abstract: Data and the use of data to make educational decisions have attained new-found prominence in K-12 education following the inception of high-stakes testing and subsequent linking of teacher evaluations and teacher-performance pay to students' outcomes on standardized assessments. Although the research literature suggested students' academic performance benefits were derived from employing data-informed decision making (DIDM), many educators have not felt efficacious about implementing and using DIDM practices. Additionally, the literature suggested a five-factor model of teachers' efficacy and anxiety with respect to using DIDM practices: (a) identification of relevant information, (b) interpretation of relevant information, (c) application of interpretations of data to their classroom practices, (d) requisite technological skills, and (e) comfort with data and statistics. This action research study was designed to augment a program of support focused on DIDM, which was being offered at a K-8 charter school in Arizona. It sought to better understand the relation between participation in professional development (PD) modules and teachers' self-efficacy for using DIDM practices. It provided an online PD component, in which 19 kindergarten through 8th-grade teachers worked through three self-guided online learning modules, focused sequentially on (a) identification of relevant student data, (b) interpretation of relevant student data, and (c) application of interpretations of data to classroom practices. Each module concluded with an in-person reflection session, in which teachers shared artifacts they developed based on the modules, discussed challenges, shared solutions, and considered applications to their classrooms. Results of quantitative data from pre- and post-intervention assessments, suggested the intervention positively influenced participants' self-efficacy for (a) identifying and (b) interpreting relevant student data. Qualitative results from eight semi-structured interviews conducted at the conclusion of the intervention indicated that teachers, regardless of previous experience using data, viewed DIDM favorably and were more able to find and draw conclusions from their data than they were prior to the intervention. The quantitative and qualitative data exhibited complementarity pointing to the same conclusions. The discussion focused on explaining how the intervention influenced participants' self-efficacy for using DIDM practices, anxiety around using DIDM practices, and use of DIDM practices. / Dissertation/Thesis / Doctoral Dissertation Leadership and Innovation 2017

Objective: To understand the use of evidence-informed decision-making within an interorganizational network, and identify the facilitators and barriers to achieving network goals. Design: Case study. Setting: Rural health district in Nova Scotia, Canada (2006 to 2011). Participants: Members from 4 organizations representing community and hospital groups participating in a regional Baby Friendly Initiative network. Methods: A descriptive mixed methods study using focus group and questionnaire methodology. Data were analyzed using framework analysis and social network analysis (SNA). Results: The SNA results highlighted the role that relationships have on the sharing of knowledge among network members. The findings highlight the need for leadership at multiple levels (community, network members, primary organizations, and the provincial government). A lack of resources to achieve the network’s goals was a key barrier. Conclusions: The role of multi-level leadership is important for future network development and community consideration. The case study methodology facilitated momentum towards the network’s goals.

Objective: To understand the use of evidence-informed decision-making within an interorganizational network, and identify the facilitators and barriers to achieving network goals. Design: Case study. Setting: Rural health district in Nova Scotia, Canada (2006 to 2011). Participants: Members from 4 organizations representing community and hospital groups participating in a regional Baby Friendly Initiative network. Methods: A descriptive mixed methods study using focus group and questionnaire methodology. Data were analyzed using framework analysis and social network analysis (SNA). Results: The SNA results highlighted the role that relationships have on the sharing of knowledge among network members. The findings highlight the need for leadership at multiple levels (community, network members, primary organizations, and the provincial government). A lack of resources to achieve the network’s goals was a key barrier. Conclusions: The role of multi-level leadership is important for future network development and community consideration. The case study methodology facilitated momentum towards the network’s goals.

In 2014, breast cancer was the second leading cause of death among Canadian women, with women over age 50 years making up 82% of the identified cases. To address this issue, the Ontario Breast Screening Program developed a media campaign that promoted the benefits of mammogram screening, but not the associated risks (i.e., false-positive, false-negative, radiation exposure, and overdiagnosis). This study was designed to determine whether there was a statistically significant relationship between knowledge of overdiagnosis and participation in mammogram screening. This cross-sectional, correlational study used schema theory supported by the effective health communication model. Forty-one women were invited to listen to a brief presentation on the benefits and risks of screening mammograms and then completed a modified Champion Health Belief Model Scale survey. Two sample t tests and logistic regression analyses of the survey scores showed that the data did not support any correlations with education and screening, but did indicate a correlation between overdiagnosis and participation. The less a participant felt that overdiagnosis was a negative consequence, the more likely they were to participate in breast screening. Survey participants also stated that promotions of mammograms should present balanced information about the benefits and risks of screening. The positive social change and policy implications of this study include providing women aged 50-69 years more information on overdiagnosis in mammograms so they are more informed participants in the decision-making process, and educating Ontario government policymakers with information about the barriers that women aged 50-69 years face in getting balanced information on mammography programs.

