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Conklin J, Dehcheshmeh MM, Archibald D, Elliott J, Hsu A, Kothari A, Stolee P, Sveistrup H. From Compliance to Care: Qualitative Findings from a Survey of Essential Caregivers in Ontario Long-Term Care Homes. Can J Aging 2024:1-10. [PMID: 38561989 DOI: 10.1017/s071498082400014x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic highlighted the importance of the care provided by family members and close friends to older people living in long-term care (LTC) homes. Our implementation science team helped three Ontario LTC homes to implement an intervention to allow family members to enter the homes during pandemic lockdowns. OBJECTIVE We used a variety of methods to support the implementation, and this paper reports results from an Ontario-wide survey intended to help us understand the nature of the care provided by family caregivers. METHODS We administered a survey of essential caregivers in Ontario, and a single open-ended question yielded a substantial qualitative data set that we analysed with a coding and theming procedure that yielded 13 themes. FINDINGS The 13 themes reveal deficiencies in Ontario's LTC sector, attempts to cope with the deficiencies, and efforts to influence change and improvement. DISCUSSION Our findings indicate that essential caregivers find it necessary to take on vital roles in order to shore up two significant gaps in the current system: they provide psychosocial and emotional (and sometimes even basic) care to residents, and they play a monitoring and advocacy role to compensate for the failings of the current regulatory compliance regime.
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Affiliation(s)
- James Conklin
- Department of Applied Human Sciences, Concordia University, Montreal, QC, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | | | - Douglas Archibald
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jacobi Elliott
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Amy Hsu
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Anita Kothari
- School of Health Studies, Western University, London, ON, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Heidi Sveistrup
- Bruyère Research Institute, Ottawa, ON, Canada
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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Elliott J, Stolee P, Mairs K, Kothari A, Conklin J. A Community of Practice on Environmental Design for Long-Term Care Residents with Dementia. Can J Aging 2023; 42:404-415. [PMID: 36799024 DOI: 10.1017/s0714980823000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
The use of communities of practice (CoP) to support the application of knowledge in improved geriatric care practice is not widely understood. This case study's aim was to gain a deeper understanding of the knowledge-to-action (KTA) processes of a CoP focused on environmental design, to improve how persons with dementia find their way around in long-term care (LTC) homes. Qualitative data were collected (key informant interviews, observations, and document review), and analysed using emergent coding. CoP members contributed extensive knowledge to the KTA process characterized by the following themes: team dynamics, employing a structured process, technology use, varied forms of knowledge, and a clear initiative. The study's CoP effectively synthesized and translated knowledge into practical tools to inform changes in practice, programs, and policy on dementia care. More research is needed on how to involve patients and caregivers in the KTA processes, and to ensure that practical application of knowledge has financial and policy support.
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Affiliation(s)
- Jacobi Elliott
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Lawson Health Research Institute, London, Canada
- School of Health Studies, Western University, London, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Katie Mairs
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Anita Kothari
- School of Health Studies, Western University, London, Canada
| | - James Conklin
- Department of Applied Human Sciences, Concordia University, Montreal, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
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3
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Elliott J, van Wyk P, Butler R, Giosa JL, Sims Gould J, Tong CE, Taabazuing MM, Johnson H, Coyne P, Mitchell F, Whate A, Callon A, Carson J, Stolee P. Developing an in-depth understanding of patient and caregiver engagement across care transitions from hospital: protocol for a qualitative study exploring experiences in Canada. BMJ Open 2023; 13:e077436. [PMID: 37479510 PMCID: PMC10364181 DOI: 10.1136/bmjopen-2023-077436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Patient and caregiver engagement is critical, and often compromised, at points of transition between care settings, which are more common, and more challenging, for patients with complex medical problems. The consequences of poor care transitions are well-documented, both for patients and caregivers, and for the healthcare system. With an ageing population, there is greater need to focus on care transition experiences of older adults, who are often more medically complex, and more likely to require care from multiple providers across settings. The overall goal of this study is to understand what factors facilitate or hinder patient and caregiver engagement through transitions in care, and how these current engagement practices align with a previously developed engagement framework (CHOICE Framework). This study also aims to co-develop resources needed to support engagement and identify how these resources and materials should be implemented in practice. METHODS AND ANALYSIS This study uses ethnographic approaches to explore the dynamics of patient and caregiver engagement, or lack thereof, during care transitions across three regions within Ontario. With the help of a front-line champion, patients (n=18-24), caregivers (n=18-24) and healthcare providers (n=36-54) are recruited from an acute care hospital unit (or similar) and followed through their care journey. Data are collected using in-depth semi-structured interviews. Workshops will be held to co-develop strategies and a plan for future implementation of resources and materials. Analysis of the data will use inductive and deductive coding techniques. ETHICS AND DISSEMINATION Ethics clearance was obtained through the Western University Research Ethics Board, University of Windsor Research Ethics Board and the University of Waterloo Office of Research Ethics. The findings from this study are intended to contribute valuable evidence to further bridge the knowledge to practice gap in patient and caregiver engagement through care transitions. Findings will be disseminated through publications, conference presentations and reports.
