Most physical rehabilitation services are not person-centered. Occupational therapy practitioners (OTPs) are vested in person-centered approaches, thereby they are optimally positioned to take leading roles in these quality improvement (QI) activities. Yet, there is a lack of OTPs-led QI activities on person-centered rehabilitation, and seminally, a lack of a QI guide informing these activities. To shape the evidence- and theory-based QI guide, we engaged a small international sample (n= 8) of potential end-users, i.e., OTPs in practice or management roles. The process involved three rounds of mixed-methods surveys, which helped in the design, refinement, and preliminary evaluation of the QI guide. Informed by theory, evidence and participants’ feedback, the final guide followed a “why, what, and how” structure. Six out of the eight participants rated the QI guide as one they are “very likely” to use. Also, the median rated value of the guide was “9” in a “0-10” scale. The QI was also well appraised by being an all-in-one resource to enable OTPs close the gap in person-centered rehabilitation practices and its improvement. The final version of the QI guide is ready to use and freely available in the Open Science Framework platform: http://osf.io/xzgpe/.

In this study, the continuous use of knowledge-based clinical decision support systems (KB-CDSS) is examined. KB-CDSS not only provides advice to clinicians, but also integrates guidelines with patient information and provides clinicians with tools that facilitate the application of guidelines in patient care. Studying KB-CDSS as a continuous application is important because continuity is a prerequisite to the success of KB-CDSS implementations and is considered as an important motivator for knowledge translation. Previous research in the area of health information systems (HIS) use has focused on the acceptance of these systems through the use of mostly information systems related constructs. Therefore, the theoretical models that explain the use of HIS have been limited and they obfuscated other phases of HIS such as continuous use. Moreover, extant research has not, to a large extent, considered the influence of KB-CDSS use on knowledge translation, the application of clinical guidelines in practice. This study seeks to fill these gaps in the literature by first integrating context-related factors with IS factors. This supports the study of antecedents of continuous use of KB-CDSS systems, exploring the relationship between continuous use and knowledge translation, and exploring changes in system dynamics (how usage patterns change with time). In order to achieve these research objectives, a literature review of healthcare and IS research was conducted, resulting in a comprehensive theoretical model that explains the antecedents of continuous use and its relationship to knowledge translation. To validate this model, data were collected from different sources, including: A questionnaire deployed to 118 physicians using the McMaster Pain Assistant KB-CDSS in three academic clinics in South Western Ontario, followed by five focus groups to further explain the context of using the systems and antecedents of its use, and the analysis of system use through data obtained from system logs and patient charts. The findings of this study show that: (i) Threats to physician professional identity surpasses intention to continue using KB-CDSS, thus influencing its use by physicians in the first six months; (ii) The relationships between factors influencing continuous system use change with time; (iii) System use has a strong relationship with knowledge translation after 6 months of use, but this relationship diminishes after 12 months of use; and (iv) How patients are affected by the system positively influences physician satisfaction with the system and hence their use of the system. This study helps in explaining the theory of physicians’ continuous use of KB-CDSS and how the antecedents of use change with time. Methodologically, this study has discovered several techniques that can be used to improve HIS research and physician acceptance of IS methods. Finally, in practice this study presents several suggestions for improving the development and deployment of KB-CDSS to enhance its use during the knowledge translation process. / Thesis / Doctor of Philosophy (PhD)

Infant Feeding in HIV in Canada is an increasingly challenging and confusing aspect of clinical care for providers and patients due to differences in recommendations in Canada compared to low income countries. The frequency of breastfeeding occurring in Canada is not documented or known, and is shrouded in stigma because of fear of criminalization or child apprehension in the midst of a culture where ‘breast is best’ messaging dominates. Breastmilk transmission data comes from observational and randomized controlled trials completed in low resource settings, which may not be generalizable to Canadian clinical settings. Previous literature has not explored provider perspectives on this issue, especially in high resource settings. We developed a survey to explore the knowledge, attitudes and practices of adult and pediatric HIV care providers in Canada. This survey explores the provider knowledge levels, risk tolerance and perceived stigma pertaining to infant feeding in HIV. Using exploratory analysis including descriptive statistics and regression modelling, we developed scales on the above listed three subject areas. The overall opinions of providers were that formula feeding should remain the recommendation due to the potential risk to the infant; and that women should be supported to access formula and resources to overcome barriers to formula feeding. Providers varied in their risk tolerance and the degree of stigma they perceived associated with