Cette thèse porte sur le développement et la validation d’un outil visuel de transfert de connaissances en santé mentale. Cet outil est nommé le PicMH-U, un acronyme pour picture-based mental health tool – university version. Cet outil de transfert de connaissances a été développé avec la participation de la population cible, soit les étudiant.e.s universitaires. L’information qu’il contient porte sur les problèmes de santé mentale qui ont le plus grand impact sur les étudiant.e.s universitaires, tel que recensé en 2016 par l’Enquête sur la santé psychologique étudiante (ESPE), et une liste de ressources psychosociales à laquelle les étudiant.e.s peuvent accéder. Ces éléments ont été ciblées pour répondre aux taux disproportionnés de problèmes psychologiques et l’importance de mettre en place des interventions psychosociales appropriées pour les étudiant.e.s universitaires. Cette thèse poursuivait deux objectifs: 1) connaître l’état de la recherche sur l’utilisation des images pour communiquer/transférer la recherche en santé mentale et en psychologie aux adultes nord-américains; et 2) de développer et valider des outils de transfert de connaissances avec un échantillon de cette population, soit : des étudiant.e.s d’une université canadienne. Le premier objectif a été satisfait à l’aide d’une revue systématique de la littérature (Article 1; Chapitre 3) et le deuxième grâce à des consultations avec la population cible (Chapitre 2) et un essai contrôlé randomisé longitudinal (Article 2; Chapitre 4). Les deux articles sont soumis à des revues évaluées par des pairs mais ils ne sont pas publiés. Les résultats présentés dans le premier article montrent que la recherche sur l’utilisation des images pour transférer des connaissances en santé mentale auprès d’adultes nord-américains se limite exclusivement à la lutte anti-tabagique. Les résultats présentés dans le deuxième article montrent de meilleurs résultats pour la condition « avec les images » (PicMH-U) que pour la condition « texte » (TextMH-U) sur tous les tests de mémoires, mais pas sur la satisfaction des utilisateurs, l’intention d’utiliser les ressources, ni l’utilisation des ressources. Cette thèse contribue à l’amélioration des domaines portant sur la communication à l’aide d’images et le transfert de connaissances en santé mentale communautaire en étudiant une intervention fréquemment utilisée dans les communautés de pratique mais qui n’est pas validée par la recherche empirique. En validant l’utilisation des images pour la communication de résultats de recherche en santé mentale chez la population étudiante, cette thèse fournit des données probantes permettant de renforcer cette pratique. / This thesis documents the development and validation of a picture-based mental health Knowledge Transfer tool for university students, named the PicMH-U. As a knowledge transfer tool, the PicMH-U was developed with the participation of the potential users (stakeholders): Canadian university students. The information it seeks to communicate is the mental health difficulties that have been found to most affect Canadian university students – as assessed by the 2016 Enquête sur la Santé Psychologique Étudiante – along with psychosocial resources they can access to seek assistance. This information and population are used in order to address the demonstrated alarming rate of mental health difficulties among university students and need for mental health awareness and intervention. The objectives for this thesis are two-fold: 1) to describe the state of the field of using images to communicate mental health/psychological research to North American adults; and 2) to develop and validate a mental health knowledge transfer/mobilization (KT) tool for a section of the adult population: university students. The first objective was satisfied through a systematic review (Article 1; Chapter 3) and the second objective through consultation with stakeholders (Chapter 2) and a longitudinal randomized controlled trial (Article 2; Chapter 4). The articles in this thesis have been submitted to peer-reviewed journals but are currently unpublished. Results from the systematic review (SR) indicate that experimental research on image-based mental health communication to North American adults is limited to tobacco use and control. The SR found that Picture Warning Labels spurred more negative affect and more conversations about the Health Warning Labels, were rated as more effective at encouraging quitting, and increased actual quit behaviors. Secondly, the randomized controlled trial found that the PicMH-U (image condition) had better results on tests of short-term, long-term, prompted and free recall, but not on user satisfaction, intention to use services, or actual use of services when compared to the text condition. This thesis contributes to the advancement of the field of picture-based communication, knowledge transfer and community mental health by researching an intervention often used in community practice but not commonly validated by experimental research. By validating the use of the picture-based mental health tool among university students, this thesis aims to provide empiric evidence to support the use of picture-based communication methods within mental health.

