Contextual influences on knowledge translation capacity in a nursing home organisation: A phenomenological hermeneutical study.

INTRODUCTION: The demand for advanced clinical care in nursing homes (NHs) is increasing. Evidence-based practices and knowledge translation (KT) initiatives are growing to bridge the gap between what is known and what is done. However, research on contextual influence on KT has primarily focused on hospital settings. AIM: To expand our understanding of contextual influences on KT capacity in a NH organisation. DESIGN AND METHODS: Lindseth and Norberg's phenomenological hermeneutical method was used to explore and describe practice development nurses' experiences, perspectives and practices regarding how contextual factors influence KT capacity in NHs. Focus group interviews, participant observations, in-depth interviews and non-participant observations provided the data. RESULTS: Two main themes and four subthemes were identified. (1) Continuous limited resources are a cultural condition that inhibits KT readiness; prioritising keeping the NH machinery running at all costs and having contrasting care philosophies undermines KT. (2) Organisational prioritisations leave KT as a missing cogwheel in the machinery; retaining a system of fragmented KT strategies and lacking a structure for collective KT effort. CONCLUSION: The study showed that KT held a minor role in the fast-paced NH machinery. Contradicting values characterise the NH organisation, resulting in a lack of a common vision and priorities. Building a sustainable KT capacity and providing evidence-based practice necessitates explicit responsibilities, dedicated resources and robust organisational support. Management has a critical role in strengthening the position of KT. Incorporating KT in daily NH practice can help staff become adaptable and confident, capable of meeting the increasing challenges of advanced care that alleviates suffering and promote the health and well-being of NH patients.

Individual and organizational features of a favorable work environment in nursing homes: a cross-sectional study.

BACKGROUND: The organizational context in healthcare (i.e., the work environment) is associated with patient outcomes and job satisfaction. Long-term care is often considered to be a challenging work environment, characterized by high job demands, low job control, a fast work pace and job dissatisfaction, which may affect patient care and increase staff turnover.This study aims to investigate the organizational context in nursing homes and the features of favorable or less favorable work environments. METHODS: This study is a cross-sectional study of registered nurses and licensed practical nurses in Bergen, Norway (n = 1014). The K-means clustering algorithm was used to differentiate between favorable and less favorable work environments, based on the Alberta Context Tool. Multilevel logistic regression analysis was used to investigate the associations between individual sociodemographic factors, nursing home factors and the probability of experiencing a favorable work environment. RESULTS: 45% of the sample (n = 453) experienced working in a favorable work environment. Contextual features (especially a supportive work culture, more evaluation mechanisms and greater organizational slack resources) and individual features (having a native language other than Norwegian, working day shifts, working full time and belonging to a younger age group) significantly increased the likelihood of experiencing a favorable work environment. CONCLUSION: The work environment in nursing homes is composed of modifiable contextual features. Action in relation to less favorable features and their associated factors should be a priority for nursing home management. This survey indicates that specific steps can be taken to reduce the reliance on part-time workers and to promote the work environment among staff working the night shift.

Integrated knowledge translation in nursing homes: exploring the experiences of practice development nurses.

BACKGROUND: Practice Development Nurses (PDNs) in Norwegian nursing homes (NHs) hold a specific responsibility for knowledge translation in this increasingly complex healthcare setting. They were involved as end users in an integrated knowledge translation (IKT) study, developing, testing and evaluating the IMPAKT (IMPlementation of Action to Knowledge Translation) intervention. PDNs participated in an educational programme tailored to their own defined needs. In a second intervention component, the PDNs applied their new skills with facilitation, in implementing the National Early Warning Score (NEWS2) in their respective NHs. The aim of this study was to explore 1) the PDNs' experiences of participating in an IKT educational intervention, and 2) how they applied the learning in planning, tailoring and initial implementation of the NEWS2. METHODS: This is a qualitative exploratory study based on a phenomenological hermeneutical method. Study participants were PDNs working in the nine NHs in the intervention group of the IMPAKT trial. We conducted nine in-depth interviews and eight non-participatory observational sessions of the intervention delivery. RESULTS: The PDNs expressed that the educational programme met their needs and enhanced their understanding about leading knowledge translation (KT). They reported a move from operating in a "big black box of implementation" to a professional and structured mode of KT. The gamechanger was a shift from KT as the PDNs' individual responsibility to KT as an organizational matter. The PDNs reported enhanced competencies in KT and in their ability to involve and collaborate with others in their facility. Organizational contextual factors challenged their KT efforts and implementation of the NEWS2. CONCLUSIONS: This study demonstrates that an IKT approach has the potential to advance and improve staff competencies and NH readiness for KT. However, individual motivations and competencies were challenged within an organizational culture which was less receptive to this new leadership role and level of KT activity.

