'Snapshot in time': a cross-sectional study exploring stakeholder experiences with environmental scans in health services delivery research.

OBJECTIVE: To describe stakeholder characteristics and perspectives about experiences, challenges and information needs related to the use of environmental scans (ESs). DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: A web-based survey platform was used to disseminate an online survey to stakeholders who had experience with conducting ESs in a health services delivery context (eg, researchers, policy makers, practitioners). Participants were recruited through purposive and snowball sampling. The survey was disseminated internationally, was available in English and French, and remained open for 6 weeks (15 October to 30 November 2022). ANALYSIS: Descriptive statistics were used to describe the characteristics and experiences of stakeholders. Thematic analysis was used to analyse the open-text questions. RESULTS: Of 47 participants who responded to the survey, 94% were from Canada, 4% from the USA and 2% from Australia. Respondents represented academic institutions (57%), health agency/government (32%) and non-government organisations or agencies (11%). Three themes were identified: (a) having a sense of value and utility; (b) experiencing uncertainty and confusion; and (c) seeking guidance. The data suggest stakeholders found value and utility in ESs and conducted them for varied purposes including to: (a) enhance knowledge, understanding and learning about the current landscape or state of various features of health services delivery (eg, programmes, practices, policies, services, best practices); (b) expose needs, service barriers, challenges, gaps, threats, opportunities; (c) help guide action for planning, policy and programme development; and (d) inform recommendations and decision-making. Stakeholders also experienced conceptual, methodological and practical barriers when conducting ESs, and expressed a need for methodological guidance delivered through published guidelines, checklists and other means. CONCLUSION: ESs have value and utility for addressing health services delivery concerns, but conceptual and methodological challenges exist. Further research is needed to help advance the ES as a distinct design that provides a systematic approach to planning and conducting ESs.

Knowledge translation strategies used for sustainability of an evidence-based intervention in child health: a multimethod qualitative study.

BACKGROUND: Sustainability of evidence-based interventions (EBIs) is suboptimal in healthcare. Evidence on how knowledge translation (KT) strategies are used for the sustainability of EBIs in practice is lacking. This study examined what and how KT strategies were used to facilitate the sustainability of Alberta Family Integrated Care (FICare)™, a psychoeducational model of care scaled and spread across 14 neonatal intensive care units, in Alberta, Canada. METHODS: First, we conducted an environmental scan of relevant documents to determine the use of KT strategies to support the sustainability of Alberta FICare™. Second, we conducted semi-structured interviews with decision makers and operational leaders to explore what and how KT strategies were used for the sustainability of Alberta FICare™, as well as barriers and facilitators to using the KT strategies for sustainability. We used the Expert Recommendations for Implementation Change (ERIC) taxonomy to code the strategies. Lastly, we facilitated consultation meetings with the Alberta FICare™ leads to share and gain insights and clarification on our findings. RESULTS: We identified nine KT strategies to facilitate the sustainability of Alberta FICare™: Conduct ongoing training; Identify and prepare local champions; Research co-production; Remind clinicians; Audit and provide feedback; Change record systems; Promote adaptability; Access new funding; and Involve patients/consumers and family members. A significant barrier to the sustainability of Alberta FICare™ was a lack of clarity on who was responsible for the ongoing maintenance of the intervention. A key facilitator to sustainability of Alberta FICare was its alignment with the Maternal, Newborn, Child & Youth Strategic Clinical Network (MNCY SCN) priorities. Co-production between researchers and health system partners in the design, implementation, and scale and spread of Alberta FICare™ was critical to sustainability. CONCLUSION: This research highlights the importance of clearly articulating who is responsible for continued championing for the sustainability of EBIs. Additionally, our research demonstrates that the adaptation of interventions must be considered from the onset of implementation so interventions can be tailored to align with contextual barriers for sustainability. Clear guidance is needed to continually support researchers and health system leaders in co-producing strategies that facilitate the long-term sustainability of effective EBIs in practice.

Parental Knowledge, Self-confidence, and Usability Evaluation of a Web-Based Infographic for Pediatric Concussion: Multimethod Study.