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Affiliation(s)
- Jacobi Elliott
- Lawson Health Research Institute, London, Ontario, Canada
- Specialized Geriatric Services, St. Joseph's Health Care London, London, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Paula van Wyk
- Kinesiology, University of Windsor, Windsor, Ontario, Canada
| | - Roy Butler
- Senior Leadership, St. Joseph's Health Care London, London, Ontario, Canada
| | - Justine L Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- SE Research Centre, Toronto, Ontario, Canada
| | | | - Catherine E Tong
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary Margaret Taabazuing
- Department of Medicine, Division of Geriatric Medicine, Western University, London, Ontario, Canada
| | - Helen Johnson
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Paige Coyne
- Kinesiology, University of Windsor, Windsor, Ontario, Canada
- Henry Ford Health System, Detroit, Michigan, USA
| | - Fallon Mitchell
- Kinesiology, University of Windsor, Windsor, Ontario, Canada
| | - Alexandra Whate
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne Callon
- Patient and Caregiver Partner, London, Ontario, Canada
| | - Judith Carson
- Patient and Caregiver Partner, Waterloo, Ontario, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Lee PX, Wong TCS, Ng PYB, Yuen HCC, Pontre I, Craig J, Taylor S, Hatfield M. Coaching in an Acute Pediatric Setting: A Qualitative Approach to Understanding the Perspectives of Occupational Therapists. Phys Occup Ther Pediatr 2023; 43:212-227. [PMID: 36253934 DOI: 10.1080/01942638.2022.2131500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS To identify barriers and enablers to implementing coaching in acute pediatric settings from the perspective of occupational therapists and develop an implementation plan to address the identified barriers at a large metropolitan hospital. METHODS Participatory Action Research was used, and two stages of focus groups were conducted with 17 occupational therapists working in an acute pediatric hospital. Reflexive thematic analysis was employed for data analysis. RESULTS Stage one themes; (1) Lack of clarity around coaching definition, (2) Acute setting barriers to coaching, (3) Family acceptance and appropriateness, and (4) Enablers for coaching. Stage two themes; (1) Addressing skepticism about coaching, (2) Logistics and approvals, and (3) Implementation strategies for coaching. In Stage Two, participants and researchers developed an implementation plan. CONCLUSION Occupational therapists perceived coaching as hard to implement in acute pediatric settings due to acuity of caseloads and traditional medical models. The six-step implementation plan aims to enhance therapist knowledge and motivation as well as reduce environmental barriers, with the aim of embedding coaching into acute pediatric settings.