Underserved youth (e.g., from families facing inadequate housing, food insecurity, financial instability) are disproportionately exposed to traumatic experiences (e.g., family discord or violence, neglect, poverty, racism), which can lead to several negative life-long consequences (e.g., affective and somatic disturbances, anxiety, depression, suicidal ideation). Community organizations that target underserved youth may be ideally situated to offset the negative consequences of trauma through leveraging a trauma-sensitive sport model for youth programming. A trauma-sensitive sport model involves a blend of positive youth development approaches (i.e., creating safe environments for youth to experience positive relationships, autonomy, and opportunities to build skills), trauma-sensitive approaches (e.g., considering the potential effects of trauma on youth’s participation and development, and prioritising their needs for safety, voice, empowerment, choice, and collaboration), and program designs that leverage and re-design sporting activities to help youth navigate trauma symptoms, build a social support system, and develop various resilience-related skills (e.g., emotional regulation, decision-making). Little research has examined the implementation and effectiveness of a trauma-sensitive sport model for youth programming in a community setting. Use of this model can contribute to greater capacities of youth sport leaders to promote underserved youth’s healthy participation and development. This dissertation was conducted in partnership with BGC Canada, a national non-profit community organization that serves disadvantaged communities. From 2016-2021, a trauma-sensitive sport model for youth programming was implemented in this organization through the Bounce Back League (BBL) initiative. The purpose of this dissertation was to explore the knowledge-to-action processes involved in translating this model in a community program setting. The knowledge-to-action cycle (KTAC; Graham et al., 2006) was used to conceptually guide the studies carried out in this dissertation, in outlining key phases for consideration in translating a trauma-sensitive sport model. While most of these phases are described in this dissertation, the empirical articles focused on assessing four phases of this cycle, which included: (a) assess barriers and facilitators to knowledge use, (b) select, tailor, and implement interventions, (c) monitor knowledge use, and (d) evaluate outcomes. Intrinsic case study methodologies were used to understand community-based knowledge translation processes and outcomes within the case of the BBL initiative. A community-based participatory research approach was used to engage in equitable collaboration between researchers and community members for the development of this initiative. Utilisation-focused evaluation principles were used to work with community members to determine what to evaluate, how to evaluate, and how results would be used. Grounded in a pragmatic paradigm, a mixed methods research design was used to collect data through the initiative, which included individual and group interviews with leaders, leader-reported logbooks, leaders self-reported questionnaires, leaders' assessments of youth's participation, communications on an online messaging platform (Slack), and researchers' observations of training opportunities and leaders' practices. The purpose of Article 1 was to outline the overarching process of integrating a trauma-sensitive sport model within the BBL program, from 2016-2021. Several stages of program development were described, including: (a) collaboratively planning the program; (b) piloting the program to three clubs; (c) adapting the program using pilot insights; (d) expanding the adapted program to ten clubs; and (e) creating opportunities to maintain, sustain, and scale-out practices throughout grant duration and beyond. Lessons learned regarding the leadership team’s experiences in terms of developing, adapting, and integrating a trauma-sensitive sport model for youth programming in this community context were shared. The purpose of Article 2 was to explore factors involved in the implementation of a trauma-sensitive sport model for youth programming in BBL. This article paralleled the KTAC phase of assess barriers and facilitators to knowledge use. A mixed-methods evaluation of the pilot phase of BBL was conducted. Three clubs participated in training, implementation, and evaluation of BBL. The data were collected through interviews, logbooks, and assessments. The quantitative data were interpreted using descriptive statistics and comparative t-tests; the qualitative data were interpreted using thematic and content analyses. The RE-AIM framework was used to categorise the various processes and outcomes involved in program implementation. The results showed that programs reached a large number of youth but struggled to retain youth from season to season. The leaders perceived that the intentional structure of the program, opportunities to practice self-regulation, relationship focus, and life skill focus, were all linked to positive participation in youth members. Components of leaders' training and program delivery were noted as successful, but the