding of the relationship between implementation and effectiveness, and suggests key implementation ingredients that could be targeted in future refinements of GIM. Together, the dissertation studies contribute to our understanding of how to use theory when developing, implementing, and evaluating behaviour change interventions targeting HCPs and other end-users in the physical disability community. / Dissertation / Doctor of Philosophy (PhD)

Multidisciplinary cancer conferences (MCCs) are prospective meetings to discuss diagnoses and treatment plans for patients with cancer. MCCs are typically attended by surgeons, medical and radiation oncologists, pathologists and radiologists. To date, the quality of MCCs, specifically MCC decision making, has not been formally evaluated in a Canadian context. We utilized progressive knowledge translation methodology, specifically the use of theory, models and an integrated knowledge translation approach, to design, implement and evaluate an intervention, titled the KT-MCC Strategy (KT-MCC). The purpose of the KT-MCC is to improve the quality of MCC decision making. This thesis is comprised of four parts. In Part 1, we completed a generalizability study to evaluate the reliability of an MCC assessment tool (MTB-MODe) in an Ontario context. In Part 2, we conducted key informant interviews using the Theoretical Domains Framework (TDF) to identify barriers and facilitators to optimal MCC decision making. In Part 3, we mapped identified TDF barriers and facilitators to the COM-B Behavioural Change Wheel to develop the KT-MCC, an intervention aimed at improving the quality of MCC decision making. In this study, we examined the validity of the key informant findings using focus groups and surveys completed by individual MCC participants. In Part 4, we conducted a before-and-after pilot study to evaluate the feasibility and impact of the KT-MCC on MCC decision making in preparation for a possible randomized controlled trial testing the efficacy of the KT-MCC. There are few examples in the KT literature that provide a complete and detailed description of the design, implementation and evaluation of a complex KT strategy using progressive KT methods such as TDF interviews to identify barriers and facilitators to practice change; the COM-B model to identify potential interventions; and use of integrated KT with front-line workers. We describe in detail our methods to design, implement and evaluate the KT-MCC. This thesis provides a significant contribution to the knowledge translation literature and provides recommendations to improve the quality of MCCs in Ontario. / Thesis / Doctor of Philosophy (PhD) / Multidisciplinary cancer conferences (MCCs) are regular meetings held by health professionals to prospectively discuss diagnoses and treatment plans for patients with cancer. The purpose of MCCs is to facilitate input from numerous experts to ensure that each patient receives an optimal treatment recommendation. To date, the quality of MCCs, specifically MCC decision making, in Ontario has not been formally evaluated. We aimed to identify gaps in Ontario MCC decision making and design an intervention to mitigate these gaps. The intervention was designed using an integrated knowledge translation approach, meaning MCC participants were involved in the design, implementation and evaluation of the intervention. The resulting intervention, called the KT-MCC Strategy, was evaluated at four Ontario MCC sites. This thesis provides a significant contribution to the knowledge translation literature and provides recommendations to improve the quality of MCCs in Ontario.