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Ahmed S, Visca R, Gogovor A, Eilayyan O, Finlayson R, Valois MF, Ware MA. Implementation of an integrated primary care prevention and management program for chronic low back pain (LBP): patient-reported outcomes and predictors of pain interference after six months. BMC Health Serv Res 2024; 24:611. [PMID: 38725037 PMCID: PMC11083802 DOI: 10.1186/s12913-024-11031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Integrated primary care programs for patients living with chronic pain which are accessible, interdisciplinary, and patient-centered are needed for preventing chronicity and improving outcomes. Evaluation of the implementation and impact of such programs supports further development of primary care chronic pain management. This study examined patient-reported outcomes among individuals with low back pain (LBP) receiving care in a novel interdisciplinary primary care program. METHODS Patients were referred by primary care physicians in four regions of Quebec, Canada, and eligible patients received an evidence-based interdisciplinary pain management program over a six-month period. Patients were screened for risk of chronicity. Patient-reported outcome measures of pain interference and intensity, physical function, depression, and anxiety were evaluated at regular intervals over the six-month follow-up. A multilevel regression analysis was performed to evaluate the association between patient characteristics at baseline, including risk of chronicity, and change in pain outcomes. RESULTS Four hundred and sixty-four individuals (mean age 55.4y, 63% female) completed the program. The majority (≥ 60%) experienced a clinically meaningful improvement in pain intensity and interference at six months. Patients with moderate (71%) or high risk (81%) of chronicity showed greater improvement in pain interference than those with low risk (51%). Significant predictors of improvement in pain interference included a higher risk of chronicity, younger age, female sex, and lower baseline disability. CONCLUSION The outcomes of this novel LBP program will inform wider implementation considerations by identifying key components for further effectiveness, sustainability, and scale-up of the program.
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Affiliation(s)
- Sara Ahmed
- Faculty of Medicine, School of Physical & Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
- Faculty of Medicine, Family Medicine, McGill University, 5858, Chemin de La Côte-Des-Neiges 3 Floor, Montreal, QC, H3S 1Z1, Canada.
- Faculty of Medicine, Family Medicine and Emergency Medicine, Université Laval, Montreal, QC, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Lethbridge Layton Mackay Rehabilitation, CIUSSS West-Central Montreal, Montreal, QC, Canada.
- Research Institute of the McGill University Health Center, Clinical Epidemiology, Montreal, QC, Canada.
| | - Regina Visca
- Faculty of Medicine, Family Medicine, McGill University, 5858, Chemin de La Côte-Des-Neiges 3 Floor, Montreal, QC, H3S 1Z1, Canada
- Centre of Expertise in Chronic Pain of the Réseau Universitaire Intégré de Santé Et Services Sociaux McGill, 1650 Cedar Ave., Montreal, QC, H3G 1A4, Canada
- Alan Edwards Pain Management Unit of the McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Amede Gogovor
- Faculty of Medicine, Family Medicine and Emergency Medicine, Université Laval, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Owis Eilayyan
- Faculty of Applied Medical Sciences, Physical Therapy Department, Al-Ahliyya Amman University, Amman, Jordan
| | - Roderick Finlayson
- Alan Edwards Pain Management Unit of the McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | | | - Mark A Ware
- Faculty of Medicine, Family Medicine, McGill University, 5858, Chemin de La Côte-Des-Neiges 3 Floor, Montreal, QC, H3S 1Z1, Canada
- Alan Edwards Pain Management Unit of the McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
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Adsul P, Shelton RC, Oh A, Moise N, Iwelunmor J, Griffith DM. Challenges and Opportunities for Paving the Road to Global Health Equity Through Implementation Science. Annu Rev Public Health 2024; 45:27-45. [PMID: 38166498 DOI: 10.1146/annurev-publhealth-060922-034822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Implementation science focuses on enhancing the widespread uptake of evidence-based interventions into routine practice to improve population health. However, optimizing implementation science to promote health equity in domestic and global resource-limited settings requires considering historical and sociopolitical processes (e.g., colonization, structural racism) and centering in local sociocultural and indigenous cultures and values. This review weaves together principles of decolonization and antiracism to inform critical and reflexive perspectives on partnerships that incorporate a focus on implementation science, with the goal of making progress toward global health equity. From an implementation science perspective, wesynthesize examples of public health evidence-based interventions, strategies, and outcomes applied in global settings that are promising for health equity, alongside a critical examination of partnerships, context, and frameworks operationalized in these studies. We conclude with key future directions to optimize the application of implementation science with a justice orientation to promote global health equity.
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Affiliation(s)
- Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA;
- Cancer Control and Population Science Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - April Oh
- National Cancer Institute, Rockville, Maryland, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Juliet Iwelunmor
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Jabali SH, Yazdani S, Pourasghari H, Maleki M. From bench to policy: a critical analysis of models for evidence-informed policymaking in healthcare. Front Public Health 2024; 12:1264315. [PMID: 38596514 PMCID: PMC11002157 DOI: 10.3389/fpubh.2024.1264315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background The use of research evidence in policy making is a complex and challenging process that has a long history in various fields, especially in healthcare. Different terms and concepts have been used to describe the relationship between research and policy, but they often lack clarity and consensus. To address this gap, several strategies and models have been proposed to facilitate evidence informed policy making and to identify the key factors and mechanisms involved. This study aims to critically review the existing models of evidence informed policy making (EIPM) in healthcare and to assess their strengths and limitations. Method A systematic search and review conducted to identify and critically assess EIPM models in healthcare. We searched PubMed, Web of Science and Scopus databases as major electronic databases and applied predefined inclusion criteria to select the models. We also checked the citations of the included models to find other scholars' perspectives. Each model was described and critiqued each model in detail and discussed their features and limitations. Result Nine models of EIPM in healthcare were identified. While models had some strengths in comprehension, flexibility and theoretical foundations, analysis also identified limitations including: presupposing rational policymaking; lacking alternatives for time-sensitive situations; not capturing policy complexity; neglecting unintended effects; limited context considerations; inadequate complexity concepts; limited collaboration guidance; and unspecified evidence adaptations. Conclusion The reviewed models provide useful frameworks for EIPM but need further improvement to address their limitations. Concepts from sociology of knowledge, change theory and complexity science can enrich the models. Future EIPM models should better account for the complexity of research-policy relationships and provide tailored strategies based on the policy context.
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Affiliation(s)
- Seyyed Hadi Jabali
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shahram Yazdani
- Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Pourasghari
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Maleki
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Seedat J. The knowledge-to-action process model for knowledge translation in oral care in South Africa. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2023; 70:e1-e9. [PMID: 37526536 PMCID: PMC10397355 DOI: 10.4102/sajcd.v70i1.951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/13/2022] [Accepted: 06/12/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Literature supports the mismatch between empirical evidence and service delivery. Given this knowledge gap, it is important that research undertaken has a theoretical foundation, considers the context and stakeholders to confirm its need and that it can be feasibly implemented and sustained. OBJECTIVES The study aimed to facilitate knowledge translation in oral care using the knowledge-to-action (K2A) process model among nurses. METHOD The study was completed in an acute hospital in South Africa. A qualitative design with ethnography incorporating video-recordings and semi-structured interviews were used. A total of 139 nurses were recruited using random purposive sampling and received training on oral care, which was monitored. Inductive thematic analysis was completed. RESULTS The model facilitated information transfer and implementation of oral care by nurses. CONCLUSION With clear directions for use and theoretical underpinning, the K2A model was well-suited to the needs of the study and stakeholders, and the complexity of the context. For challenging contexts such as public healthcare institutions in South Africa, this was ideal and critical to the success of the intervention.Contribution: When nursing managers show interest and recognise nurses for their role in implementation of interventions, the buy-in, support and sustained use of that intervention is enhanced. A model such as the K2A promotes involvement of all stakeholders (e.g. nurses and their managers) in the design and planning for implementation of an intervention, and these are critical for the successful and feasible use of the intervention.
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Affiliation(s)
- Jaishika Seedat
- Department of Speech Pathology and Audiology, Faculty of Humanities, University of the Witwatersrand, Johannesburg.
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Regalado ICR, Lindquist AR, Cardoso R, Longo E, Lencucha R, Hunt M, Thomas A, Bussières A, Boruff JT, Shikako K. Knowledge translation in rehabilitation settings in low, lower-middle and upper-middle-income countries: a scoping review. Disabil Rehabil 2023; 45:376-390. [PMID: 35188861 DOI: 10.1080/09638288.2022.2030415] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE This review aims to identify the barriers and facilitators to knowledge use and Knowledge Translation (KT) strategies in rehabilitation in low, lower-middle, and upper-middle-income countries (LMICs). MATERIALS AND METHODS A scoping review of studies of KT in rehabilitation in LMICs contexts using the Arksey and O'Malley Framework was conducted. A comprehensive search of MEDLINE and 10 other databases was undertaken to identify studies conducted primarily in LMICs. RESULTS From the initial 15.606 titles identified; 27 articles were included for final analysis. Our analysis identified the following themes: Professional culture and context; KT interventions; and the conceptualization and application of KT and Evidence Based Practice (EBP). Individual-level barriers to KT included lack of skills, knowledge about EBP and English language, lack of motivation, and decision-making power. Facilitators to KT included positive attitudes and motivation. Organization-level barriers included lack of time, lack of financial resources, limited access to scientific journals, and applicability of research to rural settings. Facilitators included adequate financial and physical resources, a supportive management environment, and the existence of training and continuing education programs. CONCLUSION This review identified common and unique barriers and facilitators to KT in LMICs when compared to KT studies conducted in high-income settings.IMPLICATIONS FOR REHABILITATIONKnowledge Translation from academic institutions to rehabilitation clinical practice in low and upper-middle-income countries is important to support evidence-based practice and patient outcomes.Barriers at the individual level include professionals' ability to understand English and knowledge of the evidence-based practice.Organization-level barriers included lack of time to access and implement new practices, lack of financial and personal resources, limited access to scientific journals, and applicability of research to rural settings.Training and continuing education programs are needed to support rehabilitation professionals' efforts to achieve the application of evidence-based practice in clinical practice.