infant feeding for their patients. Providers did not feel that breastfeeding is a criminal matter, but in some circumstances they would consider involving child protection services. Focus group consultation with women living with HIV, provided insight into the experiences, and clinical and research priorities for women living with HIV on infant feeding. A provider meeting was organized to discuss the challenges and resources pertaining to infant feeding in Canada across the provinces. Providers described diverse patient populations with differing needs. Using a World Café model for discussion, priority needs were decided through consensus including the need for knowledge translational resources to convey information to women living with HIV on infant feeding, and the need for evidence based consensus clinical management guidelines was evident. Quantifying the frequency of breastfeeding occurring in Canada by women living with HIV will help to understand how often this issue is encountered. A preliminary qualitative approach to understanding infant feeding issues for women living with HIV using focus groups is described. However, further exploration in a community based approached is needed to explore the needs and challenges faced by families affected by HIV around infant feeding. / Thesis / Master of Science (MSc) / Infant Feeding in HIV in Canada is an increasingly challenging aspect of clinical care. Information on breastmilk transmission comes from studies completed in lower income countries, and this may not be applicable to the Canadian HIV setting. Previous literature has not explored provider perspectives on this issue, especially in high-income countries like Canada. In this knowledge, attitudes and practices survey of HIV care providers in Canada, the main findings were that formula feeding should remain the recommendation due to the potential risk of HIV infection occurring in the baby, however women should be supported to access formula and resources to overcome barriers to formula feeding. Providers do not feel that breastfeeding is a criminal matter, but in some circumstances may consider involving child protection services. We performed community consultation using focus groups to understand some of the issues women face with infant feeding, some of the clinical solutions they would support, and research questions and knowledge translation they would want undertaken. A provider meeting to discuss the challenges pertaining to infant feeding in Canada demonstrated that although populations differ, the need for knowledge translational resources to convey information to women living with HIV on infant feeding was universal. Furthermore, the need for evidence based consensus clinical management guidelines would improve the quality of care provided.

This thesis includes four manuscripts with an overarching objective to develop, implement, and evaluate strategies to close the current knowledge to practice gap in the field of cancer rehabilitation. The overall goal of this objective is to provide a strategy to increase exercise knowledge and behaviour in women with breast cancer. The theory of planned behavior and knowledge-to-action cycle were used across these manuscripts in order to create and implement meaningful, easy-to-access, and effective interventions for women with breast cancer during chemotherapy treatment. The first manuscript presents a qualitative descriptive study outlining the barriers and facilitators to exercise promotion by health care professionals for women with breast cancer. Results found barriers to exercise promotion exist at the institutional, health care professional, and patient level. Patient complexity and availability of services and resources were found to influence exercise promotion in conjunction with the described barriers. The second manuscript presents a qualitative descriptive study using a focus group. The purpose of this study was to bring together a multi-disciplinary group of health care professionals who work with women with breast cancer to determine novel exercise intervention strategies to implement within the cancer care institution in Ontario. Results found that an on-site exercise program, an on-site rehabilitation professional, and more effective self-management educational strategies describing the benefits of exercise during and after breast cancer treatment were needed for women with breast cancer. The third manuscript presents a study protocol for the final thesis chapter. The purpose of this protocol was to describe a pilot study that would assess the feasibility and effectiveness of conducting an innovative knowledge translation intervention for breast cancer survivors using exercise and self-management versus usual care. The intervention was to be considered feasible if the recruitment rate reached >50%, adherence rate >75%, and retention rate >75%. The fourth manuscript presents the preliminary results of the pilot randomized controlled trial. The overall purpose of this study was to determine the feasibility of providing a complex knowledge translation intervention designed specifically for women with breast cancer using technology. This study also set out to explore preliminary estimates of effects of the knowledge translation intervention on physical activity level, exercise knowledge and behaviour, health related quality of life, overall health status, and resource utilization among breast cancer survivors. Results found the intervention to be feasible (recruitment rate of 96%, intervention retention rate of 100%, and intervention adherence rate of 89%). The exploratory findings of secondary outcomes found a significant between group difference in physical activity levels post intervention (mean difference= 25.38, 95%CI= (9.35, 41.42), p=0.003) as measure by the Godin Leisure-Time