Using a participatory ergonomic approach, this research explored if the self-identified needs and concerns of computer users are reflected in a typical occupational therapy office ergonomic educational presentation. While the study confirmed that generally the needs of computer users are met, the topics that the participants found to be most relevant were workstation layout and equipment adjustment. This study also revealed that knowledge transfer/translation is an important factor and that clinicians should consider involving clients at the initial development phase of client educational information. The study participants preferred ergonomic information to be communicated in a brief manner, emphasizing action-oriented information and avoiding medical references. They wanted client information to employ humour, colour and lots of “pizzazz.” The manner in which clinical information is communicated to clients is vital for effective client education.

Is public health policy based on scholarly evidence? With the manifold variables that policy makers must consider, is evidence-based policy even realistic? While strategies exist to translate research into policy, a need to understand better how that can play out in real-life remains. Using interviews from informants occupying a range of positions, and considering the atmosphere created by media reports, this study examines the case of smoking privileges at East Coast Forensic Hospital. After a patient committed murder while on leave, apparently to smoke, public pressure over public safety, a relative lack of relevant scholarship, ethical considerations, and the divergent voices of stakeholders created challenging circumstances for policy makers. Through the use of case study methodology, this project identifies the kinds of information that are employed in the creation or modification of policy and offers insights concerning how the influences exerted on policy makers determine how information is employed.

Knowledge translation and exchange (KTE) is integral to the formation of evidence-informed policy. Prior to the work presented in this dissertation, a significant body of literature existed in the healthcare field regarding research-to-policy KTE; however, little was known about KTE between researchers and policymakers in the Canadian food safety system or the context-specific barriers that influence KTE. A mixed-methods approach was used, grounded in concepts from the healthcare literature, to explore Canadian food safety researchers’ KTE awareness and activities with policymakers, the barriers hindering KTE engagement and success, and timing and informational disparities between research and policy needs that may hinder KTE success. Canadian food safety researcher awareness of and engagement in KTE activities with policymakers was high. However engagement in activities identified as having the greatest potential for KTE success—i.e., collaboration with policymakers at all stages of the research process, provision of syntheses such as systematic reviews, and provision of a searchable database of research findings—was low relative to end-of-research dissemination of findings to policymakers. Several barriers were identified that limited KTE engagement and success from the researcher’s perspective, including an inability to identify relevant policymakers, high policymaker turnover, a lack of resources and support in the research organization, a perceived lack of KTE skills on the part of researchers, and an inability to break free from traditional publish-or-perish research roles. Apparent informational disconnects (i.e., research output not meeting policymakers’ apparent informational needs) were identified that may further hinder KTE and evidence-informed policymaking. While new methodologies, such as systematic review, have been adapted for food safety research, boosting researchers’ potential ability to produce policy-relevant evidence, a cultural shift must occur in research and policymaking organizations, if sustained KTE is to be successful. As well, significant future investment must be made on the part of research organizations and policymakers, if KTE barriers are to be mitigated. Future research should evaluate KTE tools (e.g., sustained linkages between researchers and policymakers, provision of syntheses, provision of access to a database of research findings) to identify specific methods that may facilitate research use in food safety policymaking. / Blake Graham Fellowship, Canadian Institutes of Health Research, Public Health Agency of Canada

Establishing online communities of practice is an important part of the knowledge translation process in the modern healthcare system, but these online communities are new entity that is inherently different from traditional communities of practice that are dependent on existing social structures. The objective of this thesis is to combine communication analysis and content analysis to delve deeper into the communications within an online community to try and determine how online communities exist, and how that information can be leveraged to improve online knowledge translation. Using a novel approach this project will map the contents of online conversations to a structured medical lexicon (MeSH), and then use the inherent relationships of that lexicon to calculate term, user and thread similarities within an online community. These similarities, combined with connection analysis results, will provide a much deeper understanding of how online communities function. The methods developed here will then be tested on two separate mailing lists, the Pediatric Pain Mailing List (PPML) and SURGINET, a mailing list of general surgeons.