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Affiliation(s)
- I C R Regalado
- Department of Physiotherapy, Federal University of Rio Grande do Norte-UFRN, Avenida Senador Salgado Filho, Natal, Brazil
| | - A R Lindquist
- Department of Physiotherapy, Federal University of Rio Grande do Norte-UFRN, Avenida Senador Salgado Filho, Natal, Brazil
| | - R Cardoso
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - E Longo
- Department of Health of Children, Federal University of Rio Grande do Norte-UFRN/FACISA, Santa Cruz, Brazil
| | - R Lencucha
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - M Hunt
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - A Thomas
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - A Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - J T Boruff
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - K Shikako
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Zhao J, Bai W, Zhang Q, Su Y, Wang J, Du X, Zhou Y, Kong C, Qing Y, Gong S, Meng M, Wei C, Li D, Wu J, Li X, Chen W, Hu J. Evidence-based practice implementation in healthcare in China: a living scoping review. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 20:100355. [PMID: 35036975 PMCID: PMC8743207 DOI: 10.1016/j.lanwpc.2021.100355] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Evidence-based practice (EBP) implementation plays a crucial role in bridging the knowledge-action gaps and reducing health inequities. Little is known about its development in China. This study aims to provide an overview of the EBP implementation research progress in healthcare in China and identify gaps for future studies. METHODS We conducted a scoping review following the Joanna Briggs Institute scoping review methodology and the Cochrane Collaboration's guidance on living reviews. We performed a literature search in four Chinese databases (i.e., China National Knowledge Infrastructure, Wan Fang Database, The VIP Database, and China Biology Medicine) and three English databases (i.e., Ovid MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, and EMBASE), Google scholar, and Baidu scholar from 1996 to 2021. We included EBP implementation studies conducted in healthcare settings in China and were published in Chinese and English literature. The search will be run on a regular basis to monitor the development of new literature and determine when to update the review. FINDINGS Of the 11,276 records identified, we finally included 309 papers. The publications were on a sharp rise since 2013 and were predominantly from the nursing field (292/309, 94.50%). The commonly researched areas were symptom management (75/309, 24.27%), tube care (46/309, 14.89%), perioperative care (43/309, 13.92%), and fundamental care (43/309, 13.92%). Joanna Briggs Institute model was the most frequently used model to guide the implementation process (92/159, 59.75%). A median number of 8 people often comprised an implementation team, with 113 studies (36.57%) taking a multidisciplinary approach. 204 studies reported utilizing audit criteria to assist evaluation of evidence implementation rate with diversified methods measuring the criteria. Lack of knowledge, skills, and resources, and incomplete procedures or pathways were top barriers impeding EBP implementation. Leadership support was considered the most common facilitator. Education and training were the most frequently described implementation strategies for healthcare professionals and patients. Optimizing workflows and developing evaluation tools were the primary strategies adopted by organizations. 291 studies measured patient outcomes and 174 studies measured healthcare professional outcomes. INTERPRETATION To our knowledge, this scoping review is the first one to systematically examine the EBP implementation research progress in healthcare in China. Based on this review, we identified contributions that Chinese EBP implementation research made to the global community, and provided eight recommendations for Chinese researchers in conducting implementation studies in the future. FUNDING None.
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Affiliation(s)
- Junqiang Zhao
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Wenhui Bai
- Department of nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou, China
| | - Qian Zhang
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Yujie Su
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Jinfang Wang
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiaoning Du
- Department of nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yajing Zhou
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Chang Kong
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yanbing Qing
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Shaohua Gong
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Meiqi Meng
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Changyun Wei
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Dina Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Jian Wu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Xuejing Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Wenjun Chen
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jiale Hu
- Department of Nurse Anesthesia, Virginia Commonwealth University, Richmond, USA
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Curran JA, Gallant AJ, Wong H, Shin HD, Urquhart R, Kontak J, Wozney L, Boulos L, Bhutta Z, Langlois EV. Knowledge translation strategies for policy and action focused on sexual, reproductive, maternal, newborn, child and adolescent health and well-being: a rapid scoping review. BMJ Open 2022; 12:e053919. [PMID: 35039297 PMCID: PMC8765012 DOI: 10.1136/bmjopen-2021-053919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify knowledge translation (KT) strategies aimed at improving sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) and well-being. DESIGN Rapid scoping review. SEARCH STRATEGY A comprehensive and peer-reviewed search strategy was developed and applied to four electronic databases: MEDLINE ALL, Embase, CINAHL and Web of Science. Additional searches of grey literature were conducted to identify KT strategies aimed at supporting SRMNCAH. KT strategies and policies published in English from January 2000 to May 2020 onwards were eligible for inclusion. RESULTS Only 4% of included 90 studies were conducted in low-income countries with the majority (52%) conducted in high-income countries. Studies primarily focused on maternal newborn or child health and well-being. Education (81%), including staff workshops and education modules, was the most commonly identified intervention component from the KT interventions. Low-income and middle-income countries were more likely to include civil society organisations, government and policymakers as stakeholders compared with high-income countries. Reported barriers to KT strategies included limited resources and time constraints, while enablers included stakeholder involvement throughout the KT process. CONCLUSION We identified a number of gaps among KT strategies for SRMNCAH policy and action, including limited focus on adolescent, sexual and reproductive health and rights and SRMNCAH financing strategies. There is a need to support stakeholder engagement in KT interventions across the continuum of SRMNCAH services. Researchers and policymakers should consider enhancing efforts to work with multisectoral stakeholders to implement future KT strategies and policies to address SRMNCAH priorities. REGISTRATION The rapid scoping review protocol was registered on Open Science Framework on 16 June 2020 (https://osf.io/xpf2k).
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Affiliation(s)
- Janet A Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Allyson J Gallant
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Helen Wong
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julia Kontak
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Zulfiqar Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Etienne V Langlois
- The Partnership for Maternal, Newborn & Child Health, World Health Organization, Geneva, Switzerland
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Airoldi MJ, Vieira BS, Teplicky R, Chalfun D, Bonfim RGAS, Mancini MC, Rosenbaum P, Brandão MB. Information and Empowerment of Families of Children With Cerebral Palsy in Brazil: The Knowledge Translation Role of Nossa Casa Institute. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:709983. [PMID: 36188792 PMCID: PMC9397996 DOI: 10.3389/fresc.2021.709983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/21/2021] [Indexed: 11/15/2022]
Abstract
Knowledge translation (KT) is gaining attention in the pediatric rehabilitation field. Nossa Casa Institute is the first organization in Brazil aiming to foster cerebral palsy (CP) awareness and empower families by discussing reliable information. This study aims to build a network where individuals with CP and their families, researchers, health care professionals, and services can communicate and share experiences. In this article, we describe the experience of planning and conducting an educational and interactive online workshop to foster principles of family-centered service (FCS). We used the action cycle from the Knowledge to Action (KTA) framework to describe and ground the proposed activities. In Module 1, “Challenges and barriers to incorporate family-centered principles,” we discussed the historical perspective, main principles, and challenges related to FCS implementation. Module 2, “What is my contribution to the family-centered service?” was aimed to foster strategies to improve the implementation of principles of FCS in the care of children with disabilities. In Module 3, “What can we do together?” the groups presented their ideas and suggestions. This interactive and educational workshop was an opportunity for Nossa Casa Institute to disseminate accessible and reliable information regarding FCS and to empower families to participate actively in the rehabilitation process and advocate for the best provision of care for their children. Future actions of Nossa Casa Institute include the coordination of a national conference to connect families, individuals with CP, healthcare and rehabilitation professionals, and researchers. There is also a need, and opportunity, for formal evaluation of these KT activities.
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Affiliation(s)
| | | | - Rachel Teplicky
- CanChild Centre for Childhood Disability, Hamilton, ON, Canada
| | | | | | - Marisa C. Mancini
- Occupational Therapy Department and Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability, Hamilton, ON, Canada
| | - Marina B. Brandão
- Occupational Therapy Department and Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- *Correspondence: Marina B. Brandão
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Ekawati FM, Emilia O, Gunn J, Licqurish S, Lau P. Challenging the status quo: results of an acceptability and feasibility study of hypertensive disorders of pregnancy (HDP) management pathways in Indonesian primary care. BMC Pregnancy Childbirth 2021; 21:507. [PMID: 34261428 PMCID: PMC8278644 DOI: 10.1186/s12884-021-03970-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 06/25/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are the leading cause of maternal mortality in Indonesia. Focused HDP management pathways for Indonesian primary care practice have been developed from a consensus development process. However, the acceptability and feasibility of the pathways in practice have not been explored. This study reports on the implementation process of the pathways to determine their acceptability and feasibility in Indonesian practice. METHODS The pathways were implemented in three public primary care clinics (Puskesmas) in Yogyakarta province for a month, guided by implementation science frameworks of Medical Research Council (MRC) and the Practical Robust Implementation and Sustainability Model (PRISM). The participating providers (general practitioners (GPs), midwives, and nurses) were asked to use recommendations in the pathways for a month. The pathway implementation evaluations were then conducted using clinical audits and a triangulation of observations, focus groups (FGs), and interviews with all of the participants. Clinical audit data were analysed descriptively, and qualitative data were analysed using a mix of the inductive-deductive approach of thematic analysis. RESULTS A total of 50 primary care providers, four obstetricians, a maternal division officer in the local health office and 61 patients agreed to participate, and 48 of the recruited participants participated in evaluation FGs or interviews. All of the providers in the Puskesmas attempted to apply recommendations from the pathways to various degrees, mainly adopting preeclampsia risk factor screenings and HDP monitoring. The participants expressed that the recommendations empowered their practice when it came to HDP management. However, their practices were challenged by professional boundaries and hierarchical barriers among health care professionals, limited clinical resources, and regulations from the local health office. Suggestions for future scale-up studies were also mentioned, such as involving champion obstetricians and providing more patient education toolkits. CONCLUSION The HDP management pathways are acceptable and feasible in Indonesian primary care. A further scale-up study is desired and can be initiated with investigations to minimise the implementation challenges and enhance the pathways' value in primary care practice.
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Affiliation(s)
- Fitriana Murriya Ekawati
- Department of Family and Community Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia.
| | - Ova Emilia
- Department of Obstetrics and Gynaecology, Universitas Gadjah Mada/Sardjito Hospital, Yogyakarta, Indonesia
| | - Jane Gunn
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
| | - Sharon Licqurish
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Phyllis Lau
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
- Department of General Practice, Western Sydney University, New South Wales, Australia
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Whitehorn A, Fu L, Porritt K, Lizarondo L, Stephenson M, Marin T, Aye Gyi A, Dell K, Mignone A, Lockwood C. Mapping Clinical Barriers and Evidence-Based Implementation Strategies in Low-to-Middle Income Countries (LMICs). Worldviews Evid Based Nurs 2021; 18:190-200. [PMID: 33973346 PMCID: PMC8251858 DOI: 10.1111/wvn.12503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
Background Low‐to‐middle income countries (LMICs) experience a high burden of disease from both non‐communicable and communicable diseases. Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice. Aim To identify and categorize barriers and strategies to evidence implementation in LMICs from published evidence implementation studies. Methods A descriptive analysis of key characteristics of evidence implementation projects completed as part of a 6‐month, multi‐phase, intensive evidence‐based clinical fellowship program, conducted in LMICs and published in the JBI Database of Systematic Reviews and Implementation Reports was undertaken. Barriers were identified and categorized to the Donabedian dimensions of care (structure, process, and outcome), and strategies were mapped to the Cochrane effective practice and organization of care taxonomy. Results A total of 60 implementation projects reporting 58 evidence‐based clinical audit topics from LMICs were published between 2010 and 2018. The projects included diverse populations and were predominantly conducted in tertiary care settings. A total of 279 barriers to implementation were identified. The most frequently identified groupings of barriers were process‐related and associated predominantly with staff knowledge. A total of 565 strategies were used across all projects, with every project incorporating more than one strategy to address barriers to implementation of evidence‐based practice; most strategies were categorized as educational meetings for healthcare workers. Linking Evidence to Action Context‐specific strategies are required for successful evidence implementation in LMICs, and a number of common barriers can be addressed using locally available, low‐cost resources. Education for healthcare workers in LMICs is an effective awareness‐raising, workplace culture, and practice‐transforming strategy for evidence implementation.
