This thesis explores in which ways and why research informs and influences the public policy making process, and the extent to which existing theories and models add to our understanding of this. Since the late 1990s, the UK government has aspired to evidence-based policy making, particularly policy that is informed by research on what works. In practice, there are many barriers to this aspiration and the instrumental research use of 'what works' knowledge seems relatively rare. Existing research utilisation models offer some insights into why this is the case but they are not well supported by empirical evidence and they tend to underplay the complexities of the policy making process. Additional insights are provided by the literature on the policy process, but this does not pay much attention to research use. This thesis thus combines these perspectives. The thesis is guided by a conceptual framework that combines insights from the advocacy coalition framework (ACF), the stages heuristic, the research utilisation typology, practical rationality and the epistemic communities framework. Two qualitative case studies of Scottish national mental health policy making are considered using this conceptual framework: a suicide prevention policy and a review of mental health law. Data analysis combines 23 in-depth interviews and extensive document review. The ACF is used as a heuristic device to focus on aspects of the policy sub-system that are key to understanding research use. The findings demonstrate that despite limited research evidence on what works in mental health, research was used in the agenda setting and formulation stages of the policy making process, enriching the process and influencing policy sub-system dynamics. Five types of research use are identified; they do not occur in isolation but are layered and interlinked, and are at times contingent on one another. Research use is found to be bound up with the ways in which those involved in the policy making process work with others who share or oppose their policy beliefs, using similar or different knowledge bases. Research influenced policy beliefs, which in turn influenced policy making behaviour. Discussion of research enabled the inclusion, consideration and appreciation of new and different policy positions. It empowered weaker coalitions as well as cementing coalition dominance. It influenced policy direction and encouraged innovation and policy learning. The findings indicate that the current common usage of three categories of research use (instrumental, conceptual and political) may be too crude; real benefit was gained from applying Weiss' original seven research use types. Combining Weiss' research utilisation typology with the ACF deepened understanding of how research influences the policy making process. The findings only partially support the ACF hypotheses concerning research use, and they highlight weaknesses in a number of the ACF's assumptions and definitions. In terms of policy implications, the findings indicate a need to broaden governments' view of research use from an almost exclusive focus on the problem-solving use of 'what works' research knowledge to a wider appreciation of the ways in which research contributes to and enhances policy making.

Nature of the inquiry: My research inquiry investigated how qualities of personal interaction shape and affect the promotion of research utilisation for quality improvement in the US healthcare sector. The research investigated my own professional practice of consulting, teaching, and research regarding the improvement of healthcare practices and outcomes. Efforts to improve the quality of healthcare services are often difficult to realise and sustain. The quality improvement movement in the USA and elsewhere has not conducted much self-examination of its own processes for sources of these perennially problematic results. Relevance: The quality of healthcare services can be readily understood as having consequences of life or death, wellness or suffering. Healthcare expenditures in the USA are estimated at 16% of GDP and over 9% in the UK. Improving healthcare quality improvement efforts is a matter of profound human and social significance. Approach: The DMan research methodology is a reflexively aware process conducted as a cohort and as small learning groups of researchers during the three-year programme. The research inquiry used the complex responsive process of relating theory of learning as emergent changes of meaning or, equivalently, knowledge. As a social science of qualities, it uses the qualities of human interaction as the unit of analysis. The research utilised an interdisciplinary approach drawing upon: healthcare quality improvement literature; organizational discourse studies; research on strategy as practice; performance management; communications theories; the theory of mindful learning; interpersonal neurobiology; figurational sociology; and American pragmatist philosophy. The methodology employs a mindful reflexivity research strategy related to concepts from mindful learning and social neuroscience literature. Central methods included iterative peer and supervisor debriefing and iterative reflexive narrative practice. Findings: A contribution is made to the healthcare literature by describing how ordinary qualities of social coordination dynamics affect the promoters of healthcare research, not just potential users of research. A contribution is made to professional practice by providing a new perspective from which to analyse the sources of performance challenges prevalent in healthcare quality improvement efforts. The research findings indicate how applications of substantial organisational and social resources to promote research utilisation in the US health sector can be co-opted and dissipated away from ostensive substantive objectives. This occurs by research promoters‟ organizational discourse efforts to favourably shape power relating and other qualities of interaction of improvement initiatives. These efforts restrict the emergence of learning about the promoted changes.

