Parents of children with autism shoulder substantial responsibility for navigating intervention to address autism-related concerns, and face conditions of high uncertainty and stress to do so. There is a lack of holistic research explaining how parents cope and respond to the complexity and obstacles that characterize their situation as they navigate multiple forms of intervention across multiple systems of care. The purpose of this qualitative study was to develop a social psychological explanation in the form of a substantive theory of how Ontario parents of children with autism navigate intervention under complex informational conditions. I used grounded theory methods, a constructivist approach and symbolic interactionist analytic framework for this research. The findings are primarily based on 45 in-depth (90-minute) interviews with 32 mothers from different urban and rural Ontario regions (fathers participated in 3 cases), and 9 professionals with expertise supporting parents. Documents were also analyzed. The central process of navigating intervention, labeled making your own way, consists of adjusting to the need to navigate intervention, in which parents construct the meanings that prepare and motivate them for taking action to navigate intervention. Adjusting consists of 4 interdependent sub-processes that together explain parents’ action: defining concerns, informing the self, seeing what is involved, and emotionally adapting. I portray the central process according to three overlapping heuristic stages: beginning the autism journey, handling transitions, and easing off. Many parents develop a strong sense of urgency to which they can respond by going into high gear, expending substantial personal resources sometimes at unsustainable rates in the pursuit of intervention. The findings have implications for supporting parents to improve outcomes including parent stress. The central process of making your own way is generically transferrable to other healthcare consumer populations. Other conceptual elements have theoretical relevance for consumer-centered areas of health research. / Thesis / Doctor of Philosophy (PhD) / Parents of children with autism shoulder significant responsibility for navigating many varying services and treatments (intervention) to address autism-related concerns, and experience great uncertainty and stress as they do so. There is a lack of research explaining how these parents respond to the complexity and obstacles they encounter as they navigate intervention. Using qualitative research methods, I interviewed 32 urban and rural Ontario parents (mostly mothers) and 9 professionals with expertise supporting parents to understand in detail how parents respond to their situation by making their own way to intervention. The resulting analytic findings have implications for improving support for parents of children with autism to reduce stress in their lives and improve other outcomes. The theory developed is also relevant for understanding how other healthcare consumer populations navigate intervention, and contributes to general knowledge in different consumer-centered areas of health research.

Background: There is limited research on how web-based, point-of-care, evidence-based medicine (EBM) tools, such as evidence summaries, are being implemented and used in developing countries. Objectives: To investigate accessibility, use, and impact of an online EBM knowledge dissemination portal in orthopaedic surgery. To explore whether receiving daily targeted evidence summaries results in more frequent use of an EBM tool compared with receiving general weekly reports. To identify and explain the barriers and benefits of a point-of-care resource in the Indian context. Methods: Forty-four orthopaedic surgeons in Pune, India, were provided free access to OrthoEvidence (OE), a for-profit, online EBM knowledge dissemination portal. Participants were subsequently randomized to an Intervention group receiving daily targeted evidence summaries or a Control group receiving general weekly summaries. This study employed an explanatory sequential mixed methods design that incorporated two questionnaires, OE usage data, and semi-structured interviews to gain insight into the surgeons’ usage, perceptions and impact of OE. Results: There were no observable differences in OE usage between the Intervention and Control groups. OE was deemed to be comprehensive, practical, useful, and applicable to clinical practice by the majority of surgeons. The exit survey data revealed no differences between groups’ perceptions of the OE tool. Semi-structured interviews revealed barriers to keeping up with evidence that included limited access to relevant medical literature (limited internet connection, lack of time, minimal access to medical journals) and limited incentive to keep up with it (limited decision-making powers for residents, textbook-based residency curriculum, lack of research methods knowledge, limited context-specific research). Changing trauma practices at the hospital were noted following the intervention. Recommendations: The practice of EBM and the use of point-of-care tools in India can be promoted by investing in adequate electronic infrastructure (improvements to internet access) and by integrating EBM into training programs and surgical cultures. / Thesis / Master of Science (MSc)