Exercise Questionnaire. No significant between group differences were found for exercise knowledge scores, health related quality of life, or overall health status. / Thesis / Doctor of Philosophy (PhD) / Breast cancer survivors live with treatment-related side effects for years after their cancer treatments have ended. Regular participation in exercise can help to manage these side effects and improve quality of life in survivors. However, only small portions of breast cancer survivors take part in regular exercise. Many survivors are not aware of the benefits of exercise, how to exercise safely, or where exercise related services are available. There is a large gap between the research evidence supporting the use of exercise for women with breast cancer, and actual clinical practice. This thesis includes four papers aimed at devising and implementing a knowledge translation strategy in order to close this knowledge to practice gap in Ontario. Results suggest that an innovate program including exercise and self-management education run by a physiotherapist within the cancer institution is feasible and safe for women with breast cancer during chemotherapy.

There have been an increasing number of calls emphasizing the need to use the best-available research evidence to inform health system policies and, in response, efforts have been made in many countries to develop and implement policy-support organizations (PSOs) to enhance the use of research in policymaking. However, there is a paucity of evidence regarding both the best approaches for the successful establishment of such organizations. Moreover, there are very few attempts to consider how approaches can be applied in particular contexts, and operationalized by policymakers and stakeholders in their efforts to support EIPM through the establishment of PSOs. This dissertation incorporates a mix of methodological approaches to address this gap. First, in chapter two, a critical interpretive synthesis was used to develop a conceptual framework that can guide the process of establishing a PSO or similar entities. The framework outlines the stages in the process of establishing a policy support organization and the contextual factors at the political-, research- and health-system level that influence this process. Second, in chapter three, the framework from the CIS was used to inform the design of a survey tool and interview guide used in a sequential mixed methods study to enrich the framework by soliciting insights from those with practical experience with developing and operationalizing PSOs in real-world contexts. Specifically, this study provides insights into the approaches and strategies for each stage in the establishment process for a PSO. Lastly, in chapter four, the findings from chapter two and three were used -- along with in-depth one-on-one semi-structured interviews with policymakers, researchers and stakeholders who are familiar with the Omani system -- to develop a model for an Omani knowledge translation department, which can be used in a future co-design process for activating the department. The dissertation chapters build on each other and make substantive, methodological, and theoretical contributions. Substantively this dissertation clarifies and defines key concepts that are essential to enable a rich understanding of the process of establishing a PSO. It highlights that the process of establishing such an organization is iterative and can be influenced by multiple contextual factors that affect the individual approach that has been used to support evidence-informed policymaking. Methodologically, this dissertation is the first study of PSOs that uses a mix of conceptual framework generation, insights from a wide range of fields such as organizational development, and empirical approaches that adopt mixed methods to derive fulsome answers to specific questions about establishing PSOs. Theoretically, this dissertation provides a conceptual framework that can be used to inform the process of establishing a PSO in different contexts. The theoretical constructs of this framework were verified and strengthened through direct application in subsequent studies in the dissertation. This dissertation has many implications for policy and research. Most importantly, for those interested in establishing a PSO, my findings provide a road map for identifying the most appropriate starting point and the factors that might influence the establishment process. In addition, leaders of existing PSOs can use my findings to expand or refine their scope of work. Given that this framework focuses only on PSOs in the health sector, an important next step for research will be to include other sectors and identify any additional insight that can enhance the framework I have developed. / Thesis / Doctor of Philosophy (PhD) / Health system policymaking is a challenging task because many factors need to be balanced in policy decisions (e.g., efficiency, equity, and politics). There have been an increasing number of calls emphasizing the need to use the best-available research evidence to inform health system policies and, in response, efforts have been made in many countries to develop and implement approaches to enhance the use of research in the policymaking process. In some instances, organizations have been given sole responsibility for supporting evidence-informed policy, but evidence is limited to inform the process of establishing these organizations. This dissertation addresses this gap in the literature by: I) developing a new conceptual framework for the process of establishing organizations that can support evidence-informed policymaking; ii) identifying approaches that can be used in this process; and iii) developing a model for a proposed Omani knowledge translation department using this framework.