Optimizing a knowledge translation intervention: a qualitative formative study to capture knowledge translation needs in nursing homes.

BACKGROUND: Knowledge translation (KT) has emerged as an important consideration to reduce knowledge-to-practice gaps in healthcare settings. Research on KT approaches in nursing homes (NHs) is lacking. There is a need to understand the challenges faced in NHs and how these can be managed. This study is part of the larger IMPAKT (IMPlementation and Action for Knowledge Translation) study which addresses KT in NHs. The aim of the study presented here was to identify crucial staff and organizational needs in order to inform the development of a KT intervention in NHs. METHODS: A multimethod qualitative approach was applied. We invited practice development nurses (PDNs) to describe current practice, and to identify problems and needs concerning KT in NHs. We followed the recommendations of the development phase of the MRC framework for developing complex interventions. Data were collected through four focus groups and participatory observations in six NHs. Analysis was conducted according to structural thematic analysis based on a phenomenological hermeneutic method. RESULTS: We identified three themes that expressed the PDNs' perceived needs for successful KT implementation: (1) narrowing the PDN role, (2) developing an EBP culture and (3) establishing collaborative alliances. Nine subthemes derived from the PDNs' experiences and current practice, illustrating needs at individual, relational and organizational levels. CONCLUSIONS: Rigorous development of complex interventions may add relevance to the intervention, increase the likelihood of success and reduce research waste. Insight into the NH context and organization have helped us define problems and articulate needs that must be addressed when tailoring the IMPAKT intervention. TRIAL REGISTRATION: The IMPAKT trial was retrospectively registered in the ISRCTN Registry (Trial ID: 12,437,773) on March 19th, 2020.

A catalyst for system change: a case study of child health network formation, evolution and sustainability in Canada.

BACKGROUND: The purpose of this study was to examine key processes and supportive and inhibiting factors involved in the development, evolution, and sustainability of a child health network in rural Canada. This study contributes to a relatively new research agenda aimed at understanding inter-organizational and cross-sectoral health networks. These networks encourage collaboration focusing on complex issues impacting health - issues that individual agencies cannot effectively address alone. This paper presents an overview of the study findings. METHODS: An explanatory qualitative case study approach examined the Network's 13-year lifespan. Data sources were documents and Network members, including regional and 71 provincial senior managers from 11 child and youth service sectors. Data were collected through 34 individual interviews and a review of 127 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis. RESULTS: Three themes related to network development, evolution and sustainability were identified: (a) Network relationships as system triggers, (b) Network-mediated system responsiveness, and (c) Network practice as political. CONCLUSIONS: Study findings have important implications for network organizational development, collaborative practice, interprofessional education, public policy, and public system responsiveness research. Findings suggest it is important to explicitly focus on relationships and multi-level socio-political contexts, such as supportive policy environments, in understanding health networks. The dynamic interplay among the Network members; central supportive and inhibiting factors; and micro-, meso-, and macro-organizational contexts was identified.

Information Seeking When Problem Solving: Perspectives of Public Health Professionals.