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Affiliation(s)
- Pei Xuan Lee
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | | | - Pei Yun Beatrice Ng
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | | | - Isabelle Pontre
- Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Joanna Craig
- Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Susan Taylor
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia.,Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Megan Hatfield
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Tong CE, Lopez KJ, Chowdhury D, Arya N, Elliott J, Sims-Gould J, Grindrod K, Stolee P. Understanding racialised older adults' experiences of the Canadian healthcare system, and codesigning solutions: protocol for a qualitative study in nine languages. BMJ Open 2022; 12:e068013. [PMID: 36216419 PMCID: PMC9557314 DOI: 10.1136/bmjopen-2022-068013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Racialised immigrant older adults (RIOAs) in Canada have poorer self-rated health and are more likely to report chronic conditions, while they concurrently experience well-documented challenges in navigating and accessing the healthcare system. There is strong evidence that patient and caregiver engagement in their healthcare leads to improved management of chronic disease and better health outcomes. International research suggests that engagement has the potential to reduce health disparities and improve quality of care. We aim to (1) describe what role(s) RIOAs are/are not taking in their own healthcare, from the perspectives of participant groups (RIOAs, caregivers and healthcare providers (HCPs)); and (2) develop a codesign process with these participants, creating linguistically aligned and culturally aligned tools, resources or solutions to support patient engagement with RIOAs. METHODS AND ANALYSIS Using a cross-cultural participatory action research approach, our work will consist of three phases: phase 1, strengthen existing partnerships with RIOAs and appropriate agencies and cultural associations; phase 2, on receipt of informed consent, in-depth interviews with RIOAs and caregivers (n=~45) and HCPs (n=~10), professionally interpreted as needed. Phase 3, work with participants, in multiple interpreted sessions, to codesign culturally sensitive and linguistically sensitive/aligned patient engagement tools. We will conduct this research in the Waterloo-Wellington region of Ontario, in Arabic, Bangla, Cantonese, Hindi, Mandarin, Punjabi, Tamil and Urdu, plus English. Data will be transcribed, cleaned and entered into NVivo V.12, the software that will support team-based analysis. Analysis will include coding, theming and interpreting the data, and, preparing narrative descriptions that summarise each language group and each participant group (older adults, caregivers and HCPs), and illustrate themes. ETHICS AND DISSEMINATION Ethics clearance was obtained through the University of Waterloo Office of Research Ethics (ORE #43297). Findings will be disseminated through peer-reviewed publications, presentations and translated summary reports for our partners and participants.
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Affiliation(s)
- Catherine E Tong
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Kimberly J Lopez
- Department of Recreation and Leisure Studies, University of Waterloo, Waterloo, Ontario, Canada
| | - Diya Chowdhury
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Neil Arya
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jacobi Elliott
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Joanie Sims-Gould
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Sahay A, Mittman BS, Gholami P, Lin S, Heidenreich PA. How successful was the use of a community of practice for the implementation of evidence-based practices for heart failure within the United States Department of Veterans Affairs: Insights from a formative evaluation. Health Res Policy Syst 2022; 20:79. [PMID: 35804413 PMCID: PMC9264639 DOI: 10.1186/s12961-022-00880-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/14/2022] [Indexed: 12/01/2022] Open
Abstract
Background Communities of Practice (CoPs) are a promising approach to facilitate the implementation of evidence-based practices (EBPs) to improve care for chronic conditions like heart failure (HF). CoPs involve a complex process of acquiring and converting both explicit and tacit knowledge into clinical activities. This study describes the conceptualization, creation, capacity-building and dissemination of a CoP sustained over 9 years, and evaluates its value and impact on EBP. Methods In July 2006, a CoP called the Heart Failure Provider Network (HF Network) was established within the United States Department of Veterans Affairs (VA) with the overarching goal of improving the quality of care for HF patients. We assessed (formative) the HF Network in terms of its various activities (inputs) and proximal impacts (mediators) at the individual level, and its distal impacts (outcomes) at the site level including implementation of new/improved EBPs at the systemwide level. Results The HF Network membership grew steadily over the 9 years. The CoP has involved a total of 1341 multidisciplinary and multilevel members at all 144 VA Health Care Systems (sites). Most members were practising clinicians (n = 891, 66.4%), followed by administrators (n = 342, 25.5%), researchers (n = 70, 5.2%) and others (n = 38, 2.8%). Participation was assessed to be “active” for 70.6% versus “passive” for 29.4% of members. The distribution of active members (clinicians 64.7%, administrators 21.6%) was similar to the distribution of overall membership. Conclusions Survey respondents perceived the HF Network as useful in terms of its varied activities and resources relevant for patient care. Strong evidence shows that these members, particularly those who considered themselves influential in improving quality of care, noted multiple benefits of membership, which included confirmation of their own clinical practices, evidence-based changes to their practice and help in understanding facilitators and barriers in setting up or running HF clinics and other programmes. Such CoPs have strong impacts on the quality of care being delivered for both mandated and non-mandated initiatives.