<p>The purpose of this study was to explore and describe the experiences of academic and decision-maker researchers participating in a public health integrated knowledge translation (IKT) and exchange program of research in Ontario and British Columbia. This research sought to identify structures and processes that acted as enablers or barriers for all partners on a research team as they engaged in collaborative research. The researcher answered the following research questions: <em>What are the experiences of academics and decision-makers participating in the first two years of an integrated knowledge translation program of research?</em> <em>What structures and processes positively and negatively influence the engagement of partners on the collaborative research team?</em> Through answering these two questions the research contributes relatively new knowledge in the form of strategies for engaging academics and decision-makers engaging in collaborative public health systems and services research.</p> <p>A qualitative descriptive approach was used to gain a contextual understanding of experiences of participants in the IKT research program. Twelve semi-structured, one-on-one interviews were conducted with academic and decision-maker researchers working in British Columbia universities and Health Authorities. Qualitative content analysis of transcripts was used to explore and identify concepts emerging from the data.</p> <p>Data analysis identified IKT processes and concepts that encompass and underlie a collaborative research team. An overarching systems approach is used to examine the evolution of the collaborative team. Themes are presented in relation to IKT engagement concepts identified from the literature as well as those that emerged from analysis including: establishing and maintaining relationships, communication, capacity building, multidirectional knowledge sharing, and multidisciplinary capacity.</p> <p>By examining experiences of research partners representing both academia and decision and policy-making, this research contributes new knowledge about strategies to support collaborative health services research which can subsequently strengthen the Canadian public health systems and services research agenda.</p> / Master of Science in Nursing (MSN)

<p>Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is the most preventable cause of death in hospitalized patients. Due to its high mortality, morbidity, and cost, health care providers are obligated to not only effectively diagnose and treat VTE, but also to prevent it if possible. This has been reinforced by a number of national and international quality initiatives to prevent hospital-acquired VTE. Despite the existence of well-accepted clinical practice guidelines on VTE prophylaxis, 1 in 3 hospitalized medical patients receives an inappropriate VTE prophylaxis strategy. Both underuse of prophylaxis in patients with VTE risk, and overuse of prophylaxis in patients without VTE risk are problems. The use of inappropriate VTE prophylaxis strategies is likely due to the complexity and heterogeneity of hospitalized medical patients, and the difficulty of applying “one size fits all” practice guidelines to this group. Institution-wide knowledge translation strategies are required to close the gap between evidence and practice, and promote evidence-based VTE prophylaxis strategies in hospitalized medical patients. The objective of this thesis is to design a cluster randomized controlled trial to determine if a standardized electronic order set, with an embedded computerized decision support system and audit and feedback component, affects the use of appropriate VTE prophylaxis in hospitalized medical patients. The unit of randomization in this study is the hospital, which serves as the cluster. The unit of observation in this study is the individual patient. The primary outcome of this study is the proportion of in-hospital days during which appropriate VTE prophylaxis is administered, in intervention versus control hospitals. Secondary outcomes are the rates of hospital-acquired VTE, major bleeding and mortality, in intervention versus control hospitals. Design, analytic and ethical challenges unique to cluster randomized trials will also be discussed. Strategies to overcome them in this trial will be presented.</p> / Master of Science (MSc)

