Occupational therapy practitioners (OTPs) are reporting low levels of research application in everyday practice, causing a low frequency of evidence-based practice (EBP) implementation (Krueger et al., 2020; Myers, 2019a). A review of the literature demonstrates that individual level factors, such as lack of knowledge, skill, time, and resources for research use, coupled with organizational factors, such as low priority, support, and expectation for EBP, act as barriers to EBP (Wang et al., 2019). This doctoral project aims to build the capacity for research use at both the practitioner and the organization levels through an evidence-based multifaceted intervention program. It will impact the knowledge and skill for understanding and applying research evidence in practice and the frequency of research use in daily practice among school-based occupational therapy practitioners (Sb-OTPs), as well as the organization’s resources, priorities, and environment to support EBP. A mixed-methods design will be used, with a convenience sample of nineteen Sb-OTPs employed at a therapy agency that provides services through contract positions to local school districts. The program consists of four main components of education, provision of resources, working in groups, and organizational supports. The Knowledge-To-Action (KTA) framework (Graham et al., 2009) provides a context-focused iterative process to the program design, from problem identification to sustainability. Continual involvement of all stakeholders, assessment of barriers to tailor the intervention, and adaptation of the knowledge for use in the practice context are KTA-based core program features. The education component is informed by Social Cognitive Theory (SCT) (Bandura, 1986), brain-based learning strategies (Willis, 2006; Yee & Boyd, 2018), and literature supporting blended learning and digital health education formats (Brown et al., 2020; Hew & Lo, 2018; Liu et al., 2016). The program description, implementation, research evaluation plan, and program funding and dissemination are described in detail.

Background: Health technology assessment (HTA) is a form of policy analysis to inform recommendations for decision-makers. An equity-focused HTA recommendation consists of one that explicitly addresses the impact of health technologies on individuals disadvantaged in society because of their social conditions. However, there is a need for more evidence on the relationships between patient engagement and the development of equity-focused HTA recommendations. Objectives: The objectives of this dissertation were to examine the association between patient engagement and equity-focused HTA recommendations and identify implementation considerations for patient engagement in HTA. Methods: I used explanatory sequential mixed methods to analyze 60 HTA reports and 11 interviews with patients and analysts from Canadian organizations: the Canadian Agency for Drugs and Technologies in Health (CADTH) and Health Quality Ontario (HQO). Results: Quantitative analysis of the HTA reports showed that patient engagement significantly predicts equity-focused HTA recommendations (OR: 0.26; 95% CI: [0.16 – 0.41]). HTA reviews where HTA analysts directly interviewed patients (OR: 3.85; 95% CI: [2.40 – 6.20]) and where an advisory committee used consensus were more likely to contain equity-focused recommendations (OR: 2.27; 95% CI: [1.35 – 3.84]). Qualitative analysis of the interviews identified strategies for engaging diverse patients in HTA. Conclusion: The findings of this dissertation can inform the designing of patient engagement in HTA.

<p>This is a licentiate dissertation consisting of a summarizing section and two free-standing but coherent articles, one of which has previously been published in ascientific journal while the other is accepted for publication. The unifying link is the theme of attempting to establish the kernel of outdoor education, as it isunderstood by teachers active in the field. The study depicts with the help of semi-structured interviews the respondents’ conceptions of teaching and outdooreducation. The first article is a <em>survey </em>(accomplished in A - School and B - School) of teachers’ perceptions of learning and teaching outdoors in preschool – (to) thefirst year of the compulsory school. The second article is a study of teachers’ perceptions of the possible special nature of outdoor education after having experiencedan <em>educational intervention</em> in the subject (preschool to first year). Both articles treat the special nature of outdoor education coupled with learning and outdoorteaching in light of the overall research question, what perceptions do teachers have of learning and teaching outdoors? The summarizing section which discusses thetwo articles is divided into five different parts.</p><p>Chapter I comprises a social and environmental analysis and indicates the need for research in the field of outdoor education. Chapter II deals with the aim, issuesand theoretical perspectives of learning which are tied to knowledge through action, ecological readability and bodily learning. A number of restricted examples areselected among theoreticians and representatives of these three perspectives within the reform pedagogy movement, American pragmatism, the environmental studymovement and theories of the phenomenology of the body, the learning body in movement.</p><p>The methodological basis for the analysis of the two articles is phenomenographic and is described in Chapter III. In Chapter IV the possible special nature ofoutdoor education is analysed, noting what stands out as especially prominent in the respondents’ answers and in what way, proceeding from questions such as what isoutdoor education for you, <em>what is the difference between learning outdoors and indoors, and why teach outdoors?