Background: Most treatment for people with arthritis occurs at the primary care level yet many studies have documented the need for improved arthritis management in this environment. The dissemination of clinical practice guidelines (CPGs) has been suggested as one method for improving care delivery. Getting a Grip on Arthritis, a theory and evidence-based educational program was developed to disseminate arthritis best practices based on published CPGs for the management of osteoarthritis (OA) and rheumatoid arthritis (RA). Primary care organizations were invited to enroll providers in an inter-professional workshop. Six months of reinforcement activities were offered following the workshop to support the delivery of arthritis care in their communities. Purpose: This study was designed to determine which organizational and individual level characteristics contributed to improved provider use of arthritis best practices six months following the workshops. Methods: The ACREU Primary Care Survey was completed by workshop participants at baseline and six months following the workshops in order to evaluate their use of arthritis best practices. This survey measured providers’ responses to open-ended questions that asked how they would manage the individual patients described in three hypothetical case scenarios. One point was given for each recorded best practice and totaled for each case scenario, with the highest possible score being eight for the late RA case and moderate knee OA case, and seven for the early RA case. Requests for reinforcement activities were tracked by study staff during the six months following the workshops. A practice profile was also completed by each organization. Analysis: Two models of knowledge utilization (KU) were constructed for testing. For Model 1, two-level hierarchical linear modeling (HLM) was used to determine the direct effects of provider and organizational level variables on intended use of arthritis best practices six months post-workshops, while controlling for clustering within organizations. In model 2, logistic regression was used to determine the influence of organization level factors on one specific best practice, that is, dissemination of patient educational materials during the six months following the workshop. Results: 275 providers from 131 organizations completed both baseline and six month follow-up surveys. For Model 1, total best practice scores for all three case scenarios were predicted by the discipline of the provider, the model of care in which they worked and baseline best practice scores (P<0.05). Controlling for these variables, baseline confidence in managing arthritis also predicted the six month follow-up scores for moderate knee OA (P=0.05) and baseline satisfaction with ability to manage arthritis predicted the follow-up scores for late RA (P=0.04). For Model 2, the estimated probability of disseminating patient educational materials was >82% for community health centres, primary care networks and regionally funded models of care compared to 30% for the federally funded model of care (P<0.01), and was 88% for organizations that sent multidisciplinary team members to the workshops, compared to 70% for those that did not send such a team (P=0.07). Conclusions: Use of arthritis best practices may be influenced by provider characteristics (discipline, satisfaction and confidence in managing arthritis), the model of care in which they work and the team learning experience. These results have implications for the training and education of health professionals and the design of models of care to enhance arthritis care delivery.

Background: Most treatment for people with arthritis occurs at the primary care level yet many studies have documented the need for improved arthritis management in this environment. The dissemination of clinical practice guidelines (CPGs) has been suggested as one method for improving care delivery. Getting a Grip on Arthritis, a theory and evidence-based educational program was developed to disseminate arthritis best practices based on published CPGs for the management of osteoarthritis (OA) and rheumatoid arthritis (RA). Primary care organizations were invited to enroll providers in an inter-professional workshop. Six months of reinforcement activities were offered following the workshop to support the delivery of arthritis care in their communities. Purpose: This study was designed to determine which organizational and individual level characteristics contributed to improved provider use of arthritis best practices six months following the workshops. Methods: The ACREU Primary Care Survey was completed by workshop participants at baseline and six months following the workshops in order to evaluate their use of arthritis best practices. This survey measured providers’ responses to open-ended questions that asked how they would manage the individual patients described in three hypothetical case scenarios. One point was given for each recorded best practice and totaled for each case scenario, with the highest possible score being eight for the late RA case and moderate knee OA case, and seven for the early RA case. Requests for reinforcement activities were tracked by study staff during the six months following the workshops. A practice profile was also completed by each organization. Analysis: Two models of knowledge utilization (KU) were constructed for testing. For Model 1, two-level hierarchical linear modeling (HLM) was used to determine the direct effects of provider and organizational level variables on intended use of arthritis best practices six months post-workshops, while controlling for clustering within organizations. In model 2, logistic regression was used to determine the influence of organization level factors on one specific best practice, that is, dissemination of patient educational materials during the six months following the workshop. Results: 275 providers from 131 organizations completed both baseline and six month follow-up surveys. For Model 1, total best practice scores for all three case scenarios were predicted by the discipline of the provider, the model of care in which they worked and baseline best practice scores (P<0.05). Controlling for these variables, baseline confidence in managing arthritis also predicted the six month follow-up scores for moderate knee OA (P=0.05) and baseline satisfaction with ability to manage arthritis predicted the follow-up scores for late RA (P=0.04). For Model 2, the estimated probability of disseminating patient educational materials was >82% for community health centres, primary care networks and regionally funded models of care compared to 30% for the federally funded model of care (P<0.01), and was 88% for organizations that sent multidisciplinary team members to the workshops, compared to 70% for those that did not send such a team (P=0.07). Conclusions: Use of arthritis best practices may be influenced by provider characteristics (discipline, satisfaction and confidence in managing arthritis), the model of care in which they work and the team learning experience. These results have implications for the training and education of health professionals and the design of models of care to enhance arthritis care delivery.

