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Implementation Science as Applied to Teaching in a Medical School CurriculumPolaha, Jodi 01 March 2019 (has links)
No description available.
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Implementation Science for Pediatrician InnovatorsPolaha, Jodi 24 January 2018 (has links)
No description available.
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Bridging the gap: A scoping review on early sport specialization and diversification recommendationsBrgoch, Shea Marie January 2021 (has links)
No description available.
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Barriers and Enablers to Optimizing Primary Care Physicians' Provision of Hepatitis C Treatment: A Qualitative Study and Qualitative Knowledge SynthesisHung, Jui-Hsia 27 September 2023 (has links)
Background: Decentralization and task-shifting of hepatitis C virus (HCV) infection testing and management from specialty services to primary care is vital to achieve global and Canadian HCV elimination targets since direct-acting antiviral therapy revolutionized HCV management. Primary care providers are instrumental in enabling more accessible and sustainable community-based HCV management. Understanding primary care providers' experiences and beliefs on provision of HCV treatment in primary care is vital to optimize primary care-directed HCV treatment.
Purpose: We aimed to use best practices from implementation science to determine the key factors influencing primary care physicians' provision of HCV treatment and to synthesize the published evidence on the barriers and enablers to optimizing primary care-directed HCV treatment to inform future implementation interventions.
Method: In Study 1, we conducted theory-informed interviews with family physicians practicing in Ontario, Canada to identify perceived barriers of and enablers to their provision of HCV treatment. The interviews and data analysis were guided by the Theoretical Domains Framework (TDF), which incorporates 33 theories of behaviour change into 14 domains to systematically identify cognitive, affective, social, and environmental influences on health behaviours. In Study 2, we conducted a systematic review of the barriers and facilitators to optimizing primary care-directed HCV treatment using the TDF as the organising framework. We characterized key determinants of primary care-directed HCV treatment by using the theoretical constructs, generating themes, and mapping themes to relevant TDF domains to identify potential targets for future implementation interventions.
Results: We conducted semi-structured TDF-based interviews with 20 family physicians and found 'knowledge gap of HCV treatment guidelines', 'time and resource constraint and competing priorities in primary care', and 'clarity of primary care physicians' professional role in HCV treatment cascade' were the key barriers and enablers to provision of HCV treatment in primary care. The systematic review included 20 studies which suggested 'enabling environment', 'primary care capacity', and 'knowledge deficit in HCV treatment guidelines' were the key factors coded to 'Environmental context and resources', 'Social influences', 'Identity and social professional role', and 'Knowledge' as the most relevant TDF domains to influencing the optimization of primary care-directed HCV treatment.
Conclusion: Our results provided practical insights into the barriers and enablers to better primary care-based HCV management. Future research will focus on developing implementation strategies to tackle the barriers and fortify the enablers to optimal HCV treatment in primary care.
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Understanding How Social Media Supports Healthcare Providers’ Knowledge Use in Clinical Practice: A Realist InquiryZhao, Junqiang 10 February 2023 (has links)
Background: Despite the increasing popularity of using social media to disseminate and translate knowledge, there remains a lack of theoretical understanding of how social media can work for healthcare providers’ knowledge use. The purpose of this thesis was to understand how and under what circumstances social media supports healthcare providers’ use of knowledge in clinical practice.
Methods: Drawing on the tenets of scientific realism and the context (C) + mechanism (M) = outcome (O) (CMO) heuristic, a three-phase multi-method study was conducted to build a progressive theoretical understanding of how social media supports healthcare providers’ use of knowledge: 1) theory gleaning by a narrative review of five social media initiatives, five theories, and 58 empirical studies; 2) theory refining by a realist review of 32 articles; and 3) theory consolidation by a realist-informed qualitative study with 11 participants.
Results: The Social Media for ImpLementing Evidence (SMILE) framework was developed in the theory gleaning phase. In the theory refining phase, two causal explanations were identified: 1) the rationality-driven approach that primarily uses open social media platforms (eight CMOs), and 2) the relationality-driven approach that primarily uses closed social media platforms (six CMOs). In the theory consolidation phase, the program theory developed for open social media platforms from the realist review was refined to ten CMOs, of which four confirmed the original CMOs, four refined the original CMOs, and two were new CMO propositions. The key mechanisms included content developers’ capabilities and capacities, along with healthcare providers’ increased attention; fulfillment of information needs; access to social influence and support; perception of message value and implementability; behaviour capabilities, self-efficacy, intention, and awareness; and ability to exercise professional autonomy.
Conclusions: Through a three-phase realist theory development process, a theoretical understanding of how social media supports healthcare providers’ knowledge use in clinical practice was built. Future research is necessary to further develop this framework and investigate the synergistic effects of the rationality and relationality-driven approaches.