</em> Four categories of response can be distinguished: aplace for learning, a way of learning, an object of learning and bodily learning. At the end of Chapter IV the results of both articles are summarised. Finally, Chapter Vcomprises a discussion proceeding from a metacategorisation of all descriptive categories from both articles. The discussion has led to the identification of threethematised perspectives, namely the <em>place perspective, the environment</em> perspective and <em>the body perspective</em>. These perspectives, place, environment and body, arelinked back to the technical frame of reference in Chapter II.</p><p>The result of the two part studies, the survey study in article 1 and the educational intervention in article 2, indicates a multiplicity of varied perceptions of thespecial nature of outdoor education and can thus be said to characterise this as richly diversified. As regards teachers’ notions of the principal reasons for learning andteaching outdoors, the following four aspects are foregrounded:</p><ul><li>the place for learning</li><li>the object of learning</li><li>the way of learning</li><li>bodily learning</li></ul><p>Two main categories were identified in article 2 which are treated in education in the subject after a five-day course (10 half study days), teachers who perceive aspecial nature in outdoor education and teachers who do not. Both main categories crystallised out after the educational intervention was implemented in Byskolan andStadsskolan (the Village School and the Town School), the latter being the reference school. One year after the completion of the educational intervention mostteachers in the Village School associated the special nature of outdoor education with a more <em>authentic, body and sensory experience related, movement intensive</em> and <em>health promoting learning</em> than traditional learning in the classroom.</p><p>Proceeding from a metacategorisation the three above-mentioned thematised perspectives are described in Chapter V. These reflect the identified responsecategories in articles 1 and 2.</p><p>The analysis of the empirical material of the investigation reveals that the special nature of outdoor education from the respondents´ perspective is related to place,to the environment and to the body.</p>

Due to changes in UK and Scottish policy and NHS directives, there have been many changes and improvements in the way information is provided to patients affected by cancer and their families over the last decade. The information provided should be accurate, detailed and tailored to the individual’s needs across the whole of their cancer trajectory. People affected by laryngeal cancer could be classed as a “Cinderella” group as there is a lack of research with this group of patients and their families, in comparison to other types of cancer, even though the impact of treatment can have a profound and debilitating effect on the individual and their family’s quality of life. How this group of patients and their families use and source information to help them make sense of their experiences across their trajectory is unknown, therefore this study explored the role of information based on the experiences of people affected by laryngeal cancer across their cancer trajectory. The study adopted an interpretive prospective longitudinal approach, using two in-depth qualitative interviews with twenty patients and eighteen carers from across the main treatment pathways associated with this type of cancer. The data were analysed using Framework Analysis and influenced by Dingwall’s Illness Action Model. Four broad thematic headings were developed to explain the role of information: “Search for Normality”, “Illusion of Certainty”, “Reality of Uncertainty” and “Culture of Caring”. Relationships were identified between these headings at four key stages across the cancer trajectory. The ii broad theme “Search for Normality” overarched the whole of the cancer trajectory explaining how information was sourced and used to help this group understand their experience of symptoms. The main findings from the study show that two broad categories of information are used: information from health professionals and experiential information from one’s own and others’ experiential knowledge of health and illness. Both categories of information are sourced and used in different ways at different stages over the course of the trajectory and become inextricably linked over time. The study shows that information is not an entity that can be studied on its own but needs to be studied and explained in the ways it is situated, used and experienced within the context of the complex needs and experiences of this group of patients and their families. This study is the first longitudinal study to provide an explanation of the role of information with people affected by laryngeal cancer across their cancer trajectory. The findings show how the different types of information used from the various sources influence how people affected by laryngeal cancer perceive and understand their diagnosis, treatment and the outcome of treatment. The study findings suggest that health professionals need to situate information in the context of the individual’s understanding and prior knowledge of health and illness to ensure that it does not set unrealistic expectations, with a clear need for continuity and supportive care identified in the post-treatment and follow-up phases.