Abstract Over the past half a decade, new forms of knowledge sharing, collaboration and online participation have emerged. As a result, a new generation of IT tools are being used for the creation and exchange knowledge. This dissertation uses a knowledge management framework known as the 7C model and applies a multi-method approach to deepen the understanding on how new knowledge emerges with these tools. As the benefits of knowledge are realized when it is applied, this dissertation places special emphasis also on the usability of the knowledge. The results indicate that the knowledge creation sub-processes of comprehension and conceptualization need more scientific attention. In addition, the results suggest that comprehension can be supported by helping users to reflect and by utilizing guideline information. Supporting deeper interaction and improved linking with the existing content, allowing users to stay in a state of flow, and using decision aids can help in comprehension. Conceptualization can be supported through knowledge rationale, metaphors and analogues, decision aids, and by helping users to reach common ground and shared understanding. In order for the knowledge to be really usable, the knowledge creation should aim at producing knowledge in explicit and actionable form. Producing knowledge in the form of guidelines was found to be beneficial for the utilization of knowledge. Guidelines support learning-by-doing and reflection-in-action, which are crucial for the emergence of new tacit knowledge. Evidence-based information and decision aid tools can help in choosing the knowledge that is to be applied. Finally, the results suggest that in the era of Web 2.0, many low-cost experiences inducing constant exposure to knowledge might work better than a few high-cost experiences requiring very deep thinking. The reason for this is that contemporary users seem to be so accustomed to the ease-of-use of Web services that they simply will not use more useful but less usable solutions.

UNESCO Biosphere Reserves are examples of multifunctional landscapes recognized as sources of ecosystem services and laboratories for sustainable development. Participatory mapping of ecosystem services reveals where residents value ecosystem services in a landscape. This approach is expected to provide useful knowledge to inform land use decision-making. However, the knowledge about the spatial distribution of ecosystem service values in Biosphere Reserves and the usefulness of this knowledge for practitioners remains scarce. Through the application of Public Participation Geographic Information Systems (PPGIS) in the Kristianstads Vattenrike Biosphere Reserve located in Southern Sweden, this study identifies i) hotspots and ii) bundles of ecosystem service values, as well as iii) spatial patterns of ecosystem service values regarding the three Biosphere Reserve management zones. Complementary, this study assesses the potential usefulness of the PPGIS-derived knowledge by analyzing qualitative data from a workshop with practitioners of the Kristianstads Vattenrike Biosphere Reserve. My findings reveal distinct patterns of ecosystem service values across Kristianstads Vattenrike Biosphere Reserve that reflect the Biosphere Reserve zones’ management goals. The ecosystem service values were clustered around wetlands and the densest populated areas. Respondents mapped predominantly places for outdoor recreation, biodiversity, and places with existential value. The results highlight the importance of cultural and regulating ecosystem services to people in the Biosphere Reserve. Additionally, practitioners involved in Biosphere Reserve management emphasized the potential strategic usefulness of the PPGIS knowledge for their nature restoration work.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