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Affiliation(s)
- Anju Sahay
- United States Department of Veterans Affairs, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA.
| | - Brian S Mittman
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, 3rd Floor, Pasadena, CA, 91101, USA
| | - Parisa Gholami
- United States Department of Veterans Affairs, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
| | - Shoutzu Lin
- United States Department of Veterans Affairs, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
| | - Paul A Heidenreich
- United States Department of Veterans Affairs, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA.,Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
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Kyaw WT, Sakakibara M. Transdisciplinary Communities of Practice to Resolve Health Problems in Southeast Asian Artisanal and Small-Scale Gold Mining Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5422. [PMID: 35564816 PMCID: PMC9104413 DOI: 10.3390/ijerph19095422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 02/05/2023]
Abstract
Artisanal and small-scale gold mining (ASGM) has been a major part of people's livelihood in the rural areas of many developing countries, including those in Southeast Asia (SEA). Nevertheless, because of the use of mercury, ASGM activities have significant local and global adverse impacts on the environment and ASGM community health. Although there have been many monodisciplinary projects by academic researchers and governments to solve the environmental and health problems in SEA ASGM communities, they have not been sufficient to solve the complex socioeconomic problems. This review first outlines the nature of the SEA ASGM activities and the consequent environmental, community health, and socioeconomic problems and then introduces an approach using transdisciplinary communities of practice that involves both academic and nonacademic participants to relieve these wicked ASGM problems and to improve the environmental governance and community health in ASGM communities in SEA.
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Affiliation(s)
- Win Thiri Kyaw
- Research Institute for Humanity and Nature, Kyoto 603-8047, Japan;
| | - Masayuki Sakakibara
- Research Institute for Humanity and Nature, Kyoto 603-8047, Japan;
- Graduate School of Science and Engineering, Ehime University, Matsuyama 790-8577, Japan
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Tetui M, Coe AB, Hurtig AK, Bennett S, Kiwanuka SN, George A, Kiracho EE. A participatory action research approach to strengthening health managers' capacity at district level in Eastern Uganda. Health Res Policy Syst 2017; 15:110. [PMID: 29297346 PMCID: PMC5751402 DOI: 10.1186/s12961-017-0273-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Many approaches to improving health managers’ capacity in poor countries, particularly those pursued by external agencies, employ non-participatory approaches and often seek to circumvent (rather than strengthen) weak public management structures. This limits opportunities for strengthening local health managers’ capacity, improving resource utilisation and enhancing service delivery. This study explored the contribution of a participatory action research approach to strengthening health managers’ capacity in Eastern Uganda. Methods This was a qualitative study that used open-ended key informant interviews, combined with review of meeting minutes and observations to collect data. Both inductive and deductive thematic analysis was undertaken. The Competing Values Framework of organisational management functions guided the deductive process of analysis and the interpretation of the findings. The framework builds on four earlier models of management and regards them as complementary rather than conflicting, and identifies four managers’ capacities (collaborate, create, compete and control) by categorising them along two axes, one contrasting flexibility versus control and the other internal versus external organisational focus. Results The findings indicate that the participatory action research approach enhanced health managers’ capacity to collaborate with others, be creative, attain goals and review progress. The enablers included expanded interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability. Tension and conflict across different management functions was apparent; for example, while there was a need to collaborate, maintaining control over processes was also needed. These tensions meant that managers needed to learn to simultaneously draw upon and use different capacities as reflected by the Competing Values Framework in order to maximise their effectiveness. Conclusions Improved health manager capacity is essential if sustained improvements in health outcomes in low-income countries are to be attained. The expansion of interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability were the key means by which participatory action research strengthened health managers’ capacity. The participatory approach to implementation therefore created opportunities to strengthen health managers’ capacity. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0273-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moses Tetui
- Makerere University School of Public Health (MakSPH), Makerere University, New Mulago Complex, P.O. B0X 7072, Kampala, Uganda. .,Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Anna-Britt Coe
- Sociology Department, Umeå University, 901 87, Umeå, Sweden
| | - Anna-Karin Hurtig
