Knowledge mobilization has been described as putting research in the hands of research users. Few studies have examined knowledge mobilization within community-based organizations (CBOs). To address this research gap, this dissertation examines knowledge mobilization within a CBO that supports people with spinal cord injury (SCI). Research suggests that communication channels, or the means by which a message is delivered, may affect knowledge mobilization. This dissertation presents four manuscripts examining how communication channels were used by the CBO to disseminate physical activity guidelines and intervention strategies to people with SCI. Manuscript 1 investigated reach and effectiveness of an event-based knowledge mobilization initiative delivered by the CBO using interpersonal communication channels to disseminate the guidelines to people with SCI. Results indicated that the event-based knowledge mobilization initiative was effective for initial dissemination of the guidelines. However, further long-term efforts are needed. Manuscript 2 describes how the event-based knowledge mobilization initiative was implemented by the CBO. Recognizing that support personnel are important messengers, the reach and effectiveness of the initiative for persuading support personnel to disseminate the guidelines was examined. Results indicated that an event-based knowledge mobilization initiative can be implemented by a CBO and may be an effective strategy for CBOs to disseminate information to support personnel. Manuscript 3 further examined the role of communication channels in the process of knowledge mobilization within the CBO using network analysis. Results indicated that CBO staff and volunteers’ integration within interpersonal communication channels was associated with greater knowledge of evidence-based physical activity resources and engagement in physical activity promotion behaviours. Manuscript 4 examined the feasibility of training peers with SCI to learn an evidence-based approach to physical activity promotion called Brief Action Planning. Findings indicated that Brief Action Planning is a tool that can be feasibly learned and potentially used by peers to promote physical activity to their mentees through interpersonal communication channels. Overall this dissertation contributes to a small but emerging body of literature examining knowledge mobilization in CBOs. Findings indicate that through a community-university multidisciplinary partnership and appropriate communication channels, a CBO can effectively and feasibly disseminate evidence-based physical activity information. / Thesis (Ph.D, Kinesiology & Health Studies) -- Queen's University, 2013-08-28 17:27:32.841

The high prevalence of back and neck pain results in enormous social, psychological, and economic burden. Most seeking help for back or neck pain consult general practitioners or chiropractors. Chiropractic is a regulated health profession (serving approximately 10 – 15% of the population) that has contributed to the health and well-being of North Americans for over a century. Despite available evidence for optimal management of back and neck pain, poor adherences to guidelines and wide variations in services have been noted. For instance, overuse and misuse of imaging services have been reported in the chiropractic literature. Inappropriate use of spine imaging has a number of potential adverse outcomes, including inefficient and potentially inappropriate invasive diagnosis and subsequent treatment, and unnecessary patient exposure to ionizing radiation. Although evidence-based diagnostic imaging guidelines for spinal disorders are available, chiropractors are divided on whether these guidelines apply to them. While guidelines can encourage practitioners to conform to best practices and lead to improvements in care, reviews have demonstrated that dissemination of guidelines alone is rarely sufficient to optimise care. Evidence regarding effective methods to promote the uptake of guidelines is still lacking. There is growing acceptance that problem analysis and development of interventions to change practice should be guided by relevant theories and tailored to the target audience. To date, very little knowledge translation research has addressed research-practice gaps in chiropractic. This thesis reports rigorous methods to: (1) assess practice and providers’ characteristics, (2) determine baseline rates and variations in spine x-ray ordering, (3) evaluate the impact of disseminating guidelines to optimise spine x-ray ordering, and (4) assess determinants of spine x-ray ordering and potential targets for change prior to the design of a tailored intervention. A mixed method using two disciplinary perspectives (epidemiology and psychology) was undertaken. A cross-sectional analysis of administrative claims data was carried out on a sample of chiropractors enlisted in a large American provider network. Despite available clinical practice guidelines, wide geographical variations in x-ray use persist. Higher x-ray ordering rates were associated with practice location (Midwest and South US census regions), setting (urban, suburban), chiropractic school attended, male provider, employment, and years in practice. The impact of web-based guideline dissemination was evaluated over a five year period using interrupted time series and demonstrated a stepwise relative reduction of 5.3% in the use of x-rays. Passive guidelines dissemination appeared to be a simple, cost effective strategy in this setting to improve but not optimise x-ray ordering rates. Focus groups using the theoretical domains framework were conducted among Canadian and US chiropractors to explore their beliefs about managing back pain without x-rays. Findings were used to develop a theory-based survey to identify theoretical constructs predicting spine x-ray ordering practice. Psychological theories and theoretical constructs explained a significant portion of the variance in both behavioural simulation and intention. Results from this thesis provide an empirically-supported, theoretical basis to design quality improvement strategies to increase guidelines adherence and promote behaviour change in chiropractic. Other researchers interested in improving uptake of evidenced-based information could use this method in their own setting to investigate determinants of behaviour among other professional groups. Future research may use knowledge gained to inform the development and evaluation of a theory-based tailored intervention to improve guideline adherence and reduce the use of spine x-rays among targeted providers.