<p>This thesis was successfully defended on January 15, 2014 at McMaster University.</p> / <p>Understanding why policies change is an important pursuit for researchers and policy-makers alike. Research evidence is one of many possible factors that encourage or constrain policy change, as is the role of ‘networks’ of policy actors. Despite extensive empirical literature on each of evidence-informed health policy and policy networks, the two have rarely been studied together, particularly in low-income country policy environments. This thesis explores both of these variables in a broader structural context of institutions, interests and ideas. Concepts and approaches from social network analysis are applied to three distinct research questions and chapters with the objective to: 1) develop and test a conceptual framework for the integration of networks, institutions, interests and ideas as major variables explaining policy change; 2) test the relationship between policy network structure (closure and heterogeneity) on the use of research evidence and innovation across the three cases; and 3) model the factors that influence the formation of an evidence exchange relationship between policy actors, and the effect of those exchanges on actor-level use of research evidence. Taken together, the findings of this dissertation present persuasive support for adopting a network lens to study evidence-informed health policy and policy change.</p> / Doctor of Philosophy (PhD)

There is a pandemic of low-value clinical care that threatens the sustainability of our publicly funded healthcare systems. Over 30% of the health services provided to patients provide no benefit or may actually result in harm. Health services research is needed to critically evaluate our clinical practices and programs to ensure we create systems that consistently deliver high-value care. Unlike drug trials, health services research is complicated by enormous heterogeneity across cultures, environments, behaviours and systems. Ideally, local research communities should devise and conduct health services research to ensure that both the research questions and outcomes are relevant to community members, and thus more likely to result in sustainable healthcare systems. Embedded researcher models are emerging as a viable approach to supporting local research activities. Embedded researchers are part of the community they serve, provide research expertise to local investigators and community members, and help develop local research systems that facilitate health services research activities. While they may still collaborate with academic partners, this is not necessary for their research success. This thesis documents the transformation of a large community hospital in Ontario into a learning health centre through the use of an embedded researcher model. The first part of the thesis is focused on the results of incorporating an embedded research plan into the hospital’s new antimicrobial stewardship program. The research that emerges from this work contributes new knowledge about the value of antimicrobial stewardship to important patient outcomes such as reduced lengths of hospital stay and rates of Clostridium difficile infections. The thesis concludes with a discussion of the implementation of all the necessary components needed to support a learning health centre and how an embedded researcher model facilitated this transformation and could be used by any similar organization to achieve the same result. / Thesis / Doctor of Philosophy (PhD) / Over 30% of the health services provided by our healthcare systems does not benefit and may actually harm patients. Health services research is therefore a necessary activity required to reduce this waste. In Ontario, over 65% of patients receive their acute care in large community-based hospitals, and yet, these hospitals have minimal research activity and capacity despite repeated attempts by the academic research community to engage these institutions through a variety of collaborative models such as integrated knowledge translation. This thesis provides a blueprint for the transformation of a large community hospital into a learning health centre through the use of a locally created, locally relevant, embedded researcher model. Starting with a proof of concept through the systematic evaluation of an antimicrobial stewardship program, the thesis ends with a ‘how to’ guide for the implementation of the foundational elements needed to support health services research in similar organizations.

