No description available.

Introduction : Une utilisation non-optimale du fauteuil roulant manuel (FRM) peut avoir des répercussions sur différents aspects de la vie des enfants et jeunes qui utilisent cette aide à la mobilité. Malgré la disponibilité et l'efficacité du Wheelchair Skills Program (WSP), l'entraînement des habiletés en FRM est parfois inadéquat ou absent en pratique. Pour combler cette lacune entre les connaissances et la pratique, ce mémoire vise à identifier les besoins et les enjeux concernant l’évaluation et l’entraînement des habiletés en FRM en réadaptation pédiatrique. Méthodes: Guidé par le cadre Knowledge to Action, une étude à devis mixte séquentiel explicatif a été conduite dans un centre de réadaptation pédiatrique et ses écoles affiliées. La phase quantitative comprenait une enquête en ligne auprès d'ergothérapeutes et un questionnaire papier auprès d’usagers pédiatriques et de leurs parents. La phase qualitative comprenait des groupes de discussion avec les ergothérapeutes. L’analyse a utilisé des statistiques descriptives et une méthode déductive basée sur le Consolidated Framework for Implementation Research. Résultats : Les résultats du sondage aux ergothérapeutes (n=35) montrent une divergence entre l’importance perçue à l’égard de l’évaluation et l’entraînement des habiletés en FRM (94% jugent important) et leur prévalence dans la pratique. Peu d’ergothérapeutes utilisent des outils standardisés et forment principalement les enfants aux habiletés de base (c.-à.-d., d’intérieur) et les parents à l'entretien du FRM. Les réponses du questionnaire aux usagers corroborent ces résultats alors que les enfants et parents décrivent des difficultés à l’utilisation du FRM dans la communauté, en plus de rapporter des chutes. Les résultats des groupes de discussion révèlent des barrières à l’utilisation du WSP qui expliquent les lacunes observées dans la pratique. Conclusion : Pour surmonter les barrières à l’utilisation du WSP en réadaptation pédiatrique, des adaptations au WSP et la production d'outils pour le transfert de connaissances (TC) ont été proposées avec la création de nouvelles connaissances par la recherche. / Introduction : Suboptimal manual wheelchair use can have repercussions on different aspects of the lives of children and adolescents who use this mobility aid. Despite the availability and effectiveness of the Wheelchair Skill Program (WSP), manual wheelchair skills training is often inadequate or absent in clinical practice among occupational therapists (OTs). To bridge this evidence-practice gap, this thesis aims to identify and understand the needs and challenges regarding manual wheelchair skills testing and training practices in pediatric rehabilitation. Methods: Guided by the Knowledge to Action Framework, an explanatory sequential mixed methods design was employed. The quantitative phase involved an online survey with OTs working in a pediatric rehabilitation center and its affiliated schools and a paper survey with pediatric manual wheelchair users and their parents. The qualitative phase involved focus groups with the OTs. Data were analyzed using descriptive statistics and a deductive analysis based on the Consolidated Framework for Implementation Research. Results: According to the OT survey results (n=35), there is a discrepancy between the perceived importance of wheelchair skills testing and training (94% consider it important) and their prevalence in practice. Of the training provided, children are primarily trained indoor skills, while parents are primarily educated about wheelchair maintenance. Standardized, evidence-based tools are rarely used. The child survey results corroborate these findings as the children and parent described difficulties with many community and advanced wheelchair skills, as well as falls experienced in these situations. The focus group findings identified barriers to using the WSP which explained the gaps observed in practice. Conclusion: To address the identified barriers, recommendations of WSP adaptations and knowledge translation (KT) tools production were proposed with creation of new knowledge. Findings from this thesis establish a first step towards bridging the evidence-practice gap in manual wheelchair skills testing and training.

No description available.

