Medicine and Health Sciences Commons^™

Understanding The Knowledge Translation Practices Of Environmental Health Officers In Canada: A Mixed Methods Study, Shawna Bourne-Shields

Electronic Thesis and Dissertation Repository

Though important to Environmental Health Officer (EHO) practice, few research articles explore what evidence-informed practice looks like in environmental health or the factors that influence it. This study set out to understand the barriers to, and facilitators of, research utilization (RU) experienced by EHOs by asking: how do EHO practitioner perceptions of the barriers to RU change during an emergency; what factors influence evidence use during an emergency; and what can be done to ensure access to evidence and support effective and appropriate practice decision-making?

These questions were answered through three studies that used quantitative and qualitative methods. The Barriers …

Practice-Based Research In Speech-Language Pathology, Meghan Vollebregt

Electronic Thesis and Dissertation Repository

Practice-based research is an active and collaborative approach to clinical research that minimizes the research-practice gap. Practice-based research involves collecting data in practice to answer questions that arise from clinical practice. The findings from this research then inform future practices. Though over the past two decades there has been a significant increase in knowledge translation activities, especially the use of collaborative partnerships, the integration of these practices in speech-language pathology is in its infancy. In this thesis, I investigate the role of practice-based research in speech-language pathology. In Chapter 2, I first examine the current role of practice-based research in …

Evaluating The Process Of Involving Affected Community Members In Service Delivery And Design: A Deliberative Dialogue Case Study, Tiffany N. Scurr

Electronic Thesis and Dissertation Repository

This study investigates the use of a deliberative dialogue (DD) as a method of patient and public involvement (PPI) in decision-making and priority setting in service delivery and design. A single mixed methods case study was used to evaluate a DD that involved tenants of a rent-geared-to-income building as stakeholders alongside public health, primary care, and social services. Using quantitative survey data and inductive thematic analysis of project documents, focus groups, and field notes, we found that: (1) tenants highly valued actionable outcomes; (2) it is important to recognize diverse types of evidence and knowledge sharing; (3) engaged facilitation is …

Printed Educational Materials Directed At Ontario Primary Care Physicians Fail To Improve Adherence To Guideline Recommendations For The Management Of Diabetes Complications: A Pragmatic, Factorial, Cluster Randomized Trial, Alison Howie

Electronic Thesis and Dissertation Repository

Printed educational materials (PEMs) have long been used as a tool for knowledge translation despite the conflicting evidence surrounding their effectiveness. A pragmatic, 2x2 factorial, cluster-randomized controlled trial was designed to ascertain the effectiveness of two distinct formats of a PEM (insert and outsert) at improving adherence to guideline recommendations for the management of diabetes complications among Ontario family and general practitioners. Administrative databases were used to compare patient’s treatment regimens at baseline and one year following PEM mailout to determine whether prescription rates intensified in response to the PEMs. A total of 4,118 practices (4,957 physicians) and 185,454 patients …

Applying Knowledge Translation In Rehabilitation: An Exploration Of What It Means To Change Clinical Practice, Stacey D. Guy

Electronic Thesis and Dissertation Repository

Health care providers are often required to implement evidence-based recommendations into the care they deliver. Resources that support health care providers’ efforts are a useful knowledge translation strategy. This thesis describes the development and usability evaluation of an evidence-informed clinical practice implementation toolkit to support implementation efforts. Two studies were undertaken to provide insight into what was needed to support health care providers, and to inform the development of the toolkit. A retrospective evaluation analyzed the performance of a team implementing a pressure ulcer risk assessment for patients with spinal cord injury. The rates of adherence to the risk assessment …

Understanding The Nursing Practices And Perspectives Of Premedication And Transfusion Reaction Reporting: A Qualitative Description Study, Wenxin Miao

Electronic Thesis and Dissertation Repository

This qualitative description study is a sub-study of a knowledge translation (KT) project to implement evidence-based blood transfusion practices at an urban tertiary hospital. The goals of the KT project are to reduce the use of pre-transfusion medications (premedication) and to improve transfusion reaction (TR) reporting practices at this institution. This study explored the nursing practices and perspectives of premedication and TR reporting by conducting interviews with 25 nurses. The findings showed a lack of standardized premedication and TR reporting practices at this institution. A practice change is needed to achieve the goals of the KT project. The study also …