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Affiliation(s)
| | - Liang Fu
- JBI, The University of Adelaide, Adelaide, SA, Australia.,Department of Nursing, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, China.,School of Nursing, Fudan University, Shanghai, China
| | - Kylie Porritt
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | | | | | - Tania Marin
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | - Aye Aye Gyi
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | - Kim Dell
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | - Alex Mignone
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | - Craig Lockwood
- JBI, The University of Adelaide, Adelaide, SA, Australia
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Giannitrapani KF, Satija A, Ganesh A, Gamboa R, Fereydooni S, Hennings T, Chandrashekaran S, Mickelsen J, DeNatale M, Spruijt O, Bhatnagar S, Lorenz KA. Barriers and Facilitators of Using Quality Improvement To Foster Locally Initiated Innovation in Palliative Care Services in India. J Gen Intern Med 2021; 36:366-373. [PMID: 32901438 PMCID: PMC7878595 DOI: 10.1007/s11606-020-06152-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 08/12/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Quality improvement (QI) methods represent a vehicle for fostering locally initiated innovation cycles. We partnered with palliative care services from seven diverse practice settings in India to foster locally initiated improvement projects. OBJECTIVE To evaluate the implementation experiences of locally initiated palliative care improvement projects at seven diverse sites and understand the barriers and facilitators of using QI to improve palliative care in India. PARTICIPANTS We use a quota sampling approach to capture the perspectives of 44 local stakeholders in each of the following three categories (organizational leaders, clinic leaders, and clinical team members) through a semi-structured interview guide informed by the consolidated framework for implementation research (CFIR). We use standard qualitative methods to identify facilitators and barriers to using QI methods in seven diverse palliative care contexts. RESULTS Across all sites, respondents emphasized the following factors important in the success of quality improvement initiative: leveraging clinic level data, QI methods training, provider buy-in, engaged mentors, committed leadership, team support, interdepartmental coordination, collaborations with other providers, local champions, and having a structure for accountability. Barriers to using QI methods to improve palliative care services included lack of designated staff, high patient volume, resources, patient population geographic constraints, general awareness and acceptance of palliative care, and culture. CONCLUSIONS Empowering local leaders and medical personnel to champion, design, and iterate using QI methods represents a promising powerful tool to spread palliative care services in developing countries.
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Affiliation(s)
- Karleen F Giannitrapani
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA.
- Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Aanchal Satija
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Archana Ganesh
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Raziel Gamboa
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Soraya Fereydooni
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Taylor Hennings
- University of California Berkeley School of Public Health, Berkeley, CA, USA
| | | | | | | | - Odette Spruijt
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - Sushma Bhatnagar
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Karl A Lorenz
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA
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12
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Engebretsen E, Fraas Henrichsen G, Ødemark J. Towards a translational medical humanities: introducing the cultural crossings of care. MEDICAL HUMANITIES 2020; 46:e2. [PMID: 32341131 PMCID: PMC7402465 DOI: 10.1136/medhum-2019-011751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 05/31/2023]
Abstract
In this introductory essay, we will present a translational medical humanities approach where the humanities are not only an auxiliary to medical science and practice, but also an interdisciplinary space where both medicine and the humanities mutually challenge and inform each other. First, we explore how medicine's attempt to tackle the nature-culture divide is emblematically expressed in the concept and practice of knowledge translation (hereinafter KT). Second, we compare and contrast KT as an epistemic ideology and a socio-medical practice, with concepts and practices of translation developed in the human sciences. In particular, we emphasise Derrida's understanding of translation as inherent in all meaning making, as a fundamentally textual process and as a process necessarily creating difference rather than semantic equivalence. Finally, we analyse a case from clinical medicine showing how a more refined notion of translation can enlighten the interaction between biomedical and cultural factors. Such a translational medical humanities approach also requires a rethinking of the concept of evidence in medicine.
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Affiliation(s)
- Eivind Engebretsen
- Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Gina Fraas Henrichsen
- Centre for Health Science Education, University of Oslo Faculty of Medicine, Oslo, Norway
| | - John Ødemark
- Department of Cultural Studies and Oriental Languages, University of Oslo, Oslo, Norway
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13
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Bastani P, Alipoori S, Imani-Nasab MH, Jamalabadi S, Kavosi Z. Evidence-based decision making among healthcare managers: Evidence from a developing Country. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1632002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Peivand Bastani
- Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Somayeh Alipoori
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad-Hasan Imani-Nasab
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Sara Jamalabadi
- Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Kavosi
- Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Prihodova L, Guerin S, Tunney C, Kernohan WG. Key components of knowledge transfer and exchange in health services research: Findings from a systematic scoping review. J Adv Nurs 2019; 75:313-326. [PMID: 30168164 PMCID: PMC7379521 DOI: 10.1111/jan.13836] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/28/2018] [Accepted: 08/06/2018] [Indexed: 12/22/2022]
Abstract
AIMS To identify the key common components of knowledge transfer and exchange in existing models to facilitate practice developments in health services research. BACKGROUND There are over 60 models of knowledge transfer and exchange designed for various areas of health care. Many of them remain untested and lack guidelines for scaling-up of successful implementation of research findings and of proven models ensuring that patients have access to optimal health care, guided by current research. DESIGN A scoping review was conducted in line with PRISMA guidelines. Key components of knowledge transfer and exchange were identified using thematic analysis and frequency counts. DATA SOURCES Six electronic databases were searched for papers published before January 2015 containing four key terms/variants: knowledge, transfer, framework, health care. REVIEW METHODS Double screening, extraction and coding of the data using thematic analysis were employed to ensure rigour. As further validation stakeholders' consultation of the findings was performed to ensure accessibility. RESULTS Of the 4,288 abstracts, 294 full-text articles were screened, with 79 articles analysed. Six key components emerged: knowledge transfer and exchange message, Stakeholders and Process components often appeared together, while from two contextual components Inner Context and the wider Social, Cultural and Economic Context, with the wider context less frequently considered. Finally, there was little consideration of the Evaluation of knowledge transfer and exchange activities. In addition, specific operational elements of each component were identified. CONCLUSIONS The six components offer the basis for knowledge transfer and exchange activities, enabling researchers to more effectively share their work. Further research exploring the potential contribution of the interactions of the components is recommended.
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Affiliation(s)
- Lucia Prihodova
- UCD School of PsychologyUniversity College DublinDublinIreland
- Palliative Care Research NetworkAll Ireland Institute for Hospice and Palliative CareDublinIreland
| | - Suzanne Guerin
- UCD School of PsychologyUniversity College DublinDublinIreland
- Palliative Care Research NetworkAll Ireland Institute for Hospice and Palliative CareDublinIreland
- UCD Centre for Disability StudiesUniversity College DublinDublinIreland
| | - Conall Tunney
- UCD Centre for Disability StudiesUniversity College DublinDublinIreland
| | - W. George Kernohan
- Palliative Care Research NetworkAll Ireland Institute for Hospice and Palliative CareDublinIreland
- Institute of Nursing and Health ResearchUlster UniversityBelfastNorthern Ireland
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15
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Yapa HM, Bärnighausen T. Implementation science in resource-poor countries and communities. Implement Sci 2018; 13:154. [PMID: 30587195 PMCID: PMC6307212 DOI: 10.1186/s13012-018-0847-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 12/18/2022] Open
Abstract
Background Implementation science in resource-poor countries and communities is arguably more important than implementation science in resource-rich settings, because resource poverty requires novel solutions to ensure that research results are translated into routine practice and benefit the largest possible number of people. Methods We reviewed the role of resources in the extant implementation science frameworks and literature. We analyzed opportunities for implementation science in resource-poor countries and communities, as well as threats to the realization of these opportunities. Results Many of the frameworks that provide theoretical guidance for implementation science view resources as contextual factors that are important to (i) predict the feasibility of implementation of research results in routine practice, (ii) explain implementation success and failure, (iii) adapt novel evidence-based practices to local constraints, and (iv) design the implementation process to account for local constraints. Implementation science for resource-poor settings shifts this view from “resources as context” to “resources as primary research object.” We find a growing body of implementation research aiming to discover and test novel approaches to generate resources for the delivery of evidence-based practice in routine care, including approaches to create higher-skilled health workers—through tele-education and telemedicine, freeing up higher-skilled health workers—through task-shifting and new technologies and models of care, and increasing laboratory capacity through new technologies and the availability of medicines through supply chain innovations. In contrast, only few studies have investigated approaches to change the behavior and utilization of healthcare resources in resource-poor settings. We identify three specific opportunities for implementation science in resource-poor settings. First, intervention and methods innovations thrive under constraints. Second, reverse innovation transferring novel approaches from resource-poor to research-rich settings will gain in importance. Third, policy makers in resource-poor countries tend to be open for close collaboration with scientists in implementation research projects aimed at informing national and local policy. Conclusions Implementation science in resource-poor countries and communities offers important opportunities for future discoveries and reverse innovation. To harness this potential, funders need to strongly support research projects in resource-poor settings, as well as the training of the next generation of implementation scientists working on new ways to create healthcare resources where they lack most and to ensure that those resources are utilized to deliver care that is based on the latest research results.
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Affiliation(s)
- H Manisha Yapa
- The Kirby Institute, University of New South Wales, Sydney, Australia.,Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Till Bärnighausen
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa. .,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA. .,Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, INF 130.3, 69120, Heidelberg, Germany.
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16
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A deliberative dialogue as a knowledge translation strategy on road traffic injuries in Burkina Faso: a mixed-method evaluation. Health Res Policy Syst 2018; 16:113. [PMID: 30458868 PMCID: PMC6247528 DOI: 10.1186/s12961-018-0388-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/28/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Deliberative dialogues are increasingly being used, particularly on the African continent. They are a promising interactive knowledge translation strategy that brings together and leverages the knowledge of diverse stakeholders important to the resolution of a societal issue. Following a research project carried out in Burkina Faso on road traffic injuries, a 1-day workshop in the form of a deliberative dialogue was organised in November 2015. The workshop brought together actors involved in road safety, such as researchers, police and fire brigades, health professionals, non-governmental and civil society organisations, and representatives of government structures. The objective was to present the research results, propose recommendations to improve the situation and develop a collective action plan. Method To better understand the workshop’s utility and effects, a mixed-method evaluation was conducted. Data were obtained from two questionnaires distributed at the end of the workshop (n = 37) and 14 qualitative interviews with participants 6–10 weeks after the workshop. Descriptive statistics were used to analyse the quantitative data, and a thematic analysis was conducted for the qualitative data. Results The data revealed several positive impacts of the workshop, such as the acquisition of new knowledge about road safety, the opportunity for participants to learn from each other, the creation of post-workshop collaborations, and individual behaviour changes. However, several challenges were encountered that constrained the potential effects of the workshop, including the limited presence of political actors, the lack of engagement among participants to develop an action plan, and the difficulty in setting up a monitoring committee following the workshop. Conclusion While the deliberative workshop is not the standard format for reporting research results in Burkina Faso, this model should be reproduced in different contexts. This interactive knowledge translation strategy is useful to benefit from the experiential knowledge of the various actors and to encourage their involvement in formulating recommendations.