OBJECTIVES: Given the many different types of professionals working in public health and their diverse roles, it is likely that their information needs, information-seeking behaviors, and problem-solving abilities differ. Although public health professionals often work in interdisciplinary teams, few studies have explored their information needs and behaviors within the context of teamwork. This study explored the relationship between Canadian public health professionals' perceptions of their problem-solving abilities and their information-seeking behaviors with a specific focus on the use of evidence in practice settings. It also explored their perceptions of collaborative information seeking and the work contexts in which they sought information. METHODS: Key Canadian contacts at public health organizations helped recruit study participants through their list-servs. An electronic survey was used to gather data about (a) individual information-seeking behaviors, (b) collaborative information-seeking behaviors, (c) use of evidence in practice environments, (d) perceived problem-solving abilities, and (e) demographic characteristics. RESULTS: Fifty-eight public health professionals were recruited, with different roles and representing most Canadian provinces and one territory. A significant relationship was found between perceived problem-solving abilities and collaborative information-seeking behavior (r = -.44, p < .00, N = 58), but not individual information seeking. The results suggested that when public health professionals take a shared, active approach to problem solving, maintain personal control, and have confidence, they are more likely collaborate with others in seeking information to complete a work task. LINKING EVIDENCE TO ACTION: Administrators of public health organizations should promote collaboration by implementing effective communication and information-seeking strategies, and by providing information resources and retrieval tools. Public health professionals' perceived problem-solving abilities can influence how they collaborate in seeking information. Educators in public health organizations should tailor training in information searching to promote collaboration through collaborative technology systems.

Educating change agents: a qualitative descriptive study of graduates of a Master's program in evidence-based practice.

BACKGROUND: Health care professionals are expected to build decisions upon evidence. This implies decisions based on the best available, current, valid and relevant evidence, informed by clinical expertise and patient values. A multi-professional master's program in evidence-based practice was developed and offered. The aims of this study were to explore how students in this program viewed their ability to apply evidence-based practice and their perceptions of what constitute necessary conditions to implement evidence-based practice in health care organizations, one year after graduation. METHODS: A qualitative descriptive design was chosen to examine the graduates' experiences. All students in the first two cohorts of the program were invited to participate. Six focus-group interviews, with a total of 21 participants, and a telephone interview of one participant were conducted. The data was analyzed thematically, using the themes from the interview guide as the starting point. RESULTS: The graduates reported that an overall necessary condition for evidence-based practice to occur is the existence of a "readiness for change" both at an individual level and at the organizational level. They described that they gained personal knowledge and skills to be "change-agents" with "self-efficacy, "analytic competence" and "tools" to implement evidence based practice in clinical care. An organizational culture of a "learning organization" was also required, where leaders have an "awareness of evidence- based practice", and see the need for creating "evidence-based networks". CONCLUSIONS: One year after graduation the participants saw themselves as "change agents" prepared to improve clinical care within a learning organization. The results of this study provides useful information for facilitating the implementation of EBP both from educational and health care organizational perspectives.

Management Involvement--A Decisive Condition When Implementing Evidence-Based Practice.

BACKGROUND: Even though health professionals have a positive attitude toward evidence-based practice (EBP), they have limited skills when it comes to implementation of EBP. A postprofessional program in EPB has been offered at Bergen University College since 2004. To date, there is limited knowledge of how the graduates of the program implement and make use of the EBP principles in their working environment in different healthcare settings. AIM: The aim of the study was to explore the facilitators and strategies to successful implementation of the steps of EBP as experienced by health professionals who had completed a postgraduate program in EBP. METHODS: Grounded theory was used in gathering and analyzing data from single and focus group interviews of 20 health professionals who had attended a postprofessional program in EBP. Inclusion criteria also required current clinical practice. RESULTS: This study identified a specific set of activities used by health professionals when implementing EBP within their service organization. Creating an interest and understanding of EBP amongst their colleagues appeared to be a challenge, which they addressed by using the generated grounded theory of "tailoring principles." The dominant condition of this theory was management involvement. LINKING EVIDENCE TO ACTION: This study highlighted the importance of middle-range managers' coordinating and supporting role as a decisive component in the process of implementing EBP to clinical settings in Norway. Moreover, the dynamic complex process of "tailoring principles" also showed how the production of a clinical protocol became an outcome of implementation effectiveness as well as input for further intervention effectiveness. Tailoring the principle of EBP to the organizational and cultural context facilitated the implementation of EBP.

Evaluating the impact of an intensive education workshop on evidence-informed decision making knowledge, skills, and behaviours: a mixed methods study.

