ADHD is one of the most common childhood psychiatric disorders, with symptoms that are frequently displayed in the school environment. Past studies have measured teachers’ knowledge, attitudes, and behaviours towards ADHD, but very few studies have aimed to change teachers’ knowledge, attitudes and behaviour through the implementation of an intervention. The goal of the present study was to determine if a web-based medium is an effective tool for supporting knowledge, attitude, and behaviour change in teachers of elementary school children with ADHD. Teachers (n = 20) from Nova Scotia were recruited through word of mouth. Of these participants, 19 completed a 7-week intervention that consisted of presentations, web-links and discussion board activities related to different aspects of ADHD. Knowledge, attitudes, and behaviour were measured pre- and post-intervention. Teachers’ knowledge improved from pre- to post-intervention (p = 0.03). In terms of attitudes, although there was no change on the overall measure of attitude, there was a significant change on the Lack of Control (p = 0.001) and Perceived Competence (p = 0.000) subscales. A measure of teacher behaviour toward ADHD did not significantly change. Participants agreed that the content was presented in a way that was usable and easy to understand, the links and discussion board functions were useful, and they learned something new from each of the sessions. The study demonstrated that a web-based medium is a useful tool for knowledge creation and translation and has potential as a means of providing professional development to teachers about ADHD.

Musculoskeletal disorders are a considerable burden to the individual and the society at large. Therapeutic exercise and psychosocial interventions are longer-term therapies for relieving pain, improving function and outcomes after musculoskeletal disorders, and for enabling patients to manage their conditions. Healthcare professionals such as physiotherapists and occupational therapists widely use therapeutic exercise as part of a single or complex intervention. However, adherence to supervised or home exercise remains low among patients with musculoskeletal disorders. Understanding the barriers and facilitators of exercise adherence has the potential to improve the delivery of exercise programs and the design of interventions to improve adherence. Similarly, psychosocial interventions are recommended as a supplement to exercise therapy for the management of prolonged pain and disability after musculoskeletal disorders. Several psychosocial factors have been linked to prolonged pain and disability after hand injuries. However, while clinicians believe they have a role in managing psychosocial problems in hand therapy, barriers such as limited access and lack of knowledge pose a challenge to delivering psychosocial interventions. Current evidence shows that online-based coping skill programs provide cost-effective and accessible options for delivering psychosocial interventions in musculoskeletal care. However, there is a dearth of literature on the design, development, and implementation of online-based psychosocial interventions in hand therapy. This thesis includes four manuscripts with three overarching objectives. The first objective was to synthesize the qualitative evidence on barriers and facilitators of therapeutic exercise towards closing the gaps in adherence literature. The second objective was to understand the beliefs, attitude, knowledge and practice behavior of clinicians with regarding to managing psychosocial problems in hand therapy. The third objective was to provide a report on the design and development of a web-based coping skill training program for psychosocial problems specific to hand therapy. The fundamental aim is to provide toolkits that can be used to increase the knowledge and clinical practice behavior of physiotherapists and occupational therapists to optimize musculoskeletal health using therapeutic exercise and psychosocial interventions. The second and third manuscripts are a protocol and completed meta-synthesis of qualitative literature outlining the factors influencing adherence to therapeutic exercise in individuals with musculoskeletal disorders from the perspective of patients and healthcare professionals. We identified numerous factors influencing adherence to therapeutic exercise, which were organized according to the World Health Organization (WHO) multidimensional adherence framework. Based on the meta-ethnography line of argument, interpretation of identified themes: personal and lifestyle characteristics, health status and illness perception, nature of the program, health system, and social/environmental resources, showed that while some factors interact, others could be conceptualized as being on a continuum. These findings expanded the original model introduced by the WHO. The fourth manuscript presents a qualitative descriptive study designed to understand the knowledge, attitude, beliefs, and practice behavior of hand therapists practicing in Ontario with regards to psychosocial problems. The findings informed by the Theoretical Domains Framework provide insights into factors influencing the decision of clinicians to assess and manage psychosocial interventions in hand therapy. Addressing factors such as knowledge, attitudes, and beliefs about psychosocial factors at the individual and organizational level has the potential to increase the capacity of clinicians to adopt a clinical practice behavior that promotes the assessment and management of psychosocial problems in hand therapy. The fifth manuscript is a mixed-methods study describing the design, development, and usability testing of Hand Therapy Online COping Skills (HOCOS) training online program to support hand therapists in the management of psychosocial problems. Using a three-step process that involved needs assessment, heuristic testing, and user testing, we sought feedback from Information and Communication Technology experts and clinicians in hand therapy to develop the HOCOS prototype using iterative cycles. The results revealed heuristic violations and usability related to task performance, navigation, design aesthetics, content, functionality, and features and desire for future use. All violations were corrected in the final prototype, and participants expressed a high degree of satisfaction with using the final prototype in practice. The next phase of HOCOS design would require user testing by patients with hand injuries. / Thesis / Doctor of Philosophy (PhD) / Bone and joint injuries are very common in orthopedic practice and massive burden to individuals and society at large. Many patients are given exercises as part of their treatment to reduce pain and improve function. Unfortunately, many individuals continue to struggle with attending therapy sessions and doing exercises by themselves. Starting and continuing exercises are required to maximize the benefits from exercise recommendations. However, many barriers continue to make exercising a challenge. Research is needed to identify the challenges of starting and continuing exercises from the perspectives of both patients and healthcare professionals. In some situations, some patients with bone and joint injuries such as hand injuries continue to have pain and reduced function even after the original injury has healed. The weak relationship between the initial injury and present experience of pain and reduced function means other reasons like the mental, emotional, and social factors need to be considered in clinical practice. Healthcare professionals have reported several difficulties when dealing with psychosocial problems and want to learn strategies and skills for dealing with the mental, emotional, and social challenges affecting recovery after injuries to bones and joints. The use of the web-based coping skills training for managing psychosocial problems in individuals with bone and joint conditions has shown positive results. However, these strategies are yet to be explored in individuals with injuries to the hand and upper limb. This thesis includes four papers with the first two papers aimed at examining the literature on adherence to therapeutic exercise. Findings from these papers showed the interactions among the five factors influencing adherence to exercise according to the World Health Organization’s model: patient, health condition, treatment plan, health system, and socioeconomic factors. The third paper sought to understand the opinion of clinicians working in hand therapy about the mental, emotional, and social issues of patients. The result showed that participant’s beliefs, attitudes, knowledge and behavior concerning the assessment and management of psychosocial issues are shaped by several factors organized into six themes. The final paper reports on the steps involved in the making of a new internet coping skill program developed for use in individuals with hand and upper limb conditions. Review of the website by technology experts and clinicians showed areas for improvement which were subsequently amended until the participants reported satisfaction with the system. The clinicians expressed interest in using the online coping skill program in their hand therapy practice.

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