A growing body of research has emphasized the prevalent mental health problems faced by the fastest-growing demographic segment of Canada’s population, older adults, in addition to their particularly low rates of mental health service use. Research has also begun to demonstrate that although older adults express a desire to be involved in their health care decision-making, they are often not given sufficient information to participate in this process. In light of low rates of service use and generally poor mental health literacy, defined as knowledge and beliefs about the recognition, prevention, and management of mental health problems, several researchers posit that older adults experience a gap in the knowledge translation of mental health information. The present research explores older adults’ pathways to mental health information and treatment. In Study 1, individual interviews were conducted with older adults who came to seek psychological treatment for mental health problems (n = 15), and analyzed according to narrative analysis. The main storylines across participants’ narratives of treatment seeking included resistance to being labeled with mental health problems, muddling through the treatment seeking process, and interpretations of psychological treatment. Findings are discussed within the context of increasing efforts to enhance clarity in the complex process of seeking treatment for mental health problems. In Study 2, older adults’ mental health information preferences and predictors of information preferences were examined in a sample of community-dwelling older adults (n = 229). Results demonstrated that despite being unfamiliar with mental health treatment options, older adults reported a strong interest in receiving detailed information concerning a variety of mental health treatment options. Family, friends, and health care providers were highly rated informational sources; and written formats and discussions with health care providers were highly rated informational formats. The most consistent predictors of mental health information preferences included attitudes toward seeking psychological treatment and social support. Findings are contextualized within the importance of increasing the mental health literacy of older adults through knowledge translation efforts. Overall, findings of this research provide clear directions for decreasing the gap in mental health knowledge translation among older adults. / October 2016

Research-informed practice is crucial to ensure best possible decisions are made during care delivery. In reality, research-based evidence often does not reach patient care due to many elements that impede the implementation process. The purpose of this phenomenological study was to discover the lived experiences of nurses involved in implementing evidence-based practice (EBP) in clinical settings within hospitals in United Arab Emirates. The theoretical and conceptual basis for the study was derived from Promoting Action on Research Implementation in Health Services framework for knowledge translation and Benner's Novice to Expert theory. Twelve nurses who had experience implementing evidence to practice were the participants of this study. Data were collected through semi-structured interviews and analyzed using a qualitative hermeneutic phenomenological approach. Three themes emerged from the study that included the significance of EBP, the process of evidence translation, and the outcome of evidence translation. Nurses in the clinical settings had basic understanding of EBP and were motivated to translate evidence, but their knowledge and skill in EBP were still limited. The implication for positive social change of this study is the recommendation that leaders in healthcare and nursing, as well as educators, and researchers to recognize the need for building EBP capabilities among nurses. Organizations must include current theories, frameworks, and tools of evidence translation to cultivate a culture of EBP as a foundation for patient care.

<p>Background: In today’s highly competitive business environment, knowledge is viewed as a key strategic resource. The privatization process of telecom operators in different countries created a demand in telecom management skills, and Swedish companies like Swedtel AB became involved in exporting and transferring their knowledge and management skills. </p><p>Purpose: The purpose of this thesis paper is to identify all stages (from origins to final destination) of the Knowledge Transfer process and to contribute to the understanding about the mechanism of Knowledge Transfer between organizations.</p><p>Scope: This research is limited to the investigation of the transfer process of strategic management knowledge from consulting company Swedtel AB to privatized telecom companies in Lithuania (Lietuvos Telekomas) and Nicaragua (Enitel). </p><p>Results: Theoretical model of Knowledge Transfer was identified and tested. The model of this research was only partially supported: processes were identified in practice as described by the theory, however model required modifications in order to better reflect the reality.</p>

Background: In today’s highly competitive business environment, knowledge is viewed as a key strategic resource. The privatization process of telecom operators in different countries created a demand in telecom management skills, and Swedish companies like Swedtel AB became involved in exporting and transferring their knowledge and management skills. Purpose: The purpose of this thesis paper is to identify all stages (from origins to final destination) of the Knowledge Transfer process and to contribute to the understanding about the mechanism of Knowledge Transfer between organizations. Scope: This research is limited to the investigation of the transfer process of strategic management knowledge from consulting company Swedtel AB to privatized telecom companies in Lithuania (Lietuvos Telekomas) and Nicaragua (Enitel). Results: Theoretical model of Knowledge Transfer was identified and tested. The model of this research was only partially supported: processes were identified in practice as described by the theory, however model required modifications in order to better reflect the reality.