Le transfert de connaissances (TC) est un processus de collaboration entre les producteurs de connaissances (principalement des chercheurs) et les utilisateurs des connaissances (communautés, intervenants et décideurs) impliquant de nombreux éléments comme la synthèse, la diffusion et le partage. Cette thèse a pour objectifs de comprendre le TC dans différents projets de recherche et pratiques de gestion et de proposer une feuille de route de TC adapté au contexte brésilien. Plus spécifiquement, elle visait à : i) décrire trois projets comme exemples de trois modalités différentes de TC, ii) effectuer une analyse rétrospective des actions et stratégies de TC mises en œuvre par trois projets du réseau PDTSP-Teias couvrant la période de 2009 à 2013, et iii) vérifier comment la participation au réseau PDTSP-Teias a facilité le TC entre les producteurs et les utilisateurs de connaissances. À cette fin, cette thèse examine les pratiques de TC entre la recherche en promotion de la santé et la pratique de la santé dans le Programme de développement et d'innovation technologique en santé publique / Programa de Desenvolvimento e Inovação Tecnológica em Saúde Pública (réseau PDTSP-Teias). Un plan de TC existant de l'Institut national de santé publique du Québec (INSPQ) a été utilisé comme cadre théorique pour orienter l'approche déductive-inductive utilisée pour générer et analyser les données provenant des documents, d‘entrevues et de groupe de discussion. Méthodes : Cette thèse a utilisé une étude de cas multiple rétrospective qualitative avec trois cas imbriqués dans le réseau PDTSP-Teias. L'accent était mis sur des questions suivantes : i) quelles approches de TC le réseau PDTSP-Teias a-t-il adoptées, ii) quelles actions et stratégies de TC les trois projets du réseau PDTSP-Teias ont-ils mis en œuvre, et iii) comment la participation au réseau PDTSP-Teias a-t-elle facilité le TC entre les utilisateurs et les producteurs de connaissances. Les données empiriques comprenaient l'analyse de documents (rapports, ouvrages et articles scientifiques), des entretiens semi-structurés avec des producteurs de connaissances (N = 9) et un groupe de discussion avec des utilisateurs des connaissances (N = 4 participants). Les entretiens portaient sur le développement des projets, l'élaboration de produits de TC et l'interaction entre les producteurs et les utilisateurs de connaissances. Résultats : En ce qui concerne le premier objectif, nous avons pu distinguer différentes expertises, approches et pratiques de TC des groupes de recherche. De cette première analyse, des exemples de trois pratiques différentes de TC ont été identifiés comme étant Majoritaire, Modéré et Peu ou Pas du tout. Ces exemples ont ensuite été analysés à l'aide des huit dimensions proposées par le cadre théorique utilisé. Le deuxième objectif a constaté que six des huit dimensions analysées semblaient être mieux intégrées dans les projets : D1 Analyse du contexte et besoins des utilisateurs, D2 Connaissances à traduire, D3 Connaissances sur les utilisateurs des connaissances, D4 Partenaires de TC, D5 Stratégies de TC et D6 Approche globale de TC. Cependant, deux dimensions étaient moins bien intégrées : D7 L'évaluation de TC et D8 Les ressources. Le troisième objectif nous a permis de constater que le manque d'évaluation des projets de TC, les questions liées aux ressources financières des projets de TC, le manque de soutien organisationnel et politique pour les projets de TC, et le manque d’outils conceptuels de TC pour la mise en œuvre des projets sont des obstacles au TC au Brésil. Toutefois, la participation au réseau PDTSP-Teias semble avoir favorisé les pratiques de TC. Ces résultats ont fourni une description et une analyse approfondie de la complexité des pratiques de TC contribuant ainsi à une meilleure compréhension des pratiques de TC au Brésil. Conclusion : Compte tenu de la manière dont les cas ont été caractérisés, on peut conclure que les pratiques de TC peuvent être très différentes même dans un contexte et des conditions de recherche similaires. Ces pratiques TC contrastées peuvent être dues à l'absence d'un outil conceptuel de TC approprié. Un tel outil peut combler le vide dans les approches et stratégies de TC du Brésil. Ainsi, l'adaptation du plan de TC du INSPQ peut permettre l'évolution du dialogue entre les producteurs et les utilisateurs de connaissances dans les projets de recherche, comprendre le contexte, et contribuer à la validation et à l'adoption des produits de TC. Ces changements profiteraient au changement des connaissances, des attitudes et des comportements des différents groupes impliqués. Enfin, cette thèse propose une adaptation fondamentale du plan de TC du INSPQ au contexte brésilien. / Knowledge translation (KT) is a collaborative process between knowledge producers (mostly researchers) and knowledge users (communities and decision-makers) involving many elements like synthesis, dissemination, and sharing. This thesis' main objectives are to understand KT in different research projects and management practices and propose a KT roadmap adapted to the Brazilian context. The three specific objectives pursued were to: i) describe three projects as examples of three different modalities of KT, ii) perform a post hoc analysis of the KT actions and strategies implemented by three projects of the PDTSP-Teias network in the period from 2009 to 2013, and iii) verify how participation in the PDTSP-Teias network facilitated KT between knowledge producers and knowledge