Cette recherche porte sur l’évaluation d’une plateforme numérique, nommée Mylin, relayant des connaissances ainsi que des outils en santé mentale supportés par la science. Les interventions sur la plateforme sont accompagnées d’une description de leurs objectifs et de leur efficacité, qui est évaluée lors de la recension des écrits effectuée par le comité scientifique de Mylin. La plateforme est destinée au grand public et aux professionnels et a l’objectif d’aider ces derniers à prendre des décisions plus éclairées en s'appuyant sur des informations valides. Ce mémoire explore plus particulièrement les retombées associées à l’utilisation de Mylin selon les professionnels et les intervenants s’en servant dans le cadre de leur pratique ainsi que les facteurs pouvant influencer ces retombées. L’utilité de la plateforme a été examinée en fonction des différentes professions et des différents niveaux de littératie numérique en santé. Neuf professionnelles ont été interviewées et ont répondu à l’échelle mesurant le niveau de littératie numérique en contexte de santé (LNS). L’analyse descriptive effectuée sur les réponses à l’échelle mesurant le niveau de LNS a dévoilé que l’échantillon se composait majoritairement de participantes avec un niveau considéré comme élevé de littératie numérique. L’analyse thématique des entrevues a révélé que Mylin pouvait être utilisée pour enrichir son bagage de connaissances, pour prendre des décisions éclairées par la science et pour se développer professionnellement grâce à ces nouveaux acquis. Néanmoins, cette utilité a semblé conditionnelle à plusieurs facteurs liés aux 1) utilisatrices et leurs milieux organisationnels (par exemple, l’intérêt porté aux connaissances issues de la recherche dans leur milieu de travail), 2) au contenu diffusé sur Mylin (par exemple, son adéquation avec les besoins des utilisatrices) et 3) à la convivialité de la plateforme. Comme la plupart des professionnelles de l’échantillon avaient un niveau élevé de LNS, les comparaisons d’expériences entre les professionnelles ayant une littératie plus faible et plus élevée n'ont pas permis d’établir des tendances claires quant au lien entre la LNS et la perception d’utilité de Mylin. / This research assessed a digital platform, named Mylin, disseminating mental health evidence-based knowledge and interventions. The knowledge disseminated is about various adaptation difficulties that can interfere with the well-being and functioning of the neurodivergent population. The interventions on the platform are accompanied by a description of their objectives and their effectiveness, which is evaluated during the literature review carried out by the scientific committee of Mylin. The platform is intended for the public and professionals and aims to help them make more informed decisions based on valid information. This project explores more specifically the benefits associated with the use of Mylin according to the professionals and stakeholders using it in the context of their practice as well as the factors that can influence these benefits. The usefulness of the platform was examined in relation to different professions and different levels of digital health literacy. Nine professionals were interviewed and responded to the scale measuring the level of eHealth literacy. According to the descriptive analysis performed on the responses to the scale measuring the level of eHealth literacy, the sample was composed of a majority of participants with a level considered high in eHealth literacy. The thematic analysis of the interviews revealed that Mylin could be used to, among other things, enrich one's stock of knowledge, to make decisions informed by science and to develop professionally thanks to these new skills. Nevertheless, this usefulness appeared to be conditional on several factors related to 1) the users and their organizational backgrounds (for example, the interest taken in scientific evidence by the workplace), 2) the content disseminated on Mylin (for example, its adequacy with the needs of users) and 3) the user-friendliness of the platform. Since most of the professionals in the sample had a high level of eHealth literacy, comparisons of experiences between professionals with lower and higher literacy do not allow us to establish clear trends as to the link between this factor and Mylin's perception of usefulness.