Submitted in partial compliance with the requirements for a Master's Degree in Technology, Durban University of Technology, Durban, South Africa, 2015. / Background The Chiropractic profession is considered a form of complementary and alternative therapy which began as a vitalistic approach to health care. Over the years research has become a main focus of the profession in order to validate its claims for its treatment modalities, with the profession having made advances in producing high quality research (Newell and Cunliffe, 2003). In an era of evidenced based practice medical professionals are required to use research findings to guide their practice therefore their perceptions towards using research are important to ascertain. Although there is some literature on Chiropractors' perception of research most studies focus on specific regional populations. Very few if any studies have assessed perceptions of research from different Chiropractic populations at the same time. The aim of this study was to determine the perception, knowledge and utilisation of research and its role in the Chiropractic profession as determined by Chiropractic delegates attending an international Chiropractic conference. In order to provide information to the profession as to how Chiropractors from varying regions perceive research and to see if the shift seen in other health care professions towards evidence based practice is seen in the chiropractic profession. Method This quantitative, cross sectional, descriptive survey was administered to Chiropractic delegates attending the World Federation of Chiropractic biennial conference 2013 in Durban, South Africa. The questionnaire was compiled by using the available literature and validated by means of a focus group and pilot testing. The questionnaire was administered to the delegates as part of their delegate packs at the conference and was made available electronically via SurveyMonkey© after the conference. Participants were required to give written informed consent prior to partaking in the research. The research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 26/13). On completion the questionnaire and the signed letter of information and consent were deposited into separate sealed containers at the conference or stored on SurveyMonkey© . When the study closed, data was coded into an excel spread sheet and imported into IBM SPSS version 21 for statistical analysis. Descriptive and inferential statistics were used to analyse the data Results A response rate of 34.48% (n = 140) was obtained. More than half of the respondents were male (52.2%), from the African region (51.1%), in possession of a master's degree in Chiropractic (51.4%), and were involved in professional chiropractic practice (60.7%). The respondents had a favourable perception towards research (51.4%), with almost all respondents perceiving that research was essential to the progression of the Chiropractic profession (97.5%). A more favourable perception of research was found in those who were from Europe as opposed to Africa (p = 0.001) and had an evidence based practice (EBP) philosophical orientation as opposed to a mixer or straight approach (p < 0.001). Overall the respondents displayed an adequate knowledge of research terminology (59.2%), with those from Europe as opposed to Africa (p = 0.001) having improved research knowledge along with those who had an EBP philosophical orientation (p < 0.001) compared to the straights and mixer approaches. In terms of research utilisation the respondents showed a high utilisation of research to improve clinical practice (88.9%), for self-development (90.1%) and to change their approach to conditions, polices and practice in their area of the Chiropractic profession (83%). There was a trend that being from Europe, North America and Australisia resulted in high research utilisation than those from Africa and Asia. The effectiveness of Chiropractic care for various musculoskeletal conditions was seen as the primary research focus area for the profession (95.1%), with 75% of the respondents wanting the profession to move in the direction of science as opposed to a philosophical focus. The respondents perceived research to play an integral role within Chiropractic by promoting its acceptance among other health care professionals (87%) and by third party payers (70%). Conclusion The respondents in this study had a favourable perception, knowledge and utilisation of research and supported the role of research and science in the future of the Chiropractic profession. Future studies should be conducted on more diverse groups of Chiropractors to see if the findings of this study are replicated, as well as investigate the disparity observed between developed and developing countries. / PDF copy unavailable. please refer to hard copy for full text information / M

Nurses face ongoing difficulties in using evidence and making a reality of evidence-based practice. Studies of the factors that facilitate or impede evidence-based practice suggest that nurse managers should have a key role, but the nature of this role has not yet been fully articulated. This study aimed to explore and explain the roles of nurse managers in relation to evidence-based practice implementation. Four case studies in Scottish NHS Acute Trusts provide rich data on evidence-based practice implementation, drawing on interviews (n = 51), observation and documentary analysis. A wide literature on evidence use in nursing suggests that implementation is hindered by confusion and debate about what counts as evidence, and by an incomplete understanding by staff of the complexity of implementation processes. This study confirms such conclusions. Moreover, the study reveals that the roles of nurse managers in facilitating evidence use are currently limited, largely passive and under-articulated. As such, the findings expose significant discrepancies between nurse managers' roles in practice and those espoused in much of the literature. Partial explanation for this can be found in the organisational contexts in which nurses and their managers work (e.g. competing demands; confused communication; diffuse and overloaded roles and limits to authority and autonomy). In particular, the role of the contemporary nurse manager is one that places considerable emphasis on aspects of general management to the detriment of clinical practice issues. More positively, the study uncovered genuine facilitation in two study sites where hybrid roles of nurse manager and clinical nurse specialist were in place. In both sites, these roles had been successful in supporting and progressing implementation in discrete areas of practice and show some potential for advancing evidence-based practice more widely. These findings have significant implications for research, policy and practice in relation to evidence-based practice in nursing.