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17
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Demers M, Blanchette AK, Mullick AA, Shah A, Woo K, Solomon J, Levin MF. Facilitators and barriers to using neurological outcome measures in developed and developing countries. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 24:e1756. [DOI: 10.1002/pri.1756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 07/30/2018] [Accepted: 09/29/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Marika Demers
- School of Physical and Occupational Therapy; McGill University; Montreal Québec Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal; Montreal Québec Canada
| | - Andréanne K. Blanchette
- Department of Rehabilitation; Université Laval; Québec City Canada
- Institut de réadaptation en déficience physique de Québec; Center for Interdisciplinary Research in Rehabilitation and Social Integration; Québec City Québec Canada
| | - Aditi A. Mullick
- School of Physical and Occupational Therapy; McGill University; Montreal Québec Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal; Montreal Québec Canada
| | - Akash Shah
- Department of Physiotherapy, School of Allied Health Sciences; Manipal Academy of Higher Education; Manipal India
| | - Kathleen Woo
- School of Physical and Occupational Therapy; McGill University; Montreal Québec Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal; Montreal Québec Canada
| | - John Solomon
- Department of Physiotherapy, School of Allied Health Sciences; Manipal Academy of Higher Education; Manipal India
| | - Mindy F. Levin
- School of Physical and Occupational Therapy; McGill University; Montreal Québec Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal; Montreal Québec Canada
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18
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Votruba N, Ziemann A, Grant J, Thornicroft G. A systematic review of frameworks for the interrelationships of mental health evidence and policy in low- and middle-income countries. Health Res Policy Syst 2018; 16:85. [PMID: 30134908 PMCID: PMC6106735 DOI: 10.1186/s12961-018-0357-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The interrelationships between research evidence and policy-making are complex. Different theoretical frameworks exist to explain general evidence-policy interactions. One largely unexplored element of these interrelationships is how evidence interrelates with, and influences, policy/political agenda-setting. This review aims to identify the elements and processes of theories, frameworks and models on interrelationships of research evidence and health policy-making, with a focus on actionability and agenda-setting in the context of mental health in low- and middle-income countries (LMICs). METHODS A systematic review of theories was conducted based on the BeHeMOTh search method, using a tested and refined search strategy. Nine electronic databases and other relevant sources were searched for peer-reviewed and grey literature. Two reviewers screened the abstracts, reviewed full-text articles, extracted data and performed quality assessments. Analysis was based on a thematic analysis. The included papers had to present an actionable theoretical framework/model on evidence and policy interrelationships, such as knowledge translation or evidence-based policy, specifically target the agenda-setting process, focus on mental health, be from LMICs and published in English. RESULTS From 236 publications included in the full text analysis, no studies fully complied with our inclusion criteria. Widening the focus by leaving out 'agenda-setting', we included ten studies, four of which had unique conceptual frameworks focusing on mental health and LMICs but not agenda-setting. The four analysed frameworks confirmed research gaps from LMICs and mental health, and a lack of focus on agenda-setting. Frameworks and models from other health and policy areas provide interesting conceptual approaches and lessons with regards to agenda-setting. CONCLUSION Our systematic review identified frameworks on evidence and policy interrelations that differ in their elements and processes. No framework fulfilled all inclusion criteria. Four actionable frameworks are applicable to mental health and LMICs, but none specifically target agenda-setting. We have identified agenda-setting as a research theory gap in the context of mental health knowledge translation in LMICs. Frameworks from other health/policy areas could offer lessons on agenda-setting and new approaches for creating policy impact for mental health and to tackle the translational gap in LMICs.
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Affiliation(s)
- Nicole Votruba
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, David Goldberg Centre Rm: M0.08 PO Box 28, De Crespigny Park - Denmark Hill, London, SE5 8AF United Kingdom
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, David Goldberg Centre Rm: M0.08 PO Box 28, De Crespigny Park - Denmark Hill, London, SE5 8AF United Kingdom
- King’s Improvement Science at the Centre for Implementation Science, NIHR CLAHRC South London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, David Goldberg Centre Rm: M0.08 PO Box 28, De Crespigny Park - Denmark Hill, London, SE5 8AF United Kingdom
| | - Alexandra Ziemann
- King’s Improvement Science at the Centre for Implementation Science, NIHR CLAHRC South London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, David Goldberg Centre Rm: M0.08 PO Box 28, De Crespigny Park - Denmark Hill, London, SE5 8AF United Kingdom
| | - Jonathan Grant
- Policy Institute at King’s, Virginia Woolf Building, The Strand, King’s College London, London, United Kingdom
| | - Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, David Goldberg Centre Rm: M0.08 PO Box 28, De Crespigny Park - Denmark Hill, London, SE5 8AF United Kingdom
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19
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Ong IL, Diño MJS, Calimag MMP, Hidalgo FA. Developing a valid and reliable assessment of knowledge translation (KT) for continuing professional development program of health professionals. PeerJ 2018; 6:e5323. [PMID: 30128180 PMCID: PMC6095105 DOI: 10.7717/peerj.5323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/03/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction Knowledge Translation (KT) is expected to be a critical learning outcome of a Continuing Professional Development (CPD) program. It continues to serve as an area of interest among educators and healthcare providers due to its importance to evidence-based practice. This study endeavored to develop a valid and reliable KT learning assessment tool in CPD. Methods The Inventory of Reflective Vignettes (IRV), an innovative approach of integrating research vignettes, was utilized in crafting the 20-item IRV-KT tool. This instrument includes knowledge creation and action as essential KT constructs. KT competency was assessed in three segments (i.e., before and after CPD event and if in a lecture) using a one-group post-posttest pre-experimental design. Health professionals who successfully completed a CPD program on a knowledge translation topic were asked to complete the IRV-KT during the pilot study (n = 10) and actual implementation (n = 45). Responses were subjected to Cronbach’s reliability and criterion-validity testing. Results The initial test of the IRV-KT tool demonstrated a high internal reliability (α = 0.97) and most items yielded acceptable validity scores. During the actual implementation, a higher reliability score of 0.98 was generated with significant correlations between the before-after segments for both KT constructs of creation (r = 0.33, p < 0.05) and action (r = 0.49, p < 0.05). All items have significant positive validity coefficients (r > 0.35, p < 0.05) in all segments of the tool. Discussion The study produced a reflective assessment tool to validly and reliably assess KT learning in a CPD. IRV-KT is seen to guide the curriculum process of CPD programs to bridge learning and healthcare outcomes.
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Affiliation(s)
- Irvin L Ong
- Research Development and Innovation Center, Our Lady of Fatima University, Valenzuela City, Philippines.,The Graduate School, University of Santo Tomas, Manila, Philippines.,Phi Gamma Chapter, Sigma Theta Tau International Honor Society of Nursing, Indianapolis, IN, United States of America
| | - Michael Joseph S Diño
- Research Development and Innovation Center, Our Lady of Fatima University, Valenzuela City, Philippines.,The Graduate School, University of Santo Tomas, Manila, Philippines.,Phi Gamma Chapter, Sigma Theta Tau International Honor Society of Nursing, Indianapolis, IN, United States of America
| | | | - Fe A Hidalgo
- The Graduate School, University of Santo Tomas, Manila, Philippines
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20
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Govender P, Joubert RWE. Evidence-Based Clinical Algorithm for Hypotonia Assessment: To Pardon the Errs. Occup Ther Int 2018; 2018:8967572. [PMID: 29853815 PMCID: PMC5941769 DOI: 10.1155/2018/8967572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 03/19/2018] [Indexed: 11/17/2022] Open
Abstract
Despite the many advances in diagnostics, the clinical assessment of children with hypotonia presents a diagnostic challenge for clinicians due to the current subjectivity of the initial clinical assessment. The aim of this paper is to report on an evidence-based clinical algorithm (EBCA) that was developed for the clinical assessment of hypotonia in children as part of the output of a multiphased study towards assisting clinicians in more accurate assessments. This study formed part of a larger advanced mixed methods design. The preceding phases of the study included a systematic review, a survey amongst clinicians, a consensus process (Delphi technique), and a qualitative critique with multiple focus groups. Samples were drawn from three professional groups (occupational therapists, physiotherapists, and paediatricians). Data were analysed at each stage and merged in the development of the EBCA. The EBCA followed a rigorous process of development and critique. The methods for formulating changes in the revision and development of the EBCA are presented together with a description and presentation of the final algorithm for practice. The overarching concepts that guided the development and refinement of the EBCA are described, taking into consideration knowledge translation, evidence-based practice, and the value of EBCAs in addition to recommendations for stakeholder uptake. The EBCA is envisaged to be useful in practice for clinicians who are faced with the assessment of a child that is suspected as having hypotonia via a systematic process in identifying specific characteristics that are associated with low muscle tone.
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Affiliation(s)
- Pragashnie Govender
- School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa
| | - Robin Wendy Elizabeth Joubert
- School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa
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21
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Lal S, Gleeson J, Malla A, Rivard L, Joober R, Chandrasena R, Alvarez-Jimenez M. Cultural and Contextual Adaptation of an eHealth Intervention for Youth Receiving Services for First-Episode Psychosis: Adaptation Framework and Protocol for Horyzons-Canada Phase 1. JMIR Res Protoc 2018; 7:e100. [PMID: 29685867 PMCID: PMC5938599 DOI: 10.2196/resprot.8810] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/05/2018] [Accepted: 02/11/2018] [Indexed: 01/06/2023] Open
Abstract
Background eHealth interventions have the potential to address challenges related to access, service engagement, and continuity of care in the delivery of mental health services. However, the initial development and evaluation of such interventions can require substantive amounts of financial and human resource investments to bring them to scale. Therefore, it may be warranted to pay greater attention to policy, services, and research with respect to eHealth platforms that have the potential to be adapted for use across settings. Yet, limited attention has been placed on the methods and processes for adapting eHealth interventions to improve their applicability across cultural, geographical, and contextual boundaries. Objective In this paper, we describe an adaptation framework and protocol to adapt an eHealth intervention designed to promote recovery and prevent relapses in youth receiving specialized services for first-episode psychosis. The Web-based platform, called Horyzons, was initially developed and tested in Australia and is now being prepared for evaluation in Canada. Methods Service users and service providers from 2 specialized early intervention programs for first-episode psychosis located in different provinces will explore a beta-version of the eHealth intervention through focus group discussions and extended personal explorations to identify the need for, and content of contextual and cultural adaptations. An iterative consultation process will then take place with service providers and users to develop and assess platform adaptations in preparation for a pilot study with a live version of the platform. Results Data collection was completed in August 2017, and analysis and adaptation are in process. The first results of the study will be submitted for publication in 2018 and will provide preliminary insights into the acceptability of the Web-based platform (eg, perceived use and perceived usefulness) from service provider and service user perspectives. The project will also provide knowledge about the adaptations and process needed to prepare the platform for evaluation in Canada. Conclusions This study contributes to an important gap in the literature pertaining to the specific principles, methods, and steps involved in adapting eHealth interventions for implementation and evaluation across a diverse range of cultural, geographical, and health care settings.
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.,Health Innovation and Evaluation Hub, University of Montreal Hospital Research Center, Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada
| | - John Gleeson
- School of Psychology, Australian Catholic University, Fitzroy, Australia
| | - Ashok Malla
- Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Lysanne Rivard
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Center, Montreal, QC, Canada
| | - Ridha Joober
- Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
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22
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Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P. Improving maternal and child health policymaking processes in Nigeria: an assessment of policymakers' needs, barriers and facilitators of evidence-informed policymaking. Health Res Policy Syst 2017; 15:48. [PMID: 28722554 PMCID: PMC5516839 DOI: 10.1186/s12961-017-0217-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Nigeria, interest in the evidence-to-policy process is gaining momentum among policymakers involved in maternal, newborn and child health (MNCH). However, numerous gaps exist among policymakers on use of research evidence in policymaking. The objective of this study was to assess the perception of MNCH policymakers regarding their needs and the barriers and facilitators to use of research evidence in policymaking in Nigeria. METHODS The study design was a cross-sectional assessment of perceptions undertaken during a national MNCH stakeholders' engagement event convened in Abuja, Nigeria. A questionnaire designed to assess participants' perceptions was administered in person. Group consultations were also held, which centred on policymakers' evidence-to-policy needs to enhance the use of evidence in policymaking. RESULTS A total of 40 participants completed the questionnaire and participated in the group consultations. According to the respondents, the main barriers to evidence use in MNCH policymaking include inadequate capacity of organisations to conduct policy-relevant research; inadequate budgetary allocation for policy-relevant research; policymakers' indifference to research evidence; poor dissemination of research evidence to policymakers; and lack of interaction fora between researchers and policymakers. The main facilitators of use of research evidence for policymaking in MNCH, as perceived by the respondents, include capacity building for policymakers on use of research evidence in policy formulation; appropriate dissemination of research findings to relevant stakeholders; involving policymakers in research design and execution; and allowing policymakers' needs to drive research. The main ways identified to promote policymakers' use of evidence for policymaking included improving policymakers' skills in information and communication technology, data use, analysis, communication and advocacy. CONCLUSION To improve the use of research evidence in policymaking in Nigeria, there is a need to establish mechanisms that will facilitate the movement from evidence to policy and address the needs identified by policymakers. It is also imperative to improve organisational initiatives that facilitate use of research evidence for policymaking.