Underserved youth (e.g., from families facing inadequate housing, food insecurity, financial instability) are disproportionately exposed to traumatic experiences (e.g., family discord or violence, neglect, poverty, racism), which can lead to several negative life-long consequences (e.g., affective and somatic disturbances, anxiety, depression, suicidal ideation). Community organizations that target underserved youth may be ideally situated to offset the negative consequences of trauma through leveraging a trauma-sensitive sport model for youth programming. A trauma-sensitive sport model involves a blend of positive youth development approaches (i.e., creating safe environments for youth to experience positive relationships, autonomy, and opportunities to build skills), trauma-sensitive approaches (e.g., considering the potential effects of trauma on youth’s participation and development, and prioritising their needs for safety, voice, empowerment, choice, and collaboration), and program designs that leverage and re-design sporting activities to help youth navigate trauma symptoms, build a social support system, and develop various resilience-related skills (e.g., emotional regulation, decision-making). Little research has examined the implementation and effectiveness of a trauma-sensitive sport model for youth programming in a community setting. Use of this model can contribute to greater capacities of youth sport leaders to promote underserved youth’s healthy participation and development. This dissertation was conducted in partnership with BGC Canada, a national non-profit community organization that serves disadvantaged communities. From 2016-2021, a trauma-sensitive sport model for youth programming was implemented in this organization through the Bounce Back League (BBL) initiative. The purpose of this dissertation was to explore the knowledge-to-action processes involved in translating this model in a community program setting. The knowledge-to-action cycle (KTAC; Graham et al., 2006) was used to conceptually guide the studies carried out in this dissertation, in outlining key phases for consideration in translating a trauma-sensitive sport model. While most of these phases are described in this dissertation, the empirical articles focused on assessing four phases of this cycle, which included: (a) assess barriers and facilitators to knowledge use, (b) select, tailor, and implement interventions, (c) monitor knowledge use, and (d) evaluate outcomes. Intrinsic case study methodologies were used to understand community-based knowledge translation processes and outcomes within the case of the BBL initiative. A community-based participatory research approach was used to engage in equitable collaboration between researchers and community members for the development of this initiative. Utilisation-focused evaluation principles were used to work with community members to determine what to evaluate, how to evaluate, and how results would be used. Grounded in a pragmatic paradigm, a mixed methods research design was used to collect data through the initiative, which included individual and group interviews with leaders, leader-reported logbooks, leaders self-reported questionnaires, leaders' assessments of youth's participation, communications on an online messaging platform (Slack), and researchers' observations of training opportunities and leaders' practices. The purpose of Article 1 was to outline the overarching process of integrating a trauma-sensitive sport model within the BBL program, from 2016-2021. Several stages of program development were described, including: (a) collaboratively planning the program; (b) piloting the program to three clubs; (c) adapting the program using pilot insights; (d) expanding the adapted program to ten clubs; and (e) creating opportunities to maintain, sustain, and scale-out practices throughout grant duration and beyond. Lessons learned regarding the leadership team’s experiences in terms of developing, adapting, and integrating a trauma-sensitive sport model for youth programming in this community context were shared. The purpose of Article 2 was to explore factors involved in the implementation of a trauma-sensitive sport model for youth programming in BBL. This article paralleled the KTAC phase of assess barriers and facilitators to knowledge use. A mixed-methods evaluation of the pilot phase of BBL was conducted. Three clubs participated in training, implementation, and evaluation of BBL. The data were collected through interviews, logbooks, and assessments. The quantitative data were interpreted using descriptive statistics and comparative t-tests; the qualitative data were interpreted using thematic and content analyses. The RE-AIM framework was used to categorise the various processes and outcomes involved in program implementation. The results showed that programs reached a large number of youth but struggled to retain youth from season to season. The leaders perceived that the intentional structure of the program, opportunities to practice self-regulation, relationship focus, and life skill focus, were all linked to positive participation in youth members. Components of leaders' training and program delivery were noted as successful, but the sustained benefits of these successes were challenged by leader turnover and funding limitations. In line with the KTAC phases, insights were generated on what works and what does not in facilitating this type of programming in a community setting for underserved youth and helped inform future adaptations to the program as it was rolled out (discussed in Article 1). The purpose of Article 3 was to explore leaders' learning experiences from participating in an initial training workshop and prior to their implementation of programming. This article paralleled the select, tailor, and