Introduction: Applied occupational health research is complex and requires transparent communication between stakeholders to facilitate development and implementation of injury management strategies. Firefighting as a physically demanding, male-dominant occupation provides a unique context to develop and implement injury management strategies. Thesis Objectives: To investigate how individuals perform occupational tasks within a physically demanding occupational context considering the interrelationship between personal, task and environmental factors. A secondary objective was to evaluate the research partnership as integrated knowledge translation using the Knowledge-to-Action (KTA) Framework. Methods. A qualitative study was used to identify barriers and facilitators experienced by female firefighters. Dartfish movement analysis software was adapted to analyze kinematics associated with firefighter tasks. Relative and absolute reliability was used to establish measurement properties of Dartfish methods. Regression models identified the relative importance of individual factors on firefighter task performance. A case study of the research partnership using knowledge translation (KT) theory identified critical phases in developing occupational health research partnerships. Results. The qualitative study identified sex/gender and task/environment effects on firefighter task performance and injury risk. Tracking positional co-ordinate data using Dartfish demonstrated excellent relative reliability (ICC2,1 = 0.84-0.99) and lowest absolute reliability (SEM = 0.01m-0.11m). Strength was the strongest independent predictor of firefighter task performance time where increasing strength was associated with faster time. The case study identified components of the KTA Action Cycle that supported and described collaborative occupational health research. Conclusions. Although female firefighters share commonalities with their male counterparts, unique personal attributes and social experiences affect how they experience firefighting. Dartfish provides a reliable tool to measure kinematics in an applied context. Although refinements are required, recommendations for data collection and extraction using Dartfish in occupational contexts are provided. Occupational health research imbedded in KTA cycle confirms the importance of partnership with stakeholders to ensure the feasibility and relevance of the research. / Thesis / Candidate in Philosophy

In the emerging field of knowledge translation (KT) evaluation is typically assigned the role of quality control, constructing judgments about the merit and worth of knowledge translation activities. To date however, there has been little, if any, record of attempts to use evaluation to facilitate knowledge translation. The purpose of this research was to examine the potential role of evaluation as a mechanism for integrated knowledge translation (IKT). This study was completed in two phases and employed a prospective multiple methods case study design. Phase one explored the context of primary care, the setting in which phase two was conducted. Phase two involved the implementation of an evaluation designed to facilitate knowledge translation; an evaluation of a Memory Clinic within a primary care setting in Ontario, Canada served as the case. The evaluation was participatory and used intentional strategies to support knowledge translation. A framework from the evaluation literature, Pathways of Influence, was used to examine the influence of the evaluation at the level of the individual, interpersonal and collective. This research provides the first known description of a KT-informed evaluation. At the level of the individual, a KT-informed evaluation influenced the individuals’ knowledge about the program, attitudes towards practice-based knowledge and clinical practices and processes. At the team/interpersonal level the evaluation was seen to influence the team’s social norms, supporting the team in thinking beyond their disciplinary boundaries and to develop a shared vision and common language. The evaluation did not have influence at the level of the broader organization, however had diffuse impact on two external organizations. Results of this study suggest that adding knowledge translation to the repertoire of evaluation purposes is a natural extension of the field. Integrated knowledge translation is designed to engage individuals in the synthesis, exchange and ethically sound application of knowledge and the results of this study demonstrate that a collaborative evaluation approach promotes this interest in a potentially powerful way. / Thesis (Ph.D, Education) -- Queen's University, 2013-08-30 16:48:36.698

<p>The purpose of this study was to explore and describe the experiences of academic and decision-maker researchers participating in a public health integrated knowledge translation (IKT) and exchange program of research in Ontario and British Columbia. This research sought to identify structures and processes that acted as enablers or barriers for all partners on a research team as they engaged in collaborative research. The researcher answered the following research questions: <em>What are the experiences of academics and decision-makers participating in the first two years of an integrated knowledge translation program of research?</em> <em>What structures and processes positively and negatively influence the engagement of partners on the collaborative research team?</em> Through answering these two questions the research contributes relatively new knowledge in the form of strategies for engaging academics and decision-makers engaging in collaborative public health systems and services research.</p> <p>A qualitative descriptive approach was used to gain a contextual understanding of experiences of participants in the IKT research program. Twelve semi-structured, one-on-one interviews were conducted with academic and decision-maker researchers working in British Columbia universities and Health Authorities. Qualitative content analysis of transcripts was used to explore and identify concepts emerging from the data.</p> <p>Data analysis identified IKT processes and concepts that encompass and underlie a collaborative research team. An overarching systems approach is used to examine the evolution of the collaborative team. Themes are presented in relation to IKT engagement concepts identified from the literature as well as those that emerged from analysis including: establishing and maintaining relationships, communication, capacity building, multidirectional knowledge sharing, and multidisciplinary capacity.</p> <p>By examining experiences of research partners representing both academia and decision and policy-making, this research contributes new knowledge about strategies to support collaborative health services research which can subsequently strengthen the Canadian public health systems and services research agenda.</p> / Master of Science in Nursing (MSN)

There is a pandemic of low-value clinical care that threatens the sustainability of our publicly funded healthcare systems. Over 30% of the health services provided to patients provide no benefit or may actually result in harm. Health services research is needed to critically evaluate our clinical practices and programs to ensure we create systems that consistently deliver high-value care. Unlike drug trials, health services research is complicated by enormous heterogeneity across cultures, environments, behaviours and systems. Ideally, local research communities should devise and conduct health services research to ensure that both the research questions and outcomes are relevant to community members, and thus more likely to result in sustainable healthcare systems. Embedded researcher models are emerging as a viable approach to supporting local research activities. Embedded researchers are part of the community they serve, provide research expertise to local investigators and community members, and help develop local research systems that facilitate health services research activities. While they may still collaborate with academic partners, this is not necessary for their research success. This thesis documents the transformation of a large community hospital in Ontario into a learning health centre through the use of an embedded researcher model. The first part of the thesis is focused on the results of incorporating an embedded research plan into the hospital’s new antimicrobial stewardship program. The research that emerges from this work contributes new knowledge about the value of antimicrobial stewardship to important patient outcomes such as reduced lengths of hospital stay and rates of Clostridium difficile infections. The thesis concludes with a discussion of the implementation of all the necessary components needed to support a learning health centre and how an embedded researcher model facilitated this transformation and could be used by any similar organization to achieve the same result. / Thesis / Doctor of Philosophy (PhD) / Over 30% of the health services provided by our healthcare systems does not benefit and may actually harm patients. Health services research is therefore a necessary activity required to reduce this waste. In Ontario, over 65% of patients receive their acute care in large community-based hospitals, and yet, these hospitals have minimal research activity and capacity despite repeated attempts by the academic research community to engage these institutions through a variety of collaborative models such as integrated knowledge translation. This thesis provides a blueprint for the transformation of a large community hospital into a learning health centre through the use of a locally created, locally relevant, embedded researcher model. Starting with a proof of concept through the systematic evaluation of an antimicrobial stewardship program, the thesis ends with a ‘how to’ guide for the implementation of the foundational elements needed to support health services research in similar organizations.

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.