The prevalence of inactivity remains high, with more than 80 percent of adults failing to meet physical activity guidelines. Numerous evidence-based interventions for physical activity promotion have been developed and tested to address this need, but are typically not scaled-up and sustained in the intended practice setting. Many of these physical activity promotion programs suggest community-based delivery, often requiring researchers to train delivery personnel on intervention components. However, there is a paucity of detail on for whom, under what conditions, and how training mechanism are effective in practice. The purpose of this research was to explore the questions related to the research, theory, and practice of training. For research, a mixed-methods exploration of delivery personnel characteristics and perceived barriers and facilitators before and after program delivery or non-delivery was conducted. For theory, a systematic review of physical activity trainings for community-based delivery personnel was conducted in the literature to determine the characteristics of those who were trained, the structural and mechanistic components of said trainings, and the effectiveness of these trainings. For practice, a case-study of existing training in a community based setting was conducted to determine training processes that are likely to be successful in the real world and to evaluate the feasibility of an observational tool for physical activity trainings. The results of this dissertation show that delivery personnel characteristics and skillset may impact the acceptability, appropriateness, and effectiveness of training. They also provide preliminary support for the inclusion and importance of peer support within physical activity trainings to increase the number and representativeness of people trained and increase comfort with the training material. Further, descriptions of training for in-person physical activity programs in community settings are vague and inadequate making them difficult to replicate. Taken together, these studies provide avenues for future research and practice to develop an evidence-base for training mechanisms. / Ph. D.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2017-08-08T11:29:34Z No. of bitstreams: 2 Dissertação - Julyana Calatayud Carvalho - 2017.pdf: 3964594 bytes, checksum: 9436130a52a4288a36984d7bd2ca0bcc (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-08-08T15:00:59Z (GMT) No. of bitstreams: 2 Dissertação - Julyana Calatayud Carvalho - 2017.pdf: 3964594 bytes, checksum: 9436130a52a4288a36984d7bd2ca0bcc (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-08-08T15:00:59Z (GMT). No. of bitstreams: 2 Dissertação - Julyana Calatayud Carvalho - 2017.pdf: 3964594 bytes, checksum: 9436130a52a4288a36984d7bd2ca0bcc (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-07-03 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / There are strategies and interventions with proven effectiveness for the adequate management of neonatal pain. However, the simple dissemination of knowledge at the end of a research and/or training do not guarantee the use of knowledge by health professionals in clinical practice, resulting in a gap between knowing and doing. Given the frequent and repeated exposure of newborns to painful procedures in the neonatal unit and the deleterious consequences of untreated pain, it is urgent to implement innovative actions that promote changes in clinical practice to transform the available evidence into action. Thus, the objective of this study was to evaluate the effect of a multifaceted Knowledge Translation (KT) intervention to improve the management of neonatal pain. It is a quasi-experimental study, with no control group, of pre- and posttest type, performed at the neonatal unit of a public maternity hospital in Goiás, Brazil, from February 2015 to March 2016. The intervention used was Evidence-Based Practice for Improving Quality (EPIQ), which was divided into two phases: preparation and implementation, and change. A Research and Practice Council consisting of health professionals of the neonatal unit led and facilitated the proposed changes. Implementation was carried out in three rapid cycles, with one target for each cycle being established. Several