BACKGROUND: Health professionals require a unique set of knowledge and skills in order to meet increasing expectations to use research evidence to inform practice and policy decisions. They need to be able to find, access, interpret, and apply the best available research evidence, along with information about patient preferences, clinical expertise, and the clinical context and resources, to such decisions. This study determined preferences for continuing education following an intensive educational workshop and evaluated the impact of the workshop on evidence informed decision making (EIDM) knowledge, skills, and behaviours. METHODS: An explanatory mixed methods, longitudinal study design was implemented among a convenience sample of various health care professionals attending the workshop. EIDM knowledge, skills, and behaviours were quantitatively measured at baseline and six month follow-up, with EIDM knowledge and skills measured additionally immediately following the educational workshop (post-test measurement). To determine participants preferences for continuing education, data were collected using quantitative survey (post-test measurement) and qualitative (individual telephone interviews after six-month follow-up) methods. RESULTS: EIDM knowledge and skills increased significantly from baseline to immediately following the intervention [5.6, 95% CI (3.7, 7.4), P < 0.001] and from baseline to six-month follow-up [3.7, 95% CI (2.1, 5.3), P < 0.001], with a significant decrease from immediately following the intervention to six-month follow-up [-1.9, 95% CI (-3.5, -0.3), P 0.018]. EIDM behaviours increased, but not significantly, from baseline to six-month follow-up [1.7, 95% CI (-0.3, 3.8), P 0.095]. At baseline and six-month follow-up there was a weak, non-significant positive correlation between EIDM knowledge and skills and EIDM behaviours (r = 0.29, P 0.069 and r = 0.24, P 0.136, respectively). Over time there was a shift in preferences for timing and frequency of online continuing education strategies. Willingness to participate in continuing education, however, remained evident. CONCLUSIONS: An intensive educational workshop shows promise for increasing EIDM knowledge and skills. Increasing EIDM knowledge and skills may promote the capacity of health professionals to use research evidence when making practice and policy decisions and, in turn, lead to positive patient outcomes.

Knowledge translation strategies for enhancing nurses' evidence-informed decision making: a scoping review.

BACKGROUND: Nurses are increasingly expected to engage in evidence-informed decision making (EIDM); the use of research evidence with information about patient preferences, clinical context and resources, and their clinical expertise in decision making. Strategies for enhancing EIDM have been synthesized in high-quality systematic reviews, yet most relate to physicians or mixed disciplines. Existing reviews, specific to nursing, have not captured a broad range of strategies for promoting the knowledge and skills for EIDM, patient outcomes as a result of EIDM, or contextual information for why these strategies "work." AIM: To conduct a scoping review to identify and map the literature related to strategies implemented among nurses in tertiary care for promoting EIDM knowledge, skills, and behaviours, as well as patient outcomes and contextual implementation details. METHODS: A search strategy was developed and executed to identify relevant research evidence. Participants included registered nurses, clinical nurse specialists, nurse practitioners, and advanced practice nurses. Strategies were those enhancing nurses' EIDM knowledge, skills, or behaviours, as well as patient outcomes. Relevant studies included systematic reviews, randomized controlled trials, cluster randomized controlled trials, non-randomized trials (including controlled before and after studies), cluster non-randomized trials, interrupted time series designs, prospective cohort studies, mixed-method studies, and qualitative studies. Two reviewers performed study selection and data extraction using standardized forms. Disagreements were resolved through discussion or third party adjudication. RESULTS: Using a narrative synthesis, the body of research was mapped by design, clinical areas, strategies, and provider and patient outcomes to determine areas appropriate for a systematic review. CONCLUSIONS: There are a sufficiently high number of studies to conduct a more focused systematic review by care settings, study design, implementation strategies, or outcomes. A focused review could assist in determining which strategies can be recommended for enhancing EIDM knowledge, skills, and behaviours among nurses in tertiary care.

Occupational Therapy Students' Evidence-Based Practice Skills as Reported in a Mobile App: Cross-Sectional Study.