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, United States of America
| | - Suzanne N Kiwanuka
- Makerere University School of Public Health (MakSPH), Makerere University, New Mulago Complex, P.O. B0X 7072, Kampala, Uganda
| | - Asha George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, United States of America.,School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, Republic of South Africa
| | - Elizabeth Ekirapa Kiracho
- Makerere University School of Public Health (MakSPH), Makerere University, New Mulago Complex, P.O. B0X 7072, Kampala, Uganda
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Van Eerd D, Newman K, DeForge R, Urquhart R, Cornelissen E, Dainty KN. Knowledge brokering for healthy aging: a scoping review of potential approaches. Implement Sci 2016; 11:140. [PMID: 27756358 PMCID: PMC5070130 DOI: 10.1186/s13012-016-0504-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 10/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Developing a healthcare delivery system that is more responsive to the future challenges of an aging population is a priority in Canada. The World Health Organization acknowledges the need for knowledge translation frameworks in aging and health. Knowledge brokering (KB) is a specific knowledge translation approach that includes making connections between people to facilitate the use of evidence. Knowledge gaps exist about KB roles, approaches, and guiding frameworks. The objective of the scoping review is to identify and describe KB approaches and the underlying conceptual frameworks (models, theories) used to guide the approaches that could support healthy aging. METHODS Literature searches were done in PubMed, EMBASE, PsycINFO, EBM reviews (Cochrane Database of systematic reviews), CINAHL, and SCOPUS, as well as Google and Google Scholar using terms related to knowledge brokering. Titles, abstracts, and full reports were reviewed independently by two reviewers who came to consensus on all screening criteria. Documents were included if they described a KB approach and details about the underlying conceptual basis. Data about KB approach, target stakeholders, KB outcomes, and context were extracted independently by two reviewers. RESULTS Searches identified 248 unique references. Screening for inclusion revealed 19 documents that described 15 accounts of knowledge brokering and details about conceptual guidance and could be applied in healthy aging contexts. Eight KB elements were detected in the approaches though not all approaches incorporated all elements. The underlying conceptual guidance for KB approaches varied. Specific KB frameworks were referenced or developed for nine KB approaches while the remaining six cited more general KT frameworks (or multiple frameworks) as guidance. CONCLUSIONS The KB approaches that we found varied greatly depending on the context and stakeholders involved. Three of the approaches were explicitly employed in the context of health aging. Common elements of KB approaches that could be conducted in healthy aging contexts focussed on acquiring, adapting, and disseminating knowledge and networking (linkage). The descriptions of the guiding conceptual frameworks (theories, models) focussed on linkage and exchange but varied across approaches. Future research should gather KB practitioner and stakeholder perspectives on effective practices to develop KB approaches for healthy aging.
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Affiliation(s)
- Dwayne Van Eerd
- Institute for Work and Health, 481 University Avenue, Suite 800, Toronto, Ontario, Canada, M5G 2E9. .,School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1.
| | - Kristine Newman
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada, M5B 2K3
| | - Ryan DeForge
- World Health Innovation Network, Odette School of Business, University of Windsor, 401 Sunset Avenue, Windsor, Ontario, Canada, N9B 3P4
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, 6299 South Street, Halifax, Nova Scotia, Canada, B3H 4R2
| | - Evelyn Cornelissen
- Department of Family Practice, Faculty of Medicine, University of British Columbia, 2312 Pandosy Street, Kelowna, British Columbia, Canada, V1Y 1T3
| | - Katie N Dainty
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, Canada, M5B 1T8.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, Canada, M5T 3M6
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11
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Abstract
A recovery paradigm that promotes service user involvement, empowerment, and agency has been a guiding principle for the transformation of mental health services internationally. Incorporating recovery values into traditional mental health care settings, however, has been problematic due to organizational, structural, and attitudinal barriers. A new emphasis on contexts, values, and partnerships with service users requires providers to collectively redefine their roles, creating a shift in both individual and organizational identities. This conceptual article provides an in-depth exploration of the social and cultural factors involved in frontline mental health care, highlighting the nature of shared cognition in organizational learning as well as the conflicting forces that promote social stability and change. Using theory drawn from clinical, organizational, and social science literature, the article will discuss the competing ideologies in mental health care, emphasizing the need to create new learning conversations that honor the system’s capacity while creating the necessary dissonance for transformation.