KT strategies were used in combination, according to what the goal and barriers indicated, such as: reminders, bedside training, videos, educational leaflets, auditing and feedback, clinical protocols and didactic presentation. In Cycle 1, all professionals were sensitized to the adequate management of neonatal pain, and 89.4% of the professionals considered it possible to use the presented strategies. In cycle 2, the PIPP-R and EDIN scales were used to assess pain. At the first audit of cycle 2, of the total of 64 painful procedures (aspiration, blood collection and catheter insertion), the PIPP-R scale was applied in 30.8% of these procedures and EDIN in 26.2%. In the second audit of cycle 2, from 38 painful procedures, the PIPP-R scale was registered in 23.7% and EDIN, 23.8%. In cycle 3, the goals of cycle 2 were maintained and 20% oral glucose administration was included for relief of acute pain during peripheral catheter insertion and blood collection. In the audit of cycle 3, glucose was administered in 29.6% from the total of 54 painful procedures. After the completion of the implementation process, a final audit was carried out for 25 days. From the total of 444 painful procedures, the PIPP-R scale was applied in 26.6% and the EDIN scale was applied 50.7%; and glucose was 17 administered in 25.1% of these procedures. We conclude that, while faced with a challenging context and with the multifaceted KT intervention used in this study (EPIQ), it was possible to observe a significant increase, by health professionals, in the use of scales to assess pain and oral glucose administration to relieve neonatal pain. However, strategies to improve and sustain these outcomes are needed to ensure that every newborn has their pain evaluated and treated. / Existem estratégias e intervenções com efetividade comprovada para o manejo adequado da dor neonatal. No entanto, a simples disseminação do conhecimento no término de uma pesquisa e/ou em capacitações não garantem a utilização do conhecimento pelos profissionais de saúde na prática clínica, resultando em uma lacuna entre o saber e o fazer. Diante da exposição frequente e repetida dos recém-nascidos a procedimentos dolorosos na unidade neonatal e, as consequências deletérias da dor não tratada, é urgente a implementação de ações inovadoras que promovam mudanças na prática clínica transformando a evidência disponível em ação. Assim, este estudo objetivou avaliar o efeito de uma intervenção multifacetada de Knowledge translation (KT), para melhorar o manejo da dor neonatal. Tratase de um estudo quase experimental, sem grupo controle, do tipo pré e pós-teste, realizado na unidade neonatal de uma maternidade pública de Goiás, Brasil, no período de fevereiro de 2015 a março de 2016. A intervenção utilizada foi a Evidence-Based Practice for Improving Quality (EPIQ), dividida em duas fases: preparação e implementação e mudança. Um Conselho de Pesquisa e Prática constituído pelos profissionais de saúde da unidade neonatal liderou e facilitou as mudanças propostas. A implementação foi realizada em três ciclos rápidos, sendo estabelecida uma meta para cada ciclo. Foram utilizadas diversas estratégias de KT combinadas, de acordo com a meta e barreiras apontadas, tais como: lembretes, treinamento a beira leito, vídeos, folhetos educativos, auditoria e feedback, protocolos clínicos e apresentação didática. No Ciclo 1, todos os profissionais foram sensibilizados para o manejo adequado da dor neonatal, sendo que 89,4% dos profissionais consideraram possível utilizar as estratégias apresentadas. No Ciclo 2, foram implementadas as escalas PIPP-R e EDIN para a avaliação da dor. Na primeira auditoria do ciclo 2, do total de 64 procedimentos dolorosos (aspiração, coleta de sangue e inserção de cateter), a escala PIPP-R foi aplicada em 30,8% destes procedimentos e a EDIN 26,2%. Na segunda auditoria do ciclo 2, dos 38 procedimentos dolorosos, a escala PIPP-R foi registrada 23,7% vezes e a escala EDIN, 23,8%. No ciclo 3, foram mantidas as metas do ciclo 2 e incluída a administração de glicose oral 20% para alívio da dor aguda durante a inserção de cateter periférico e coleta de sangue. Na auditoria do ciclo 3, a glicose foi administrada em 29,6% do total de 54 procedimentos dolorosos. Após