implement interventions phase and the evaluate outcomes phase of the KTAC model. The value-creation framework was used to explore learning experiences based on the interactions and values that leaders discussed. Participants were leaders who attended initial training workshops. A mixed-methods approach was used to collect data through observations, interviews, and self-reported questionnaires. The quantitative data were interpreted using descriptive statistics and Wilcoxon Signed-Ranks Tests; the qualitative data were interpreted using thematic analysis. The results showed that the leaders: (a) valued having a variety of learning opportunities that were relevant to their roles and contexts, (b) appreciated the diverse focus on foundational and practical content, and (c) shared an interest to learn how to support trauma-exposed youth and facilitate better programming. Implications were discussed for the improvement of training opportunities to better meet leaders' needs within a community organization and support leaders' intentions to apply knowledge into action. Article 4 builds on the previous study, where the purpose was to explore leaders' learning experiences as they implemented programming and while they participated in continuing training and development activities. This article also paralleled the select, tailor, and implement interventions phase and the evaluate outcomes phase of the KTAC model. The participants were leaders who were involved in implementing BBL at their clubs. A mixed-methods approach was used to collect data through interviews, observations, surveys, and communications on an online messaging platform (Slack). The quantitative data were analysed using descriptive statistics, data charting, and non-parametric analyses; the qualitative data were interpreted using thematic analysis. The results indicated that the leaders learned through various interactions throughout their practice (e.g., implementing programs at their homes sites, receiving mentoring, conversations with peers), and discussed gains in applied value (e.g., program facilitation strategies, youth-support skills), realised value (e.g., youth's receptivity and behaviour change), and transformative value (e.g., transfer of leaders' skills, influence on club culture). Implications were discussed for the improvement of training opportunities to promote ongoing social learning and maintenance of program practices. The purpose of Article 5 was to explore the fidelity and quality of leaders' application of a trauma-sensitive sport model to programming. This article paralleled the monitor knowledge use phase of the KTAC model. The promising practices criteria were used as an evaluation framework to categorise dimensions of quality relevant to program effectiveness. Leaders from 11 BBL programs participated. A mixed-methods approach was used to collect data through observations, interviews, and logbooks. The quantitative data were interpreted using descriptive statistics; the qualitative data were interpreted using thematic analysis. The results showed that: (a) all programs showed evidence of supportive adult and youth relationships, (b) programs led by trained leaders maintained program fidelity and implemented more features to a stronger extent than untrained leaders, (c) trained leaders may have compromised mastery orientation opportunities in favour of other program components. Implications were discussed related to what may facilitate or constrain program fidelity and quality in this setting, and how training and development opportunities can mitigate challenges in leaders' capacities. This dissertation offered an evaluation of the knowledge-to-action processes involved in integrating a trauma-sensitive sport model into BGC Canada. The results of this dissertation provided insights of how BGC Canada leaders learned and facilitated a trauma-sensitive sport model for youth programming, the differences training and development may contribute to the quality of their program practices, and how involvement in this initiative resulted in changes in leaders' behaviours, skills, and identities, as well as positive youth developmental outcomes. Practical implications were shared on how BGC Canada and similar community organizations can enhance their partnership and facilitate these interventions. As well, the value of taking a systems-based approach to planning future interventions with a trauma-sensitive sport model was also discussed to maximise multi-level impacts. Academic implications were shared on how future research can also take a systems-based approach to evaluating knowledge translation processes in youth sport interventions.

<p><strong>Introduction:</strong> In Ontario alone, an estimated 6,700 people (3,000 women; 3,700 men) will die of lung cancer in 2011 (Canadian Cancer Society, 2011). A diagnosis of cancer is associated with complex decisions; the array of choices of cancer treatments brings about hope, but also anxiety over which treatment is best suited for the individual patient (Blank, Graves, Sepucha et al., 2006). The overall cancer experience depends on the quality of this decision (Blank et al., 2006). Clinical practice guidelines are knowledge translation tools to facilitate treatment decision-making. In Ontario, guidelines have been developed and disseminated with the purpose to inform clinical decisions, improve evidence based practice, and to reduce unwanted practice variation in the province. But has this been achieved? To study this issue, the purpose of the current study was to gain an in-depth understanding and develop a theoretical framework of how Ontario physicians are making treatment decisions with their non-small cell lung cancer patients. The following research questions guided the study: (a) How do physicians make treatment decisions with their stage II, stage IIIA and stage IIIB non-small cell lung cancer patients in Ontario? (b) How do knowledge translation tools, such as Cancer Care Ontario guidelines, influence the decision-making process?