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Affiliation(s)
- Chigozie J Uneke
- Knowledge Translation Platform, African Institute for Health Policy & Health Systems, Ebonyi State University, PMB 053, Abakaliki, Nigeria.
| | - Issiaka Sombie
- West African Health Organisation, 175 avenue Ouezzin Coulibaly, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
| | - Namoudou Keita
- West African Health Organisation, 175 avenue Ouezzin Coulibaly, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
| | - Virgil Lokossou
- West African Health Organisation, 175 avenue Ouezzin Coulibaly, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
| | - Ermel Johnson
- West African Health Organisation, 175 avenue Ouezzin Coulibaly, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
| | - Pierre Ongolo-Zogo
- Hopital Central Yaounde, CDBPH Lawrence VERGNE Building 2nd Floor, Avenue Henry Dunant Messa, Yaoundé, Cameroon
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A Knowledge Translation framework on ageing and health. Health Policy 2017; 121:282-291. [DOI: 10.1016/j.healthpol.2016.12.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 12/05/2016] [Accepted: 12/31/2016] [Indexed: 12/14/2022]
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Mutatina B, Basaza R, Obuku E, Lavis JN, Sewankambo N. Identifying and characterising health policy and system-relevant documents in Uganda: a scoping review to develop a framework for the development of a one-stop shop. Health Res Policy Syst 2017; 15:7. [PMID: 28166798 PMCID: PMC5294842 DOI: 10.1186/s12961-017-0170-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health policymakers in low- and middle-income countries continue to face difficulties in accessing and using research evidence for decision-making. This study aimed to identify and provide a refined categorisation of the policy documents necessary for building the content of a one-stop shop for documents relevant to health policy and systems in Uganda. The on-line resource is to facilitate timely access to well-packaged evidence for decision-making. METHODS We conducted a scoping review of Uganda-specific, health policy, and systems-relevant documents produced between 2000 and 2014. Our methods borrowed heavily from the 2005 Arksey and O'Malley approach for scoping reviews and involved five steps, which that include identification of the research question; identification of relevant documents; screening and selection of the documents; charting of the data; and collating, summarising and reporting results. We searched for the documents from websites of relevant government institutions, non-governmental organisations, health professional councils and associations, religious medical bureaus and research networks. We presented the review findings as numerical analyses of the volume and nature of documents and trends over time in the form of tables and charts. RESULTS We identified a total of 265 documents including policies, strategies, plans, guidelines, rapid response summaries, evidence briefs for policy, and dialogue reports. The top three clusters of national priority areas addressed in the documents were governance, coordination, monitoring and evaluation (28%); disease prevention, mitigation, and control (23%); and health education, promotion, environmental health and nutrition (15%). The least addressed were curative, palliative care, rehabilitative services and health infrastructure, each addressed in three documents (1%), and early childhood development in one document. The volume of documents increased over the past 15 years; however, the distribution of the different document types over time has not been uniform. CONCLUSION The review findings are necessary for mobilising and packaging the local policy-relevant documents in Uganda in a one-stop shop; where policymakers could easily access them to address pressing questions about the health system and interventions. The different types of available documents and the national priority areas covered provide a good basis for building and organising the content in a meaningful way for the resource.
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Affiliation(s)
| | - Robert Basaza
- College of Health Sciences, Makerere University, Kampala, Uganda.,International Health Sciences University, Kampala, Uganda
| | - Ekwaro Obuku
- College of Health Sciences, Makerere University, Kampala, Uganda.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
| | - John N Lavis
- McMaster Health Forum, Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology & Biostatistics, and Department of Political Science, McMaster University, 1280 Main St. West, CRL 209, Hamilton, ON L8S 4L6, Ontario, Canada.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, United States of America
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Facilitating factors and barriers to malaria research utilization for policy development in Malawi. Malar J 2016; 15:512. [PMID: 27760552 PMCID: PMC5070004 DOI: 10.1186/s12936-016-1547-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/05/2016] [Indexed: 11/12/2022] Open
Abstract
Background Research on various determinants of health is key in providing evidence for policy development, thereby leading to successful interventions. Utilization of research is an intricate process requiring an understanding of contextual factors. The study was conducted to assess enhancing factors and barriers of research utilization for malaria policy development in Malawi. Methods Qualitative research approach was used through in-depth interviews with 39 key informants that included malaria researchers, policy makers, programme managers, and key stakeholders. Purposive sampling and snowballing techniques were used in identifying key informants. Interview transcripts were entered in QSR Nvivo 11 software for coding and analysis. Results Respondents identified global efforts as key in advancing knowledge translation, while local political will has been conducive for research utilization. Other factors were availability of research, availability of diverse local researchers and stakeholders supporting knowledge translation. While barriers included: lack of platforms for researcher-public engagement, politics, researchers’ lack of communication skills, lack of research collaborations, funder driven research, unknown World Health Organization policy position, and the lack of a malaria research repository. Conclusion Overall, the study identified facilitating factors to malaria research utilization for policy development in Malawi. These factors need to be systematically coordinated to address the identified barriers and improve on malaria research utilization in policy development. Malaria research can be key in the implementation of evidence-based interventions to reduce the malaria burden and assist in the paradigm shift from malaria control to elimination in Malawi.
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Enhancing Nurses' Oral Therapy Practice in 4 Latin American Countries: A Collaborative and Participatory Approach. Cancer Nurs 2016; 40:E49-E59. [PMID: 27636130 DOI: 10.1097/ncc.0000000000000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Oral therapy (OT) use for cancer is increasing globally. Yet, nurses in 4 Latin American countries lacked knowledge and educational opportunities to safely care for people receiving OTs. Global partnerships to contextualize education and create local capacity may enhance nursing practice. OBJECTIVE Within 4 Latin American countries, this study aims to (1) develop, deliver, and evaluate an OT cancer nursing education program and (2) evaluate the feasibility and efficacy of using an integrated knowledge translation (iKT) framework to develop the program and foster nurses' capacity for OT care. METHODS Using the iKT framework, a "train the trainer" model was used to develop, contextualize, pilot test, implement, and evaluate the OT education program. An online survey evaluated nurses' perceived benefits, ease of use, barriers, facilitators, and recommendations for improvement. Nurses' self-reported OT practices were evaluated 9 months after the final workshop. RESULTS One hundred nineteen nurses across 4 countries participated in a pilot and/or final OT educational workshop, facilitated by 6 local nurse champions. The nurse champions found the program easy to use and modify. Participants reported using the curriculum to teach other nurses and patients and networking opportunities for problem solving. Barriers included nurses' role clarity and time for education. CONCLUSIONS The iKT approach was an effective method to develop the OT curriculum and build OT capacity among nurses and leaders within the 4 countries. IMPLICATIONS FOR PRACTICE The iKT approach may be useful in low- or middle-income countries to enhance nursing education and practice. Future OT education projects should strengthen strategies for ongoing support after education intervention.
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Alvarez GG, Van Dyk DD, Colquhoun H, Moreau KA, Mulpuru S, Graham ID. Developing and Field Testing a Community Based Youth Initiative to Increase Tuberculosis Awareness in Remote Arctic Inuit Communities. PLoS One 2016; 11:e0159241. [PMID: 27415757 PMCID: PMC4945095 DOI: 10.1371/journal.pone.0159241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 06/29/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Inuit in Canada have the highest reported tuberculosis (TB) incidence rate in Canada, even higher than other Canadian Indigenous groups. The aim of this study was to increase TB awareness among Inuit youth and their communities by equipping those who can best reach this population with a community based, youth focused, education initiative built on interventions adapted from a previous TB awareness study. METHODS The Taima TB Youth Education Initiative was a field test case study of a knowledge translation (KT) strategy aimed at community members who provide health education in these communities. In the first stage of this study, interventions from a larger TB awareness campaign were adapted to focus on youth living in remote Inuit communities. During the second stage of the study, investigators field tested the initiative in two isolated Inuit communities. It was then applied by local implementation teams in two other communities. Evaluation criteria included feasibility, acceptability, knowledge uptake and health behavior change. RESULTS Implementation of the adapted KT interventions resulted in participation of a total of 41 youth (19 females, 22 males) with an average age of 16 years (range 12-21 years) in four different communities in Nunavut. Community celebration events were attended by 271 community members where TB messaging were presented and discussed. All of the health care workers and community members surveyed reported that the adapted interventions were acceptable and a useful way of learning to some extent. Knowledge uptake measures indicated an average TB knowledge score of 64 out of 100. Local partners in all four communities indicated that they would use the Taima TB Youth Education Initiative again to raise awareness about TB among youth in their communities. CONCLUSIONS The TB awareness interventions adapted for the Taima TB Youth Education Initiative were acceptable to the Inuit communities involved in the study. They resulted in uptake of knowledge among participants. Implementation by local implementation teams was feasible as evidenced by the participation and attendance of youth and community members in all communities. The ability to implement the interventions by local implementation teams indicates there is potential to scale up in other remote communities in the arctic setting.
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Affiliation(s)
- Gonzalo G. Alvarez
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
| | - Deborah D. Van Dyk
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Sunita Mulpuru
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ian D. Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Duc DM, Bergström A, Eriksson L, Selling K, Thi Thu Ha B, Wallin L. Response process and test-retest reliability of the Context Assessment for Community Health tool in Vietnam. Glob Health Action 2016; 9:31572. [PMID: 27293124 PMCID: PMC4904068 DOI: 10.3402/gha.v9.31572] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/17/2016] [Accepted: 04/19/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The recently developed Context Assessment for Community Health (COACH) tool aims to measure aspects of the local healthcare context perceived to influence knowledge translation in low- and middle-income countries. The tool measures eight dimensions (organizational resources, community engagement, monitoring services for action, sources of knowledge, commitment to work, work culture, leadership, and informal payment) through 49 items. OBJECTIVE The study aimed to explore the understanding and stability of the COACH tool among health providers in Vietnam. DESIGNS To investigate the response process, think-aloud interviews were undertaken with five community health workers, six nurses and midwives, and five physicians. Identified problems were classified according to Conrad and Blair's taxonomy and grouped according to an estimation of the magnitude of the problem's effect on the response data. Further, the stability of the tool was examined using a test-retest survey among 77 respondents. The reliability was analyzed for items (intraclass correlation coefficient (ICC) and percent agreement) and dimensions (ICC and Bland-Altman plots). RESULTS In general, the think-aloud interviews revealed that the COACH tool was perceived as clear, well organized, and easy to answer. Most items were understood as intended. However, seven prominent problems in the items were identified and the content of three dimensions was perceived to be of a sensitive nature. In the test-retest survey, two-thirds of the items and seven of eight dimensions were found to have an ICC agreement ranging from moderate to substantial (0.5-0.7), demonstrating that the instrument has an acceptable level of stability. CONCLUSIONS This study provides evidence that the Vietnamese translation of the COACH tool is generally perceived to be clear and easy to understand and has acceptable stability. There is, however, a need to rephrase and add generic examples to clarify some items and to further review items with low ICC.