o término do processo de implementação, foi realizada uma auditoria final durante 25 dias. Do total de 444 procedimentos dolorosos, a escala PIPP-R foi aplicada em 26,6% 15 e a escala EDIN foi aplicada 50,7%; e a glicose foi administrada em 25,1% desses procedimentos. Concluímos que, diante de um contexto desafiador e com a intervenção multifacetada de KT utilizada neste estudo (EPIQ) foi possível observar um aumento significativo pelos profissionais de saúde no uso das escalas para avaliar a dor e a administração de glicose oral para aliviar a dor neonatal. No entanto, são necessárias estratégias para melhorar e sustentar esses resultados, no sentido de garantir que todo recém-nascido tenha sua dor avaliada e tratada.

<p>Integrating laboratory information into prescribing tasks may improve medication safety. This thesis addresses several methodological issues in the progress of two studies: a systematic review of randomized trials addressing the impact of drug-lab safety alerts on adverse drug events and changes in prescribing or lab monitoring and a randomized trial using an electronic survey to compare prescribing decisions in complex clinical scenarios including integrated lab data with those in which the lab data were available on request. The systematic review found 32 studies; 10 addressed multiple drug-lab combinations, and 22 addressed single drug-lab combinations, including 14 targeting anticoagulation. We report a benefit of anticoagulation-related alerts (OR of an adverse event (bleeding or thrombosis) 0.88 (95% CI 0.78-1.00) and improved prescribing in multi-drug studies (OR 2.22, 95% CI 1.19-4.17), but substantial study heterogeneity precluded combining studies of other drugs. Methodological issues addressed in the RCT include medication selection, scenario design, recruitment, and assessment of the representativeness of the sample. We selected medications for study scenarios that are commonly prescribed by Canadian primary care physicians, and are associated with clinically important harm that may be preventable through laboratory monitoring. Data sources included IMS Brogan data on prescribing patterns and the Discharge Abstracts Database (DAD) and the National Ambulatory Care Reporting System (NACRS) from 2006-2007 to 2008-2009. Our study had 148 completed surveys. The study sample differed from the population of Ontario family physicians by gender, and use of electronic medical records. We found no difference in prescribing decisions (OR 1.21, 95% CI 0.84-1.75) between the study groups and no predictors of improved prescribing decisions. The lack of demonstrated impact of integrating lab data into clinical decision-making may be related to the study being underpowered, to a true lack of clinical benefit, or to a lack of discriminatory power in the scenarios.</p> / Master of Science (MSc)

<p>Evidence briefs are an innovative and promising approach to synthesizing the best available research evidence to support evidence-informed health policymaking in low- and middle-income countries. Unfortunately, despite their increased use, little work has been undertaken to understand how the contexts in which briefs are prepared and the issues that they address influence the ways in which policymakers and stakeholders view them. Furthermore, there have been few efforts to determine whether and how evidence briefs influence the policy processes related to the priority policy issues for which they are prepared. This thesis begins to address these issues through four manuscripts that use a range of methods and approaches to develop a deeper understanding of briefs and their use, as well as the ways in which they can be evaluated in low- and middle-income countries. Taken together the chapters present: 1) the development of a theoretical framework through a systematic review that highlights how factors related to contexts and issues can influence policymakers’ and stakeholders’ views about evidence briefs and their design features; 2) results from a survey conducted across six countries that provide insights into how policymakers, stakeholders and researchers who have read evidence briefs view them and their design features; 3) an approach to operationalizing factors related to contexts and issues as variables for use in quantitative analyses of evidence briefs; and 4) four case studies that explain how evidence briefs prepared for priority policy issues in low- and middle-income countries influenced the policy processes related to these issues. These chapters constitute substantive, methodological and disciplinary contributions to the field of health systems research, and in particular about how to support its use in efforts to strengthen health systems. They also support the continued use and evaluation of evidence briefs in efforts to strengthen health systems in low- and middle-income countries.</p> / Doctor of Philosophy (PhD)