BACKGROUND: Evidence-based practice (EBP) is an important aspect of the health care education curriculum. EBP involves following the 5 EBP steps: ask, assess, appraise, apply, and audit. These 5 steps reflect the suggested core competencies covered in teaching and learning programs to support future health care professionals applying EBP. When implementing EBP teaching, assessing outcomes by documenting the student's performance and skills is relevant. This can be done using mobile devices. OBJECTIVE: The aim of this study was to assess occupational therapy students' EBP skills as reported in a mobile app. METHODS: We applied a cross-sectional design. Descriptive statistics were used to present frequencies, percentages, means, and ranges of data regarding EBP skills found in the EBPsteps app. Associations between students' ability to formulate the Population, Intervention, Comparison, and Outcome/Population, Interest, and Context (PICO/PICo) elements and identifying relevant research evidence were analyzed with the chi-square test. RESULTS: Of 4 cohorts with 150 students, 119 (79.3%) students used the app and produced 240 critically appraised topics (CATs) in the app. The EBP steps "ask," "assess," and "appraise" were often correctly performed. The clinical question was formulated correctly in 53.3% (128/240) of the CATs, and students identified research evidence in 81.2% (195/240) of the CATs. Critical appraisal checklists were used in 81.2% (195/240) of the CATs, and most of these checklists were assessed as relevant for the type of research evidence identified (165/195, 84.6%). The least frequently correctly reported steps were "apply" and "audit." In 39.6% (95/240) of the CATs, it was reported that research evidence was applied. Only 61% (58/95) of these CATs described how the research was applied to clinical practice. Evaluation of practice changes was reported in 38.8% (93/240) of the CATs. However, details about practice changes were lacking in all these CATs. A positive association was found between correctly reporting the "population" and "interventions/interest" elements of the PICO/PICo and identifying research evidence (P<.001). CONCLUSIONS: We assessed the students' EBP skills based on how they documented following the EBP steps in the EBPsteps app, and our results showed variations in how well the students mastered the steps. "Apply" and "audit" were the most difficult EBP steps for the students to perform, and this finding has implications and gives directions for further development of the app and educational instruction in EBP. The EBPsteps app is a new and relevant app for students to learn and practice EBP, and it can be used to assess students' EBP skills objectively.

Minimizing the risk of intrusion: a grounded theory of intimate partner violence disclosure in emergency departments.

AIMS: To report a study of processes used by women to disclose intimate partner violence to healthcare professionals in urban emergency department settings. BACKGROUND: Women seek emergency care for impairment related to intimate partner violence yet face barriers non-judgmental and supportive care. DESIGN: A two-phase sequential explanatory mixed methods study. METHODS: The study was conducted in Ontario, Canada (May 2006-December 2007). In a sub-analysis of quantitative data with 1182 participants, 15% of women patients reported intimate partner violence, but only 2% disclosed to a healthcare professional. To understand these results, grounded theory with 19 participants was completed. RESULTS/FINDINGS: Participants identified that the basic social problem was the violence 'being found out' by healthcare professionals while receiving care. To address this problem, women undertook a process to minimize intrusion including: deciding to seek care, evaluating the level of trust with the presenting healthcare professional, and establishing personal readiness to disclose. The trajectory of this process was different for each participant with some negotiating all phases leading to violence disclosure. The length of time it took for participants to move through each phase varied across all participants. Common to all participants was the anticipation and the actual experience of intrusion and its influence on women's willingness to disclose intimate partner violence. CONCLUSION: The results suggest nurses may be able to facilitate disclosure of intimate partner violence through limiting intrusion. This can include assessment in a private setting, and fewer professionals who interact with the client.

Building capacity for evidence informed decision making in public health: a case study of organizational change.

BACKGROUND: Core competencies for public health in Canada require proficiency in evidence informed decision making (EIDM). However, decision makers often lack access to information, many workers lack knowledge and skills to conduct systematic literature reviews, and public health settings typically lack infrastructure to support EIDM activities. This research was conducted to explore and describe critical factors and dynamics in the early implementation of one public health unit's strategic initiative to develop capacity to make EIDM standard practice. METHODS: This qualitative case study was conducted in one public health unit in Ontario, Canada between 2008 and 2010. In-depth information was gathered from two sets of semi-structured interviews and focus groups (n = 27) with 70 members of the health unit, and through a review of 137 documents. Thematic analysis was used to code the key informant and document data. RESULTS: The critical factors and dynamics for building EIDM capacity at an organizational level included: clear vision and strong leadership, workforce and skills development, ability to access research (library services), fiscal investments, acquisition and development of technological resources, a knowledge management strategy, effective communication, a receptive organizational culture, and a focus on change management. CONCLUSION: With leadership, planning, commitment and substantial investments, a public health department has made significant progress, within the first two years of a 10-year initiative, towards achieving its goal of becoming an evidence informed decision making organization.