Nurse And Midwife Educators' Experiences Of Translating Teaching Methodology Knowledge Into Practice In Rwanda, Jean Pierre Ndayisenga

Electronic Thesis and Dissertation Repository

Nurse and midwife educators play a vital role in nursing and midwifery students’ development pre-graduation by enabling them to gain essential competencies in caring for mothers, newborns, and infants. In 2017, to enhance the quality of pre-service education of nurses and midwives in Rwanda, the Training, Support, and Access Model (TSAM) for Maternal, Newborn and Child Health (MNCH) project funded continuous professional development (CPD) training workshops about teaching methodologies for nurse and midwife educators from the six main programs of nursing and midwifery education around the country. This qualitative descriptive study was conducted to explore nurse and midwife educators’ experiences …

From Evidence To Practice: A Systematic Approach To Implementing Electrical Stimulation Therapy For Treating Pressure Injuries In Community Dwelling Individuals With Spinal Cord Injury, Deena Lala

Electronic Thesis and Dissertation Repository

Pressure injuries are a common secondary health complication among individuals with a spinal cord injury (SCI) and can have a profound effect on quality of life. Unfortunately, pressure injury care in community dwelling individuals with SCI is often fragmented and inconsistent across Canada. Current best practice guidelines strongly recommend the use of electrical stimulation therapy (EST) to manage pressure injury in this population; however, there is little uptake of EST, and is not considered as a first-line treatment by many clinicians. Therefore, the objective of this dissertation is two-folds 1) to determine the impact of pressure injuries on individuals with …

Oncoplastic Surgery: Is It Time To Change? From Innovation To Adoption Using Mentorship Program, Eman Khayat

Electronic Thesis and Dissertation Repository

Oncoplastic surgery is considered the standard of care for breast cancer therapy in numerous Western World countries, particularly in Europe. Despite the advancement of knowledge, Canada still lags in adoption of oncoplasty into the standard surgical practice. In our study, a mentorship program was used to introduce oncoplastic surgery to practicing breast surgeons at LHSC. The change in perception and adoption of oncoplastic surgery were evaluated using semi-structured interviews, before and after the intervention, by qualitative thematic analysis method. Mentorship program was validated as a superior method of learning new surgical techniques by practicing surgeons, demonstrating acceptance of different levels …

Exploring Quality Improvement For Diabetes Care: A Multiple Case Study Of Primary Care Teams In First Nations Communities In Canada, Meghan Fournie

Electronic Thesis and Dissertation Repository

Clinical quality improvement (QI) teams from First Nations communities across Canada participated in an 18-month QI collaborative program called the TransFORmation of IndiGEnous Primary HEAlthcare Delivery (FORGE AHEAD) clinical QI initiative. Community-based participatory research and multiple case study methodologies were utilized to explore the experience of two clinical QI teams from diverse primary care settings in First Nations communities as they engaged in developing and implementing changes in practice to improve the quality of diabetes care. This study provides insight into how clinical QI teams drew upon multiple sources of knowledge and information to inform their QI activities, the importance …

Using A Deliberative Dialogue To Facilitate The Uptake Of Research Evidence In Rehabilitation For Children With Cerebral Palsy, Alisiyah Daya

Electronic Thesis and Dissertation Repository

This study explores how to facilitate the use of research evidence to optimize outcomes for children with cerebral palsy (CP) in practice. Findings from two studies were used as the basis for exploring how to comprehensively assess developmental trajectories of children with CP and plan individualized interventions. Seventeen affiliated stakeholders (e.g. physicians, senior leadership, frontline clinicians, families and youth with CP) participated in this study.

Data from a deliberative dialogue and interviews were analyzed using grounded theory methods with a pragmatic perspective. The results highlighted that all areas of practice must engage in knowledge translation to be effective. Stakeholders outlined …

Knowledge Translation And The Governance Of Health Research In Canada: A Critical Discourse Analysis, Kathleen S. Ellis

Electronic Thesis and Dissertation Repository

Knowledge translation (KT) is a dominant discourse in the governance of health research in Canada. I critically examine the KT discourse of the Canadian Institutes of Health Research (CIHR), Canada’s major health research funder. Informed by a governmentality perspective, I explore how the KT discourse operates to shape the directions of health research and the activities of health researchers using critical discourse analysis with a sample of publicly available CIHR documents.