Background: This thesis aimed to develop, implement, and evaluate a multi-faceted integrated knowledge translation (iKT) intervention to disseminate and support adoption of the ‘F-words in Childhood Disability’. Grounded in the WHO’s ICF framework, the ‘F-words’ (Function, Family, Fitness, Fun, Friends, and Future) offer a holistic family-centred approach to childhood disability. Methods: This thesis was guided by the action cycle of Graham et al.’s (2006) knowledge-to-action (KTA) framework. Chapter 2 reports a knowledge translation (KT) initiative (i.e., an online video) to disseminate the ‘F-words’ and explore people’s reception of these ideas. Chapter 3’s scoping review identifies and assesses KT strategies that directly target families raising children and youth with special health care needs. Chapter 4 describes a pilot study to evaluate the usability and utility of an online ‘F-words’ KT resource. Chapter 5 reports a case study of our longitudinal KT research program, and uses Diffusion of Innovation (DOI) theory to understand the factors that contributed to the adoption of the ‘F-words’. Results: Multi-faceted KT strategies, co-developed with stakeholders, were essential to moving the ‘F-words’ into practice. The video (Chapter 2) reached >700 views in two months and 98% of 137 survey respondents indicated they ‘extremely liked’/‘liked’ the ideas. The scoping review (Chapter 3) identified six studies, all of which evaluated educational materials and deemed them to be useful and important to families. The pilot evaluation (Chapter 4) revealed the online resource to have positive usability and utility for families and service providers. The case study (Chapter 5) highlighted that diffusion, dissemination and implementation strategies were all needed and that DOI factors (i.e., the innovation characteristics, communication channels, social networks, and time) contributed to the adoption of the ‘F-words’. Based on a multi-faceted integrated KT research program we now have extensive examples of ‘F-words’ adoption by families, service providers, and health care organizations. Conclusions: This thesis illustrates a step-wise theory-informed approach to the development and evaluation of a multi-faceted iKT intervention. By studying each step of the action cycle, this work contributes new knowledge to both the processes involved in disseminating research evidence, and associated outcomes from a multi-faceted iKT intervention. Findings from this thesis contribute new discoveries to both KT practice and science. / Thesis / Doctor of Philosophy (PhD) / In the 21st century, research supports a holistic family-centred approach to childhood disability. Unfortunately, a research to practice gap remains, and the professional-led biomedical approach still informs many practices. In 2012, Rosenbaum and Gorter published “The ‘F-words’ in childhood disability: I swear this is how we should think!” They highlighted the importance of ‘Function, Family, Fitness, Fun, Friends, and Future’, grounded in the World Health Organization’s framework for health. This thesis developed and evaluated a knowledge translation research program to move the ‘F-words’ into practice. Objectives, all achieved, were to: i) apply strategies to spread awareness of the ‘F-words’ and explore people’s reception of these ideas; ii) identify and assess strategies to share research with families; iii) develop and evaluate an online resource to support use of the ‘F-words’; and iv) study the processes involved and factors that contributed to the ‘F-words’ adoption. These findings have implications for both doing and studying knowledge translation.