Community-based interventions for enhancing access to or consumption of fruit and vegetables among five to 18-year olds: a scoping review.

BACKGROUND: Low fruit and vegetable ( FV) consumption is a key risk factor for morbidity and mortality. Consumption of FV is limited by a lack of access to FV. Enhanced understanding of interventions and their impact on both access to and consumption of FV can provide guidance to public health decision-makers. The purpose of this scoping review is to identify and map literature that has evaluated effects of community-based interventions designed to increase FV access or consumption among five to 18-year olds. METHODS: The search included 21 electronic bibliographic databases, grey literature, targeted organization websites, and 15 key journals for relevant studies published up to May 2011. Retrieved citations were screened in duplicate for relevance. Data extracted from included studies covered: year, country, study design, target audience, intervention setting, intervention strategies, interventionists, and reported outcomes. RESULTS: The search located 19,607 unique citations. Full text relevance screening was conducted on 1,908 studies. The final 289 unique studies included 30 knowledge syntheses, 27 randomized controlled trials, 55 quasi-experimental studies, 113 cluster controlled studies, 60 before-after studies, one mixed method study, and three controlled time series studies. Of these studies, 46 included access outcomes and 278 included consumption outcomes. In terms of target population, 110 studies focused on five to seven year olds, 175 targeted eight to 10 year olds, 192 targeted 11 to 14 year olds, 73 targeted 15 to 18 year olds, 55 targeted parents, and 30 targeted teachers, other service providers, or the general public. The most common intervention locations included schools, communities or community centres, and homes. Most studies implemented multi-faceted intervention strategies to increase FV access or consumption. CONCLUSIONS: While consumption measures were commonly reported, this review identified a small yet important subset of literature examining access to FV. This is a critically important issue since consumption is contingent upon access. Future research should examine the impact of interventions on direct outcome measures of FV access and a focused systematic review that examines these interventions is also needed. In addition, research on interventions in low- and middle-income countries is warranted based on a limited existing knowledge base.

The effectiveness of knowledge translation strategies used in public health: a systematic review.

BACKGROUND: Literature related to the effectiveness of knowledge translation (KT) strategies used in public health is lacking. The capacity to seek, analyze, and synthesize evidence-based information in public health is linked to greater success in making policy choices that have the best potential to yield positive outcomes for populations. The purpose of this systematic review is to identify the effectiveness of KT strategies used to promote evidence-informed decision making (EIDM) among public health decision makers. METHODS: A search strategy was developed to identify primary studies published between 2000-2010. Studies were obtained from multiple electronic databases (CINAHL, Medline, EMBASE, and the Cochrane Database of Systematic Reviews). Searches were supplemented by hand searching and checking the reference lists of included articles. Two independent review authors screened studies for relevance, assessed methodological quality of relevant studies, and extracted data from studies using standardized tools. RESULTS: After removal of duplicates, the search identified 64, 391 titles related to KT strategies. Following title and abstract review, 346 publications were deemed potentially relevant, of which 5 met all relevance criteria on full text screen. The included publications were of moderate quality and consisted of five primary studies (four randomized controlled trials and one interrupted time series analysis). Results were synthesized narratively. Simple or single KT strategies were shown in some circumstances to be as effective as complex, multifaceted ones when changing practice including tailored and targeted messaging. Multifaceted KT strategies led to changes in knowledge but not practice. Knowledge translation strategies shown to be less effective were passive and included access to registries of pre-processed research evidence or print materials. While knowledge brokering did not have a significant effect generally, results suggested that it did have a positive effect on those organizations that at baseline perceived their organization to place little value on evidence-informed decision making. CONCLUSIONS: No singular KT strategy was shown to be effective in all contexts. Conclusions about interventions cannot be taken on their own without considering the characteristics of the knowledge that was being transferred, providers, participants and organizations.