<p>Background: About 22.4 million people were living with HIV/AIDS in 2008 out of which women constitute approximately 57%. Namibia is one of the highly affected countries with a national HIV prevalence of 17.8% among women attending antenatal clinics. Antiretroviral medications have become available in Namibia since 2002 and presently all district hospitals and some health centres provide ARVs to those in need. Namibia is rated as one of the few countries in sub-Sahara Africa with a high coverage of ART, with 80% of those in need of ART receiving the treatment. An increasing trend has been observed whereby HIV+ women on ARV are becoming pregnant. Little is known about the attitude, knowledge and behavior of these women towards family planning and use of contraceptives and what barriers they may be facing in accessing these services.Aim: To determine the factors affecting the utilization of family planning services by HIV+ pregnant women receiving PMTCT services. Methodology: The study was a cross sectional study using both quantitative and qualitative methods to assess the critical elements of knowledge, attitude and perceptions of the study participants towards family planning services. The study also assessed the health system and other factors that impact on the use of contraceptives by HIV+ women. It was conducted in northern Namibia at Oshakati Health centre among randomly selected pregnant HIV+ women attending for PMTCT services.Results: Among the 113 respondents, who participated in the study, 97.3% knew at least one method of family planning but only 53.6% actually used any method of contraception prior to current pregnancy. Among the 46.4% who did not use any contraception, the reasons often cited for non-use were because they wanted a baby (52%), spouse objection (10%), being afraid of the effects (14%) and other reasons such as belief, culture and distance to travel to the health facility. 88% of the respondents indicated a willingness to use contraceptives after current pregnancy and expressed general satisfaction with services at the health centre while asking for more information on family planning services.Conclusion: HIV+ women have high awareness on some contraceptives but use of contraceptives is not as high as many of them have a desire to have children for self esteem and leave a legacy for the future. Knowledge of the risks of pregnancy on HIV+ woman may be limited and there is a need to improve educational intervention in this regard as well as integrate family planning services into all HIV/AIDS services.</p>

<p>Background: About 22.4 million people were living with HIV/AIDS in 2008 out of which women constitute approximately 57%. Namibia is one of the highly affected countries with a national HIV prevalence of 17.8% among women attending antenatal clinics. Antiretroviral medications have become available in Namibia since 2002 and presently all district hospitals and some health centres provide ARVs to those in need. Namibia is rated as one of the few countries in sub-Sahara Africa with a high coverage of ART, with 80% of those in need of ART receiving the treatment. An increasing trend has been observed whereby HIV+ women on ARV are becoming pregnant. Little is known about the attitude, knowledge and behavior of these women towards family planning and use of contraceptives and what barriers they may be facing in accessing these services.Aim: To determine the factors affecting the utilization of family planning services by HIV+ pregnant women receiving PMTCT services. Methodology: The study was a cross sectional study using both quantitative and qualitative methods to assess the critical elements of knowledge, attitude and perceptions of the study participants towards family planning services. The study also assessed the health system and other factors that impact on the use of contraceptives