This thesis examines Leadership Development in both a corporate setting and an expedition-based setting. The assumptions that are the foundations of current Leadership Development originate, and are informed by, aspects of the natural sciences. These methods are critiqued in terms of usability and applicability in the context of human relating. An alternative approach is investigated based on nonlinear causality and the complex responsive process of relating using the work of Stacey (2003, 2007, 2010), Stacey and Griffin (2005), Stacey et al. (2000). What is explored is the Leader as expert and the ability through communication, decision making, and planning to create certainty. What is problematized is the fantasy that this creates in ongoing day-to-day interactions. The work explores interactions between a leadership consultant/coach and clients in varied domains: the role of the practitioner in the delivery and creation of theory, models, best practices and standard operating procedures; and the reflections of both the practitioner and clients that what is emerging cannot be foreseen. This leads to a further exploration cycle of the human experience in organizations and how reification, the uncanny, and the struggle for recognition might offer other ways of making sense of the experience. The work examines the role of the consultant/teacher and the client/student and the emergence of knowledge. It further investigates the relationship of time and causality and how this is connected to theoretical knowledge and knowledge in action. This leads to a further connection of thinking, reflecting and reflexivity and what this means as practice for leadership development. Using the context of leadership coaching for management teams and connecting the reflexive aspect of knowledge, what is argued is that sensemaking as developed by Weick (1995, 2001, 2009), Weick and Sutcliffe (2007) is not a sufficient practice to explain and create best practices, standard operating procedures, models, and theories. What is also necessary, and is identified as sensemaking and connected to Elias (1987) work, is our own involvement and detachment as we abstract to understand what is happening in the moment between human agents. It is argued that paying attention to these aspects of ongoing human relating offer the possibility of thicker and a more contextualized understanding of the emergent unpredictable outcomes that leaders deal with every day.

This is a licentiate dissertation consisting of a summarizing section and two free-standing but coherent articles, one of which has previously been published in ascientific journal while the other is accepted for publication. The unifying link is the theme of attempting to establish the kernel of outdoor education, as it isunderstood by teachers active in the field. The study depicts with the help of semi-structured interviews the respondents’ conceptions of teaching and outdooreducation. The first article is a survey (accomplished in A - School and B - School) of teachers’ perceptions of learning and teaching outdoors in preschool – (to) thefirst year of the compulsory school. The second article is a study of teachers’ perceptions of the possible special nature of outdoor education after having experiencedan educational intervention in the subject (preschool to first year). Both articles treat the special nature of outdoor education coupled with learning and outdoorteaching in light of the overall research question, what perceptions do teachers have of learning and teaching outdoors? The summarizing section which discusses thetwo articles is divided into five different parts. Chapter I comprises a social and environmental analysis and indicates the need for research in the field of outdoor education. Chapter II deals with the aim, issuesand theoretical perspectives of learning which are tied to knowledge through action, ecological readability and bodily learning. A number of restricted examples areselected among theoreticians and representatives of these three perspectives within the reform pedagogy movement, American pragmatism, the environmental studymovement and theories of the phenomenology of the body, the learning body in movement. The methodological basis for the analysis of the two articles is phenomenographic and is described in Chapter III. In Chapter IV the possible special nature ofoutdoor education is analysed, noting what stands out as especially prominent in the respondents’ answers and in what way, proceeding from questions such as what isoutdoor education for you, what is the difference between learning outdoors and indoors, and why teach outdoors? Four categories of response can be distinguished: aplace for learning, a way of learning, an object of learning and bodily learning. At the end of Chapter IV the results of both articles are summarised. Finally, Chapter Vcomprises a discussion proceeding from a metacategorisation of all descriptive categories from both articles. The discussion has led to the identification of threethematised perspectives, namely the place perspective, the environment perspective and the body perspective. These perspectives, place, environment and body, arelinked back to the technical frame of reference in Chapter II. The result of the two part studies, the survey