Transparens är avgörande för att förbättra hållbarheten förmikrotransaktioner i spel, eftersom det gör det möjligt för spelarna att fattainformerade beslut. Men det är viktigt att ha en balans eftersom för myckettransparens kan ha negativa ekonomiska konsekvenser för företagen, då detkan avskräcka köp. Syftet med studien är att skapa förståelse kring hurtransparens kan användas som ett verktyg för att spelutvecklare ska kunnadesigna hållbara mikrotransaktioner. I studien genomfördes intervjuer medåtta spelare och fyra spelutvecklare. Dessutom användes en probe för attfördjupa den empiriska insamlingen av upplevelser kring transparens. Istudien definieras även hållbart spelande, genom att fokusera på att designamikrotransaktioner utefter ett hållbart spelande kan datorspelsindustrin bidratill en ökning av den sociala och ekonomiska hållbarheten. Fem temanidentifierades genom en tematisk analys där transparens kan stödjainformerade beslut: valuta, värde, varningar, kommunikation och tillit.Studiens resultat kan användas av spelutvecklare och andra aktörer inomdatorspelsindustrin för att främja informerade beslut med en mer transparentoch hållbar spelkultur. / Transparency is crucial to improving the sustainability of microtransactionsin gaming, as it enables players to make informed decisions. However, it isimportant to strike a balance because excessive transparency can havenegative economic consequences for companies, as it may discouragepurchases. The purpose of the study is to generate an understanding of howtransparency can be used as a tool for game developers to design sustainablemicrotransactions. The study involved interviews with eight players andfour game developers. Additionally, a probe was used to further enhance theempirical collection of experiences related to transparency. The study alsodefines sustainable gaming, as designing microtransactions based onsustainable gaming can contribute to increased social and economicsustainability within the gaming industry. Five themes were identifiedthrough a thematic analysis where transparency can support informeddecision-making: currency, value, warnings, communication, and trust. Thefindings of this study can be utilized by game developers and otherstakeholders in the gaming industry to promote informed decision-makingand foster a more transparent and sustainable gaming culture.

Introduction: Les incertitudes des pronostics cliniques et les dilemmes moraux associés aux technologies des tests prénataux affectent les expériences et les processus décisionnels des femmes et des couples. D’une part, la validité des normes relatives au ‘consentement autonome’ et au conseil ‘non directif’ est remise en question. D’autre part, les aides à la décision sont prônées pour rehausser la prise de décision éclairée. L’objectif de ce mémoire est de construire un modèle de l’expérience des femmes et des couples qui font face aux tests prénataux afin d’identifier les facteurs qui amélioreraient les expériences, la prise de décision et le rôle des aides à la décision et informeraient le modèle de soin. Méthodologie: La modélisation et l’analyse des expériences des femmes et des couples qui affrontent les tests prénataux reposent sur une méta-ethnographie des études qualitatives et sur une analyse narrative thématique des études quantitatives. La critique d’un outil (PT) en matière de tests prénataux est également effectuée en ayant recours aux critères de qualité de l’International Patient Decision Aid Standards (IPDAS). Résultats: Un cadre conceptuel décrivant les expériences vécues est construit et l’analyse thématique le complète en soulignant que la prise de décision n’est que rarement éclairée. Les normes d’une ‘décision autonome’ et d’un ‘conseil non directif’ sont problématiques pour les femmes. Les aides à la décision amélioraient les scores de connaissances, sans pour autant modifier la perception du risque, ni les niveaux d'anxiété. L’outil PT favorise une prise de décision basée sur les préférences, mais les critères IPDAS sont difficilement applicables et leur rôle dans une décision de qualité est incertain. Discussion et conclusion: Les résultats éclairent les facteurs macro, méso et micro pouvant améliorer les expériences vécues des femmes et des couples et affecter la prise de décision et l’utilisation des aides à la décision. Un changement de paradigme préconisant le concept d’autonomie relationnelle dans le modèle de soins est suggéré. Dans le contexte des avancées en matière de test prénataux, une réévaluation des normes de pratique et de modèles de soin est requise. Le rôle des aides à la décision devra être élucidé. / Introduction: The clinical prognostic uncertainties and moral dilemmas associated with technological advances of prenatal testing impact the experiences and decision-making of women and couples. While the validity of the norms of ‘autonomous consent’ and ‘non-directive’ counseling is being questioned, decision aids are promoted to enhance informed decision-making. The goals of this thesis are to develop a model of the experiences of women and couples in prenatal testing so as to identify factors that may improve experiences, decision-making, the role of decision aids and inform the care model. Methods: A model of the experiences of prenatal testing is developed through a meta-ethnography of qualitative studies and a narrative synthesis of the themes explored in quantitative studies. A prenatal testing (PT) decision tool is critically assessed using the International Patient Decision Aids Standards (IPDAS) quality criteria for decision aids. Results: A conceptual framework of the experiences of women and couples in prenatal diagnosis is constructed and complemented by a narrative thematic analysis showing that decision-making is rarely informed and that the norms of an ‘autonomous decision’ and a ‘non-directive’ counselling are problematic for women. Decision aids improve knowledge scores, but do no modify risk perception or anxiety levels. A PT tool increases preference based informed decision-making, but quality criteria are not always applicable and their role in quality decision-making is unclear. Discussion and conclusion: The results highlight macro, meso and micro-level factors that may improve the experiences of women and couples and inform decision-making processes as well as the use of decision aids. A paradigm shift towards the concept of relational autonomy in the prenatal diagnosis model of care is suggested. Advances in prenatal testing require a re-evaluation of the norms of practice and care model. The role of decision aids requires further elucidation.