users. To this end, this thesis examines KT practices between health promotion research and health practice in the Program for Technological Development and Innovation in Public Health/Programa de Desenvolvimento e Inovação Tecnológica em Saúde Pública (PDTSP-Teias network). An existing KT plan from the Quebec Public Health Institute (Institut national de santé publique du Québec - INSPQ) was employed as a theoretical framework to orient the deductive-inductive approach used to generate and analyze documents, interviews, and focus group materials. Methods: This thesis used a retrospective qualitative multiple case study with three cases nested in the PDTSP-Teias network. The focus was on relevant questions concerning KT in health promotion in Brazil, such as i) what KT approaches did the PDTSP-Teias network adopt, ii) what KT actions and strategies did the three projects of the PDTSP-Teias network implement, and iii) how did participation in the PDTSP-Teias network facilitate KT between knowledge users and knowledge producers. The empirical data included document analysis (reports, books, and scientific papers), semi-structured interviews with knowledge producers (N=9), and one focus group with knowledge users (N=4 participants). The interview guide addressed three sets of questions: project development, KT product elaboration, and interaction between knowledge producers and knowledge users. Results: Regarding the first objective, we were able to distinguish different KT expertise, approaches, and practices of the research groups. From this initial analysis, examples of three different KT practices were identified as Predominantly, Moderately, and Hardly or Not at all. These examples were then analyzed using the eight dimensions proposed by the theoretical framework. The second objective found that six of the eight dimensions analyzed seemed to be better integrated in the projects: D1 Analysis of the Context and Users’ Needs, D2 Knowledge to be Translated, D3 Knowledge about the Knowledge Users, D4 KT Partners, D5 KT Strategies, and D6 Overall KT Approach. However, two dimensions were less well-integrated: D7 KT Evaluation and D8 Resources. The third objective allowed us to see that the lack of KT project evaluation, issues related to KT projects financial resources, lack of organizational and political support addressed to KT projects, and lack of conceptual KT tools to implement KT projects are barriers to KT in Brazil. Nevertheless, albeit with some limits, participation in the PDTSP-Teias network seems to have facilitated KT practices. These results provided a description and an in-depth analysis of the complexity of KT practices in areas of high social vulnerability and contributed to a better understanding of KT practices in Brazil. Conclusion: Considering how the cases were characterized, it can be concluded that KT practices can be quite different even in a similar context and research conditions. These contrasting KT practices may be due to the absence of a suitable conceptual KT tool. Such a tool can fill the gap in Brazil's KT approaches and strategies. Thus, the adaptation of the INSPQ KT plan can allow the evolution of the dialogue between knowledge producers and knowledge users in research projects, understand the context, and contribute to the validation and adoption of KT products. These changes would benefit the change in knowledge, attitudes, and behavior of the different groups involved. Lastly, this thesis offers a seminal adaptation of the INSPQ KT plan to the Brazilian context.

Introdução: A Translação do Conhecimento (TC) consiste em uma teoria do conhecimento para a ação que visa à redução das lacunas entre a produção do conhecimento e sua aplicação em boas práticas profissionais e em políticas públicas que promovem melhorias na saúde e nas condições de vida da população. A extensão universitária, articulada ao ensino e à pesquisa, representa uma oportunidade para a TC nas Instituições de Ensino Superior (IES). Contudo, a exiguidade de indicadores de extensão dificulta a avaliação da indissociabilidade dessa tríade acadêmica. Objetivos: 1. Identificar a incorporação dos conteúdos inovadores relacionados à Promoção do Desenvolvimento Infantil (PDI) no ensino, na pesquisa e na extensão, antes e depois de dois anos da participação das IES em projetos de intervenção local (PIL) em municípios paulistas; 2. Elaborar mapas conceituais (MC) para a síntese do processo translacional ocorrido em cursos de graduação de saúde e de educação; 3. Propor indicadores de extensão inovadora; 4. Construir um modelo de avaliação fundamentado no processo de TC. Método: pesquisa exploratória e descritiva, por meio de estudo de casos múltiplos, baseado na triangulação de técnicas qualitativas. Os sujeitos da pesquisa foram sete coordenadores e três professoras de três IES envolvidas nos PIL. Foram coletados dados em duas etapas: I. a) Análise de ementas e planos de ensino de 2009 dos