Background Evidence-based practice has increasingly been recognized as a priority by professional physiotherapy organizations and influential researchers and clinicians in the field. Numerous studies in the past decade have documented that physiotherapists hold generally favorable attitudes to evidence-based practice and recognize the importance of using research to guide their clinical practice. Research has predominantly investigated barriers to research use. Less is known about the circumstances that actually support use of research by physiotherapists. This study explores the conditions at different system levels that physiotherapists in Sweden perceive to be supportive of their use of research in clinical practice. Methods Patients in Sweden do not need a referral from a physician to consult a physiotherapist and physiotherapists are entitled to choose and perform any assessment and treatment technique they find suitable for each patient. Eleven focus group interviews were conducted with 45 physiotherapists, each lasting between 90 and 110 minutes. An inductive approach was applied, using topics rather than questions to allow the participants to generate their own questions and pursue their own priorities within the framework of the aim. The data were analyzed using qualitative content analysis. Results Analysis of the data yielded nine favorable conditions at three system levels supporting the participant’s use of research in clinical practice: two at the individual level (attitudes and motivation concerning research use; research-related knowledge and skills), four at the workplace level (leadership support; organizational culture; research-related resources; knowledge exchange) and three at the extra-organizational level (evidence-based practice guidelines; external meetings, networks, and conferences; academic research and education). Conclusions Supportive conditions for physiotherapists’ use of research exist at multiple interdependent levels, including the individual, workplace, and extra-organizational levels. Research use in physiotherapy appears to be an interactive and interpretative social process that involves a great deal of interaction with various people, including colleagues and patients.

Denna kvalitativa studie genomfördes för att undersöka vilken roll utvärdering av belöningssystem har i företag verksamma i Sverige. Studien utgår från teorin Evidence- Based Practice och dess underkategorier som specifikt behandlar belöningssystem. Dessa teorier applicerades på data inhämtad från intervjuer med personer ansvariga för belöningssystem på olika företag. I studien framkom, i likhet med de få tidigare studier som genomförts inom området, att utvärdering av belöningssystem inte har någon central roll hos de undersökta företagen. Anledningen till denna undanskymda roll anses dock inte vara en misstro mot behovet av det. Istället framkom att en starkt bidragande orsak till det restriktiva utförandet av utvärdering är att området anses komplext med stora problem relaterade till att identifiera lämpliga metoder för det praktiska utförandet.

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.

Despite a substantial evidence-base for pediatric pain management, pain is not always well managed in clinical practice. Appreciative Inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. A prospective, repeated-measures, mixed-methods case study was conducted to (a) explore the implementation process of AI as a KT intervention in pain, (b) examine the beginning effects of AI on pain related outcomes, and (c) describe extraneous factors related to the PARiHS framework. Outcomes were measured at six and three weeks pre-intervention and three and six months post-intervention, ending with a semi-structured interview on the acceptability of the intervention. Data were analyzed using descriptive and inferential statistics, and quantitative and qualitative content analyses. Twelve nurses (nine staff and three administrative/clinical leaders) from a surgical unit at a pediatric hospital participated in the study. They perceived their context to be relatively complex, with a culture focused on clinical competence, family-centered care, and teamwork, and a transformational leadership style. Overall, participants were satisfied with the intervention structure, which consisted of four three-hour, interactive sessions delivered over two weeks to promote change based on positive examples of pain management on the unit, and suggested only minor refinements. The intervention was delivered with high fidelity and most participants (n = 11) attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. There was a statistically significant improvement in participants’ pain knowledge and attitudes post-intervention. This outcome was significantly and positively correlated with participants’ attitudes towards research. Both of these factors had a significant relationship with participants’ effort to document pain assessments. Participants named AI a ‘refreshing approach to change’ because it was positive and democratic, with a focus on building on existing practices. They felt the process cultivated a positive reception to change, broadened their horizons around pain, and enhanced their team spirit. The facilitators were considered credible with effective communication skills. Given the promising results of this study, the refinement and evaluation of the AI intervention are warranted in other contexts and for other clinical practices.