The importance of sustainable development within the construction industry and its environmental and social impacts as well as economic significance has become more apparent over recent years. A key factor perceived as contributing to an organization’s business success is the integration of environmental, social, and economic issues into decision-making processes. The pressure from stakeholders regarding their expectations on sustainability has risen, and the importance of understanding the stakeholders’ opinions and perspectives in a construction project while simultaneously maintaining sustainable project management increases. The aim of this thesis is to analyze how stakeholder sustainability expectations can be promoted and achieved during a construction project life cycle and related building process stages by supporting the project manager using a specifically designed visual tool. This will be investigated by answering three research questions proposed in the Introduction chapter (page 5). The visual tool is created with the focus on defining and establishing sustainability parameters based on stakeholder expectations. The tool should be applicable to a broad variety of construction projects with different focus on stakeholder expectations. Furthermore, a theoretical framework has been developed as part of the analysis based on existing theories; the Business Model Canvas (Osterwalder & Pigneur, 2010), Global Performance Framework (International Civil Aviation Organization, 2009) and Stakeholder Theory. The proposed framework and its visual tool component are a means to support a project manager with stakeholder communication, collaboration and informed decision-making. The visual tool is adapted to include a common language and structure to enhance the communication and collaboration amongst key stakeholders and support a project manager with ensuring that the construction project is focused on achieving sustainability results expected by the stakeholders. / Betydelsen av hållbar utveckling inom byggbranschen och dess miljö- och sociala påverkan samt den ekonomiska betydelsen har blivit tydligare de senaste åren. En nyckelfaktor som uppfattas som bidragande till en organisations finansiella framgångar är integreringen av miljömässiga, sociala och ekonomiska frågor i beslutfattningsprocessen. Trycket från intressenter gällande deras förväntningar på hållbarhet har ökat, och betydelsen av att uppfatta intressenternas åsikter och perspektiv inom ett byggnadsprojekt – och samtidigt upprätthålla hållbar projektledning – har ökat. Syftet med denna studie är att analysera hur intressenters hållbarhets förväntningar kan främjas och uppnås under ett byggnadsprojekts livscykel och relaterat till byggnadsprocess steg genom att stödja projektledaren med användning av ett specifikt designat visuellt verktyg. Detta kommer att undersökas genom att svara på tre forskningsfrågor föreslagna i introduktionskapitlet (sida 5). Det visuella verktyget är skapat med fokuset på att definiera och etablera hållbarhets parametrar baserat på intressenters förväntningar. Verktyget ska kunna tillämpas på en mängd olika byggnadsprojekt med olika fokus på intressenters förväntningar. Ett teoretiskt ramverk har utvecklats som del av analysen baserat på redan existerande teorier; Business Model Canvas (Osterwalder & Pigneur, 2010), Global Performance Framework (International Civil Aviation Organization, 2009) och Intressentmodellen. Det föreslagna ramverket och dess visuella verktyg som utgör en av dess komponenter, är ett sätt att stödja en projektledare med intressentkommunikation, samverkan och informerat beslutsfattande. Det visuella verktyget har anpassats till att inkludera ett gemensamt språk och struktur för att förbättra kommunikation och samarbetet bland nyckelintressenter och stödja en projektledare med att säkerställa att ett byggprojekt har som fokus att uppnå förväntade hållbarhetsresultat.