Usability Methods and Attributes Reported in Usability Studies of Mobile Apps for Health Care Education: Scoping Review.

BACKGROUND: Mobile devices can provide extendable learning environments in higher education and motivate students to engage in adaptive and collaborative learning. Developers must design mobile apps that are practical, effective, and easy to use, and usability testing is essential for understanding how mobile apps meet users' needs. No previous reviews have investigated the usability of mobile apps developed for health care education. OBJECTIVE: The aim of this scoping review is to identify usability methods and attributes in usability studies of mobile apps for health care education. METHODS: A comprehensive search was carried out in 10 databases, reference lists, and gray literature. Studies were included if they dealt with health care students and usability of mobile apps for learning. Frequencies and percentages were used to present the nominal data, together with tables and graphical illustrations. Examples include a figure of the study selection process, an illustration of the frequency of inquiry usability evaluation and data collection methods, and an overview of the distribution of the identified usability attributes. We followed the Arksey and O'Malley framework for scoping reviews. RESULTS: Our scoping review collated 88 articles involving 98 studies, mainly related to medical and nursing students. The studies were conducted from 22 countries and were published between 2008 and 2021. Field testing was the main usability experiment used, and the usability evaluation methods were either inquiry-based or based on user testing. Inquiry methods were predominantly used: 1-group design (46/98, 47%), control group design (12/98, 12%), randomized controlled trials (12/98, 12%), mixed methods (12/98, 12%), and qualitative methods (11/98, 11%). User testing methods applied were all think aloud (5/98, 5%). A total of 17 usability attributes were identified; of these, satisfaction, usefulness, ease of use, learning performance, and learnability were reported most frequently. The most frequently used data collection method was questionnaires (83/98, 85%), but only 19% (19/98) of studies used a psychometrically tested usability questionnaire. Other data collection methods included focus group interviews, knowledge and task performance testing, and user data collected from apps, interviews, written qualitative reflections, and observations. Most of the included studies used more than one data collection method. CONCLUSIONS: Experimental designs were the most commonly used methods for evaluating usability, and most studies used field testing. Questionnaires were frequently used for data collection, although few studies used psychometrically tested questionnaires. The usability attributes identified most often were satisfaction, usefulness, and ease of use. The results indicate that combining different usability evaluation methods, incorporating both subjective and objective usability measures, and specifying which usability attributes to test seem advantageous. The results can support the planning and conduct of future usability studies for the advancement of mobile learning apps in health care education. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/19072.

A pragmatic evaluation of a public health knowledge broker mentoring education program: a convergent mixed methods study.

BACKGROUND: Public health professionals are expected to use the best available research and contextual evidence to inform decision-making. The National Collaborating Centre for Methods and Tools developed, implemented, and evaluated a Knowledge Broker mentoring program aimed at facilitating organization-wide evidence-informed decision-making in ten public health units in Ontario, Canada. The purpose of this study was to pragmatically assess the impact of the program. METHODS: A convergent mixed methods design was used to interpret quantitative results in the context of the qualitative findings. A goal-setting exercise was conducted with senior leadership in each organization prior to implementing the program. Achievement of goals was quantified through deductive coding of post-program interviews with participants and management. Interviews analyzed inductively to qualitatively explain progress toward identified goals and identify key factors related to implementation of EIDM within the organization. RESULTS: Organizations met their goals for evidence use to varying degrees. The key themes identified that support an organizational shift to EIDM include definitive plans for participants to share knowledge during and after program completion, embedding evidence into decision-making processes, and supportive leadership with organizational investment of time and resources. The location, setting, or size of health units was not associated with attainment of EIDM goals; small, rural health units were not at a disadvantage compared to larger, urban health units. CONCLUSIONS: The Knowledge Broker mentoring program allowed participants to share their learning and support change at their health units. When paired with organizational supports such as supportive leadership and resource investment, this program holds promise as an innovative knowledge translation strategy for organization wide EIDM among public health organizations.

Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review.