Despite a substantial evidence-base for pediatric pain management, pain is not always well managed in clinical practice. Appreciative Inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. A prospective, repeated-measures, mixed-methods case study was conducted to (a) explore the implementation process of AI as a KT intervention in pain, (b) examine the beginning effects of AI on pain related outcomes, and (c) describe extraneous factors related to the PARiHS framework. Outcomes were measured at six and three weeks pre-intervention and three and six months post-intervention, ending with a semi-structured interview on the acceptability of the intervention. Data were analyzed using descriptive and inferential statistics, and quantitative and qualitative content analyses. Twelve nurses (nine staff and three administrative/clinical leaders) from a surgical unit at a pediatric hospital participated in the study. They perceived their context to be relatively complex, with a culture focused on clinical competence, family-centered care, and teamwork, and a transformational leadership style. Overall, participants were satisfied with the intervention structure, which consisted of four three-hour, interactive sessions delivered over two weeks to promote change based on positive examples of pain management on the unit, and suggested only minor refinements. The intervention was delivered with high fidelity and most participants (n = 11) attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. There was a statistically significant improvement in participants’ pain knowledge and attitudes post-intervention. This outcome was significantly and positively correlated with participants’ attitudes towards research. Both of these factors had a significant relationship with participants’ effort to document pain assessments. Participants named AI a ‘refreshing approach to change’ because it was positive and democratic, with a focus on building on existing practices. They felt the process cultivated a positive reception to change, broadened their horizons around pain, and enhanced their team spirit. The facilitators were considered credible with effective communication skills. Given the promising results of this study, the refinement and evaluation of the AI intervention are warranted in other contexts and for other clinical practices.

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.

Objective: The effectiveness and efficiency of health promotion programs and policies relies on evidence to inform and guide these practices in an age of increased cost-efficiency and accountability. To achieve impact and continuous improvement requires the application of evidence to inform and guide population and public health decisions. To facilitate the broader use of knowledge derived from research and evaluation, we must identify the factors that facilitate or impede the use of such evidence among pubic health professionals. At the individual level, we have developed considerable understanding of these factors; however, at the organisational level this understanding lags. The purpose of this study was to examine how the organisational context of Ontario health units influences evidence-informed public health practice. Methods: The study employed a multiple case study design. Data sources included interviews, internal health unit documents and correspondence from three health units (reflecting high, moderate and low use of evidence) participating in the SHAPES-Ontario Knowledge Exchange Extension Project. Qualitative analyses using constant comparative methods intended to maximize trustworthiness identified macro-, meso- and micro-environmental level factors related to the use of local tobacco and physical activity data in public health program planning and evaluation. Individual and cross-case analyses determined the extent of each factor’s influence, how the factors inter-related and identified similarities and differences between sites. Results: Several internal contextual factors were directly and indirectly influential on knowledge use. The most directly influential factors were commitment/receptiveness to use evidence, and the leadership and internal co-ordinated action given to facilitate uptake and use. The degree of each of these factors directly influenced the level of knowledge use. Other internal contextual factors were also influential on utilisation however, through a less direct route. This included organisational mandates/priorities as well as previous experiences with knowledge use which were influential on the other contextual factors, as a result indirectly influencing knowledge use. Overall, it appears the more extensive the contextual factor the more extensive the influence, directly or indirectly, on knowledge use. Additionally, several external factors influential on the internal context and knowledge use within health units were identified, including external relationships, external processes and procedures, external mandates and priorities as well as external resources. The need to adapt to these external contextual factors was necessary in order for health units to have a strong working relationship with external parties (i.e., schools and school boards). As a result of this relationship, health units conformed and adapted to external contexts such as the processes/procedures, priorities and resources of schools. In turn, this adaptation process influenced the type of information utilised by health units as well as how the information was used and to what degree. At this point, the inter-relation between external contextual factors as well as direct connections to internal contextual factors was not entirely clear and requires further examination. Conclusions/Implications: Studying these cases has illuminated the processes and structures that contribute or impede evidence-informed practice. The findings and interpretations of this study help to identify organisational supports that facilitate the use of population health intervention research, in turn, contributing to more effective and efficient health programs and policies aimed at improving population health.