cursos de graduação em Enfermagem, Educação Física, Fisioterapia, Pedagogia, Psicologia e Terapia Ocupacional; b) Entrevistas com informantes-chave sobre o ensino, a pesquisa e a extensão relacionados à PDI; c) Reaplicação das duas fases anteriores com base no ano letivo de 2011; II. Construção de mapas conceituais (MC) para evidenciar a TC em núcleos acadêmicos das IES selecionadas. A análise temática dos documentos e das entrevistas, a síntese cruzada dos casos e o mapeamento conceitual por meio do Cmap Tools®, versão 5.05.01, foram adotados para avaliação dos dados. Desenvolveu-se um esquema analítico com base na ausência ou na presença de oito conteúdos inovadores relacionados à PDI no ensino, na pesquisa e na extensão, a saber: 1. Ausente, 2. Incipiente (apenas no ensino), 3. Regular (no ensino e na pesquisa), 4. Relevante (no ensino e na extensão) e 5. Completa. Resultados: após dois anos de parceria das IES nos projetos, destacaram-se as mudanças ocorridas nos seguintes cursos de graduação: Enfermagem passa de incipiente (75%) para relevante (87,5%) e Psicologia de ausente (87,5%) para relevante (75%) em Centro Universitário Comunitário; no curso de Terapia Ocupacional a classificação ausente (75%) torna-se relevante (75%) e completa (25%) em Universidade Pública Federal; houve a criação de duas disciplinas nos currículos de Pedagogia e Psicologia em Fundação Educacional Privada. Os MC ilustraram o processo de TC ocorrido nas três IES e contribuíram para a elaboração do modelo teórico de Avaliação Translacional de Extensão em Núcleos Acadêmicos (ATENA) composto por 12 indicadores de extensão inovadora. Conclusões: o modelo de ATENA verifica a aplicabilidade das evidências científicas e inovações tecnológicas nas ações de ensino, pesquisa e extensão na interação dos representantes das IES com atores sociais relevantes dos serviços locais e da comunidade a fim de promover a formação profissional, crítica, reflexiva e cidadã. / Introduction: Knowledge Translation (KT) is a theory to action that aims to reduce the gap between knowledge production and application into best practices and public policies in order to improve health and live conditions. Extension in Universities, regardless teaching and research, depicts an opportunity to KT in Higher Education Institutions (HEI). However, there is a lack of extension indicators that complicate evaluation of inextricableness of extension, teaching and research. Objectives: 1. Identifying the incorporation of innovative contents on Early Childhood Promotion (ECP) in teaching, research and extension, before and after two years local intervention-based projects (LIP) at inner state of Sao Paulo, Brazil; 2. Creating concept maps (CM) to synthetize the KT process occurred in Health and Education undergraduate courses; 3. Proposing innovative extension indicators; 4. Building evaluative model with a KT underpinning. Method: it is an exploratory and descriptive research, based on multiple cases study and qualitative triangulation. Subjects were seven coordinators and three teachers from three HEI that have been participating on LIP. Data were collected in two stages: I. a) Analysis of syllabi and study plans until 2009 related to Nursing, Physical Education, Physiotherapy, Pedagogy, Psychology and Occupational Therapy undergraduate courses; b) Key-informants interviews about teaching, research and extension activities about ECP; c) Reapplication of a and b phases based on 2011 school year; II. Creating CM to evince KT in HEIs academic centers. Thematic analysis of documents and transcripted interviews, cross-case synthesis and concept mapping by Cmap Tools® 5.05.01 were adopted to evaluate data. We have developed an analytical scheme based on absence or presence of eight innovative contents on ECP in teaching, research and extension, namely: 1. Absent, 2. Incipient (only in teaching), 3. Regular (in teaching and research), 4. Relevant (in teaching and extension) and 5. Complete. Results: after two-years HEI and LIP partnership, we have highlighted changes occured in the following undergraduate courses: Nursing that was incipient (75%) and has become relevant (87,5%), Psychology from absent (87,5%) to relevant (75%) in a Community College; Occupational Therapy that was absent (75%) has turned into relevant (75%) and complete (25%) in a Public University; there was a creation of two disciplines focused on ECP in Private College Pedagogy and Psychology curricula. CM have illustrated KT process occurred in HEI and contributed to elaborate a theoretical model of Translational Evaluation on Extension in Academic Centers composed by 12 innovative extension indicators. Conclusions: this model verifies evidence and innovation applicability into teaching, research and extension activities and interaction among HEI faculty and students and local services and community stakeholders in order to achieve a professional, critical, reflexive and citizen formation.