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Affiliation(s)
- Ronna Schwartz
- McGill University Health Centre, Montreal, Quebec, Canada
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12
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Kothari A, Boyko JA, Conklin J, Stolee P, Sibbald SL. Communities of practice for supporting health systems change: a missed opportunity. Health Res Policy Syst 2015. [PMID: 26208500 PMCID: PMC4515005 DOI: 10.1186/s12961-015-0023-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Communities of practice (CoPs) have been used in the health sector to support professional practice change. However, little is known about how CoPs might be used to influence a system that requires change at and across various levels (i.e. front line care, organizational, governmental). In this paper we examine the experience of a CoP in the Canadian province of Ontario as it engages in improving the care of seniors. Our aim is to shed light on using CoPs to facilitate systems change. METHODS This paper draws on year one findings of a larger multiple case study that is aiming to increase understanding of knowledge translation processes mobilized through CoPs. In this paper we strategically report on one case to illustrate a critical example of a CoP trying to effect systems change. Primary data included semi-structured interviews with CoP members (n = 8), field notes from five planning meetings, and relevant background documents. Data analysis included deductive coding (i.e. pre-determined codes aligned with the larger project) and inductive coding which allowed codes and themes to emerge. A thorough description of the case was prepared using all the coded data. RESULTS The CoP recognized a need to support health professionals (nurses, dentists) and related paraprofessionals with knowledge, experience, and resources to appropriately address their clients' oral health care needs. Accordingly, the CoP led a knowledge-to-action initiative that involved a seven-part webinar series meant to transfer step-by-step, skill-based knowledge through live and archived webinars. Although the core planning team functioned effectively to develop the webinars, the CoP was challenged by organizational and long-term care sector cultures, as well as governmental structures within the broader health context. CONCLUSION The provincial CoP functioned as an incubator that brought together best practices, research, experiences, a reflective learning cycle, and passionate champions. Nevertheless, the CoP's efforts to stimulate practice changes were met with broader resistance. Research about how to use CoPs to influence health systems change is needed given that CoPs are being tasked with this goal.
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Affiliation(s)
- Anita Kothari
- Western University, School of Health Studies and Schulich Interfaculty Program in Public Health, 1151 Richmond St, London, N6A 3K7, Canada.
| | - Jennifer A Boyko
- Western University, School of Health Studies and Faculty of Information and Media Studies, London, Canada.
| | - James Conklin
- Department of Applied Human Sciences and Élisabeth Bruyère Research Institute, Concordia University, Portland, USA.
| | - Paul Stolee
- University of Waterloo, School of Public Health and Health Systems, Waterloo, Canada.
| | - Shannon L Sibbald
- Western University, School of Health Studies, Schulich Interfaculty Program in Public Health and Department of Family Medicine, London, Canada.
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13
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Francis-Coad J, Etherton-Beer C, Bulsara C, Nobre D, Hill AM. Investigating the impact of a falls prevention community of practice in a residential aged-care setting: a mixed methods study protocol. J Adv Nurs 2015; 71:2977-86. [DOI: 10.1111/jan.12725] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Jacqueline Francis-Coad
- School of Physiotherapy; Institute of Health Research; The University of Notre Dame Australia; Fremantle Western Australia Australia
| | - Christopher Etherton-Beer
- School of Medicine and Pharmacology; University of Western Australia; Crawley Western Australia Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery; The University of Notre Dame Australia; Fremantle Western Australia Australia
| | - Debbie Nobre
- Brightwater Care Group; Osborne Park Western Australia Australia
| | - Anne-Marie Hill
- School of Physiotherapy; Institute of Health Research; The University of Notre Dame Australia; Fremantle Western Australia Australia
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14
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Conklin J, Farrell B, Ward N, McCarthy L, Irving H, Raman-Wilms L. Developmental evaluation as a strategy to enhance the uptake and use of deprescribing guidelines: protocol for a multiple case study. Implement Sci 2015; 10:91. [PMID: 26084798 PMCID: PMC4470007 DOI: 10.1186/s13012-015-0279-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/08/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The use of developmental evaluation is increasing as a method for conducting implementation research. This paper describes the use of developmental evaluation to enhance an ongoing study. The study develops and implements evidence-based clinical guidelines for deprescribing medications in primary care and long-term care settings. A unique feature of our approach is our use of a rapid analytical technique. METHODS/DESIGN The team will carry out two separate analytical processes: first, a rapid analytical process to provide timely feedback to the guideline development and implementation teams, followed by a meta-evaluation and second, a comprehensive qualitative analysis of data after the implementation of each guideline and a final cross-case analysis. Data will be gathered through interviews, through observational techniques leading to the creation of field notes and narrative reports, and through assembling team documents such as meeting minutes. Transcripts and documents will be anonymized and organized in NVIVO by case, by sector (primary care or long-term care), and by implementation site. A narrative case report, directed coding, and open coding steps will be followed. Clustering and theming will generate a model or action map reflecting the functioning of the participating social environments. DISCUSSION In this study, we will develop three deprescribing guidelines and will implement them in six sites (three family health teams and three long-term care homes), in a sequential iterative manner encompassing 18 implementation efforts. The processes of 11 distinct teams within four conceptual categories will be examined: a guideline priority-setting group, a guideline development methods committee, 3 guideline development teams, and 6 guideline implementation teams. Our methods will reveal the processes used to develop and implement the guidelines, the role and contribution of developmental evaluation in strengthening these processes, and the experience of six sites in implementing new evidence-based clinical guidelines. This research will generate new knowledge about team processes and the uptake and use of deprescribing guidelines in family health teams and long-term care homes, with a goal of addressing polypharmacy in Canada. Clinicians and researchers creating clinical guidelines to introduce improvements into daily practice may benefit from our developmental evaluation approach.