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

<p>The overall aim of this thesis was to study the implementation of guidelines, change processes and contextual variables from the perspective of improvements and neonatal nursing care’s endeavours to be more evidenced-based. Because health care is exposed to extensive change pressure and because the impact of effectiveness research on clinical practice is limited, it becomes urgent to understand how knowledge utilisation initiatives can be facilitated.</p><p>Three studies involved managers and nurses at all neonatal units in Sweden. Two of these studies also included nurses from other healthcare organisations. The fourth study included all staff at four neonatal units. The study designs used were cross-sectional, comparative and prospective longitudinal surveys; questionnaires were used as data collection tools in all four studies.</p><p>Evaluation of the utilisation of the neonatal nursing guidelines showed that the guidelines were known to the nurse managers and used at most of the units, though to varying degrees and in different ways. Fifteen months after guideline dissemination, 8 of 35 units had changed practice, of which 2 units had completed the implementation process of a guideline. Involvement in the preceding guideline project facilitated the completion of improvement projects compared with participation in training courses for quality improvement (QI) only. There was no difference between these two groups on long-standing involvement in improvement work. Nurses who continued QI work over a 4-year period were more active in seeking research and implementing research findings in clinical practice than those who ceased the improvement work. The QI-sustainable nurses reported better contextual support for research-related activities. In a separate study staff perceptions of organisational factors appeared stable over the course of one year at the aggregated level. Improvements in skills development and participatory management predicted higher overall organisational and staff well-being. </p><p>The findings emphasize the importance of including both individual and organisational factors in the strategic planning for evidence-based nursing. Plans have to be long-term and consider that change is a slow process. Leadership commitment is essential and there are clear benefits in developing a learning and professional supportive environment as well as of involving staff in organisational decision making.</p>

The overall aim of this thesis was to study the implementation of guidelines, change processes and contextual variables from the perspective of improvements and neonatal nursing care’s endeavours to be more evidenced-based. Because health care is exposed to extensive change pressure and because the impact of effectiveness research on clinical practice is limited, it becomes urgent to understand how knowledge utilisation initiatives can be facilitated. Three studies involved managers and nurses at all neonatal units in Sweden. Two of these studies also included nurses from other healthcare organisations. The fourth study included all staff at four neonatal units. The study designs used were cross-sectional, comparative and prospective longitudinal surveys; questionnaires were used as data collection tools in all four studies. Evaluation of the utilisation of the neonatal nursing guidelines showed that the guidelines were known to the nurse managers and used at most of the units, though to varying degrees and in different ways. Fifteen months after guideline dissemination, 8 of 35 units had changed practice, of which 2 units had completed the implementation process of a guideline. Involvement in the preceding guideline project facilitated the completion of improvement projects compared with participation in training courses for quality improvement (QI) only. There was no difference between these two groups on long-standing involvement in improvement work. Nurses who continued QI work over a 4-year period were more active in seeking research and implementing research findings in clinical practice than those who ceased the improvement work. The QI-sustainable nurses reported better contextual support for research-related activities. In a separate study staff perceptions of organisational factors appeared stable over the course of one year at the aggregated level. Improvements in skills development and participatory management predicted higher overall organisational and staff well-being. The findings emphasize the importance of including both individual and organisational factors in the strategic planning for evidence-based nursing. Plans have to be long-term and consider that change is a slow process. Leadership commitment is essential and there are clear benefits in developing a learning and professional supportive environment as well as of involving staff in organisational decision making.