</p> <p><strong>Methods:</strong> A qualitative approach of grounded theory, following a social constructivist paradigm outlined by Kathy Charmaz (2006), was used in this study. 21 semi-structured interviews were conducted; 16 interviews with physicians and 5 with health care administrators. The method of analysis integrated grounded theory philosophy to identify the treatment decision-making process in non-small cell lung cancer, from the physician perspective.</p> <p><strong>Findings:</strong> The theory depicts the treatment decision-making process to involve five key “guides” (or factors) to inform the treatment-decision making process: the unique patient, the unique physician, the family, the clinical team, and the clinical evidence.</p> <p><strong>Conclusion:</strong> Decision-making roles in lung cancer are complex and nuanced. The use of evidence, such as, clinical practice guidelines, is one of many considerations. Information from a large number of sources and a wide array of factors, people, emotions, preferences, clinical expertise, experiences, and clinical evidence informs the dynamic process of treatment decision-making. This theory of the treatment decision-making process (from the physician perspective) has implications relevant to treatment decision-making research, theory development, and guideline development for non-small cell lung cancer.</p> / Master of Science (MSc)

<p>The thesis presents three papers discussing some of the methodological issues regarding studies investigating complex community-based cardiovascular health interventions. All three studies involved the Cardiovascular Health Awareness Program (CHAP), a standardised blood pressure and risk factor assessment and educational sessions held in pharmacies or other locally accessible areas in small to mid-sized communities in Ontario, Canada.</p> <p>The first paper reviews the literature and proposes a guide on how to develop a theoretical framework for complex community-based interventions using CHAP as an example. The paper describes a stepwise process of developing a theoretical framework including challenges encountered and strategies employed to overcome them.</p> <p>The second paper presents how recently published randomized controlled trials evaluating complex community-based cardiovascular health interventions monitored and reported implementation fidelity based on a structured review of the published articles and a survey of their primary authors. The results showed that fidelity reporting of included studies was better than those described in previous reviews. Fidelity was verified through self-reports by implementers and supervision by researchers. Strategies described to standardize intervention delivery were through training of implementers and use of implementation guides. The authors’ survey results were consistent with the review results though there were some gaps which could be improved to strengthen fidelity reporting.</p> <p>A data analysis issue with studies investigating complex community-based interventions is that outcomes can be affected by factors from multiple levels. The third paper explores the association of individual, partnership, and community-related factors with CHAP participants’ use of health-related community resources and cardiovascular risk behaviours. This was a cross-sectional analysis of an on-going cohort study. The results showed that individual factors (age and self-efficacy) had the most consistent association with the outcomes. Community and partnership level variables showed less consistent association with the outcome. Methodological and analytical challenges were presented.</p> / Doctor of Philosophy (PhD)

<p>Community participation has been identified as a key facilitator of community health among marginalized populations in international health statements. However, knowledge gaps in the community participation literature regarding marginalized populations has been attributed to the lack of consistent definitions of community participation, ambiguity about the features of community participation initiatives (e.g., methods and strategies) that are appropriate for marginalized populations, and limitations of existing community participation frameworks in specifying the ways and means in which different marginalized populations might effectively participate, as well as in recognizing that community participation is highly contextual and situational. All of these factors have made it difficult to draw broader conclusions about the impact of participation methods and strategies for marginalized populations from evaluations of participation initiatives.</p> <p>The overall purpose of this thesis is to better understand how to involve marginalized populations in the planning and decision-making for local health services. First, a critical interpretive synthesis (CIS) was conducted to better understand the role of community development principles used in community participation initiatives with marginalized populations and the factors contributing to the influence of the principles in enabling the participation of these populations. Second, an in-depth comparative case study of four community participation initiatives in Ontario Community Health Centres (CHCs)—which are primary health care organizations serving 74 high-risk communities throughout the Province of Ontario—was conducted to identify the core features of participation initiatives with marginalized populations, and reflect on the particular challenges of engaging marginalized populations. Third, four focus groups were held at four Ontario CHCs to examine the role of frameworks as mechanisms for translating knowledge about community participation practice with marginalized populations. Overall, this thesis broadens our understanding of community participation with marginalized populations in the context of local health services planning and decision making. Specifically, this thesis contributes a theoretical basis for future research and provides practical knowledge for planning and evaluating community participation initiatives with marginalized populations.</p> / Doctor of Philosophy (PhD)

