Economic evaluations and network meta-analyses (NMAs) are complex methodologies. Increasing their transparency and accessibility could enhance confidence in the legitimacy of policy decisions informed by these analyses. Four systematic reviews were conducted to understand policymakers’ informational needs and to determine what guidance researchers have on how to present economic evaluations and NMAs. Qualitative interviews were conducted with Canadian policymakers, i.e., knowledge users, to understand barriers and facilitators to using and communicating economic evaluations and NMAs and with individuals in international health technology assessment organizations, i.e. knowledge producers, to explore current approaches to communicating economic evaluations and NMAs. A toolkit for NMAs and economic evaluations was proposed based on an integrated review of these findings and guided by the Knowledge-to-Action framework. Examples of tools were developed and applied to an economic evaluation and NMA of osteoporosis therapies. Systematic reviews and qualitative interviews found that communication approaches that provide robust content, identify contextual factors relevant to policy decisions and enhance clarity were valued. Twelve tools were proposed that enhance communication, education and access to resources for policymakers. Two of these tools were developed: Economic Guidance for Researchers and NMA Guidance for Researchers.

La recherche en santé génère des publications scientifiques de plus en plus nombreuses. Or cette production scientifique n'est pas systématiquement intégrée dans la santé publique. Chercheurs et décideurs politiques ont des fonctionnements et des contraintes qui ne facilitent pas naturellement les échanges et l'application des connaissances (AC) issues de la recherche dans les politiques de santé. Cette thèse porte sur cet écart entre recherche et politiques de santé et analyse les facteurs déterminants du succès ou de l'échec du transfert des connaissances entre recherche et politiques de santé au Cambodge. Le premier chapitre définit le processus d'application des connaissances (AC) et passe en revue les rares interventions d'AC rapportées dans la littérature. Cette revue montre que l'AC n'est pas un concept nouveau, même s'il demeure peu maîtrisé et peu développé. Dans ce chapitre, nous passons également en revue les outils utilisés pour modéliser des processus et des recherches en santé. Nous concluons que l'UML (langage unifié de modélisation) apparait comme le meilleur outil de modélisation disponible pour analyser le processus d'AC. Le deuxième chapitre décrit une intervention d'AC que nous avons mise en place, puis analyse son impact et les déterminants de son succès partiel, utilisant pour cela les outils UML. La plupart des barrières étaient liées soit à une désynchronisation entre la production de connaissances, soit à la prise de décisions politiques et au manque de connaissance mutuelle entre chercheurs et décideurs. Parmi les facteurs favorisants, on a relevé le rôle déterminant d'un acteur qui était à la fois ‘décideur' et chercheur, ainsi que les bénéfices liés à l'intervention vecteurs de communication entre chercheurs et décideurs. Le troisième chapitre analyse tout d'abord quantitativement et qualitativement la production scientifique de la recherche en santé au Cambodge et montre que cette production scientifique ne couvre qu'en partie les priorités de santé publique du Cambodge même si plus de 85% des articles publiés sur la santé au Cambodge étaient accessibles gratuitement. L'étude suivante permet d'identifier les principales sources d'information des décideurs politiques ayant contribué à la préparation de la première loi nationale de lutte contre l'antibio-résistance. Nous montrons que la littérature scientifique n'est pas, au Cambodge comme ailleurs, un média approprié pour communiquer avec des autorités sanitaires. Finalement, en dernier chapitre, nous intégrons les diverses conclusions des précédents chapitres dans l'analyse des déterminants de l'AC, en tirons un modèle générique UML (diagramme de classes), que nous vérifions ensuite sur quatre projets de recherche conduits également au Cambodge dont trois ont réussi leur transfert de connaissances. Ce modèle qui pourrait être utilisable au Cambodge ou dans d'autres pays à ressources limitées. Nous concluons que si les principes de l'AC peuvent se résumer en quelques règles, ils se heurtent à de nombreuses barrières lorsqu'ils sont déclinés opérationnellement. L'AC est un processus complexe, itératif, dynamique et très contexte-dépendant. Un certain nombre de barrières à l'AC identifiées au Cambodge sont strictement identiques à celles rencontrées en Occident. Parmi les facteurs favorisants de l'AC, nous montrons que le rapprochement entre chercheurs et institutions nationales ou provinciales de santé est un atout majeur. / Health research generates a growing body of scientific literature. However this scientific production is not systematically integrated into public health. Researchers and policy makers have operations and constraints that do not naturally facilitate exchanges and knowledge translation (KT) from research into health policy. This thesis focuses on the gap between research and health policy and analyzes the determinants of success or failure of KT between research and health policies in Cambodia.The first chapter defines the KT process and reviews the scarce KT interventions reported in the literature. This review shows that KT is not a new concept, even though it remains somewhat under applied. In this chapter, we also look at the tools used to model processes and health research. We conclude that the UML (unified modeling language) appears to be the best modeling tool available to analyze the KT process.The second chapter describes a KT intervention we implemented and subsequently analyzes its impact and the determinants of its partial success, using UML tools. Most of identified barriers were related to either a lack of synchronization between the production of knowledge and the health policy making, or to some lack of mutual understanding between researchers and policymakers. Among the contributing factors, we identified the key roles of an actor who was both policymaker and researcher, and of organizations which acted as communication vectors between researchers and policymakers.The third chapter first includes the quantitative and qualitative analysis of the health research scientific production in Cambodia. It shows that even though more than 85% of articles published were accessible free of charge they do not cover all public health priorities of Cambodia. The following study identifies the main sources of information for policy makers who contributed to the preparation of the first national health policy against antibiotic resistance. We show that, as elsewhere, the scientific literature is not an appropriate medium to communicate with the Cambodian health authorities.Finally in the last chapter we integrate the various findings from previous chapters into the analysis of the determinants of KT. From this analysis we draw a generic UML model (class diagram), that we test on four research projects also conducted in Cambodia. This model may be used in Cambodia or in other countries with limited resources.We conclude that if the principles of the CA can be summarized in a few simple rules, they face many barriers when they are operationally implemented. KT is a dynamic, complex , iterative, and highly context –dependent process. A number of barriers to KT identified in Cambodia are identical to those found in the West. Among the facilitating factors for KT, we show that the connection between research institutions and national or provincial health is a major asset.