study in article 1 and the educational intervention in article 2, indicates a multiplicity of varied perceptions of thespecial nature of outdoor education and can thus be said to characterise this as richly diversified. As regards teachers’ notions of the principal reasons for learning andteaching outdoors, the following four aspects are foregrounded: the place for learning the object of learning the way of learning bodily learning Two main categories were identified in article 2 which are treated in education in the subject after a five-day course (10 half study days), teachers who perceive aspecial nature in outdoor education and teachers who do not. Both main categories crystallised out after the educational intervention was implemented in Byskolan andStadsskolan (the Village School and the Town School), the latter being the reference school. One year after the completion of the educational intervention mostteachers in the Village School associated the special nature of outdoor education with a more authentic, body and sensory experience related, movement intensive and health promoting learning than traditional learning in the classroom. Proceeding from a metacategorisation the three above-mentioned thematised perspectives are described in Chapter V. These reflect the identified responsecategories in articles 1 and 2. The analysis of the empirical material of the investigation reveals that the special nature of outdoor education from the respondents´ perspective is related to place,to the environment and to the body. / <p>Serienumret är felaktigt i avhandlingen och skall vara 251.</p>

Purpose. The purpose of this dissertation is to understand the state of recommended practice for sedation interruptions (SI) and to discover factors that hinder or facilitate critical care nurses’ use in practice. To garner insight about why this evidence-informed intervention is not being used as recommended to improve mechanically ventilated patient outcomes. Methods. A series of studies using a multi-methods design and guided by the Knowledge to Action Framework: study 1) a systematic review and critical appraisal examined the quality and reporting of all available guidelines and care bundles with recommendations related to SI for mechanically ventilated adults in critical care; study 2) a needs assessment included an environmental scan of the study site and gap-analysis using a retrospective chart audit to measure the nature and magnitude of the evidence-practice gap; study 3) a descriptive qualitative study used semi-structured theory-based interviews to deepen our understanding of the determinants that influence SI use in preparation for a future implementation study. Findings. Study 1 included 11 guidelines and care bundles with 15 recommendations about SI. Deficiencies in the methodological quality of the current guidelines and care bundles may impact overall credibility and applicability of the recommendations, though SI is currently recommended best-practice. Study 2 confirmed the existence of an evidence-practice gap related to SI and affirmed the need to discover barriers and drivers to best practice implementation (study 3). We identified nine facilitators and 20 barriers to SI use by nurses. Facilitators were associated with the innovation (e.g., the importance of protocols) and the potential adopters (e.g., SI are specific to the nurse's role). The barriers were associated with the potential adopters (e.g., nurses’ knowledge gaps and variable goals of SI) and the practice environment (e.g., lack of availability of extra staff and multidisciplinary rounds). Conclusion. Before adequately implementing SI and evaluating uptake by nurses, we need to address modifications to existing guidelines and recommendations, even though SI is considered best practice. A theory-informed implementation study can further activate the use of SI for mechanically ventilated adults in critical care.

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.

Syftet med denna essä är att undersöka facilitatorers handlande när ett skifte i en grupp äger rum. Med skifte avses en ny förståelse av ett innehåll som bearbetas. Facilitator är den som underlättar en grupps process att arbeta med någon typ av material eller fråga. Essäns frågeställning är vilka aspekter av praktisk kunskap utövar facilitatorn när hon erfar att en grupp skiftar sin förståelse. Studien är fenomenologisk och etnografisk då facilitatorers egna erfarenheter är i fokus. I essän ställs egen erfarenhet, intervjuer och samtal med fem facilitatorer i dialog med improvisationsteater och filosofer som skrivit om praktisk kunskap. Ur dessa samtal träder ett antal aspekter av praktisk kunskap fram. En aspekt är intuition som blir till i det relationella, kroppsliga och erkännande mötet med andra. När tanken inte förmår vägleda kan intuition infinna sig baserat på känslan som kommer ur intention och tidigare erfarenheter. Erfarenheter är en aspekt av praktisk kunskap och bildar mönster med andra erfarenheter. Intuition utgår från dessa erfarenheters mönsterbildning och vägleder vidare handling. En annan aspekt är samspelet mellan känsla, emotion, tanke och handling, både som kronologiskt och överlappande skeende. En ytterligare aspekt är kunnande-i-handling liksom reflektion-i-handling som akt av