Many strategies can be used to support the use of research evidence in decision-making. However, such strategies have been understudied in crisis zones, where decision-making may be particularly complex, many factors may influence decision-makers’ use of research evidence, and professional judgements may be particularly relied upon. Using synthesis and qualitative research methods, this dissertation examines the role of research evidence in crisis zones and strategies to support its use in decision-making. First, chapter 2 describes a critical interpretive synthesis, which drew upon a broad body of literature around evidence use in crisis zones to develop a new conceptual framework that outlines strategies that leverage the facilitators and address the barriers to evidence use in crisis zones in four systems, namely the political, health, international humanitarian aid, and health research systems. Second, in chapter 3, the focus narrows, and an embedded qualitative case study design was used to gain a deeper understanding into one of the four identified systems, the political system, and specifically the factors that influenced the use of research evidence in the governmental health policy-development processes for Syrian refugees in Lebanon and Ontario. Finally, in chapter 4, a user testing study design was used to zero-in on decision-makers’ experiences with a particular strategy within the health research system, namely an evidence website focused specifically on topics relevant in crisis zones. This dissertation provides a rich understanding of research evidence use by examining knowledge translation strategies in a setting that has been largely unexplored in the broader KT map: crisis zones. The findings from this thesis point to the need for comprehensive strategies to support evidence use in decision-making that draw upon the existing literature and are adapted for crisis zones, which can occur sequentially or simultaneously within or across the four identified systems. / Thesis / Doctor of Philosophy (PhD) / In humanitarian aid, and specifically in crisis zones, there are many different types of information decision-makers can draw from when making decisions. One specific type of information is research evidence; however, the use of research evidence, and the ways it can inform decision-making in crisis zones, has been understudied. This dissertation addresses this key gap in understanding by: 1) developing a new tool that can help decisions-makers use research evidence to inform their decisions in crisis zones within the political, health, humanitarian aid and health research systems; 2) examining the factors that influence the use of research evidence in the governmental health policy-development processes for Syrian refugees in Lebanon and Ontario; and 3) examining the perspectives of decisions-makers around using one way of supporting the use of research evidence — an evidence website — to support evidence-informed decision-making in crisis zones.