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Affiliation(s)
- Duong M Duc
- Faculty of Social Science - Behaviours and Health Education, Hanoi School of Public Health, Hanoi, Vietnam.,International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden;
| | - Anna Bergström
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Institute for Global Health, University College London, London, UK
| | - Leif Eriksson
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Katarina Selling
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Bui Thi Thu Ha
- Faculty of Social Science - Behaviours and Health Education, Hanoi School of Public Health, Hanoi, Vietnam
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Knowledge, skills, and attitudes to implementing best practice in hospitals in Central Vietnam. INT J EVID-BASED HEA 2016; 14:142-149. [PMID: 27089395 DOI: 10.1097/xeb.0000000000000081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although nurses recognize the importance of evidence-based practice (EBP) to improve health outcomes, they still find its implementation complex. Successful EBP requires nurses to have the knowledge and expertise to appraise and critically apply evidence into practice. OBJECTIVES The study sought to identify Central Vietnam nurses' knowledge, skills, and attitudes to implementing EBP. METHODS A cross-sectional descriptive research design was implemented to identify nurses' ability to conduct EBP in two large hospitals in Central Vietnam. A total of 234 nurses returned completed surveys. Data were analyzed with descriptive and inferential statistics. RESULTS Nurses in Central Vietnam were not prepared for undertaking EBP. Only 29.5% of the respondents said they were familiar with the term EBP. Although they embraced a positive attitude toward EBP, they felt less confident to implement this innovation. Many failed to engage with research and still relied most heavily on informal information to guide their practice. IMPLICATIONS The evidence obtained from this study supports the need for an education intervention to develop nurses' knowledge and skills of research and research usage.
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Målqvist M. Preserving misconceptions or a call for action?--A hermeneutic re-reading of the Nativity story. Glob Health Action 2015; 8:30386. [PMID: 26707126 PMCID: PMC4691587 DOI: 10.3402/gha.v8.30386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 12/09/2015] [Accepted: 12/14/2015] [Indexed: 11/18/2022] Open
Abstract
Background Behaviour is guided by perceptions and traditions. As such, understanding culture and religion is important in order to understand healthcare behaviour. Religious perceptions shape a person's understanding of the world and are maintained through texts and tradition. One such important religious text in relation to sexual and reproductive health is the Nativity story. This account of the conception and birth of Jesus is well known in the Christian cultural sphere and beyond, and it has for generations shaped perceptions of childbirth. Methods This paper attempts a re-reading of the Nativity story using a hermeneutic approach. Results and Conclusion This reveals a dual understanding of the Nativity, not just as an account of immaculate transcendence and a rosy Christmas tale, but as a source of identification for pregnant women and mothers and a call to action for improved maternal and child healthcare.
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Affiliation(s)
- Mats Målqvist
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Church of Sweden, Uppsala, Sweden;
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Niermeyer S. From the Neonatal Resuscitation Program to Helping Babies Breathe: Global impact of educational programs in neonatal resuscitation. Semin Fetal Neonatal Med 2015; 20:300-8. [PMID: 26265602 DOI: 10.1016/j.siny.2015.06.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Two educational programs in neonatal resuscitation, the Neonatal Resuscitation Program (NRP) and Helping Babies Breathe (HBB) have found widespread acceptance globally as practical tools to improve newborn survival and reduce death from perinatal asphyxia. The programs share a common scientific evidence base and both employ adult education principles with an emphasis on building skills. However, they differ in their target audience and context, their core content, and the methods used for knowledge translation. This review describes how the design of NRP transported it outside the USA to countries around the globe and how the program has contributed to improvements in care at multiple levels from the bedside to guidelines and research. It examines the gaps in the reach of NRP that stimulated the development of HBB and helped shape a different approach to education of health care providers in resource-limited settings. Implementation of HBB is summarized to date, and evidence provided of its effectiveness in reducing neonatal death and stillbirth. Finally, consideration of how the programs function together suggests their future potential to strengthen health systems and maximize the impact on the health of newborns.
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Affiliation(s)
- Susan Niermeyer
- University of Colorado School of Medicine, Section of Neonatology, Aurora, CO, USA.
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Bergström A, Skeen S, Duc DM, Blandon EZ, Estabrooks C, Gustavsson P, Hoa DTP, Källestål C, Målqvist M, Nga NT, Persson LÅ, Pervin J, Peterson S, Rahman A, Selling K, Squires JE, Tomlinson M, Waiswa P, Wallin L. Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings. Implement Sci 2015; 10:120. [PMID: 26276443 PMCID: PMC4537553 DOI: 10.1186/s13012-015-0305-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 08/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. METHODS The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. RESULTS The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. CONCLUSIONS Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.
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Affiliation(s)
- Anna Bergström
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Sarah Skeen
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
| | - Duong M Duc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Hanoi School of Public Health, Hanoi, Vietnam.
| | - Elmer Zelaya Blandon
- Fundacion Coordinación de Hermanamientos e Iniciativas de Cooperación CHICA, León, Nicaragua.
| | | | - Petter Gustavsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Dinh Thi Phuong Hoa
- Hanoi School of Public Health, Hanoi, Vietnam. .,Research Institute for Child Health, National Hospital of Paediatrics, Hanoi, Vietnam.
| | - Carina Källestål
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Mats Målqvist
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Nguyen Thu Nga
- Research Institute for Child Health, National Hospital of Paediatrics, Hanoi, Vietnam.
| | - Lars-Åke Persson
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Jesmin Pervin
- Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Stefan Peterson
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. .,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Anisur Rahman
- Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Katarina Selling
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Janet E Squires
- Ottawa Hospital Research Institute, Ottawa, Canada. .,School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
| | - Peter Waiswa
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. .,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden. .,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
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Davison CM, Ndumbe-Eyoh S, Clement C. Critical examination of knowledge to action models and implications for promoting health equity. Int J Equity Health 2015; 14:49. [PMID: 26022369 PMCID: PMC4460698 DOI: 10.1186/s12939-015-0178-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 05/22/2015] [Indexed: 11/09/2022] Open
Abstract
Introduction Knowledge and effective interventions exist to address many current global health inequities. However, there is limited awareness, uptake, and use of knowledge to inform action to improve the health of disadvantaged populations. The gap between knowledge and action to improve health equity is of concern to health researchers and practitioners. This study identifies and critically examines the usefulness of existing knowledge to action models or frameworks for promoting health equity. Methods We conducted a scoping review of existing literature to identify knowledge to action (KTA) models or frameworks and critiqued the models using a health equity support rubric. Results We identified forty-eight knowledge to action models or frameworks. Six models scored between eight and ten of a maximum 12 points on the health equity support rubric. These high scoring models or frameworks all mentioned equity-related concepts. Attention to multisectoral approaches was the factor most often lacking in the low scoring models. The concepts of knowledge brokering, integrative processes, such as those in some indigenous health research, and Ecohealth applied to KTA all emerged as promising areas. Conclusions Existing knowledge to action models or frameworks can help guide knowledge translation to support action on the social determinants of health and health equity. There is a need to further test existing models or frameworks. This process should be informed by participatory and integrative research. There is room to develop more robust equity supporting models. Electronic supplementary material The online version of this article (doi:10.1186/s12939-015-0178-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Colleen M Davison
- Department Public Health Sciences, Queen's University, 63 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada.
| | - Sume Ndumbe-Eyoh
- National Collaborating Centre for Determinants of Health, St Francis Xavier University, P.O. Box 5000, Antigonish, NS, B2G 2WG, Canada.
| | - Connie Clement
- National Collaborating Centre for Determinants of Health, St Francis Xavier University, P.O. Box 5000, Antigonish, NS, B2G 2WG, Canada.
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Utilization of research findings for health policy making and practice: evidence from three case studies in Bangladesh. Health Res Policy Syst 2015; 13:26. [PMID: 26016797 PMCID: PMC4449578 DOI: 10.1186/s12961-015-0015-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 05/04/2015] [Indexed: 11/11/2022] Open
Abstract
Background In striving to contribute towards improved health outcomes, health research institutions generate and accumulate huge volumes of relevant but often underutilized data. This study explores activities undertaken by researchers from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), an international research institution that promotes the utilization of their findings in the policymaking processes in Bangladesh. Methods The study used an exploratory case study design and employed qualitative methods to explore activities implemented to promote research utilization and the extent to which researchers felt that their findings contributed to the policymaking process. Data were collected between September and December 2011 through key informant interviews, focus group discussions with study investigators, and database and document reviews. We reviewed findings from 19 reproductive health studies conducted and completed by icddr,b researchers between 2001 and 2011. We interviewed 21 key informants, including 13 researchers, two policy makers, and six programme implementers. Data were entered into Microsoft Word and analyzed manually following a thematic framework approach. Following the World Health Organization/Turning Research into Practice (WHO/TRIP) framework, three case studies of how research findings were utilized in the policymaking processes in Bangladesh were documented. Results Activities implemented to promote research utilization included conducting dissemination workshops, publishing scientific papers, developing policy briefs, providing technical assistance to policymakers and programme implementers, holding one-on-one meetings, and joining advocacy networks. The majority of the researchers (12 of 13) reported that their study findings were utilized to influence policymaking processes at different levels. However, some researchers reported being unaware of whether and how their findings were utilized. As regards actual utilization of research findings, the evidence from the three case studies indicate that research findings can be utilized instrumentally, conceptually and symbolically, and at different stages within the policymaking process, including agenda setting and policy formulation and implementation. Conclusions The results show that research findings from icddr,b were promoted and utilized in health policymaking processes in Bangladesh using a variety of utilization approaches. These results suggest a need for using multiple approaches to promote utilization of research findings in health policymaking processes.
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H. Al Ghabeesh S. Barriers and Suggested Facilitators to the Implementation of Best Practice: An Integrative Review. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojn.2015.51009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Buchanan H. The uptake of evidence-based practice by occupational therapists in South Africa. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2014. [DOI: 10.1179/otb.2011.64.1.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Nabyonga-Orem J, Ssengooba F, Macq J, Criel B. Malaria treatment policy change in Uganda: what role did evidence play? Malar J 2014; 13:345. [PMID: 25179532 PMCID: PMC4164770 DOI: 10.1186/1475-2875-13-345] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/26/2014] [Indexed: 01/22/2023] Open
Abstract
Background Although increasing attention is being paid to knowledge translation (KT), research findings are not being utilized to the desired extent. The present study explores the role of evidence, barriers, and factors facilitating the uptake of evidence in the change in malaria treatment policy in Uganda, building on previous work in Uganda that led to the development of a middle range theory (MRT) outlining the main facilitatory factors for KT. Application of the MRT to a health policy case will contribute to refining it. Methods Using a case study approach and mixed methods, perceptions of respondents on whether evidence was available, had been considered and barriers and facilitatory factors to the uptake of evidence were explored. In addition, the respondents’ rating of the degree of consistency between the policy decision and available evidence was assessed. Data collection methods included key informant interviews and document review. Qualitative data were analysed using content thematic analysis, whereas quantitative data were analysed using Excel spreadsheets. The two data sets were eventually triangulated. Results Evidence was used to change the malaria treatment policy, though the consistency between evidence and policy decisions varied along the policy development cycle. The availability of high-quality and contextualized evidence, including effective dissemination, Ministry of Health institutional capacity to lead the KT process, intervention of the WHO and a regional professional network, the existence of partnerships for KT with mutual trust and availability of funding, tools, and inputs to implement evidence, were the most important facilitatory factors that enhanced the uptake of evidence. Among the barriers that had to be overcome were resistance from implementers, the health system capacity to implement evidence, and financial sustainability. Conclusion The results agree with facilitatory factors identified in the earlier developed MRT, though additional factors emerged. These results refine the earlier MRT stating that high-quality and contextualized evidence will be taken up in policies, leading to evidence-informed policies when the MoH leads the KT process, partnerships are in place for KT, the WHO and regional professional bodies play a role, and funding, tools, and required inputs for implementing evidence are available. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-345) contains supplementary material, which is available to authorized users.