This KT discourse is constructed through three rationales: a “gap” between knowledge creation and its application; financial and health care accountabilities for public investment in health research; and, the …

Re-Cognizing Power In The Culture Of Dementia Care Knowledge, Ryan T. Deforge

Electronic Thesis and Dissertation Repository

In light of increasing system demands, system regulations, and constrained resources, those living and working with dementia in the long-term care sector are vulnerable to oppressive care practices. This is true so long as our understanding of how social power affects the ways in which dementia care knowledge is created, shared, and enacted remains limited. Based on prolonged field observations and on informal and formal interviews with care recipients, family members, and staff, the aim of this critical qualitative research was to examine the culture of dementia care knowledge in two sites: a specialized dementia care unit in a long-term …

Reassembling Knowledge Translation Through A Case Of Autism Genomics: Multiplicity And Coordination Amidst Practiced Actor-Networks, Julia J. Bickford

Electronic Thesis and Dissertation Repository

Knowledge translation (KT) has become a ubiquitous and important component within the Canadian health research funding environment. Despite a large and burgeoning literature on the topic of KT, research on the science of KT spans a very narrow philosophical spectrum, with published studies almost exclusively positioned within positivism. Grounded in a constructionist philosophical position and influenced by actor-network theory, this dissertation aims to contribute to the Canadian KT discussion by imagining new possibilities for conceptualizing KT.

This is an empirical-theoretical study which is based on eight months of data collection, including interviews, participant observation, and document analysis. This data collection …

How Do Parents Use Health Information With The Aid Of A Knowledge Broker When Living With And Caring For Their Young Children With Cerebral Palsy?, Stephanie E. Lagosky

Electronic Thesis and Dissertation Repository

This research aims to understand how parents use health information (such as those developed from the Move & PLAY study) with the aid of a knowledge broker when living with and caring for young children with cerebral palsy. This research was conducted under a qualitative case study methodology and used questionnaires and in-depth interviews to collect data. Findings include the complexity of both parental use of health information and the desire to use a knowledge broker. A provisional model has been created to help describe information use of parents with young children with cerebral palsy. This provisional model is an …

Adherence To Canadian Best Practice Recommendations For Stroke Care: The Case Of Post-Stroke Depression, Katherine L. Salter

Electronic Thesis and Dissertation Repository

Context: Canadian best practice recommendations for identification and treatment of post-stroke depression (PSD) have been established, but whether they have been adopted is not known.

Objectives: To compare current with recommended best practice.

Methods: A retrospective chart review from 5 inpatient rehabilitation programs in Southwestern Ontario was completed and a short online survey addressing current practices, opinions and attitudes regarding PSD conducted.

Results: Screening for PSD was documented in 41 of 294 patient records. Of the 41 patients screened, 16 were referred for assessment and 6 diagnosed with PSD. However, 113 patients (38.9%) received pharmacotherapy. Most staff …

An Exploration Of Knowledge Translation Amongst Homecare Providers, Family Caregivers, And Clients, L. Jansen

Electronic Thesis and Dissertation Repository

The aim of this two-phased investigation was to enhance understanding of urinary incontinence (UI) knowledge translation (KT) to inform how UI management knowledge might be translated within in-home nursing practice and family caregiving. Although UI can be managed conservatively, it is a principal reason for the breakdown of family-care and care recipient admission to long-term care. Research has afforded little insight into family caregivers’ experience of KT and the process of in-home KT for UI management.

The first study used a hermeneutic phenomenological approach to explore family caregivers’ experience of UI KT. Data were collected from in-depth interviews with a …

An Integrated Knowledge Translation Experience: Use Of The Network Of Pediatric Audiologists Of Canada To Facilitate The Development Of The University Of Western Ontario Pediatric Audiological Monitoring Protocol (Uwo Pedamp V1.0)., Sheila T F Moodie

Electronic Thesis and Dissertation Repository

The goals of this project were: (1) to determine the important factors that influence implementation of evidence-based practice by Canadian audiologists; and (2) to utilize the knowledge-to-action process (Graham et al., 2006) during the development of a guideline for outcome measures to evaluate the auditory development and performance of young children who wear hearing aids, to facilitate clinical uptake and identify barriers to implementation (Bagatto, Moodie & Scollie, 2010; Bagatto et al., 2011; Bagatto, Moodie, Seewald, Bartlett, & Scollie, 2011; Moodie, Bagatto et al., 2011; Moodie, Kothari et al., 2011).

Two projects (Chapters 3 and 4) included the participation of …