sustained benefits of these successes were challenged by leader turnover and funding limitations. In line with the KTAC phases, insights were generated on what works and what does not in facilitating this type of programming in a community setting for underserved youth and helped inform future adaptations to the program as it was rolled out (discussed in Article 1). The purpose of Article 3 was to explore leaders' learning experiences from participating in an initial training workshop and prior to their implementation of programming. This article paralleled the select, tailor, and implement interventions phase and the evaluate outcomes phase of the KTAC model. The value-creation framework was used to explore learning experiences based on the interactions and values that leaders discussed. Participants were leaders who attended initial training workshops. A mixed-methods approach was used to collect data through observations, interviews, and self-reported questionnaires. The quantitative data were interpreted using descriptive statistics and Wilcoxon Signed-Ranks Tests; the qualitative data were interpreted using thematic analysis. The results showed that the leaders: (a) valued having a variety of learning opportunities that were relevant to their roles and contexts, (b) appreciated the diverse focus on foundational and practical content, and (c) shared an interest to learn how to support trauma-exposed youth and facilitate better programming. Implications were discussed for the improvement of training opportunities to better meet leaders' needs within a community organization and support leaders' intentions to apply knowledge into action. Article 4 builds on the previous study, where the purpose was to explore leaders' learning experiences as they implemented programming and while they participated in continuing training and development activities. This article also paralleled the select, tailor, and implement interventions phase and the evaluate outcomes phase of the KTAC model. The participants were leaders who were involved in implementing BBL at their clubs. A mixed-methods approach was used to collect data through interviews, observations, surveys, and communications on an online messaging platform (Slack). The quantitative data were analysed using descriptive statistics, data charting, and non-parametric analyses; the qualitative data were interpreted using thematic analysis. The results indicated that the leaders learned through various interactions throughout their practice (e.g., implementing programs at their homes sites, receiving mentoring, conversations with peers), and discussed gains in applied value (e.g., program facilitation strategies, youth-support skills), realised value (e.g., youth's receptivity and behaviour change), and transformative value (e.g., transfer of leaders' skills, influence on club culture). Implications were discussed for the improvement of training opportunities to promote ongoing social learning and maintenance of program practices. The purpose of Article 5 was to explore the fidelity and quality of leaders' application of a trauma-sensitive sport model to programming. This article paralleled the monitor knowledge use phase of the KTAC model. The promising practices criteria were used as an evaluation framework to categorise dimensions of quality relevant to program effectiveness. Leaders from 11 BBL programs participated. A mixed-methods approach was used to collect data through observations, interviews, and logbooks. The quantitative data were interpreted using descriptive statistics; the qualitative data were interpreted using thematic analysis. The results showed that: (a) all programs showed evidence of supportive adult and youth relationships, (b) programs led by trained leaders maintained program fidelity and implemented more features to a stronger extent than untrained leaders, (c) trained leaders may have compromised mastery orientation opportunities in favour of other program components. Implications were discussed related to what may facilitate or constrain program fidelity and quality in this setting, and how training and development opportunities can mitigate challenges in leaders' capacities. This dissertation offered an evaluation of the knowledge-to-action processes involved in integrating a trauma-sensitive sport model into BGC Canada. The results of this dissertation provided insights of how BGC Canada leaders learned and facilitated a trauma-sensitive sport model for youth programming, the differences training and development may contribute to the quality of their program practices, and how involvement in this initiative resulted in changes in leaders' behaviours, skills, and identities, as well as positive youth developmental outcomes. Practical implications were shared on how BGC Canada and similar community organizations can enhance their partnership and facilitate these interventions. As well, the value of taking a systems-based approach to planning future interventions with a trauma-sensitive sport model was also discussed to maximise multi-level impacts. Academic implications were shared on how future research can also take a systems-based approach to evaluating knowledge translation processes in youth sport interventions.