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Adrien A, Thompson LH, Archibald CP, Sandstrom PA, Munro M, Emmanuel F, Blanchard JF. Translating knowledge from Pakistan's second generation surveillance system to other global contexts. Sex Transm Infect 2012; 89 Suppl 2:ii53-7. [PMID: 23258896 PMCID: PMC3756434 DOI: 10.1136/sextrans-2012-050774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background From 2004 to 2011, a collaborative project was undertaken to enhance the capacity of the Government of Pakistan to implement an effective second-generation surveillance system for HIV/AIDS, known as the HIV/AIDS Surveillance Project (HASP). In four separate rounds, behavioural questionnaires were administered among injection drug users, and female, male and hijra (transgender) sex workers. Dried blood spots were collected for HIV testing. Methods Through interviews with project staff in Pakistan and Canada, we have undertaken a critical review of the role of HASP in generating, using and translating knowledge, with an emphasis on capacity building within both the donor and recipient countries. We also documented ongoing and future opportunities for the translation of knowledge produced through HASP. Results Knowledge translation activities have included educational workshops and consultations held in places as diverse as Colombia and Cairo, and the implementation of HASP methodologies in Asia, the Middle East and sub-Saharan Africa. HASP methodologies have been incorporated in multiple WHO reports. Importantly, the donor country, Canada, has benefited in significant ways from this partnership. Operational and logistical lessons from HASP have, in turn, improved how surveillance is performed in Canada. Through this project, significant capacity was built among the staff of HASP, non-governmental organisations which were engaged as implementation partners, data coordination units which were established in each province, and in the laboratory. As is to be expected, different organisations have different agendas and priorities, requiring negotiation, at times, to ensure the success of collaborative activities. Overall, there has been considerable interest in and opportunities made for learning about the methodologies and approaches employed by HASP. Conclusions Generally, the recognition of the strengths of the approaches and methodologies used by HASP has ensured an appetite for opportunities of mutual learning.
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Affiliation(s)
- Alix Adrien
- Direction de Santé Publique, Agence de la Santé et des Services Sociaux de Montreal, , Montréal, Quebec, Canada
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El-Jardali F, Lavis JN, Ataya N, Jamal D, Ammar W, Raouf S. Use of health systems evidence by policymakers in eastern Mediterranean countries: views, practices, and contextual influences. BMC Health Serv Res 2012; 12:200. [PMID: 22799440 PMCID: PMC3476435 DOI: 10.1186/1472-6963-12-200] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 07/16/2012] [Indexed: 11/10/2022] Open
Abstract
Background Health systems evidence can enhance policymaking and strengthen national health systems. In the Middle East, limited research exists on the use of evidence in the policymaking process. This multi-country study explored policymakers’ views and practices regarding the use of health systems evidence in health policymaking in 10 eastern Mediterranean countries, including factors that influence health policymaking and barriers and facilitators to the use of evidence. Methods This study utilized a survey adapted and customized from a similar tool developed in Canada. Health policymakers from 10 countries (Algeria, Bahrain, Jordan, Lebanon Oman, Pakistan, Palestine, Sudan, Tunisia, and Yemen) were surveyed. Descriptive and bi-variate analyses were performed for quantitative questions and thematic analysis was done for qualitative questions. Results A total of 237 policymakers completed the survey (56.3% response rate). Governing parties, limited funding for the health sector and donor organizations exerted a strong influence on policymaking processes. Most (88.5%) policymakers reported requesting evidence and 43.1% reported collaborating with researchers. Overall, 40.1% reported that research evidence is not delivered at the right time. Lack of an explicit budget for evidence-informed health policymaking (55.3%), lack of an administrative structure for supporting evidence-informed health policymaking processes (52.6%), and limited value given to research (35.9%) all limited the use of research evidence. Barriers to the use of evidence included lack of research targeting health policy, lack of funding and investments, and political forces. Facilitators included availability of health research and research institutions, qualified researchers, research funding, and easy access to information. Conclusions Health policymakers in several countries recognize the importance of using health systems evidence. Study findings are important in light of changes unfolding in some Arab countries and can help undertake an analysis of underlying transformations and their respective health policy implications including the way evidence will be used in policy decisions.
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Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, Room 107C, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
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Gross A, Forget M, St George K, Fraser MMH, Graham N, Perry L, Burnie SJ, Goldsmith CH, Haines T, Brunarski D. Patient education for neck pain. Cochrane Database Syst Rev 2012:CD005106. [PMID: 22419306 DOI: 10.1002/14651858.cd005106.pub4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Neck disorders are common, disabling, and costly. The effectiveness of patient education strategies is unclear. OBJECTIVES To assess the short- to long-term effects of therapeutic patient education (TPE) strategies on pain, function, disability, quality of life, global perceived effect, patient satisfaction, knowledge transfer, or behaviour change in adults with neck pain associated with whiplash or non-specific and specific mechanical neck pain with or without radiculopathy or cervicogenic headache. SEARCH METHODS We searched computerised bibliographic databases (inception to 11 July 2010). SELECTION CRITERIA Eligible studies were randomised controlled trials (RCT) investigating the effectiveness of TPE for acute to chronic neck pain. DATA COLLECTION AND ANALYSIS Paired independent review authors conducted selection, data abstraction, and 'Risk of bias' assessment. We calculated risk ratio (RR) and standardised mean differences (SMD). Heterogeneity was assessed; no studies were pooled. MAIN RESULTS Of the 15 selected trials, three were rated low risk of bias. Three TPE themes emerged.Advice focusing on activation: There is moderate quality evidence (one trial, 348 participants) that an educational video of advice focusing on activation was more beneficial for acute whiplash-related pain when compared with no treatment at intermediate-term [RR 0.79 (95% confidence interval (CI) 0.59 to 1.06)] but not long-term follow-up [0.89 (95% CI, 0.65 to 1.21)]. There is low quality evidence (one trial, 102 participants) that a whiplash pamphlet on advice focusing on activation is less beneficial for pain reduction, or no different in improving function and global perceived improvement from generic information given out in emergency care (control) for acute whiplash at short- or intermediate-term follow-up. Low to very low quality evidence (nine trials using diverse educational approaches) showed either no evidence of benefit or difference for varied outcomes. Advice focusing on pain & stress coping skills and workplace ergonomics: Very low quality evidence (three trials, 243 participants) favoured other treatment or showed no difference spanning numerous follow-up periods and disorder subtypes. Low quality evidence (one trial, 192 participants) favoured specific exercise training for chronic neck pain at short-term follow-up.Self-care strategies: Very low quality evidence (one trial, 58 participants) indicated that self-care strategies did not relieve pain for acute to chronic neck pain at short-term follow-up. AUTHORS' CONCLUSIONS With the exception of one trial, this review has not shown effectiveness for educational interventions, including advice to activate, advice on stress-coping skills, workplace ergonomics and self-care strategies. Future research should be founded on sound adult learning theory and learning skill acquisition.
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Affiliation(s)
- Anita Gross
- School of Rehabilitation Science&Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
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Pearson A, Jordan Z, Munn Z. Translational science and evidence-based healthcare: a clarification and reconceptualization of how knowledge is generated and used in healthcare. Nurs Res Pract 2012; 2012:792519. [PMID: 22474583 PMCID: PMC3306933 DOI: 10.1155/2012/792519] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 11/20/2011] [Indexed: 11/26/2022] Open
Abstract
The importance of basing health policy and health care practices on the best available international evidence ("evidence-based health care") and on translating knowledge or evidence into action ("translation science" or "translational research") is increasingly being emphasized across all health sectors inmost countries. Evidence-based healthcare is a process that identifies policy or clinical questions and addresses these questions by generating knowledge and evidence to effectively and appropriately deliver healthcare in ways that are effective, feasible, and meaningful to specific populations, cultures, and settings. This evidence is then appraised, synthesized, and transferred to service delivery settings and health professionals who then utilize it and evaluate its impact on health outcomes, health systems, and professional practice. Many of the common theories that address this translational process place it apart from the evidence-based practice cycle and most recognise only two translational gaps. This paper seeks to clarify the nature of evidence-based healthcare and translation science and proposes a reconceptualization that both brings together these two dominant ideas in modern healthcare and asserts the existence of a third fundamental gap that is rarely addressed the gap between knowledge need and discovery.
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Affiliation(s)
- Alan Pearson
- The Joanna Briggs Institute, The University of Adelaide, North Terrace, Adelaide, SA 5005, Australia
| | - Zoe Jordan
- The Joanna Briggs Institute, The University of Adelaide, North Terrace, Adelaide, SA 5005, Australia
| | - Zachary Munn
- The Joanna Briggs Institute, The University of Adelaide, North Terrace, Adelaide, SA 5005, Australia
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Orem JN, Mafigiri DK, Marchal B, Ssengooba F, Macq J, Criel B. Research, evidence and policymaking: the perspectives of policy actors on improving uptake of evidence in health policy development and implementation in Uganda. BMC Public Health 2012; 12:109. [PMID: 22316003 PMCID: PMC3305540 DOI: 10.1186/1471-2458-12-109] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 02/09/2012] [Indexed: 11/16/2022] Open
Abstract
Background Use of evidence in health policymaking plays an important role, especially in resource-constrained settings where informed decisions on resource allocation are paramount. Several knowledge translation (KT) models have been developed, but few have been applied to health policymaking in low income countries. If KT models are expected to explain evidence uptake and implementation, or lack of it, they must be contextualized and take into account the specificity of low income countries for example, the strong influence of donors. The main objective of this research is to elaborate a Middle Range Theory (MRT) of KT in Uganda that can also serve as a reference for other low- and middle income countries. Methods This two-step study employed qualitative approaches to examine the principal barriers and facilitating factors to KT. Step 1 involved a literature review and identification of common themes. The results informed the development of the initial MRT, which details the facilitating factors and barriers to KT at the different stages of research and policy development. In Step 2, these were further refined through key informant interviews with policymakers and researchers in Uganda. Deductive content and thematic analysis was carried out to assess the degree of convergence with the elements of the initial MRT and to identify other emerging issues. Results Review of the literature revealed that the most common emerging facilitating factors could be grouped under institutional strengthening for KT, research characteristics, dissemination, partnerships and political context. The analysis of interviews, however, showed that policymakers and researchers ranked institutional strengthening for KT, research characteristics and partnerships as the most important. New factors emphasized by respondents were the use of mainstreamed structures within MoH to coordinate and disseminate research, the separation of roles between researchers and policymakers, and the role of the community and civil society in KT. Conclusions This study refined an initial MRT on KT in policymaking in the health sector in Uganda that was based on a literature review. It provides a framework that can be used in empirical research of the process of KT on specific policy issues.
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Affiliation(s)
- Juliet Nabyonga Orem
- WHO Uganda office, Health systems and services cluster, P, O, Box 24578, Kampala, Uganda.