konstnärlighet och hantverkskunnande vilket leder vidare till betydelsen av att kunna improvisera. En facilitator har att vara i det skeende som pågår utan att ta över skeendet. Det är i unika skeenden som aspekter av den praktiska kunskapen yttrar sig som en helhet bestående av flertal samverkande aspekter. Det handlar om ett förhållningssätt att vara varande som facilitator. / The purpose of this essay is to investigate the actions of facilitators when a shift in a group takes place. Shift refers to a new understanding of a content being processed. Facilitator is the one who facilitates a group's process of working with any type of material or issue. The essays question is which aspects of practical knowledge the facilitator exercises when she experiences that a group is shifting its understanding. The study is phenomenological and ethnographic as the facilitators' own experiences are in focus. In the essay the own experience, interviews and conversations with five facilitators are put in dialogue with improvisation theatre and philosophers who have written about practical knowledge. From these conversations, a number of aspects of practical knowledge appear. One aspect is intuition formed in relational, bodily and recognition meetings with others. When the thought is not able to guide, intuition can emerge based on the feeling that comes from intention and previous experience. Experiences are an aspect of practical knowledge and form patterns with other experiences. Intuition is based on the pattern formation of these experiences and guides further action. Another aspect is the interaction between feeling, emotion, thought and action, both as a chronological and overlapping course of events. Further aspect is knowledge-in-action as well as reflection-in-action as the act of artistry and craftsmanship, which further leads to the importance of being able to improvise. A facilitator has to be in the course of events that goes on without taking over the event. It is in unique course of events that aspects of practical knowledge manifest themselves as a whole consisting of several interacting aspects. It is about an approach to be as a facilitator.

Problématique : Alors que l’on connaît depuis plusieurs décennies les conséquences dramatiques des injustices sociales sur la santé, il existe un profond problème d’application des connaissances pour informer les pratiques et/ou les politiques. Au-delà d’un manque de prise en compte des connaissances pour l’action, il semblerait que la difficulté à lutter contre les inégalités soit plutôt liée à l’enracinement des systèmes de production et d’utilisation des connaissances dans des structures injustes. Approche théorique et cadre conceptuel : Cette thèse s’inscrit dans la quatrième vague de recherche sur le transfert de connaissances qui consiste à mieux comprendre les caractéristiques sociales des connaissances. En d’autres mots, il s’agit d’intégrer une approche d’épistémologie sociale dans la recherche sur le transfert de connaissances. Nous nous intéressons spécifiquement au concept d’oppression épistémique qui consiste en la répétition dans la durée de trois degrés d’exclusions épistémiques. L’exclusion de troisième degré représente un mode de vie épistémique qui est dirigé par des groupes sociaux dominants, qui ne permet pas de prendre en compte d’autres systèmes de pensée et de connaissances que les leurs. L’exclusion de second degré est le fait, pour des individus déjà opprimés socialement, de devoir utiliser des ressources qui ne sont pas les leurs, pour pouvoir participer à la construction de nouvelles ressources communes dans ce système. L’exclusion de premier degré concerne l’impossibilité, pour des individus, d’être considéré comme des « connaisseur·ses » du fait de préjugés à leur encontre. Cette thèse vise à analyser comment les pratiques quotidiennes et le contexte de la santé mondiale favorisent une oppression épistémique. Méthodologie : Nous étudions trois phénomènes correspondant aux trois degrés d’exclusion épistémique, en suivant une échelle d’analyse à trois niveaux (macroscopique, mésoscopique, microscopique) qui rappellent les trois branches de l’épistémologie sociale (système, groupe, individus). Pour cela, nous étudions en premier lieu la construction d’une ressource épistémique commune en santé mondiale à un niveau macroscopique : la couverture santé universelle (CSU) grâce à une revue critique des écrits. En deuxième lieu, nous étudions l’appropriation de cette ressource épistémique à un niveau mésoscopique, et la manière dont un groupe de scientifiques prend ou non en compte des voix dissidentes, en promouvant une définition différente de la CSU. Pour cela, nous réalisons une étude de cas d’un programme de recherches interventionnelles sur la CSU. En troisième lieu, nous étudions le rôle de la source des connaissances sur leur perception grâce à une expérimentation en santé mondiale. Résultats : À travers l’avènement de la CSU, nous observons la présence d’un pouvoir productif qui, tout en donnant l’impression d’une approche ancrée dans les droits humains et inclusive, favorise une conception marchande de la santé, menée par un « centre » de la santé mondiale. Nous avons également observé que l’appropriation de la CSU dans un programme de recherches interventionnelles