The objective of this dissertation was to conduct an evaluation of a knowledge mobilization process in a community-based organization that supports adults with intellectual disabilities. The aim of the project was to understand how stakeholders share knowledge, use knowledge, and collaborate to make decisions regarding practices to support friendships for adults with intellectual disabilities. We produced two literature reviews; one systematically documented the views of adults with intellectual disabilities with regard to their relationships, and the other examined existing literature on strategies to support friendships. We also conducted two primary research studies in which we documented and evaluated knowledge mobilization activities in community-based organizations. We used a mixed-methods approach and collected data from a variety of stakeholder groups associated with a community-based organization, including staff members and the organization’s director, adults with intellectual disabilities, and family caregivers. Additionally, we collected data from staff working in a variety of community-based organizations that support adults with intellectual disabilities. During our primary research studies, we produced a variety of knowledge mobilization outputs regarding friendship support, including an evidence brief, a conference presentation, online presentations in French and English, and an informational website in French and English. The results of the studies included in this dissertation, our recommendations regarding community-based knowledge mobilization, and the knowledge mobilization outputs we developed can be used to improve knowledge mobilization practices in community-based services. Studying knowledge mobilization to support individuals with intellectual disabilities highlights some of the complexities that should be considered within community-based services, such as working with a variety of stakeholder groups, and including stakeholders that are potentially vulnerable to social exclusion.