BACKGROUND: Research on interventions to positively impact health and housing status of people who are homeless has received substantially increased attention over the past 5 years. This rapid review examines recent evidence regarding interventions that have been shown to improve the health of homeless people, with particular focus on the effect of these interventions on housing status. METHODS: A total of 1,546 articles were identified by a structured search of five electronic databases, a hand search of grey literature and relevant journals, and contact with experts. Two reviewers independently screened the first 10% of titles and abstracts for relevance. Inter-rater reliability was high and as a result only one reviewer screened the remaining titles and abstracts. Articles were included if they were published between January 2004 and December 2009 and examined the effectiveness of an intervention to improve the health or healthcare utilization of people who were homeless, marginally housed, or at risk of homelessness. Two reviewers independently scored all relevant articles for quality. RESULTS: Eighty-four relevant studies were identified; none were of strong quality while ten were rated of moderate quality. For homeless people with mental illness, provision of housing upon hospital discharge was effective in improving sustained housing. For homeless people with substance abuse issues or concurrent disorders, provision of housing was associated with decreased substance use, relapses from periods of substance abstinence, and health services utilization, and increased housing tenure. Abstinent dependent housing was more effective in supporting housing status, substance abstinence, and improved psychiatric outcomes than non-abstinence dependent housing or no housing. Provision of housing also improved health outcomes among homeless populations with HIV. Health promotion programs can decrease risk behaviours among homeless populations. CONCLUSIONS: These studies provide important new evidence regarding interventions to improve health, housing status, and access to healthcare for homeless populations. The additional studies included in this current review provide further support for earlier evidence which found that coordinated treatment programs for homeless persons with concurrent mental illness and substance misuse issues usually result in better health and access to healthcare than usual care. This review also provides a synthesis of existing evidence regarding interventions that specifically support homeless populations with HIV.

Experiences with using a mobile application for learning evidence-based practice in health and social care education: An interpretive descriptive study.

BACKGROUND: Health and social care students are expected to apply evidence-based practice (EBP). An innovative mobile application, EBPsteps, was developed to support learning EBP. AIM: The aim of this study was to explore health and social care students' experiences of learning about EBP using the mobile application EBPsteps during their clinical placements. METHODS: An interpretive description approach guided the exploration of student experiences. Four focus groups were conducted with a convenience sample of students from three undergraduate degree programs: occupational therapy, physical therapy, and social education. The constant comparison method was used to categorize and compare the qualitative data. RESULTS: Three integrated themes were generated: "triggers for EBP", "barriers to EBP", and "design matters". Information needs, academic requirements, and encouragement from clinical instructors triggered the students to use EBPsteps. Lack of EBP knowledge, lack of academic demand, and lack of emphasis on EBP in clinical placement were barriers to using EBPsteps. Design issues mattered, as use of the app was motivated by design features such as the opportunity to practice EBP in one place and taking notes in a digital notebook. The use of the app was hindered by anticipation that the use of phones during clinical placements would be viewed negatively by others and by specific design features, such as unfamiliar icons. CONCLUSIONS: The students perceived the EBPsteps app as a relevant tool for learning EBP, although they also suggested specific changes to the design of the app. Requirements must be embedded in the curriculum to ensure that the app is used. Our findings bring important information to developing and implementing mobile applications as a teaching method in health and social care educations.

Evidence-Based Research Series-Paper 1: What Evidence-Based Research is and why is it important?

OBJECTIVES: There is considerable actual and potential waste in research. Evidence-based research ensures worthwhile and valuable research. The aim of this series, which this article introduces, is to describe the evidence-based research approach. STUDY DESIGN AND SETTING: In this first article of a three-article series, we introduce the evidence-based research approach. Evidence-based research is the use of prior research in a systematic and transparent way to inform a new study so that it is answering questions that matter in a valid, efficient, and accessible manner. RESULTS: We describe evidence-based research and provide an overview of the approach of systematically and transparently using previous research before starting a new study to justify and design the new study (article #2 in series) and-on study completion-place its results in the context with what is already known (article #3 in series). CONCLUSION: This series introduces evidence-based research as an approach to minimize unnecessary and irrelevant clinical health research that is unscientific, wasteful, and unethical.