by HIV+ women. It was conducted in northern Namibia at Oshakati Health centre among randomly selected pregnant HIV+ women attending for PMTCT services.Results: Among the 113 respondents, who participated in the study, 97.3% knew at least one method of family planning but only 53.6% actually used any method of contraception prior to current pregnancy. Among the 46.4% who did not use any contraception, the reasons often cited for non-use were because they wanted a baby (52%), spouse objection (10%), being afraid of the effects (14%) and other reasons such as belief, culture and distance to travel to the health facility. 88% of the respondents indicated a willingness to use contraceptives after current pregnancy and expressed general satisfaction with services at the health centre while asking for more information on family planning services.Conclusion: HIV+ women have high awareness on some contraceptives but use of contraceptives is not as high as many of them have a desire to have children for self esteem and leave a legacy for the future. Knowledge of the risks of pregnancy on HIV+ woman may be limited and there is a need to improve educational intervention in this regard as well as integrate family planning services into all HIV/AIDS services.</p>

Afin de favoriser l’utilisation des connaissances issues de la recherche en éducation, le Centre de transfert pour la réussite éducative du Québec et l’Équipe RENARD de recherche en transfert de connaissances ont souhaité habiliter certains acteurs du milieu de l’éducation à jouer le rôle d’agents facilitateurs dans leur milieu. Pour ce faire, ils ont développé et implanté, dans le cadre d’un projet-pilote le Référentiel d’agir compétent à l’intégration de connaissances favorables à la réussite éducative des jeunes du Québec. La présente thèse répond à trois objectifs : 1) présenter et analyser la démarche d’élaboration de cet outil; 2) présenter et analyser la théorie de programme du projet-pilote de mise en oeuvre de l’outil et finalement 3) présenter les résultats de l’évaluation des processus et des mécanismes de changement de ce projet-pilote. Pour ce faire, une méthodologie qualitative est utilisée, s’inspirant de l’approche intégrative d’évaluation des processus et des effets fondée sur la théorie de programme (Chen, 2015). Le premier article de la thèse permet de présenter la démarche d’élaboration de l’outil et de constater que celle-ci est conforme à la plupart des bonnes pratiques en la matière. Le deuxième article de la thèse présente les composantes du modèle d’action et celles de modèle de changement du projet-pilote. Cet article permet, en analysant les composantes de ces modèles en regard des écrits scientifiques pertinents, d’établir que la théorie de programme du projet-pilote est plausible, c’est-à-dire qu’il est possible de croire que la mise en oeuvre de ce projet peut mener aux déclenchements des mécanismes de changement et à l’obtention des effets prévus. Finalement, le troisième article démontre que le projet a eu une influence sur les perceptions des participants quant à leurs rôles dans le processus menant à l’utilisation des connaissances issues de la recherche et que ceux-ci ont réussi, dans une certaine mesure, à mettre en pratique dans leur milieu les ressources acquises dans le cadre du projet. Ce dernier article présente aussi une analyse des composantes du projet qui ont favorisé ou entravé l’obtention de ces résultats. / To foster research knowledge utilization, the Centre de transfert pour la réussite éducative du Québec and the Équipe RENARD de recherche sur le transfert des connaissances wished to empower school practitionners to play the role of intermediate agents. To do so, they developped and implemented a competency model : the Référentiel d’agir compétent à l’intégration de connaissances favorables à la