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Physical Activity Promotion for Older Adults in Extension through Domestic and International EffortsBalis, Laura Elizabeth 17 April 2018 (has links)
The Land-Grant University Cooperative Extension (herein: Extension) system has been an underutilized resource for physical activity programming. With the recent addition of physical activity as a focus of Extension work, efforts are needed improve dissemination and implementation of evidence-based physical activity interventions. Improving implementation requires overcoming limitations including institutional support and perceptions of Extension health educators who could develop, deliver, and evaluate these programs. A participatory approach that includes input at all delivery levels (program participants, delivery agents, and administrators) can aid implementation through considering program acceptability, appropriateness, and feasibility from the beginning. This dissertation includes three manuscripts that explore the Extension's role in promoting physical activity in older adults, both in the United States and abroad. Manuscript 1 detailed a systematic review of community-based older adult physical activity programs that was conducted in order to determine the characteristics of effective older adult physical activity programs and the extent to which programs implemented in Extension systems nationwide employ these characteristics. The results indicated notable differences between peer-reviewed literature and Extension programs as well as presented an opportunity for Extension programs to more effectively use evidence-based program characteristics, including behavioral theories and group dynamics. The results also suggested that Extension programs could more effectively report their findings through peer-reviewed sources so that effective programs can be disseminated to reach a broader population. Manuscript 2 was an exploratory study conducted as a first step in bringing older adult physical activity programming to Ghana through Extension. Results of the mixed-methods study suggested that older adults in Ghana have mostly positive perceptions of physical activity and would be receptive to an in-person physical activity program. In particular, without specific prompting on principles of group dynamics, across all focus groups, participants mentioned aspects of groupness ranging from the need for accountability to the enjoyment of exercising with others. The results also indicated a need for education on Ministry of Health physical activity recommendations and how to meet them. These findings can be used as the first step to adapting and delivering an evidence-based intervention in Ghana through an integrated research-practice partnership. This approach includes community-level decision making to ensure the resultant program is a good fit in the intended delivery system. Manuscript 3 detailed the translation of an evidence-based older adult physical activity program to an Extension system in a rural state (population 585,501). Results suggested that Extension health educators have overall positive perceptions of physical activity programming, but they experience barriers in delivering these programs. While the program has the potential to reach a representative sample of the population, the adoption rate among Extension health educators was low, and system-wide changes may be needed to improve physical activity program adoption rates among educators. Overall, results of the three manuscripts provided evidence and recommendations for Extension professionals to improve physical activity program implementation through using evidence-based interventions and characteristics, considering perceptions of end users prior to program implementation, and considering system-level changes that promote physical activity program adoption. / Ph. D.
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A DEVELOPEMENTAL, FORMATIVE EVALUATION TO INFORM IMPLEMENTATION OF BIDIRECTIONAL HEALTH INFORMATION EXCHANGE IN COMMUNITY PHARMACIESKatelyn N Hettinger (15353329) 27 April 2023 (has links)
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<p>Although community pharmacists have further reduced medication errors and improved care with access to patient data through unidirectional health information exchange (HIE), access to routine patient data has not been sustained. Several barriers to sustaining use and access of HIE in community pharmacies have been noted, such as lack of implementation supports and technological restrictions. Further, pharmacists and pharmacy technicians have not been involved in the development of HIE systems for their use previously. My research aims to optimize HIE access for community pharmacists through our co-developed HIE interface prototype specifically for use by community pharmacy teams in collaboration with PioneerRx, a pharmacy dispensing software system and our state HIE, the Indiana Health Information Exchange (IHIE), and provide supports for the sustainability of community pharmacist access to HIE.</p>
<p>Therefore, the objectives of my research are to 1) conduct a formative usability evaluation of the HIE interface prototype with community pharmacists and pharmacy technicians to inform strategies to improve the HIE interface design for future implementation in community pharmacies (“<em>Study One”</em>) and 2) identify the potential barriers, facilitators, and recommendations for HIE implementation in community pharmacies through semi-structured interviews to create a curated list of resources to address identified implementation needs to assist with the future implementation of HIE (“<em>Study Two”</em>).</p>
<p>The findings from Study One demonstrate the HIE interface prototype was viewed favorably by pharmacists and pharmacy technicians, with the average System Usability Scale (SUS) score 69 (scale 0 – 100, where 100 is the best). Pharmacists reported higher satisfaction than technicians on average (74 vs. 65, respectively). Key problems identified included accessibility of HIE links and placement in the existing workflow and application label name clarifications. The same eight pharmacists and eight pharmacy technicians, with the addition of seven patients, completed interviews in Study Two. Five barriers, four facilitators, and two recommendations were identified. These were further characterized into four key implementation needs: instruction on how to use HIE, guidance on workflow and team roles, and provider and patient facing resources for discussing HIE. Curated draft implementation resource items that are responsive to all four key implementation needs are in development. The combination of findings from Study One and Study Two create the blueprint for pharmacy-team informed implementation of HIE in community pharmacies.</p>
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Prescribe a bike: reducing income-based disparities in bike access for health promotion and active transport through primary careRyan, Kathleen Mary 22 June 2016 (has links)
Low-income groups have greater potential to gain from incorporating health promotion into daily living using bike-share to increase physical activity and expand transport options. The potential is unmet because of socioeconomics and access. Disproportionate uptake of bike-share by higher income individuals widens the gaps in health equity and transportation equity as bike-share use over-represents males with more resources, less need, and lower health risk. The Prescribe a Bike (RxBike) program, a key focus of this study, is a partnership between primary care providers (PCPs) at an urban safety net hospital and the city’s existing income-based, subsidized bike-share membership.
