During the last decade, there has been growing international interest in generating new knowledge regarding understanding, developing and evaluating mechanisms that support the use of research evidence by policymakers as a strategy to strengthen health systems in low-and middle-income countries (LMICs). This thesis contributes to this knowledge through three original scientific contributions that employ a mixed methods approach, with the goal of supporting the use of research evidence in the Colombian health system. Specifically, in the chapters I present: 1) the development of an analytical schema that explains the conceptualization of the Colombian government, research funder and universities of an evidence-informed health system; 2) two case studies that explain whether and how political factors influenced the role of research evidence in the agenda-setting and policy-development stages of two past health policy decisions in Colombia; and 3) a protocol for a randomized controlled trial evaluating the effectiveness of a multifaceted intervention in increasing the utilization of an evidence service and the intention to use synthesized research evidence by policy advisors and analysts at the Colombian Ministry of Health. As a whole, the chapters presented in this thesis provide substantive, methodological and disciplinary contributions to the field of health systems research and particularly to the study of efforts that aim to support evidence-informed policy in LMICs. They also help to provide insights that can be utilized to support a more nuanced approach to the use of research evidence in LMICs that takes into account the many factors that can influence health system policymaking. Ideally, this will help those engaged in developing mechanisms to support the use of research evidence in the policy process, and contribute to stronger health systems across the world. / Thesis / Candidate in Philosophy

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Abstract available in the Annals of Behavioral Medicine.

Background: Disadvantaged social, economic, and environmental factors create Adverse Childhood Experiences (ACEs), which can harm a child’s developing brain and have lasting effects on health. These experiences range from physical, emotional, or sexual abuse to parental divorce or substance abuse. Afflicted children have a significantly increased risk of behavioral and health issues later in childhood, as well as adult onset chronic health problems. We hypothesize that primary care ACEs screening, intervention by a primary care-behavior health care integrated care team, and referrals for parenting support and resources will be feasible, acceptable, and beneficial from parent and provider perspectives. Methods: Parents with an ACE score of four or higher at the one-month checkup will be offered The Incredible Years interactive video intervention during checkups through 9 months of age. Parents or children with an ACE score of four or higher at the 1-4 year well child visits will be referred to participate in Nurturing Parenting group visits provided by a partnering community agency. Both programs are evidence-based, family-centered trauma-informed programs supporting positive child rearing practices. Process and outcome variables will be assessed using surveys administered after patient screening and following each program session, and primary care providers will be surveyed at the end of the project period. Process and outcome measures include; number of families screened for ACEs, number referred to parenting programs, the number of program sessions completed and attendance and changes in selfassessed parenting competence. This study will demonstrate the feasibility of integrating traumainformed practices into primary pediatric care, document an increase in referrals to community support services and document an increase in self assessed parenting competence among parents who have suffered 4 or more ACEs. Results: Preliminary survey results show that families evaluate the process of undergoing ACEs screening and follow up discussion with providers in a favorable manner. Additionally, families with elevated ACEs scores that meet criteria for additional interventions, received the corresponding program in as acceptable and appropriate. Provider surveys are forthcoming, however the additional screening, intervention provided by the Behavioral Health Team, and feasibility survey collection has not affected the clinic’s productivity or delayed patient care. Upon initially starting screening and survey administration at clinic, an error was noted in the reporting of ACEs screening results in the EMR. Data collection was delayed while the EMR function was edited by IT administrator. Conclusions: Our multidisciplinary team will continue to collect data and continue to evaluate and streamline all aspects of the project in order to enhance the care of our patients and families. Additionally, will evaluate concerns and recommendations noted with provider administration survey at conclusion of data collection.

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No description available.

The purpose of this qualitative phenomenological study was to investigate the perceptions of classroom-level educators regarding the application of trauma-informed instructional practices. This was achieved by evaluating educators' understanding of the influence of trauma on students, their level of familiarity with trauma-informed instructional practices, and their assessments of the effectiveness of these practices. Trauma refers to an individual's response to a single traumatic incident, a succession of traumatic events, or extended exposure to a traumatic event (SAMHSA, 2014). As awareness of the prevalence of childhood trauma has increased, it is acknowledged as a serious public health issue (Lang et al., 2015). Trauma-informed care is a strengths-based, victim-centered framework under which organizations recognize trauma, understand, and limit the potential long-term repercussions of exposure to traumatic experiences, even if an individual does not perceive trauma as influencing their behavior (Kubiak et al., 2017; Office for Victims of Crime, n.d.). Educators have a distinct advantage in identifying students' traumatic stress symptoms, which can directly affect social-emotional growth and academic achievement (Conley et al., 2014; Donisch et al., 2022). Schools play a crucial role in establishing settings that safeguard students against adverse childhood experiences (ACEs), cultivate resilience, and nurture a sense of belongingness (Conley et al., 2014; Hertz, 2020). Eight educators from one northeast Tennessee school district who provided general and special education instruction to students in PreK-12th grade participated in the study. Data collection consisted of one-on-one video conferencing interviews. The data were coded and analyzed to identify emerging themes, synthesized, and summarized (Creswell & Creswell, 2018). The following themes emerged: (a) increased awareness of trauma and ACEs, (b) desire for additional training, (c) diversity of adverse childhood experiences (ACEs) and trauma exposures, (d) perceived negative behaviors resulting from or masking trauma, (e) the significance of procedures and structure, (f) the need for supplementary resources, (g) the importance of relationship building, (h) importance of opportunities for success, (i) facilitation of individualized instruction, (j) increased empathy, (k) increased patience and self-awareness, and (l) emotional, physical, and mental stress.