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Affiliation(s)
- James Conklin
- Department of Applied Human Sciences, Concordia University, Montreal, Quebec, Canada.
- Bruyère Research Institute, Ottawa, Canada.
| | - Barbara Farrell
- Bruyère Research Institute, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Natalie Ward
- Bruyère Research Institute, Ottawa, Canada
- School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, Canada
| | - Lisa McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
| | | | - Lalitha Raman-Wilms
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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15
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Abstract
RÉSUMÉLa qualité de vie (QV) dont bénéficient les résidents des centres d'hébergement de soins de longue durée (SLD) est un résultat important des soins. Cette étude descriptive transversale a examiné la qualité de vie auto-declarée de résidents des établissements de SLD au Canada, tout en utilisant l'auto-évaluation interRAI Nursing Home Quality of Life Survey. Un objectif secondaire était de tester les propriétés pschométriques de l'instrument. Les tests psychométriques de l'instrument ont soutenu sa fiabilité et la validité de sa convergence et de son contenu pour l'évaluation de QV des résidents. Les résultats ont montré que les résidents ont évalués positivement plusieurs aspects de leur vie, comme d'avoir la vie privée lors des visites (76,9%) et l'honnêteté du personnel en traitant avec eux (73,6%). Les résidents ont accordé des taux inférieures à d'autres aspects, comme l'autonomie, la liaison entre le personnel et les résidents, et les relations personnelles. Les résultats suggèrent des lacunes importantes entre les philosophies de soins dans les établissements et leur traduction dans un environnement de soins ou les soins sont vraiment dirigés aux résidents. En outre, les résultats ont des implications potentielles pour la planification de soins aux résidents, la programmation de l'installation, le développement de la politique sociale et de la recherche future.
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16
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Lucero R, Sheehan B, Yen P, Velez O, Nobile-Hernandez D, Tiase V. Identifying consumer's needs of health information technology through an innovative participatory design approach among English- and Spanish-speaking urban older adults. Appl Clin Inform 2014; 5:943-57. [PMID: 25589909 DOI: 10.4338/aci-2014-07-ra-0058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/07/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES We describe an innovative community-centered participatory design approach, Consumer-centered Participatory Design (C2PD), and the results of applying C2PD to design and develop a web-based fall prevention system. METHODS We conducted focus groups and design sessions with English- and Spanish-speaking community-dwelling older adults. Focus group data were summarized and used to inform the context of the design sessions. Descriptive content analysis methods were used to develop categorical descriptions of design session informant's needs related to information technology. RESULTS The C2PD approach enabled the assessment and identification of informant's needs of health information technology (HIT) that informed the development of a falls prevention system. We learned that our informants needed a system that provides variation in functions/content; differentiates between actionable/non-actionable information/structures; and contains sensory cues that support wide-ranging and complex tasks in a varied, simple, and clear interface to facilitate self-management. CONCLUSIONS The C2PD approach provides community-based organizations, academic researchers, and commercial entities with a systematic theoretically informed approach to develop HIT innovations. Our community-centered participatory design approach focuses on consumer's technology needs while taking into account core public health functions.