réussite éducative des jeunes du Québec. This thesis has three objectives : 1) present and analyze the program theory of this competency model’s elaboration process; 2) present and analyze the program theory of the implementation of this competency model and 3) present the results of the evaluation of the process and mecanism of the project. In order to achieve these objectives, a qualitative methodology has been used, based on the Integrative process/outcome evaluation approach described by Chen (2015). The first article of the thesis present the competency model’s elaboration process and analyze this process comparing it with the best practices in the field. The second article present the components of the action model and those of the change model. In comparing the action and change model’s components with the litterature, the second article demonstrate that the program theory of the project is plausible. The third and last article of the thesis shows that the project has had an influence on the way the participants perceive there role in fostering knowledge utilization. This article also reveals that the participants have been able, to some extent, to utilize in their practice the ressources they acquired in the project. Finally, this article also present an analyze of the components that have helped or hindered the achievements of the project.

眾所周知，現代社會如僅靠行政人員個人的經驗、智慧與直覺，不僅不足以制定具有前瞻性、能夠指道社會未來發展之政策，甚至無法解決許多當前發生的重大問題，如都市治安、公害防治、社會福利、交通問題、子女教育、都市發展、通貨膨漲等。因之，現代決策必須充分結合學術團體及個人的研究成果與各方智慧，共同完成決策，才能達到提昇決策品質、解決問題與福國利民的目標。 我國一向重視結合「學術與行政」，因此行政機關除鼓勵所屬人員自行從事研究發展工作外，還投入大量經費委託組織外的學者專家進行專業性的研究，如行政院環保署自七十六年成立以來，共投入二十八億餘元辦理委託研究；再如行政院研考會於民國六十九年至七十九年，共投入七千六百萬餘元辦理委託研究；經建會於八十年度即投入三千五百四十三餘萬元進行委託研究；單係環境科技之委託研究，七十七年度至八十年度行政機關及國營事業就投入六十二億二千九百萬元。另外行政院所屬機關中從事研究發展工作者有：經濟部、國防部、交通部、農委會、原能會、衛生署、環保署、教育部等。 國家投入如此豐沛的人力、物力、財力於委託研究上，各項委託研究成果的應用情形如何？是否有助於政府部門規劃出高品質之公共政策？還是僅生產出汗牛充棟的資訊，並未被充分應用？若未被充分應用，其原因何在？如何才能提升行政機關政策研究成果之應用率？凡此問題值得吾人深入追蹤探討與評估。 本文主要的研究問題如下： 根據西方文獻顯示，研究與應用配合情形不佳，我國行政機關應用委託研究的情形為何？委託研究成果與應用間存不存在差距？若存在差距究係何種因系造成？ 若存在差距，如何才能在研究與應用間建立橋樑，強化二者間的連結並提高委託研究成果的應用率？ 行政機關的委託研究成果對該機關業務產生的影響為何？即委託研究在行政工作上扮演何種角色？ 行政機關應用該機關委託研究成果行為，大多發生於政策過程的那一階段？以何種方式應用委託研究成果？ 為何有些委託研究成果被行政機關應用？有的未被應用？影響委託研究成果被中央銀級行政機關採用或拒絕的因素為何？ 目前「研究應用」領域中的理論，例如兩界論（two communities theory）知識特定理論(knowledge specific theory)、決策者限制理論(policy maker constraint theory)等，幾乎均為西方之產物，是否可以應用於我國，解釋我國行政機關應用研究成果的現象？即何種研究應用理論模式，最適合描述我國行政機關應用委託研究成果之情形？ 本文採用文獻探討、個案研究，紮根的理論研究法及次級資料分析四種方法搜集、組織、分析行政院環保署的實證資料，回答以上各項問題，期望對我國中央級行政機關—環保署應用委託研究成果情形及辦理委託研究工作，有較深入且廣泛的認識，並提出改進建議，以供有關機關參考。 本論文第一章基於文獻探討(閱讀前人的研究成果)，引發筆者的研究動機並確立本研究欲探究之問題與目的。由於筆者研究資源有限，故須在進行研究時縮小研究範圍，然後籍由四種研究方法搜集、組織並分析資料(第二章)：並於第三章中、界定本研究關鍵名詞--「研究應用」的意義與測量方式：第四、五、六、七章則為本研究果之陳述；第八章結論與展望部分，除將本研究所獲致的結果，再做一扼要整理敘述，還根據過去此領域之研究者及筆者的研究心得，為有興趣者，未來從事相關研究，提出進一步的研究建議。 本研究歸納國外文獻及國內實證資料後發現：行政機關中低度應用研究成果是一個中外均普遍的現象，研究者與行政人員間的確存在差距，但二者間差距並不大，支持兩界論樂觀派的說法。環保署委託研究成果或建議的採行情形，根據實証資料顯示比率並不高，將近50%的委託研究成果只有小部分被採用。而實際上，環保署委託研究成果的採行率可能更低。造成此種差距的因素很多，根據筆者推論，關鍵因素可能為決策的本質、研究者與行政人員的本質不同(兩界論)及官僚體系的層層過濾等三項，但委託研究成果對行政機關業務所造成的影響仍不容忽視且非常複雜又不易衡量，因每項研究成果造成的影響均可能有所不同，各種情形均有。個別委託研究對行政機關業務影響的大小，須視該項研究成果本身具備的條件、決策者的意向及外在環境等因素的配合情形而定。 應用研究成果的階段方面，根據環保署的實証資料顯示，環保署人員通常係在「研擬及評估問題的解決方案」、「研擬法規草案」、「界定或了解問題」時，最常參考引用委託研究成果，可知委託研究成果對政策制定過程影響最大的階段係在行政作業初期階段，因此可下結論環保署委託研究的主要功能為：行政機關解決問題、準備具體方案及作決策所須的基本資料。事實上，應用研究成果是一個非常複雜的過程與現象，應用研究成果的過程通常不是一次就結束，而是一點一點地、不定時地、可能由不同的人分別應用研究內容，因此欲回答委託研究成果通常係應用於決策或行政工作哪一階段，實難以一言蔽之。此外，關於應用研究的方式，一般而言可分為工具性應用、啟發性應用、及策略性應用三種。環保署的實證資料顯示，工具性應用最多；策略性應用次之啟發性應用最少。由於研究應用為一項複雜的現象，因此，任何一項委託研究均可能以多重的方式被應用，其應用方式端視行政機關人員的需求而定。如一項委託研究成果既可提供待解決問題的基本資料，又可作為行政人員說服反對者或民意代表的工具，則更可能是啟發行政人員產生新構想或採取新行動的刺激。 關於影響研究被行政機關應用與否的因素，大致可按因素性質歸入三個模式中：研究特性模式、應用者／應用機關特性模式及系絡模式。到底係那些特定因素造成的影響，尚須視委託研究個別的情形而定。 為強化研究與應用間的連結，提升委託研究成果的採行率，應自研究的規劃階段即開始重視「應用」的問題，即以應用為導向進行研究，以利日後完成研究，將成果應用於解決政策問題上。 誠如此領域眾多前輩所言，研究應用實為一動態且複雜的現象，但一步一步慢慢來，此領域還是可以且值得吾人探索的，本文於最後列出建構一般性的研究應用理論等七項未來可供進一步研究的方向，供有興趣的研究者參考。