BACKGROUND: Concussions, which are known as mild traumatic brain injuries, are complex injuries caused by direct or indirect blows to the head and are increasingly being recognized as a significant public health concern for children and their families. Previous research has identified few studies examining the efficacy of educational interventions on parental concussion knowledge. The aim of this research was to actively work together with children who have experienced a concussion and their parents to develop, refine, and evaluate the usability of a web-based infographic for pediatric concussion. OBJECTIVE: The objective of this study was to report on the usability of the infographic, parental knowledge, and self-confidence in pediatric concussion knowledge before and after exposure to the infographic. METHODS: A multiphase, multimethod research design using patient engagement techniques was used to develop a web-based infographic. For this phase of the research (usability, knowledge, and confidence evaluation), parents who could communicate in English were recruited via social media platforms and invited to complete web-based questionnaires. Electronic preintervention and postintervention questionnaires were administered to parents to assess changes to concussion knowledge and confidence after viewing the infographic. A usability questionnaire with 11 items was also completed. RESULTS: A web-based, infographic was developed. The infographic is intended for parents and children and incorporates information that parents and children identified as both wants and needs about concussion alongside the best available research evidence on pediatric concussion. A total of 31 surveys were completed by parents. The mean scores for each item on the usability surveys ranged from 8.03 (SD 1.70) to 9.26 (SD 1.09) on a 10-point Likert scale, indicating that the usability components of the infographic were largely positive. There was no statistically significant difference between preintervention and postintervention knowledge scores (Z=-0.593; P=.55; both preintervention and postintervention knowledge scores had a median of 9 out of 10). In contrast, there was a statistically significant difference between preintervention (mean 3.9/5, SD 0.56) and postintervention (mean 4.4/5, SD 0.44) confidence in knowledge scores (t30=-5.083; P<.001). CONCLUSIONS: Our results demonstrate that parents positively rated a web-based, infographic for pediatric concussion. In addition, although there was no statistically significant difference overall in parents' knowledge scores before and after viewing the infographic, their confidence in their knowledge did significantly increase. These results suggest that using a web-based infographic as a knowledge translation intervention may be useful in increasing parents' confidence in managing their child's concussion.

"You Can't Fix Your Brain": Exploring concussion experiences of children and parents.

PURPOSE: To explore the experiences, information needs and preferences of children who have had a concussion and their parents who have cared for them. DESIGN: Qualitative description. METHODS: Semi-structured qualitative interviews were conducted via Zoom with children who have had a concussion between ages 5 and 16 years and parents who have cared for a child with a concussion. Interviews were audio-recorded and transcribed. RESULTS: Fourteen interviews were conducted with children and parents who have experiences with concussion. Four major themes were identified: (1) mechanism of injury and concussion symptoms experienced by children, (2) parent concerns, emotions, and health care experience with child's concussion, (3) concussions affect more than just your head and, (4) health information seeking, and preferences of parents and children related to concussion. Children and their parents have unique experiences, information needs and preferences regarding concussion. PRACTICE IMPLICATIONS: This information offers valuable insights about developing resources about childhood concussion that parents and children will find useful and relevant. This research has direct relevance to healthcare professionals who may encounter children with concussion in their daily practice so they can ensure the needs of children and families are being met. Our findings will be used to create the content for an innovative knowledge translation tool about pediatric concussion.

Contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions.

BACKGROUND: In 2012, Alberta Health Services created Strategic Clinical NetworksTM (SCNs) to develop and implement evidence-informed, clinician-led and team-delivered health system improvement in Alberta, Canada. SCNs have had several provincial successes in improving health outcomes. Little research has been done on the sustainability of these evidence-based implementation efforts. METHODS: We conducted a qualitative realist evaluation using a case study approach to identify and explain the contextual factors and mechanisms perceived to influence the sustainability of two provincial SCN evidence-based interventions, a delirium intervention for Critical Care and an Appropriate Use of Antipsychotics (AUA) intervention for Senior's Health. The context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic guided our research. RESULTS: We conducted thirty realist interviews in two cases and found four important strategies that facilitated sustainability: Learning collaboratives, audit & feedback, the informal leadership role, and patient stories. These strategies triggered certain mechanisms such as sense-making, understanding value and impact of the intervention, empowerment, and motivation that increased the likelihood of sustainability. For example, informal leaders were often hands-on and influential to front-line staff. Learning collaboratives broke down professional and organizational silos and encouraged collective sharing and learning, motivating participants to continue with the intervention. Continual audit-feedback interventions motivated participants to want to perform and improve on a long-term basis, increasing the likelihood of sustainability of the two multi-component interventions. Patient stories demonstrated the interventions' impact on patient outcomes, motivating staff to want to continue doing the intervention, and increasing the likelihood of its sustainability. CONCLUSIONS: This research contributes to the field of implementation science, providing evidence on key strategies for sustainability and the underlying causal mechanisms of these strategies that increases the likelihood of sustainability. Identifying causal mechanisms provides evidence on the processes by which implementation strategies operate and lead to sustainability. Future work is needed to evaluate the impact of informal leadership, learning collaboratives, audit-feedback, and patient stories as strategies for sustainability, to generate better guidance on planning sustainable improvements with long term impact.

Research- and health-related youth advisory groups in Canada: An environmental scan with stakeholder interviews.