<p>This dissertation takes the format of a "three paper model" (i.e. Sandwich Thesis), and all three articles have been submitted for publication.</p> <p>Article 1 (Chapter 4) - appears in <em>Food, Culture & Society (2014).</em></p> <p>Article 2 (Chapter 5) - appears in <em>Social Science & Medicine (2014).</em></p> <p>Article 3 (Chapter 6) - Revise & Resubmit from <em>Sociology of Health & Illness</em></p> / <p>Food and the various aspects surrounding what we eat, what we <em>should</em> eat, and concerns about how to remain healthy and ward off disease and illness is escalating while our choices are endless. In this competitive food market a new type has emerged: the functional food. Functional foods are those that have an added health benefit beyond the basic nutritional content and display physiological benefits in reducing chronic diseases. A popular category of functional foods are those that purport to lower one's cholesterol. In particular, high cholesterol is marketed as a "disease" rather than a risk factor for various cardiovascular diseases, such as heart disease. Little is known about the sociological diagnosis of high cholesterol and the marketing of functional foods, in particular with women. This dissertation address this gap by asking: (1) How is high cholesterol (HC) identified and marketed as a disease rather than a risk factor for cardiovascular diseases in functional food advertising - specifically addressing the Becel® pro.activ® margarine campaign? (2) How do women understand the issue and <em>causes </em>of high cholesterol; and (3) What do women understand the <em>solution </em>to high cholesterol to be and how do they view Becel's^® high cholesterol solution? --The findings center on 4 key issues: <ol> <li>The construction and marketing of high cholesterol <em>as a disease</em> (i.e. via the sociology of diagnosis), rather than a risk factor for heart disease;</li> <li>The causes of high cholesterol and attribution of blame are placed on women's poor lifestyle choices and seen as an individual responsibility;</li> <li>There are class differences regarding women's knowledge and awareness of the social determinants of health (SDOH); and</li> <li>The solution to high cholesterol is individualized via the 'proactive myopia' repertoire.</li> </ol></p> / Doctor of Philosophy (PhD)

Many strategies can be used to support the use of research evidence in decision-making. However, such strategies have been understudied in crisis zones, where decision-making may be particularly complex, many factors may influence decision-makers’ use of research evidence, and professional judgements may be particularly relied upon. Using synthesis and qualitative research methods, this dissertation examines the role of research evidence in crisis zones and strategies to support its use in decision-making. First, chapter 2 describes a critical interpretive synthesis, which drew upon a broad body of literature around evidence use in crisis zones to develop a new conceptual framework that outlines strategies that leverage the facilitators and address the barriers to evidence use in crisis zones in four systems, namely the political, health, international humanitarian aid, and health research systems. Second, in chapter 3, the focus narrows, and an embedded qualitative case study design was used to gain a deeper understanding into one of the four identified systems, the political system, and specifically the factors that influenced the use of research evidence in the governmental health policy-development processes for Syrian refugees in Lebanon and Ontario. Finally, in chapter 4, a user testing study design was used to zero-in on decision-makers’ experiences with a particular strategy within the health research system, namely an evidence website focused specifically on topics relevant in crisis zones. This dissertation provides a rich understanding of research evidence use by examining knowledge translation strategies in a setting that has been largely unexplored in the broader KT map: crisis zones. The findings from this thesis point to the need for comprehensive strategies to support evidence use in decision-making that draw upon the existing literature and are adapted for crisis zones, which can occur sequentially or simultaneously within or across the four identified systems. / Thesis / Doctor of Philosophy (PhD) / In humanitarian aid, and specifically in crisis zones, there are many different types of information decision-makers can draw from when making decisions. One specific type of information is research evidence; however, the use of research evidence, and the ways it can inform decision-making in crisis zones, has been understudied. This dissertation addresses this key gap in understanding by: 1) developing a new tool that can help decisions-makers use research evidence to inform their decisions in crisis zones within the political, health, humanitarian aid and health research systems; 2) examining the factors that influence the use of research evidence in the governmental health policy-development processes for Syrian refugees in Lebanon and Ontario; and 3) examining the perspectives of decisions-makers around using one way of supporting the use of research evidence — an evidence website — to support evidence-informed decision-making in crisis zones.