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Affiliation(s)
- R Lucero
- Columbia University, School of Nursing , New York, NY
| | - B Sheehan
- Columbia University, School of Nursing , New York, NY
| | - P Yen
- The Ohio State University, College of Medicine , Biomedical Informatics, Columbus, OH
| | - O Velez
- IFC International , Rockville, MD
| | | | - V Tiase
- NewYork-Presbyterian Hospital , Department of Information Technology, New York, NY 10032
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17
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Fuller J, Oster C, Dawson S, O'Kane D, Lawn S, Henderson J, Gerace A, Reed R, Nosworthy A, Galley P, McPhail R, Cochrane EM. Improving the network management of integrated primary mental healthcare for older people in a rural Australian region: protocol for a mixed methods case study. BMJ Open 2014; 4:e006304. [PMID: 25227632 PMCID: PMC4166139 DOI: 10.1136/bmjopen-2014-006304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION An integrated approach to the mental healthcare of older people is advocated across health, aged care and social care sectors. It is not clear, however, how the management of integrated servicing should occur, although interorganisational relations theory suggests a reflective network approach using evaluation feedback. This research will test a network management approach to help regional primary healthcare organisations improve mental health service integration. METHODS AND ANALYSIS This mixed methods case study in rural South Australia will test facilitated reflection within a network of health and social care services to determine if this leads to improved integration. Engagement of services will occur through a governance group and a series of three 1-day service stakeholder workshops. Facilitated reflection and evaluation feedback will use information from a review of health sector and local operational policies, a network survey about current service links, gaps and enablers and interviews with older people and their carers about their help seeking journeys. Quantitative and qualitative analysis will describe the policy enablers and explore the current and ideal links between services. The facilitated reflection will be developed to maximise engagement of senior management in the governance group and the service staff at the operational level in the workshops. Benefit will be assessed through indicators of improved service coordination, collective ownership of service problems, strengthened partnerships, agreed local protocols and the use of feedback for accountability. ETHICS, BENEFITS AND DISSEMINATION Ethics approval will deal with the sensitivities of organisational network research where data anonymity is not preserved. The benefit will be the tested utility of a facilitated reflective process for a network of health and social care services to manage linked primary mental healthcare for older people in a rural region. Dissemination will make use of the sectoral networks of the governance group.
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Affiliation(s)
- Jeffrey Fuller
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Candice Oster
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Suzanne Dawson
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Deb O'Kane
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- School of Medicine, Flinders University, Adelaide, Australia
| | - Julie Henderson
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Adam Gerace
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Richard Reed
- School of Medicine, Flinders University, Adelaide, Australia
| | - Ann Nosworthy
- Southern Fleurieu & Kangaroo Island Positive Ageing Taskforce, Victor Harbor, Australia
| | - Philip Galley
- Southern Adelaide-Fleurieu-Kangaroo Island Medicare Local, Bedford Park, Australia
| | - Ruth McPhail
- Country Health South Australia Local Health Network Mental Health Services, Adelaide, Australia
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18
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Wathen CN, Sibbald SL, Jack SM, Macmillan HL. Talk, trust and time: a longitudinal study evaluating knowledge translation and exchange processes for research on violence against women. Implement Sci 2011; 6:102. [PMID: 21896170 PMCID: PMC3178499 DOI: 10.1186/1748-5908-6-102] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 09/06/2011] [Indexed: 11/27/2022] Open
Abstract
Background Violence against women (VAW) is a major public health problem. Translation of VAW research to policy and practice is an area that remains understudied, but provides the opportunity to examine knowledge translation and exchange (KTE) processes in a complex, multi-stakeholder context. In a series of studies including two randomized trials, the McMaster University VAW Research Program studied one key research gap: evidence about the effectiveness of screening women for exposure to intimate partner violence. This project developed and evaluated KTE strategies to share research findings with policymakers, health and community service providers, and women's advocates. Methods A longitudinal cross-sectional design, applying concurrent mixed data collection methods (surveys, interviews, and focus groups), was used to evaluate the utility of specific KTE strategies, including a series of workshops and a day-long Family Violence Knowledge Exchange Forum, on research sharing, uptake, and use. Results Participants valued the opportunity to meet with researchers, provide feedback on key messages, and make personal connections with other stakeholders. A number of factors specific to the knowledge itself, stakeholders' contexts, and the nature of the knowledge gap being addressed influenced the uptake, sharing, and use of the research. The types of knowledge use changed across time, and were specifically related to both the types of decisions being made, and to stage of decision making; most reported use was conceptual or symbolic, with few examples of instrumental use. Participants did report actively sharing the research findings with their own networks. Further examination of these second-order knowledge-sharing processes is required, including development of appropriate methods and measures for its assessment. Some participants reported that they would not use the research evidence in their decision making when it contradicted professional experiences, while others used it to support apparently contradictory positions. The online wiki-based 'community of interest' requested by participants was not used. Conclusions Mobilizing knowledge in the area of VAW practice and policy is complex and resource-intensive, and must acknowledge and respect the values of identified knowledge users, while balancing the objectivity of the research and researchers. This paper provides important lessons learned about these processes, including attending to the potential unintended consequences of knowledge sharing.
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Affiliation(s)
- C Nadine Wathen
- Faculty of Information and Media Studies, The University of Western Ontario, London, Ontario, Canada.
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