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El-Jardali F, Lavis JN, Ataya N, Jamal D. Use of health systems and policy research evidence in the health policymaking in eastern Mediterranean countries: views and practices of researchers. Implement Sci 2012; 7:2. [PMID: 22236561 PMCID: PMC3286421 DOI: 10.1186/1748-5908-7-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 01/11/2012] [Indexed: 11/10/2022] Open
Abstract
Background Limited research exists on researchers' knowledge transfer and exchange (KTE) in the eastern Mediterranean region (EMR). This multi-country study explores researchers' views and experiences regarding the role of health systems and policy research evidence in health policymaking in the EMR, including the factors that influence health policymaking, barriers and facilitators to the use of evidence, and the factors that increase researchers' engagement in KTE. Methods Researchers who published health systems and policy relevant research in 12 countries in the EMR (Bahrain, Egypt, Iran, Jordan, Lebanon, Libya, Morocco, Oman, Palestine, Sudan, Syria, and Yemen) were surveyed. Descriptive analysis and Linear Mixed Regression Models were performed for quantitative sections and the simple thematic analysis approach was used for open-ended questions. Results A total of 238 researchers were asked to complete the survey (response rate 56%). Researchers indicated transferring results to other researchers (67.2%) and policymakers in the government (40.5%). Less than one-quarter stated that they produced policy briefs (14.5%), disseminated messages that specified possible actions (24.4%), interacted with policymakers and stakeholders in priority-setting (16%), and involved them in their research (19.8%). Insufficient policy dialogue opportunities and collaboration between researchers and policymakers and stakeholders (67.9%), practical constraints to implementation (66%), non-receptive policy environment (61.3%), and politically sensitive findings (57.7%) hindered the use of evidence. Factors that increase researchers' engagement in KTE activities in the region were associated with involving policymakers and stakeholders at various stages such as priority-setting exercises and provision of technical assistance. Conclusions Researchers in the EMR recognize the importance of using health systems evidence in health policymaking. Potential strategies to improve the use of research evidence emphasize two-way communication between researchers and policymakers. Findings are critical for the upcoming World Health Report 2012, which will emphasize the significance of conducting and translating health research to inform health policies.
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Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon.
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Tomatis C, Taramona C, Rizo-Patrón E, Hernández F, Rodríguez P, Piscoya A, Gonzales E, Gotuzzo E, Heudebert G, Centor RM, Estrada CA. Evidence-based medicine training in a resource-poor country, the importance of leveraging personal and institutional relationships. J Eval Clin Pract 2011; 17:644-50. [PMID: 21276140 PMCID: PMC3145831 DOI: 10.1111/j.1365-2753.2011.01635.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Efforts to implement evidence-based medicine (EBM) training in developing countries are limited. We describe the results of an international effort to improve research capacity in a developing country; we conducted a course aimed at improving basic EBM attitudes and identified challenges. METHOD Between 2005 and 2009, we conducted an annual 3-day course in Perú consisting of interactive lectures and case-based workshops. We assessed self-reported competence and importance in EBM using a Likert scale (1 = low, 5 = high). RESULTS Totally 220 clinicians participated. For phase I (2005-2007), self-reported EBM competence increased from a median of 2 to 3 (P < 0.001) and the perceived importance of EBM did not change (median = 5). For phase II (2008-2009), before the course, 8-72% graded their competence very low (score of 1-2). After the course, 67-92% of subjects graded their increase in knowledge very high (score of 4-5). The challenges included limited availability of studies relevant to the local reality written in Spanish, participants' limited time and lack of long-term follow-up on practice change. Informal discussion and written evaluation from participants were universally in agreement that more training in EBM is needed. CONCLUSIONS In an EBM course in a resource-poor country, the baseline self-reported competence and experience on EBM were low, and the course had measurable improvements of self-reported competence, perceived utility and readiness to incorporate EBM into their practices. Similar to developed countries, translational research and building the research capacity in developing countries is critical for translating best available evidence into practice.
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Newborn care and knowledge translation - perceptions among primary healthcare staff in northern Vietnam. Implement Sci 2011; 6:29. [PMID: 21447179 PMCID: PMC3080332 DOI: 10.1186/1748-5908-6-29] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 03/29/2011] [Indexed: 11/17/2022] Open
Abstract
Background Nearly four million neonatal deaths occur annually in the world despite existing evidence-based knowledge with the potential to prevent many of these deaths. Effective knowledge translation (KT) could help to bridge this know-do gap in global health. The aim of this study was to explore aspects of KT at the primary healthcare level in a northern province in Vietnam. Methods Six focus-group discussions were conducted with primary healthcare staff members who provided neonatal care in districts that represented three types of geographical areas existing in the province (urban, rural, and mountainous). Recordings were transcribed verbatim, translated into English, and analyzed using content analysis. Results We identified three main categories of importance for KT. Healthcare staff used several channels for acquisition and management of knowledge (1), but none appeared to work well. Participants preferred formal training to reading guideline documents, and they expressed interest in interacting with colleagues at higher levels, which rarely happened. In some geographical areas, traditional medicine (2) seemed to compete with evidence-based practices, whereas in other areas it was a complement. Lack of resources, low frequency of deliveries and, poorly paid staff were observed barriers to keeping skills at an adequate level in the healthcare context (3). Conclusions This study indicates that primary healthcare staff work in a context that to some extent enables them to translate knowledge into practice. However, the established and structured healthcare system in Vietnam does constitute a base where such processes could be expected to work more effectively. To accelerate the development, thorough considerations over the current situation and carefully targeted actions are required.
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Shokoohi M, Nedjat S, Golestan B, Soltani A, Majdzadeh R. Can criteria for identifying educational influentials in developed countries be applied to other countries? A study in Iran. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2011; 31:95-102. [PMID: 21671275 DOI: 10.1002/chp.20112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION There are published criteria for identifying educational influentials (EIs). These criteria are based on studies that have been performed in developed countries. This study was performed to identify criteria and characteristics of EIs in Iran. METHODS The study was conducted on residents, interns, and clerks at a major educational hospital in Iran. This study had 3 stages: (1) preparation of an inclusive list of EI characteristics through 3 focus group discussions with 22 individuals, in which 30 primary characteristics of EIs were found; (2) reducing the number of characteristics by examining 154 individuals for exploratory factor analysis and internal consistency evaluation by Cronbach's alpha, after which the characteristics were reduced to 25; (3) finalizing the criteria through discriminant validity. RESULTS Fifteen characteristics were identified in 4 domains: (1) knowledge (high level of clinical knowledge, being up-to-date and an expert, high level of clinical skills); (2) communication skills (good communication with others, easily accessible, good public relations, and oratory); (3) taking into account the stakeholders (involving patients in decision making, allowing students to identify problems, delivering decisions to others, and interest in transfer of material); and (4) professional ethics (pursuing the patients' maximum benefit, observing ethics in education and research). Overall, they have a sensitivity and specificity of 87% and 74%, respectively. DISCUSSION Three of the four domains we found were already identified in other studies; however, the "taking into account the stakeholders" domain has not been previously reported. The other domains and criteria were similar to those found in developed countries.
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Kohn MK, Berta W, Langley A, Davis D. Evidence-based decision making in health care settings: from theory to practice. Adv Health Care Manag 2011; 11:215-34. [PMID: 22908671 DOI: 10.1108/s1474-8231(2011)0000011012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The relatively recent attention that evidence-based decision making has received in health care management has been at least in part due to the profound influence of evidence-based medicine. The result has been several comparisons in the literature between the use of evidence in health care management decisions and the use of evidence in medical decision making. Direct comparison, however, may be problematic, given the differences between medicine and management as they relate to (1) the nature of evidence that is brought to bear on decision making; (2) the maturity of empirical research in each field (in particular, studies that have substantiated whether or not and how evidence-based decision making is enacted); and (3) the context within which evidence-based decisions are made. By simultaneously reviewing evidence-based medicine and management, this chapter aims to inform future theorizing and empirical research on evidence-based decision making in health care settings.
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Affiliation(s)
- Melanie Kazman Kohn
- Department of Health Policy, Management, and Evaluation, Faculty of Medicine, University of Toronto, ON, Canada
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Alvaro C, Lyons RF, Warner G, Hobfoll SE, Martens PJ, Labonté R, Brown RE. Conservation of resources theory and research use in health systems. Implement Sci 2010; 5:79. [PMID: 20961445 PMCID: PMC2978118 DOI: 10.1186/1748-5908-5-79] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 10/20/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health systems face challenges in using research evidence to improve policy and practice. These challenges are particularly evident in small and poorly resourced health systems, which are often in locations (in Canada and globally) with poorer health status. Although organizational resources have been acknowledged as important in understanding research use resource theories have not been a focus of knowledge translation (KT) research. What resources, broadly defined, are required for KT and how does their presence or absence influence research use?In this paper, we consider conservation of resources (COR) theory as a theoretical basis for understanding the capacity to use research evidence in health systems. Three components of COR theory are examined in the context of KT. First, resources are required for research uptake. Second, threat of resource loss fosters resistance to research use. Third, resources can be optimized, even in resource-challenged environments, to build capacity for KT. METHODS A scan of the KT literature examined organizational resources needed for research use. A multiple case study approach examined the three components of COR theory outlined above. The multiple case study consisted of a document review and key informant interviews with research team members, including government decision-makers and health practitioners through a retrospective analysis of four previously conducted applied health research studies in a resource-challenged region. RESULTS The literature scan identified organizational resources that influence research use. The multiple case study supported these findings, contributed to the development of a taxonomy of organizational resources, and revealed how fears concerning resource loss can affect research use. Some resources were found to compensate for other resource deficits. Resource needs differed at various stages in the research use process. CONCLUSIONS COR theory contributes to understanding the role of resources in research use, resistance to research use, and potential strategies to enhance research use. Resources (and a lack of them) may account for the observed disparities in research uptake across health systems. This paper offers a theoretical foundation to guide further examination of the COR-KT ideas and necessary supports for research use in resource-challenged environments.
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Affiliation(s)
- Celeste Alvaro
- Atlantic Health Promotion Research Centre, Faculty of Health Professions, Dalhousie University, Canada
| | - Renée F Lyons
- Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Health, University of Toronto; Atlantic Health Promotion Research Centre, Dalhousie University, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Canada
| | - Stevan E Hobfoll
- Department of Behavioral Sciences at Rush University and Medical College, USA
| | - Patricia J Martens
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Canada
| | - Ronald Labonté
- Institute of Population Health, Department of Epidemiology and Community Medicine, University of Ottawa, Canada
| | - Richard E Brown
- UCLA Center for Health Policy Research, School of Public Health, University of California, USA
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Drake JK, Hutchings JE, Elias CJ. Making evidence work for communities: the role of nongovernmental organizations in translating science to programs. J Womens Health (Larchmt) 2010; 19:2119-24. [PMID: 20874239 DOI: 10.1089/jwh.2010.2050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Evidence-informed public health refers to the process of applying proven interventions within the context of community preferences in order to achieve positive health impacts. A key role for nongovernmental organizations (NGOs) in evidence-informed public health is to use and expand on research to help shape appropriate interventions for diverse communities. This article suggests that NGOs are particularly well positioned for this role for a number of reasons, including their geographic reach, their engagement with diverse stakeholders, and their extragovernmental position, which enables them to develop and advocate for innovative, scientifically sound solutions to long-standing health challenges. Three case studies are presented that highlight how NGOs can harness these advantages to shape evidence-informed policies and programs to improve women's health: PATH's multicountry HPV Vaccines project, the International Consortium for Emergency Contraception, and a collaborative effort to combat maternal mortality in Mali.
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