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

L’utilisation des connaissances issues de la recherche (CIR) est primordiale pour informer les politiques, les interventions et les pratiques en santé, spécialement dans les pays à faible revenu où les indicateurs de santé des populations sont toujours inquiétants. Toutefois, encore peu d’études ont été réalisées pour mieux comprendre comment favoriser le transfert et l’utilisation de ces connaissances, spécialement en Afrique de l’Ouest. La présente thèse vise donc à faire avancer les connaissances en évaluant différentes stratégies de transfert de connaissances (TC) en santé publique mises en œuvre au Burkina Faso dans le cadre du programme de recherche Équité-Santé (2012-2017). Ces stratégies de TC visaient à créer des opportunités d’échanges entre les chercheurs et les utilisateurs potentiels des CIR et ainsi, réduire l’écart entre les connaissances issues de la recherche en santé et leur utilisation. Trois stratégies de TC distinctes ont été étudiées soit 1) un atelier de dissémination de la recherche, 2) un atelier incluant un processus délibératif et 3) une stratégie de courtage de connaissances. Elles ont impliqué une diversité d’acteurs tels que des chercheurs, des décideurs, des professionnels de santé et des représentants d’organisations non-gouvernementales et de la société civile. Une évaluation de la mise en œuvre et des effets a été réalisée pour les deux ateliers et une évaluation des processus de mise en œuvre a été conduite pour la stratégie de courtage de connaissances, étant donné l’arrêt de l’initiative plus tôt que prévu. Les activités d’évaluation ont mobilisé des approches méthodologiques complémentaires et divers outils pour collecter les données (entretiens qualitatifs, questionnaires d’évaluation et observations sur le terrain). Les résultats montrent que les stratégies de TC ont été appréciées par les acteurs car elles ont permis l’apprentissage de nouvelles connaissances et ont représenté une opportunité importante de réseautage afin d’apprendre les uns des autres. Cependant, ces différentes expériences ont mis en lumière plusieurs enjeux tels que le pouvoir décisionnel des acteurs parfois limité, la présence déficiente des décideurs politiques aux activités ainsi que les ressources et incitatifs organisationnels souvent restreints. La présence d’un leadership fort pour assurer une mise en œuvre efficace, le renforcement des relations de partenariat, le développement des compétences en communication et la possibilité d’offrir un accompagnement à long terme aux acteurs représentent également des défis importants pour assurer une mise en œuvre efficace des activités de transfert de connaissances. Davantage d’études sont nécessaires pour mettre en œuvre des stratégies de TC et évaluer leur efficacité. En se basant sur les résultats de la thèse, certaines recommandations générales peuvent être formulées. Par exemple, il apparait important que les stratégies de TC soient en cohérence avec les besoins et ressources des milieux, qu’elles visent le renforcement des capacités et incluent un processus évaluatif en temps réel afin que les stratégies soient adaptées au contexte. En conclusion, la thèse contribue à l’avancement des connaissances sur le TC en santé mondiale en proposant un modèle conceptuel à expérimenter pour guider le développement et la mise en œuvre des stratégies de TC. / The use of research-based evidence (RBE) is essential for informing health policies, programs and practices, especially in low-income countries where population health indicators are still alarming. However, there are still few studies to understand how to improve knowledge translation (KT) processes and research utilisation, especially in West Africa. Thus, this thesis aims to advance the body of knowledge by evaluating different KT strategies in public health implemented in Burkina Faso as part of a research program Équité-Santé (2012-2017). These KT strategies were intended to create exchange opportunities between researchers and potential RBE users and thus reduce the gap between health research knowledge and its use. Three different KT strategies were studied: 1) a research dissemination workshop, 2) a deliberative workshop and 3) a knowledge brokering strategy. They involved a diversity of health system actors such as researchers, policymakers, health professionals and representatives of non-governmental organizations and civil society. An evaluation of the implementation and effects was conducted for both workshops and only an evaluation of the implementation process was conducted for the knowledge brokering strategy, because the initiative came to an early end. Complementary methodological approaches were mobilized during evaluation and different data collection tools were used (qualitative interviews, evaluation questionnaires and field observations). The evaluation results show that stakeholders have appreciated the KT strategies because they learned new knowledge and had a networking opportunity to learn from each other. However, these experiences have brought to light several issues such as the actors’ limited decision-making authority, weak engagement of political actors as well as scarce resources and organizational incentives. The presence of a strong leadership during implementation, partnership synergy, continuous communication skills’ development and long-term support to stakeholder also represent important challenges to assure an effective implementation of KT strategies. More studies are needed to implement KT strategies and evaluate their effectiveness. Based on the results, some general recommendations can be made. For example, it appears important that KT strategies are in line with stakeholders’ needs and resources, facilitate capacity building and include a real-time evaluative process to enable KT strategies to be constantly adapted to the implementation context. In conclusion, the thesis contributes to the advancement of knowledge about KT in global health by proposing a conceptual model to be considered and experimented during KT development and implementation.