Leadership is important to quality improvement initiatives in healthcare. However, few studies have evaluated leadership interventions to enhance nurses’ use of guideline recommendations in the field of knowledge translation. Purpose: To develop and evaluate an intervention designed to operationalize a leadership strategy composed of relations, change, and task-orientated leadership behaviours, and to examine its influence on nurses’ use of guideline recommendations in home-care nursing. Design: Sequential mixed methods pilot study with post-only cluster randomized controlled trial. Methods Phase I: Intervention Development 1. A participatory approach was used at a community healthcare organization with 23 units across the province of Ontario, Canada. The guideline selected was developed by the Registered Nurses’ Association of Ontario for the assessment and management of foot ulcers for people with diabetes. 2. Integrative literature review, qualitative interviews, and baseline chart audits were conducted. 3. Four units were randomized to control or experimental groups. 4. Clinical and management leadership teams participated in a 12-week intervention consisting of printed materials, interactive workshop, and teleconferences. Participants received summarized chart audit data, identified priority indicators for change, and created a team leadership action plan to address barriers and influence guideline use. Phase II: Evaluation 5. Chart audits compared differences in nursing process and patient outcomes. Primary outcome: eight-item nursing assessment score. 6. Qualitative interviews evaluated the intervention and leadership behaviours. Results: No significant difference was found in the primary outcome. A significant difference was observed in nurses’ documentation of five priority indicators chosen by the experimental groups (p=.02). Gaps in care included: 53%, 76%, and 94% of patients not assessed for ulcer depth, foot circulation, or neuropathy (respectively); 75% and 93% did not receive wound debridement or hydrogel dressings. Receiving data to identify priority indicators for change and developing a leadership action plan were reported as useful to guideline implementation. The experimental group described using more relations-oriented leadership behaviours conducting audit and feedback, and sending reminders. Conclusion: Findings from this pilot study suggest that leadership is a team process involving relations, change, and task-oriented behaviours enacted by managers and clinical leaders. A leadership model is proposed as a beginning taxonomy to inform future leadership intervention studies.

Aim: This paper is a report on a study that explored the professional development of intensive care unit nurses in journal clubs. Background: Evidence-based practice is important in nursing care (Krom, Batten, & Bautista, 2010). However few nurses feel comfortable using evidence to guide their practice (Pravikoff, Tanner, & Pierce, 2005). Journal clubs are a way to establish science as conversation (Wright, 2004) and foster knowledge translation for evidence-based nursing practice (Goodfellow, 2004). Methods: Monthly journal club meetings were held with the participation of a total of 71 healthcare professionals (65 nurses, 2 physicians, 2 pharmacists, 1 physiotherapist, and 1 respiratory therapist), who worked in two intensive care units of an Ontario hospital. After six months of meetings, 21 individual interviews were conducted with nurses, physicians, pharmacists, and nurse educators. Additional data collection included two focus groups, surveys, a review of staff meeting minutes, and researcher field notes. Findings: Journal clubs provided nurses with incentive to read research articles, improved nurses’ confidence in reading research, created a community of peers who worked collaboratively to improve clinical practice, provided a structure for nurses to reflect-on-practice, and led to reported changes in clinical practice. However, the data suggests that any gains in competence of nurses with the critical appraisal of research articles were probably modest. Barriers to participating in journal clubs and evidence-based practice are also identified. Conclusion: Journal clubs can foster knowledge translation and evidence-based practice through creating a community of practice and by providing nurses with motivation, structure, and confidence to read research articles. However, nurses reported a lack of critical appraisal skills and uncertainty about how to implement evidence into practice. Journal clubs may have a greater impact when implemented alongside other knowledge translation strategies such as working with clinical nurse specialists in order to enhance evidence-based practice.