Trauma, and or traumatic events affect two-thirds of individuals in the United States (Marsac et al., 2016). Individuals diagnosed with Autism Spectrum Disorder (ASD) are more vulnerable to trauma because of their social communication and emotional regulatory deficits (Kerns, 2015). With no field standard for treating clients who have trauma in the field of ABA, the present study investigated if when a practicing BCBA participates in a Trauma-Informed Care (TIC) training they will gain skill and knowledge of TIC to better treat their clients with trauma. This study utilized a CE on the CuspEmergence website created by Dr. Camile Kolu titled “Introduction to Ethics of Trauma-Informed Behavior Analysis”. Participants completed the entire training, a total of four chapters, and results indicated that through the use of a TIC training BCBA’s were able to demonstrate an increase in both skill and knowledge of TIC.

Background: Evidence-informed practice (EIP) is part of a healthcare ethos, in which practitioners apply evidence together with their expertise contextualized by the unique values of the patient. Studies about EIP focus on attitudes or confidence related to EIP. Individuals’ abilities to assess their own knowledge or performance are low. Therefore, a positive rating of attitude or confidence does not likely portray accurately the EIP knowledge or ability of the practitioner. It was hypothesized that awareness of evidence might be a more accurate measure. Objective: This study sought to understand registered massage therapists’ (RMTs) awareness of the current evidence for practice and to identify sources of information that inform that awareness. Methods: An online questionnaire-based mixed-methods cross-sectional study was conducted. Ontario RMTs were invited to participate. This report focuses on the results of the quantitative analysis. Results: In total, 1,762 questionnaires were included; a 16.9% response rate. The mean awareness score was 9.4 ± 7.2. A multiple regression showed four factors that explained 4% of the variation seen in the awareness score: membership in the professional association (RMTAO), EIP attitude score, post-graduate education, and home-based practice. Of seven sources of information provided, respondents rated cumulative professional experience as most important, followed by recent research studies and education. Cumulative professional experience also rated as most frequently used, followed by other RMTs and education. Conclusions: This study investigated the level of awareness of evidence of RMTs. The results of the awareness score showed opportunity for improvement and require further investigation. Future research should explore other factors, which may show a better model of predictability of the awareness score. It is proposed that awareness of the evidence for practice might be a better predictor of use of evidence in practice than self-reported attitude or capacity but further research is needed. / Thesis / Master of Science (MSc)

Background: There are professional expectations for public health nurses to engage in and develop competencies in evidence-informed decision-making (EIDM). The purpose of this research study was to develop and psychometrically test a measure to assess competence in EIDM among public health nurses. Methods: Guided by the Standards for Educational and Psychological Testing (American Educational Research Association, American Psychological Association, & National Council on Measurement in Education, 2014), a three stage study was employed to develop and psychometrically evaluate the new self-report EIDM Competence Measure: 1) Stage one: a systematic review of existing measures assessing four EIDM competence attributes of knowledge, skills, attitudes/beliefs, and behaviours; 2) Stage two: item development for the EIDM Competence Measure comprised of four subscales (knowledge, skills, attitudes/beliefs, and behaviours); and 3) Stage three: psychometric testing (reliability, validity, acceptability) which included item reduction from an original 40-item to a final 27-item tool. Results: The EIDM Competence Measure consists of 27 items aligning with a four-factor model of EIDM knowledge, skills, attitudes/beliefs, and behaviours establishing internal structure validity. Cronbach’s alpha for these four factors was 0.96, 0.93, 0.80, and 0.94, respectively. Significant associations between EIDM competence subscale scores and education, EIDM training/project involvement, and organizational culture established validity based on relationships to other variables. For the original 40-item tool, missing data was minimal as 93% of participants completed all items and mean completion time was 7 minutes and 20 seconds. Conclusions: The EIDM Competence Measure is a conceptually and psychometrically robust instrument that has potential for use in public health nursing practice. / Dissertation / Doctor of Philosophy (PhD) / Nurses who work in public health have professional expectations to participate in evidence-informed decision-making (EIDM). Because of this, it is important to measure how competent they are in EIDM. The purpose of this study was to develop and test a tool that measures EIDM competence among public health nurses using a three-stage study. The first stage involved reviewing literature on existing tools that measure different components of EIDM competence including EIDM knowledge, skills, attitudes/beliefs, and behaviours among nurses. The second stage involved using existing tool items and developing new items for a new tool named the EIDM Competence Measure. In the third stage, the EIDM Competence Measure was tested to assess its validity, reliability, and acceptability among public health nurses in Ontario. The EIDM Competence Measure was found to have strong validity, reliability, and acceptability, showing that there is potential for its use in public health nursing practice.