Objective: The effectiveness and efficiency of health promotion programs and policies relies on evidence to inform and guide these practices in an age of increased cost-efficiency and accountability. To achieve impact and continuous improvement requires the application of evidence to inform and guide population and public health decisions. To facilitate the broader use of knowledge derived from research and evaluation, we must identify the factors that facilitate or impede the use of such evidence among pubic health professionals. At the individual level, we have developed considerable understanding of these factors; however, at the organisational level this understanding lags. The purpose of this study was to examine how the organisational context of Ontario health units influences evidence-informed public health practice. Methods: The study employed a multiple case study design. Data sources included interviews, internal health unit documents and correspondence from three health units (reflecting high, moderate and low use of evidence) participating in the SHAPES-Ontario Knowledge Exchange Extension Project. Qualitative analyses using constant comparative methods intended to maximize trustworthiness identified macro-, meso- and micro-environmental level factors related to the use of local tobacco and physical activity data in public health program planning and evaluation. Individual and cross-case analyses determined the extent of each factor’s influence, how the factors inter-related and identified similarities and differences between sites. Results: Several internal contextual factors were directly and indirectly influential on knowledge use. The most directly influential factors were commitment/receptiveness to use evidence, and the leadership and internal co-ordinated action given to facilitate uptake and use. The degree of each of these factors directly influenced the level of knowledge use. Other internal contextual factors were also influential on utilisation however, through a less direct route. This included organisational mandates/priorities as well as previous experiences with knowledge use which were influential on the other contextual factors, as a result indirectly influencing knowledge use. Overall, it appears the more extensive the contextual factor the more extensive the influence, directly or indirectly, on knowledge use. Additionally, several external factors influential on the internal context and knowledge use within health units were identified, including external relationships, external processes and procedures, external mandates and priorities as well as external resources. The need to adapt to these external contextual factors was necessary in order for health units to have a strong working relationship with external parties (i.e., schools and school boards). As a result of this relationship, health units conformed and adapted to external contexts such as the processes/procedures, priorities and resources of schools. In turn, this adaptation process influenced the type of information utilised by health units as well as how the information was used and to what degree. At this point, the inter-relation between external contextual factors as well as direct connections to internal contextual factors was not entirely clear and requires further examination. Conclusions/Implications: Studying these cases has illuminated the processes and structures that contribute or impede evidence-informed practice. The findings and interpretations of this study help to identify organisational supports that facilitate the use of population health intervention research, in turn, contributing to more effective and efficient health programs and policies aimed at improving population health.