The high prevalence of back and neck pain results in enormous social, psychological, and economic burden. Most seeking help for back or neck pain consult general practitioners or chiropractors. Chiropractic is a regulated health profession (serving approximately 10 – 15% of the population) that has contributed to the health and well-being of North Americans for over a century. Despite available evidence for optimal management of back and neck pain, poor adherences to guidelines and wide variations in services have been noted. For instance, overuse and misuse of imaging services have been reported in the chiropractic literature. Inappropriate use of spine imaging has a number of potential adverse outcomes, including inefficient and potentially inappropriate invasive diagnosis and subsequent treatment, and unnecessary patient exposure to ionizing radiation. Although evidence-based diagnostic imaging guidelines for spinal disorders are available, chiropractors are divided on whether these guidelines apply to them. While guidelines can encourage practitioners to conform to best practices and lead to improvements in care, reviews have demonstrated that dissemination of guidelines alone is rarely sufficient to optimise care. Evidence regarding effective methods to promote the uptake of guidelines is still lacking. There is growing acceptance that problem analysis and development of interventions to change practice should be guided by relevant theories and tailored to the target audience. To date, very little knowledge translation research has addressed research-practice gaps in chiropractic. This thesis reports rigorous methods to: (1) assess practice and providers’ characteristics, (2) determine baseline rates and variations in spine x-ray ordering, (3) evaluate the impact of disseminating guidelines to optimise spine x-ray ordering, and (4) assess determinants of spine x-ray ordering and potential targets for change prior to the design of a tailored intervention. A mixed method using two disciplinary perspectives (epidemiology and psychology) was undertaken. A cross-sectional analysis of administrative claims data was carried out on a sample of chiropractors enlisted in a large American provider network. Despite available clinical practice guidelines, wide geographical variations in x-ray use persist. Higher x-ray ordering rates were associated with practice location (Midwest and South US census regions), setting (urban, suburban), chiropractic school attended, male provider, employment, and years in practice. The impact of web-based guideline dissemination was evaluated over a five year period using interrupted time series and demonstrated a stepwise relative reduction of 5.3% in the use of x-rays. Passive guidelines dissemination appeared to be a simple, cost effective strategy in this setting to improve but not optimise x-ray ordering rates. Focus groups using the theoretical domains framework were conducted among Canadian and US chiropractors to explore their beliefs about managing back pain without x-rays. Findings were used to develop a theory-based survey to identify theoretical constructs predicting spine x-ray ordering practice. Psychological theories and theoretical constructs explained a significant portion of the variance in both behavioural simulation and intention. Results from this thesis provide an empirically-supported, theoretical basis to design quality improvement strategies to increase guidelines adherence and promote behaviour change in chiropractic. Other researchers interested in improving uptake of evidenced-based information could use this method in their own setting to investigate determinants of behaviour among other professional groups. Future research may use knowledge gained to inform the development and evaluation of a theory-based tailored intervention to improve guideline adherence and reduce the use of spine x-rays among targeted providers.

Osteoporosis is a major public health concern, affecting over 200 million people worldwide. There is valid evidence outlining how osteoporosis can be diagnosed and managed, but gaps exist between evidence and practice. Graham’s “Knowledge to Action” (KTA) process for knowledge translation and the Medical Research Council (MRC) framework for complex interventions were used to address these gaps. The first 4 KTA steps were collapsed into 3 phases of the PhD research plan. In PhD Phase 1, a systematic review was conducted to identify tools that facilitate decision making in osteoporosis disease management (DM). Results showed that few DM tools exist, but promising strategies were those that incorporated reminders and education and targeted physicians and patients. PhD Phase 2 used the findings from the systematic review and consultation with clinical and human factors engineering experts to develop a conceptual design of the tool. Multiple components targeted to both physicians and patients at the point of care, and which could be used as a standalone system or modifiable for integration with electronic health record systems were outlined. PhD Phases 3a and 3b were devoted to the assessment of the barriers to knowledge. In Phase 3a, a qualitative study of focus groups was conducted with physicians to identify attitudes and perceived barriers to implementing decision support tools in practice, and to identify the features that should be included in the design. Findings from 4 focus groups combined with aging research, and input from design and information experts were used to transform the conceptual design into a functional prototype. In Phase 3b, each component of the prototype was tested in 3 usability evaluation studies using an iterative, participant-centered approach to assess how well the prototype met end users’ needs. Findings from the usability study informed the final prototype, which is ready for implementation as part of the post PhD plan to fulfill the requirements of the remaining steps of the KTA and MRC frameworks.