Opening Up Scholarship in the Humanities: Digital Publishing, Knowledge Translation, and Public Engagement considers the concept of humanistic, open, social scholarship and argues for its value in the contemporary academy as both a set of socially oriented activities and an organizing framework for such activities. This endeavour spans the interrelated areas of knowledge creation, public engagement, and open access, and demonstrates the importance of considering this triad as critical for the pursuit of academic work moving forward—especially in the humanities. Under the umbrella of open social scholarship, I consider open access as a baseline for public engagement and argue for the vitalness of this sort of work. Moreover, I suggest that there is a strong connection between digital scholarship and social knowledge creation. I explore the knowledge translation lessons that other fields might have for the humanities and include a journalist–humanist case study to this end. I also argue for the value of producing research output in many different forms and formats. Finally, I propose that there are benefits to explicitly popularizing the humanities. In sum, this dissertation speculates on past, current, and future scholarly communication activities, and proposes that such activities might be opened up for wider engagement and, thus, social benefit. / Graduate

Cancer-related fatigue (CRF) as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer and cancer treatment that is not proportional to recent activity, such as physical activity, that interferes with usual functioning (Howell et al., 2015; National Comprehensive Cancer Network, 2020). CRF is one of the most common symptoms experienced by cancer patients at all stages of the cancer trajectory which significantly impacts patient’s quality of life, return to work, mental health, and can lead to disability (Bower, 2014b; Jones et al., 2016). Much research has focused on the development of CRF assessment and intervention strategies which have promoted the development of comprehensive evidence-based guidelines (Howell et al., 2015; National Comprehensive Cancer Network, 2020). However, previous research has identified many practice gaps in their implementation (Berger et al., 2015; Borneman et al., 2007; Pearson et al., 2015a, 2017b). This thesis’ objectives were to gain a deeper understanding of potential barriers to CRF clinical guideline implementation to identify potential knowledge translation strategies of CRF guidelines into practice following a Knowledge-To-Action (KTA) framework perspective (Graham et al., 2006; Straus et al., 2013). In Study 1, a qualitative research design was used to recruit a total of 62 participants—16 patients, 32 healthcare providers (HCPs), and 15 community support providers (CSPs). Drawing on the KTA model, the goal of the study was to explore key stakeholders’ (patients, HCPs, CSPs) experiences and opinions on CRF assessment and management and to explore underlying causes of CRF treatment gaps. No specific hypothesis were determined given the exploratory nature of the study. The results of this study highlight CRF guideline implementation gaps, patient dissatisfaction with CRF care, and challenges contributing to CRF assessment and management gaps. The results also suggested the presence of two underlying mechanisms contributing to treatment gaps: A Perfect Storm and Patient-Provider Communication Gaps. Understanding these mechanisms provides clarity on the potential causes maintaining CRF treatment gaps and can help direct targeted knowledge translation strategies to improve the implementation of CAPO CRF guidelines into practice. Consistent with a recent Delphi study (Pearson et al., 2017b), the results supported the need for professionals’ training on CRF guidelines to fill knowledge gaps. In Study 2, a mixed-methods pilot study with 18 HCPs and CSPs was used to develop and evaluate the acceptability and feasibility of a one-time training session for HCPs and CSPs on CAPO CRF guidelines, once again flowing the KTA framework (Graham et al., 2006; Straus, 2011). A secondary objective was to evaluate the learning outcomes of the training session including CAPO CRF guidelines knowledge, self-efficacy, and intent to apply CAPO CRF guidelines in practice. Overall, results suggest that offering a brief one-time training for HCPs and CSPs on CRF guidelines may be effective in increasing knowledge, self-efficacy, and intent to apply guidelines into practice. Similarly, that KT tools are appreciated by HCPs/CSPs and may be used in practice to supplement and sustain the knowledge and skills gained in training.