ABSTRACT Purpose of the study. Through secondary data analysis of results from the School Mental Health Services Integration Survey (SMHSIS), this study describes indicators of school mental health integration preparedness, including role identification, willingness to engage in tasks associated with mental health services integration and implementation facilitators. The study also investigated the utility of a modified version of the Evidence-Based Practice Attitude Scale (EBPAS) for use with school staff. Study rationale. With as many as 20% of children meeting criteria for mental disorders that cause impairment, the gaps in mental health services delivery to this special needs population are evident and persistently problematic. Less than a third receive the services they need due to structural as well as attitudinal barriers to accessing services. Trends toward delivering services where children are located are noted and schools have emerged as de facto provider of mental health services to children. Yet, schools are not traditionally arranged or organized toward mental health services delivery, and though school-based mental health innovations are emerging there is no agreed upon unifying framework for integration of mental health services into school settings. Whereas school-based mental health is connecting to the evidence-base more often, evidence-based practices remain under-utilized. The present study examines school mental health services integration readiness in a large urban school district in central Florida. Methods. The SMHSIS was conducted by email and participants included seven group of professional staff, including principals and assistant principals, teachers, guidance counselors, social workers, psychologists, school resource officers, and school health staff. Data analysis involved exploratory factor analysis (EFA) of survey sections, in an effort to uncover indicators of readiness for school mental health integration preparedness in three domains, role identification, willingness, and implementation facilitators. One-way analysis of variance (ANOVA) and post hoc tests were conducted to examine differences in perspectives on these domains, by professional group. Finally, a multiple regression model was used to examine the relationship between 6 predictor variables and a single continuous dependent variable, mean scores on the EBPAS. Results. EFA resulted in the identification of 6 variables in the domains of role identification, willingness, and implementation facilitators. Analysis of variance demonstrated significant differences by professional group in perspectives on these variables. In the role identification domain, social workers, school psychologists, and guidance counselors endorsed adoption of a provider role, and school principals and assistance principals as a group adopted a facilitator role. Social workers and psychologists were uniquely high and emerged as leaders in endorsing willingness to engage in tasks associated with mental health services delivery. However, it was noted that no group endorsed a non-willing, or non-participant role. Implementations facilitators were identified in the areas of overall organizational structure, individual support, and shared professional responsibility. Finally, a summary of the regression showed that indicates that 29.0% of the variance in EBPAS scores was explained by the 6 predictor variables. The Willingness variable made the strongest unique contribution to predicting EBPAS outcomes. One other variable, Shared Professional Responsibility also made a significant unique contribution to the variance in the dependent variable, and none of the remaining four variables approached statistical significance. Conclusions and implications. Taken together, these outcomes form the basis for a better understanding the current environment for integration of mental health services delivery in a large urban school district, and indicators for readiness to adopt evidence-based practices. Survey outcomes provide useful information to school administrators and EBP developers on characteristics that can facilitate services integration, and call attention to training and policy needs. More broadly, outcomes potentially contribute to the development of a formalized framework for mental health services delivery in schools. Finally, areas of divergence in beliefs about services delivery, as well as congruence in the attitudes of groups of professional staff have been examined. By engaging various levels and types of school staff simultaneously on a single survey, the survey design has the added value of addressing the need for more complex research methods in the investigation of mental health services in schools.

The deleterious manifold of juvenile delinquency for victims, offenders, and the general public necessitate effective prevention strategies. Researchers have asserted that one of the most effective ways in which delinquency is prevented is through school-based intervention. Specifically, much attention has been given to identifying the most efficacious evidence-based treatments (EBTs) through an evidence-based practice (EBP) approach. Critics, however, argue that several limitations exist in the EBP process and suggest that a practice-based evidence (PBE) approach may be more sufficient to meet the needs of youth who are at-risk of delinquency. Guided by the Social Development Model, it is broadly the aim of this three-article dissertation to explore the most effective school-based delinquency prevention approaches. Drawing from the EBP approach, the first article mimics a process that practitioners are encouraged to employ. Multiple EBT websites were systematically searched for the most efficacious school-based delinquency prevention interventions. Four interventions met inclusion criteria. These interventions highlighted both strengths and limitations. Out of the limitations from the first article, the second article investigated the extent to which a PBE approach may be an alternative option for youth most at-risk of a delinquent trajectory: being male, from a lower socioeconomic urban community, and primarily minority youth. The article offers the results of a pretest/posttest design with a sustaining school-based intervention that was developed by social workers. The final article reports on the results of a randomized controlled trial that investigated the effectiveness of the first year of the XY-Zone on protective factors among youth at-risk for delinquency. The second and third article revealed promising results and provide preliminary evidence for important next steps. Additional research, with a longitudinal design and larger sample size, is needed. This dissertation suggests that both approaches can inform the other. As globalization and advanced resources continue to springboard awareness of both the problems and solutions to delinquency prevention in schools, it is likely that advancements in the EBP and PBE approaches will give way to the ever-debated research and practice gap growing much nearer than ever before. / text