Les troubles douloureux de l’épaule (TDE) affectent jusqu’à 55% de la population générale et sont souvent difficiles à traiter. L’objectif de cette thèse était de développer une intervention de mobilisation des connaissances permettant d’implanter les recommandations de guides de pratique clinique (GPC) couvrant la prise en charge des TDE. Pour ce faire, un processus basé sur le cadre conceptuel Knowledge-to-Action a été utilisé. D’abord, une revue systématique des recommandations des GPC à implanter pour améliorer la prise en charge des TDE a été effectuée. Puis, les écarts dans la pratique des cliniciens ont été identifiés à l’aide d’un sondage documentant la prise en charge des TDE ainsi qu’une étude évaluant la concordance entre les physiothérapeutes et les orthopédistes au niveau du diagnostic et de la prise en charge des TDE. Ensuite, les déterminants à l’implantation des recommandations des GPC ont été identifiés en procédant à deux études qualitatives ciblant les expériences et les attentes des patients vivant avec un TDE, puis les barrières et facilitateurs à l’implantation des recommandations des GPC identifiés par les cliniciens. Enfin, l’utilisation du Behaviour Change Wheel et des déterminants ont permis d’identifier des stratégies visant à implanter les recommandations de GPC sur la prise en charge des TDE en première ligne de soins. La revue systématique des GPC a permis de déterminer qu’initialement, les TDE ne requièrent généralement pas d’imagerie médicale et de référence à un médecin spécialiste, mais qu’un programme de réadaptation actif est requis. Selon les résultats du sondage, les médecins de famille (n=76) ont recommandé plus d’imagerie que les physiothérapeutes (n=175). Jusqu’à deux physiothérapeutes sur trois ont sélectionné des traitements non recommandés par les GPC. Les résultats de l’étude de concordance démontrent que l’accord entre physiothérapeutes et orthopédistes était bon au niveau du diagnostic et modéré au niveau du triage des candidats chirurgicaux. Les patients souffrant de TDE interrogés (n=13) ont mentionné, dans la première étude qualitative, avoir attendu que leur douleur soit incapacitante avant de consulter un professionnel. Ces participants s’attendaient alors à recevoir un diagnostic clair et à être référés pour des tests d’imagerie. Finalement, ils espéraient recevoir des explications complètes et se voir proposer des options pertinentes de traitements. Les 19 physiothérapeutes et 16 médecins de famille interrogés dans la deuxième étude qualitative ont indiqué comme barrières à l’utilisation des recommandations des GPC : le manque de connaissances, le manque d’habileté à réaliser une évaluation clinique de l’épaule et la crainte de ne pas détecter une pathologie grave, si présente, sans un test d’imagerie. Le temps insuffisant de consultation avec les patients, leurs attentes et le manque d’accès à certains soins ont aussi été indiqués comme des barrières. Les principales stratégies identifiées suivant ces études incluent donc des interventions éducatives, la préparation de champions cliniques et la création d’équipes cliniques interdisciplinaires. À l’aide de ces stratégies, l’implantation pilote de l’intervention sera réalisée dans des groupes de médecine familiale. L’impact potentiellement bénéfique de cette implantation pourrait, à terme, améliorer la prise en charge des patients atteints de TDE. / Shoulder pain is a common and difficult to manage condition that can affect up to 55% of the general population. To optimize shoulder pain management in primary care, the main objective of this thesis was to develop a knowledge mobilization intervention to implement the recommendations from clinical practice guidelines (CPGs) covering the management of different shoulder disorders. A knowledge mobilization process based on four steps of the Knowledge-to-Action framework was used in this thesis. First, a systematic review of CPGs was performed to identify recommendations to be implemented for improving shoulder pain management in primary care. Then, the evidence-practice gaps were assessed using a survey documenting family physicians and physiotherapists shoulder pain management as well as in a study evaluating the concordance between physiotherapists and orthopedists for shoulder pain diagnosis and management. The determinants influencing CPGs recommendations’ implementation were identified by conducting two qualitative studies. The first study explored the experiences and expectations of patients living with shoulder