Purpose: This study had three objectives. The first objective was to develop the contents of a continuing professional development module (CPDM) for physical therapists geared toward increasing the use of standardized balance measures examine patients with balance dysfunction. The second objective was to assess the impact of the CPDM by measuring change in the clinicians' choice of measures using a patient case as well as the degree to which they changed their practice. The final purpose was to identify barriers and facilitators of knowledge translation using a CPDM. Subjects: A sample of convenience was used to recruit therapists through two home care agencies. Forty therapists participated in a one-day continuing professional development module (CPDM) regarding the use of standardized balance measures for patients with balance dysfunction. Method: A CPDM was designed based on the literature on adult learning, knowledge translation, and continuing professional development formats. Overlapping themes derived from this literature were combined to develop and present the module. Balance measures chosen for the content of the course were based on the literature and clinical relevance. Several tools were developed and administered to collect data on four levels of evaluation including: 1) participation using return rate of commitment to change forms, 2) satisfaction using a 5-point Likert evaluation form, 3) change in learning using change in pre/post case study scoring and a self assessment tool, and 4) change in performance using a commitment to change form and interview themes. Statistical tests used included descriptive, paired t-tests, and wilcoxon ranked sign test. In addition, semi-structured interviews were utilized. Results: Subjects satisfaction in the module was excellent and there was an 80% return rate of the commitment to change (CTC) forms. Statistically significant change scores were found in pre/post case study testing and self-assessment questions in regards to learning occurring following the module. Commitment to change forms and interview themes supported an actual change in clinicians' performance. Conclusion: Knowledge transfer can occur in a CPDM. The changes appeared to result from utilizing principles including accountability, multiple teaching strategies and facility support. The results of this study support the development of a CPDM to facilitate knowledge transfer in this specific area of physical therapy practice, as well as provide a model for other knowledge translation studies in the profession of physical therapy.

This study, which is focused on addressing the rising prevalence of gestational diabetes mellitus (GDM) in South Asians begins from the perspective that the development of diabetes has scope across public health and anthropology. The onset and progression are rooted within social determinants of health and cultural practices. Similarly, pregnancy—which is a crucial component of the life course—is a time where not only nutrients are shared between mother and child, but also when knowledge is exchanged, and cultural ways are imparted to the pregnant person from their friends and family. Within the South Asian community of Southern Ontario, recent public health evidence demonstrates a high rate of GDM where 1 in 3 South Asians will develop the condition. Babies born to GDM mothers are of higher birthweight and percent body fat than those of non-GDM mothers. Interventions to prevent GDM are important because GDM itself is a risk factor for postpartum obesity, diabetes, and atherosclerosis in the mother, and also because infants with more adipose tissue are more likely to become insulin resistant in adolescence and develop diabetes and cardiovascular disease as adults. Discussions to strengthen the public health response to this challenge can incorporate evidence-based counselling tools (e.g., easily scalable knowledge translation (KT) tools) that can be used by prenatal clinicians providing primary care. Given that diet and physical activity can be influenced not only by an individual locus of control, but also by familial interactions/networks and cultural/traditional foods and expectations, there is a need to better understand and weave in these experiences. I sought to better understand 1) the prenatal lifestyle counselling experiences of South Asians and their family doctors; and 2) the KT tools that have been designed and used in this population; then I used these learnings to develop and evaluate a conceptually-informed, evidence-based KT tool for pregnant South Asians and their family physicians. This dissertation begins with an introduction of patient and provider experiences with lifestyle change. I then present a systematic review and narrative synthesis of prenatal KT tools designed for South Asians. This is followed by a case report that outlines the process taken to develop a patient-facing and provider-facing KT tool (‘SMART START’). Next, I include the design and evaluation of a mixed methods pilot evaluation study of ‘SMART START.’ Finally, I culminate with an epilogue that ties in lessons learned and challenges that were overcome throughout the conduct of this work. The concluding chapter also includes a link to a video that captures the story behind this dissertation and the documentation of how all the aforementioned pieces are nested within and built upon one another. / Dissertation / Candidate in Philosophy

Background. In order to deliver effective and efficient public health services, the best available research evidence should be considered when making public health decisions. The process of evidence-informed decision making (EIDM) involves searching for research evidence, appraising and synthesizing the high quality evidence, and adapting the evidence with consideration of local contextual factors and community preferences. For many public health departments achieving EIDM has been a challenge. Methods. This study aimed to learn how EIDM spread through interpersonal interactions within the health department of a provincial government in Canada. The health department was selected based on anecdotal evidence suggesting that ideas of EIDM had diffused within this department. Employees were invited to participate in an electronic survey about their interactions regarding EIDM. The data collected from this survey were analyzed using social network analysis methods. This helped to show how the interpersonal connections helped to spread the ideas of EIDM within the organization. Results. In this organization EIDM discussion occurred most often within the organizational divisions, whereas influence for EIDM often occurred both within and between divisions. The type of relationship that appeared most important in discussion of EIDM was colleague relationships, while supervisors were more important for encouraging use of EIDM. Furthermore, individuals in leadership positions within the organization were shown to have played an important role in the diffusion of EIDM. Limitations and Conclusions. Low participation resulted in a limited picture of the whole network of this organization. The use of social network analysis is a relatively novel approach for studying the diffusion of EIDM, and there are challenges to this approach that requires special consideration when working with organizations. / Thesis / Master of Science in Nursing (MSN)