Serious gaps between best and actual stroke rehabilitation practices continue to exist, even with the plethora of evidence and guidelines for stroke best practice management. To address this knowledge gap with an effective knowledge translation (KT) intervention, six steps of the Knowledge to Action (KTA) Model were applied to these specific research objectives: 1) to conduct a systematic review to examine evidence on the effectiveness of single/multi-component KT interventions for improving knowledge, attitudes, and rehabilitation practice behaviors of occupational therapists (OTs) and physical therapists (PTs), in order to inform the design of a KT intervention; 2) to conduct usability testing to explore factors that facilitate or hinder OTs' and PTs' use of an evidence-based, stroke rehabilitation-specific e-learning resource (Stroke Engine; www.strokengine.ca), as a preliminary step in its potential use as a KT intervention; and, 3) to conduct a KT intervention study to determine the extent of knowledge acquired regarding stroke rehabilitation best practices by OTs and PTs while using Stroke Engine as an e-learning KT intervention for three months. A sub-objective was to identify the association between knowledge acquired and factors related to the clinician, their work environment, and adherence to the KT intervention. Main findings from this research agenda suggested that use of active, multi-component KT interventions resulted in some knowledge gains among physical therapists, but additional research was needed to understand impact of these strategies on occupational therapists. During Stroke Engine testing, factors hindering its use were identified and the website was modified to maximize its usability as an e-learning KT intervention. Clinicians were satisfied with Stroke Engine as it provided them with the latest stroke evidence in a quick, user-friendly format. Finally, significant improvements in clinicians' proportion of 'evidence-based' responses on the Stroke Rehabilitation Knowledge Questionnaire were observed between baseline and following Stroke Engine use as a KT intervention. Intensity of Stroke Engine use was the most significant predictor for clinicians' improved 'evidence-based' knowledge on the Questionnaire. It was concluded that Stroke Engine has promise as an effective e-learning KT intervention for enhancing rehabilitation clinicians' knowledge of stroke best practices.

Patients with dementia are often unaware of their disease and do not seek medical attention; thus, health care providers must shift to "active detection" to identify at-risk patients early. No previous studies have focused on promoting this shift, so this study evaluates the efficacy of a new program to improve the knowledge and confidence of primary care providers in the early detection, diagnosis, and management of mild dementia. Physicians and nurses (n = 38) were recruited from 14 practices in Ontario, Canada. The Mild Dementia Knowledge Transfer Program was run at each practice. As a Neuroscience Master’s student I demonstrated the cognitive assessment procedures, and recipients assessed remaining patients with my guidance. Assessments included patient interviews using a Data Gathering Form –developed for the Program – to provide informal cognitive assessment, and the Montreal Cognitive Assessment (MoCA) test. The procedures were discussed between assessments to enhance learning. Later, recipients discussed the assessment results with the dementia specialist and myself; diagnoses and initial care plans were formulated collaboratively. Questionnaires measuring knowledge and confidence regarding detection, assessment and care of mild dementia were developed to measure change pre-post and three months after the Program. Linear mixed-effects models analysis with time as fixed effect and intercept as random effect was conducted to test change. Program recipients showed increases in knowledge-confidence score after the program (10.3; P < .001) paralleling increases in both knowledge and confidence sub-scores; there was no decline after three months (P = .83). No differences were observed between medical and nursing staff. The number of assessments done by recipients was positively associated with knowledge-confidence change (P = .01). Most recipients (70%) rated the program as excellent; 65% rated interactivity as the best part, 34% rated time commitment as the worst part, and 91% rated the program as making it easier to detect dementia. Due to the complex nature of dementia, the Program was performance-oriented, specialist-supported, clinic-based, and flexible to the needs of recipients. It showed acceptability and feasibility within primary care, and the results support its’ efficacy to improve primary care providers’ self-rated knowledge and confidence in mild dementia care. / Thesis (Master, Neuroscience Studies) -- Queen's University, 2010-07-26 21:38:54.945

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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.

This study seeks to understand how collaborative information communication technologies (cICT) are used to support knowledge translation and optimize physician’s roles in chronic pain management. A survey was developed and distributed to 170 physicians in two chronic pain mentoring networks in Ontario and Nova Scotia. With a response rate of 74.1% the study identified the use of a broad variety of cICTs; with email as the most used. A majority of respondents (85.0%) used email to support discussions and 69.8% found it to be valuable in learning about chronic pain management. A higher frequency of email (adjusted OR=10.70, 95% CI: 2.84-40.33) and number of cICTs (adjusted OR=2.93, 95% CI: 1.19-7.21) used to communicate in the networks were associated with more interactions. These results highlight how cICTs can support the interactions and learning that are part of the knowledge translation process in optimizing the roles of physicians in chronic pain management.