pain and the second aimed to interview clinicians for identifying barriers and facilitators to the implementation of CPGs recommendations. Finally, based on the identified determinants and using the Behaviour Change Wheel method, we identified strategies for implementing CPGs recommendations covering the management of shoulder pain in primary care. Based on the systematic review of shoulder CPGs, we identified that shoulder pain generally does not initially require diagnostic imaging and referral to a medical musculoskeletal specialist, but that an active rehabilitation program is required. According to the survey results, family physicians (n=76) recommended more imaging than physiotherapists (n=175) for rotator cuff tendinopathy and adhesive capsulitis, although this is not indicated. Up to two out of three physiotherapists selected treatments not recommended by CPGs in the management of shoulder pain. The results of the concordance study showed that the agreement between physiotherapists and orthopedists was good in terms of diagnosis and moderate in terms of triage of surgical candidates. Patients (n=13) interviewed in the first qualitative study reported waiting until their shoulder pain was disabling before seeing a family physician or a physiotherapist. Participants expected a clear diagnosis and imaging tests to explain their shoulder pain. They also wished to receive clear and thorough explanations and relevant treatment options. The 19 physiotherapists and 16 family physicians that participated in focus groups indicated as barriers to the use of CPGs recommendations: lack of knowledge, poor skills in performing a clinical evaluation and fear of not identifying a serious pathology without medical imaging. Patients’ expectations, insufficient consultation time with patients and lack of patients’ access to certain care, such as rehabilitation treatments were also identified as barriers. The main strategies identified following these studies therefore include educational interventions, the preparation of clinical champions and the creation of interdisciplinary clinical teams. Using these strategies, pilot implementation of the intervention will be carried out in family medicine groups. The potentially beneficial impact of this implantation could ultimately improve the management of patients with shoulder pain in primary care.

An all-of-society approach is foundational for increasing disaster resilience and creating adaptive capacity in the face of disasters and climate change. Youth participation within disaster risk reduction (DRR) and disaster risk management (DRM) is an inclusive strategy to engage youth in an all-of-society approach. While this is an emerging and fast-growing area of study, ingraining social inclusion in practice is slow. Through a series of four articles, this dissertation describes two separate qualitative studies exploring youth participation in DRR and DRM through the youth perspective. Participatory research methodologies dismantle power dynamics inherent in traditional research, and they are well-suited for research on youth participation. As such, our first study used Photovoice methodology to explore youth perceptions of youth capabilities in disasters, and to understand their experiences of the COVID-19 pandemic. Examples of youth participation initiatives in DRR are scattered, necessitating exploration of the process of participation in diverse contexts and types of disaster events. We conducted the second study using case study methodology to explore facilitators of - and barriers to - youth contributions towards DRR efforts in the context of local flooding, tornado, and pandemic events in Ottawa, Ontario, Canada. This dissertation provides insight on how to promote youth resilience, capacity, and strengths in disasters. Based on these findings, we argue that a paradigm shift in DRR towards an asset-based approach is essential to implement youth participation in practice. An asset-based approach aligns with the capability-oriented worldview in youth participation literature and theories. The complexity arises in attempting to apply asset-based lessons from the literature into the traditionally needs-based orientation of DRR policy and DRM practice. More research is needed to document youth actions in DRR and to determine asset indicators to evaluate implementation efforts. This dissertation begins an important conversation around applying an asset-based approach to youth participation in DRR through the perspectives of youth.