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No. of bitstreams: 2 Dissertação - Bárbara Morais Arantes - 2014.pdf: 768117 bytes, checksum: a473c32fd85f4cc22b2e97a9297b24fb (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-02-05 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Much knowledge has been produced in the area of Health Promotion (HP), but this information is not always translated so that it can be incorporated into everyday practice of health managers and professionals at the local level. The knowledge translation (KT) can contribute to more effective processes in health. The aim of this study was to analyze the effectiveness of KT in the context of health promotion for managers and professionals in public health. The strategies used were literature survey, semi-structured narrative interviews with managers and professionals of a large municipality and documentary analysis of Health Promotion. Content analysis was applied to establish the analytical categories. About the concepts of HP, it was noted that there is still a great confusion with other concepts; the HP actions reported arouse from programs and official publications and the respondents considered any action which was not clinical as being HP; knowledge sources of HP were associated with official documents more than with scientific papers, which were referred only when postgraduate courses were taken; little is known about knowledge translation; the main challenges were related to access and to scientific language, the access to publications of scientific papers has become more available online; among the challenges it is highlighted the great demand for permanent education for managers and professionals. We conclude that the knowledge translation in the context of health promotion takes place most effectively by the primary care team, which by managers; there is still confusion of content and concepts of health promotion with strong linkages to prevention and education health; promotion practices are associated to those induced by public policies and programs predominantly from official documents and manuals from the Ministry of Health, principal source used by managers and professionals, access to new knowledge was associated with the academic world by internet, official sources by the documents and manuals, on the processes of knowledge translation most important were collective activities such as workshops and reading group, among these challenges include the difficulty of access to restricted sites and / or paid on the Internet, setting up spaces for discussion and exchange of experiences. / Muito conhecimento tem sido produzido na área de Promoção da Saúde (PS), porém essas informações nem sempre são traduzidas de forma que possam ser incorporadas na prática cotidiana de gestores e profissionais de saúde no nível local. A tradução do conhecimento pode contribuir para processos mais efetivos em saúde. O objetivo deste estudo foi analisar a efetividade da tradução do conhecimento (TC) no contexto da promoção da saúde por gestores e profissionais em saúde pública. As estratégias utilizadas foram levantamento bibliográfico, entrevistas narrativas semi-estruturadas com gestores e profissionais de um município de grande porte e análise documental com resgate de documentos sobre Promoção de Saúde. A análise de conteúdo foi aplicada para o estabelecimento das categorias analíticas. Sobre os conceitos de PS notou-se que há grande confusão com outros conceitos; as ações de PS relatadas originam-se de programas e publicações oficiais e os entrevistados demonstraram considerar quaisquer ações não clínicas como sendo de PS; as fontes de conhecimento sobre PS foram mais associadas a documentos oficiais que a artigos científicos, sendo estes referidos quando da realização de cursos de pós-graduação; pouco se conhece a respeito de tradução do conhecimento; os principais desafios foram relativos a acesso e linguagem científica, sendo que o acesso a publicações de caráter científico tem se tornado maior pela disponibilização on-line; entre as sugestões destaca-se a demanda de educação permanente por gestores e profissionais. Conclui-se que a tradução do conhecimento no contexto da Promoção da Saúde se dá de forma mais efetiva pelos profissionais da atenção básica, que pelos gestores; ainda há confusão de conteúdos e conceitos de Promoção da Saúde com forte vinculação à prevenção e à educação em saúde; as práticas de Promoção são associadas àquelas induzidas pelas políticas públicas e pelos programas oficiais predominantemente originários de documentos e manuais do Ministério da Saúde, principal fonte utilizada por gestores e profissionais; o acesso aos novos conhecimentos foi associado ao mundo acadêmico por meio de internet, bem como às fontes oficiais por meio dos documentos e manuais, sobre os processos de tradução do conhecimento destacaram-se as atividades coletivas como oficinas e leitura em grupo; entre os desafios citados destacam-se a dificuldade de acesso a sítios restritos e/ou pagos na internet, constituição de espaços de discussões e trocas de experiências.

This thesis is about primary care medicine in the United States today. Specifically, I look into primary care providers’ experiences working with patients in the context of the public’s current access to extensive health and medical information online. In this thesis, I discuss and analyze my conversations with physicians, nurse practitioners, and a physicians’ assistant about their objectives in primary care, the challenges they face, and their perceptions of patients’ ability to seek out information on their own. I explore providers’ educational emphasis in primary care consultations, and argue that this focus on education informs their views of patients’ independent research and involvement in care. I further argue that regardless of my informants’ enthusiasm about patient involvement and the merits of patient-education, these providers still hold and express a strong authority over medical knowledge and decisions. Thus in looking at the influence of what could be seen as a democratization of medical knowledge through public access and the Internet, it seems that the limitations of such access are still great in U.S. medical practice.