Background: The evidence-based approach to policymaking has greatly facilitated policymakers' capacity to make scientifically informed policy decisions, especially in the medical and public health contexts. However, this approach is most beneficial for policy development when trustworthy research is used. Predatory journals and publishers pose a potential threat to evidence-based policy making, since they are more likely than traditional academic journals to publish unreliable evidence. Research Objectives: The purpose of this thesis is to advance knowledge on what factors contribute to the citation of predatory journal articles in policy documents by answering the following research questions: 1) How do people preparing public health documents consider the trustworthiness of research evidence? 2) How do they source and evaluate the research evidence they cite? Methods: I identified a cross-sectional sample of public health policy documents from Overton - the world's largest policy document database - that cited articles published by the OMICS group. OMICS is a well-established predatory publisher. I extracted meta-data (e.g., document source) and document characteristics such as whether they described their method of selection or quality assessment for cited sources. Authors of these documents with contact information listed, as well as a convenience sample of people who have prepared public health documents, were invited for a semi-structured interview. I thematically analyzed these interviews by organizing the codes (both deductive and inductive) into key overarching themes. Results: Two hundred forty-two public health policy documents were included. The World Health Organization was the most common source accounting for 45 documents (19%). A total of 283 articles were cited from 126 OMICS journals. Only 54 (22%) of the policy documents described their source-selection methodology, and 22 (9%) assessed the quality of cited sources. Five key overarching themes were generated from the thematic analysis of the interview data, highlighting that information cited in policy documents is sourced and evaluated in several ways, many of which are related to a series of factors which could be contributing to the predatory journal citations. Conclusion: Public health policy documents are prepared using a variety of methods for information selection and evaluation, but the exact approach for doing so is rarely reported within the document itself. This may contribute to the reliance on untrustworthy research to inform policy; and thus, may help amplify misinformation entering policy globally. Certain steps can be taken to help minimize any potential negative impact of relying on such sources, but a better understanding of policymakers' perspectives may be required to ensure successful implementation.

For years, neonates have been "therapeutic orphans" and denied the benefits of clinical research because most therapeutic options are usually tested in the adult population. Most treatments and interventions have not been explored, and there is room potential rigorous, evidence-based clinical trials towards diseases specific to this population. Regenerative medicine holds great promise by potentially offering new ways of treating incurable diseases. However, bench to bedside translations often fail due to low recruitment rate. Thus, there is a need for effective interventions to increase trial participation and execution to help accelerate neonatal research. Behaviour theories could help to better understand trial participation, screening and recruiting behaviours, inform fit-for-purpose interventions, and assist in building cumulative evidence. There is a lack of clarity on the barriers and enablers to clinical trial participation from important stakeholder groups; NICU parents and research staff members. Study 1 reports findings on identified barriers and enablers that might affect parents' decision-making to participate in an early phase mesenchymal stromal cell (MSC) therapy trial including concerns with safety, efficacy and expected outcomes, but were willing to consider consenting to the trial after watching the animated video and having altruistic consideration. Study 2 reports findings on identified barriers and enablers that might affect research personnel recruitment to a multi-centre MSC trial which include: having cautious hope about the trial, importance of coordination with the clinical staff and study team and optimizing the study flow. Due to the challenging context of the study, the participants prefer to have clinicians involved with the recruitment. Lasty, Study 3 reports findings on identified barriers and enablers to screening potential patients for an adeno- associated viral vector gene therapy trial. Physicians were optimistic about the treatment but were concerned about the safety, feasibility, the expected outcomes of the treatment, and available resources (personnel, equipment, funding). Many expressed the need for support from clinical professionals prior to approaching parents and highlighted variability in screening roles. The resulting comprehensive set of factors helps to identify priorities for future research and provide insights towards developing novel interventions for neonatal research.