Three studies using quantitative and qualitative methods were performed to: examine utilization of bike-share by Boston residents among subsidized and non-subsidized members; examine perceived attributes of the RxBike program by Boston Medical Center (BMC) PCPs; and evaluate BMC patient referrals. The overarching conceptual model uses elements of theories from health services and organizational behavior, in a public health framework.
Analysis of Boston resident utilization at the trip-level (2012-2015) demonstrated overall ridership was increasingly by males and residents of more advantaged neighborhoods. Subsidized members had significantly higher likelihood of living in neighborhoods with socioeconomic and health disadvantage, and less gender disparity when compared to non-subsidized members. The impact was minimal because subsidized members made only 7.17% of trips. The survey of PCPs revealed mismatch between highly favorable opinion of RxBike appropriateness and lower intent to refer. Female gender and not being an urban biker predicted lower likelihood of intent to refer. Examination of open-ended survey comments mirrored quantitative data and expanded on the range of provider biking safety concerns in Boston. From 2013-2015, 27 BMC providers made only 72 referrals to RxBike. Patients referred had high cardiovascular health risk, resided in neighborhoods with extremely high levels of disadvantage, and in neighborhoods without meaningful access to bike-share kiosks.
Overall, the subsidized membership extends reach of bike-share to residents of neighborhoods with more health and socioeconomic risk than the rest of the city; RxBike has strong potential to impact this vulnerable population. The most critical matters for program success are safety and neighborhood access.
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Examining the Relationship Between Implementation and Student Outcomes: The Application of an Implementation Measurement FrameworkSpear, Caitlin 14 January 2015 (has links)
The current study evaluated the implementation of evidence-based reading interventions using a multifaceted implementation measurement approach. Multilevel modeling was used to examine how three direct measures of implementation related to each other and to student academic outcomes and to examine patterns of implementation across time. Eight instructional groups were video taped weekly for nine weeks, and pre- and post-test assessments were given to 31 at-risk kindergartners from two schools using established evidence-based practices. Each implementation measure represented a different measurement approach (i.e., discrete behavioral measurement, global ratings) and focused on different aspects of implementation (e.g., structural, process, or multicomponent elements). Overall, results of this analysis indicated that (a) the implementation tools were highly correlated with each other, (b) only the multicomponent tool independently accounted for group differences, (c) together the multicomponent and process-oriented measures appear to account for additional variance in group differences, and (d) there were no significant trends in implementation across time as measured by any of the tools, however there were significant differences in trends over time between groups when using the structural measure. Implications for research and practice are discussed, including the importance of taking a multifaceted approach to measuring implementation and aligning implementation measures with program theory.
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The Social Organization of Best Practice for Acute Stroke: An Institutional EthnographyWebster, Fiona 25 February 2010 (has links)
Since 1995, a thrombolytic therapy, rt-PA, has been approved for use with acute stroke that significantly reduces, and sometimes reverses, neurological damage. Treatment has to be given within a few hours of the start of symptoms and can only commence once a CT-scan has confirmed a particular type of stroke. In the evidence-based medicine and knowledge translation literature, variations in practice are constituted as a problem to be solved. It is assumed that a physician decides whether or not to use this therapy based on his/her evaluation of the scientific evidence.
In this thesis, I demonstrate that what are less evident in many of these claims are issues related to the social production of knowledge. Little attention is paid to who conducts research, who promotes its findings, and who is expected to implement them. The positivist discourse of evidence-based medicine assumes that research produces knowledge that is neutral and can be translated into treatment that is in the patient’s best interest. Yet these assumptions remain empirically unexamined, despite social science critiques of these processes.
Institutional Ethnography is an approach in sociology developed by Dorothy Smith. Based on Smith’s understanding of the social organization of knowledge, it allows for an examination of the complex social relations organizing people’s experiences of their everyday working lives. Beginning in the experiences of physicians who provide acute stroke services, this dissertation explores an example of how best practice medicine is developed, translated, and taken up in practice across various sites in the province of Ontario. For Smith, texts mediate and organize people’s experiences. In my study, the discourses of both evidence-based medicine and knowledge translation, designed to improve patient care, come into view as managerial tools designed to control the delivery of care. I render visible how in fact things work as they do in real life settings in a way that links back actual people to the texts, or discourse, organizing their experiences. In so doing, I am able to uncover some of the assumptions and hidden priorities underlying the current emphasis on translating scientific knowledge in medicine into practice.
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