Health economists, national decision-makers and global health specialists have been interested in calculating the cost of a disease for many years. Only more recently they started to generate more comprehensive frameworks and tools to estimate the full range of healthcare related costs of illness in a user’s perspective in resource-poor settings. There is now an ongoing trend to guide health policy, and identify the most effective ways to achieve universal health coverage. The user fee exemptions health financing schemes, which grounded the tuberculosis control strategy, have been designed to improve access to essential care for ill individuals with a low capacity to pay. After decades of functioning and substantial progress in tuberculosis detection rate and treatment success, this thesis analyses the extent of the coverage (financial and social protection) of two disease control programs in West Africa. Learning from the concept of the medical poverty trap (Whitehead, Dahlgren, et Evans 2001) and available framework related to the economic consequences of illness (McIntyre et al. 2006), a conceptual framework and a data collection tool have been developed to incorporate the direct, indirect and intangible costs and consequences of illness incurred by chronic patients. In several ways, we have sought to provide baseline for comprehensive analysis and standardized methodology to allow comparison across settings, and to contribute to the development of evidence-based knowledge.<p><p>To begin, filling a knowledge gap (Russell 2004), we have performed microeconomic research on the households’ costs-and-consequences-of-tuberculosis in Burkina Faso and Benin. The two case studies have been conducted both in rural and urban resource-poor settings between 2007 and 2009. This thesis provides new empirical findings on the remaining financial, social and ‘healthcare delivery related organizational’ barriers to access diagnosis and treatment services that are delivered free-of-charge to the population. The direct costs associated with illness incurred by the tuberculosis pulmonary smear-positive patients have constituted a severe economic burden for these households living in permanent budget constraints. Most of these people have spent catastrophic health expenditure to cure tuberculosis and, at the same time, have faced income loss caused by the care-seeking. To cope with the substantial direct and indirect costs of tuberculosis, the patients have shipped their families in impoverishing strategies to mobilize funds for health such as depleting savings, being indebted and even selling livestock and property. Damaging asset portfolios of the disease-affected households on the long run, the coping strategies result in a public health threat. In resource-poor settings, the lack of financial protection for health may impose inability to meet basic needs such as the rights to education, housing, food, social capital and access to primary healthcare. Special feature of our work lies in the breakdown of the information gathered. We have been able to demonstrate significant differences in the volume and nature of the amounts spent across the successive stages of the care-seeking pathway. Notably, pre-diagnosis spending has been proved critical both in the rural and urban contexts. Moreover, disaggregated cost data across income quintiles have highlighted inequities in relation to the direct costs and to the risk of incurring catastrophic health expenditure because of tuberculosis. As part of the case studies, the tuberculosis control strategies have failed to protect the most vulnerable care users from delayed diagnosis and treatment, from important spending even during treatment – including significant medical costs, and from hidden costs that might have been exacerbated by poor health systems. To such devastating situations, the tuberculosis patients have had to endure other difficulties; we mean intangible costs such as pain and suffering including stigmatization and social exclusion as a result of being ill or attending tuberculosis care facilities. The analysis of all the social and economic consequences for tuberculosis-affected households over the entire care-seeking pathway has been identified as an essential element of future cost-of-illness evaluations, as well as the need to conduct benefit incidence assessment to measure equity.<p><p>This work has allowed identifying a series of policy weaknesses related to the three dimensions of the universal health coverage for tuberculosis (healthcare services, population and financial protection coverage). The findings have highlighted a gap between the standard costs foreseen by the national programs and the costs in real life. This has suggested that the current strategies lack of patient-centered care, context-oriented approaches and systemic vision resulting in a quality issue in healthcare delivery system (e.g. hidden healthcare related costs). Besides, various adverse effects on households have been raised as potential consequences of illness; such as illness poverty trap, social stigma, possible exclusion from services and participation, and overburdened individuals. These effects have disclosed the lack of social protection at the country level and call for the inclusion of tuberculosis patients in national social schemes. A last policy gap refers to the lack of financial protection and remaining inequities with regards to catastrophic health expenditure still occurring under use fee exemptions strategies. Thereby, one year before 2015 – the deadline set for the Millennium Development Goals – it is a matter of priority for Benin and Burkina Faso and many other countries to tackle adverse effects of the remaining social, economic and health policy and system related barriers to tuberculosis control. These factors have led us to emphasize the need for countries to develop sustainable knowledge. <p><p>National decision-makers urgently need to document the failures and bottlenecks. Drawing on the findings, we have considered different ways to strengthen local capacity and generate bottom-up decision-making. To get there, we have shaped a decision framework intended to produce local evidence on the root causes of the lack of policy responsiveness, synthesize available evidence, develop data-driven policies, and translate them into actions.<p><p>Beyond this, we have demonstrated that controlling tuberculosis was much more complex than providing free services. The socio-economic context in which people affected by this disease live cannot be dissociated from health policy. The implications of microeconomic research on the households’ costs and responses to tuberculosis may have a larger scope than informing implementation and adaptation of national disease-specific strategies. They can be of great interest to support the definition of guiding principles for further research on social protection schemes, and to produce evidence-based targets and indicators for the reduction and the monitoring of economic burden of illness. In this thesis, we have build on prevailing debates in the field and formulated different assumptions and proposals to inform the WHO Global Strategy and Targets for Tuberculosis Prevention, Care and Control After 2015. For us, to reflect poor populations’ needs and experiences, global stakeholders should endorse bottom-up and systemic policy-making approaches towards sustainable people-centered health systems.<p><p>The findings of the thesis and the various global and national challenges that have emerged from case studies are crucial as the problems we have seen for tuberculosis in West Africa are not limited to this illness, and far outweigh the geographical context of developing countries.<p><p><p>Keywords: Catastrophic health expenditure, Coping strategies, Cost-of-illness studies, Direct, indirect and intangible costs, Evidence-based Public health, Financial and Social protection for health, Health Economics, Health Policy and Systems, Informed Decision-making, Knowledge translation, People-centered policy-making, Systemic approach, Universal Health Coverage<p> / Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished

A gap exists in the methods used in industry and available in academia that prevents customers and engineers from having a voice when considering engineering risk appetite in the dynamic shaping of early-phase conceptual design trade study outcomes. Current methods used in Collaborative Design Centers either collect risk information after a conceptual design has been created, treat risk as an afterthought during the trade study process, or do not consider risk at all during the creation of conceptual designs. This dissertation proposes a risk-informed decision making framework that offers a new way to account for risk and make decisions based upon risk information within conceptual complex system design trade studies. A meaningful integration of the consideration of risk in trade studies is achieved in this framework thus elevating risk to the same level as other important system-level design parameters. Trade-offs based upon risk appetites of individuals are explicitly allowed under the framework, enabled by an engineering-specific psychometric risk survey that provides aspirational information to use in utility functions. This dissertation provides a novel framework and supporting methodologies for risk-informed design decisions and trades to be made that are based upon engineering risk appetites in conceptual design trade studies. / Graduation date: 2012