n’a pas permis de créer une définition dissidente de la CSU. Plusieurs alliances épistémiques, c’est-à-dire des affiliations entre membres partageant la même orientation des études pour analyser la CSU sont apparues : une alliance santé publique, une alliance économique, une alliance anthropologique et une alliance critique. Cette dernière, qui proposait une réflexion globale sur la déconstruction et la gouvernance de la CSU, a été manquée, du fait d’inégalités concomitantes. Enfin, nous avons pu voir à un niveau microscopique que le « messager » peut être plus important que le « message » et participer à invisibiliser ou diminuer certaines voix dans la gouvernance globale en santé. Discussion et valeur ajoutée de la thèse : Les trois degrés d’exclusion épistémiques peuvent s’entrevoir de façon complémentaire. Du fait de la proximité des mondes scientifique et politique, et de la volonté de produire des connaissances pour l’action en santé mondiale, l’avènement de la CSU peut influencer la manière dont les scientifiques s’approprient ce concept. Cela peut limiter les possibilités de diversité épistémique et favoriser l’exclusion de certaines voix. À l’inverse, le sentiment d’exclusion peut conduire à se limiter dans sa contribution intellectuelle. Partant du postulat dont chacun·e de nous peut participer à changer les structures qui créent les injustices, en résistant à l’oppression épistémique, nous proposons un continuum d’actions pour lutter contre les inégalités dans la gouvernance globale en santé. / Background: The dramatic consequences of social injustice on health have been known for several decades, but social injustice also has an impact on knowledge translation. Rather than relating to a lack of knowledge uptake for action, the difficulty in addressing inequalities connects to knowledge production and use systems rooted in unjust structures. Theoretical approach and conceptual framework: This thesis aims to better understand the social characteristics of knowledge, and explores the integration of a social epistemology approach into knowledge translation research. We specifically focus on epistemic oppression, which consists of the repetition over time of three types of mutually reinforced epistemic exclusion. One type applies to an epistemic way of life led by dominant social groups, who prevent new systems of thought and knowledge, different from their own, to surface. A second type relates to socially oppressed individuals who must use resources they do not own to contribute to the construction of new common resources within the dominant system. The last type of epistemic exclusion consists of the impossibility of individuals being recognized as "knowers" because of prejudices that make them appear illegitimate. This thesis aims to analyze how everyday practices and the global health context foster epistemic oppression. Methodology: We study three processes, each related to a type of epistemic exclusion and following a three-level scale of analysis (macroscopic, mesoscopic and microscopic), which also covers the three branches of social epistemology (system, group and individual). First, we focus on the construction of an epistemic resource in global health at a macroscopic level, namely, universal health coverage (UHC), through a critical review of the literature. Secondly, we study the appropriation of this epistemic resource at a mesoscopic level, and how a group allows or does not allow dissenting voices, thus promoting a different definition of UHC. To this end, we conduct a case study of an interventional research program on UHC. Finally, we elaborate on the role of knowledge sources on the perception of knowledge through an experiment in global health. Results: The case of UHC demonstrates the existence of a productive power that, while giving the impression of an inclusive human approach, favours a market-based conception of health led by a global health "centre". We also observed that the appropriation of UHC in an interventional research program did not create a dissident; unorthodox definition of UHC. Several epistemic alliances (i.e. affiliations between members sharing the same orientation of studies to analyse UHC), emerged: a public health alliance, an economic alliance, an anthropological alliance, and a critical alliance. The latter, which suggested a global reflection on the deconstruction and governance of the UHC, did not occur because of concomitant inequalities. Finally, at a microscopic level, we showed that the "messenger" can be more important than the "message" when disseminating knowledge. Discussion and research value: The three types of epistemic exclusion can be read complementarily. Due to the proximity of the scientific and political worlds, and the desire to produce knowledge for action in global health, the social construction of UHC may influence how scientists appropriate this concept. It may limit the possibilities of epistemic diversity, and thus promoting the exclusion of some voices and points of view. A feeling of exclusion can, in turn, lead to self-limitation. Based on the premise that everyone can contribute to changing the structures that create injustice by resisting epistemic oppression, we propose a continuum of actions to address inequalities in global health governance.