BACKGROUND: Engaging youth throughout the research process improves research quality and outcomes. Youth advisory groups provide one way for youth to express their opinions on relevant issues. OBJECTIVE: This study aimed to identify research- and health-related youth advisory groups ('groups') in Canada and understand the best practices of these groups. METHODS: Google searches and supplementary methods were used to identify relevant groups in Canada. Group information was extracted from websites or through interviews with key informants. RESULTS: We identified 40 groups. Groups were commonly part of a hospital/healthcare facility, nonprofit/health organization or research group. The majority focused on a specific content area, most commonly, mental health. Over half the groups advised on health services. Members' ages ranged from 9 to 35 years. The number of members ranged from 5 to 130. Interviews (n = 12) identified seven categories relating to group practices: (a) group purpose/objectives, (b) group development, (c) group operations, (d) group structure, (e) adult involvement, (f) membership and recruitment and (g) group access. Challenges and facilitators to the success of groups were described within the following themes: (a) retaining engagement, (b) creating a safe environment and (c) putting youth in positions of influence. Advice and recommendations were provided regarding the development of a new group. CONCLUSION: This study provides a comprehensive overview of research- and health-related youth advisory groups in Canada. This information can be used to identify groups that stakeholders could access as well as inform the development of a new group. PATIENT OR PUBLIC CONTRIBUTION: Youth advisory group representatives were interviewed as part of the study.

Exploring the Experiences and Information Needs of Parents Caring for a Child With a Urinary Tract Infection: A Qualitative Study.

Urinary tract infections (UTIs) are common in children, however, clinical practice variations can leave parents unsure how to care for their child. We aim to develop knowledge tools that provide evidence-based information about pediatric UTIs. To inform tool development, we asked parents to share their experiences and information needs in caring for a child with a UTI. Using qualitative description methods, 16 semistructured interviews were conducted with 18 parents. Parents were recruited through the emergency department (ED) of a major Canadian urban pediatric hospital. Five major themes emerged: (1) parent descriptions of their child's symptoms and behaviors; (2) UTIs have an effect on the entire family; (3) reasons for going to the ED; (4) parent experiences with UTI treatment, management, and follow-up strategies for their child; and (5) parent information needs and preferred information sources for UTIs. Our findings highlight the diversity of UTI symptoms children experience, which causes uncertainty and confusion for parents. This diversity suggests the development of knowledge tools for parents about UTIs is needed.

Parents' Experiences and Information Needs While Caring for a Child With Functional Constipation: A Systematic Review.

Pediatric functional constipation (FC) reportedly affects at least 1 in 10 children worldwide. Parent and family education is a key component for successful treatment, yet there is little research exploring what information families need and how to best support them. The aim of this review is to synthesize current evidence on the experiences and information needs of parents caring for a child with FC. We systematically searched published research and completed screening against a priori inclusion criteria. Thirteen studies (n = 10 quantitative, n = 3 qualitative) were included. We found 2 main themes, precarious footing and profound and pervasive effects. Heavy caregiving burdens fueled doubts, misinformation, relationship breakdown, and treatment deviation. In light of clinical recommendations, our findings reveal a potential mismatch between parents' needs and care provision for FC. It is likely that both parents and health care providers would benefit from resources and interventions to improve care related to pediatric FC.

Parent information needs and experience regarding acute otitis media in children: A systematic review.

BACKGROUND: Acute otitis media (AOM)-inflammation of the middle ear-is the most common pediatric condition, affecting up to 75 % of children at some time before age 5 years. Despite the high incidence of AOM in children, it presents diverse challenges to parents who do not have accurate information on AOM and its management. OBJECTIVE: To respond to this paucity of information we sought to synthesize the literature to provide a comprehensive understanding of parental information needs and experiences relating to AOMmanagement. This systematic review is an important first step in developing parent-informed knowledge translation tools for AOM to bridge the knowledge-practice gap. PATIENT INVOLVEMENT: None. METHOD: Four electronic databases were searched and articles were screened according to pre- established inclusion criteria. Articles were included in the review if they (1) examined parental information needs and experiences with respect to AOM; (2) were written in English; and (3) were published from January 2000 onward. RESULTS: Out of 1121 articles retrieved, 21 articles met the inclusion criteria. The findings from this review revealed that parents' knowledge about AOM is generally limited. Further, parents were often poorly informed about what AOM was, which resulted in uncertainty about how to help their child with AOM. DISCUSSION: Our review findings illustrate that parents of children with AOM have pervasive unmet information needs and information deficits negatively impact AOM management, child and family well-being. PRACTICAL VALUE: Parental experiences and information needs identified through this review were used to develop innovative, evidence-based knowledge translation tools for parents of children with AOM.

Parent Experiences Caring for a Child With Bronchiolitis: A Qualitative Study.

BACKGROUND: Bronchiolitis is an acute lower respiratory infection, with significant impacts on children and families and strains on the health care system. Understanding parents' experiences and information needs caring for a child with bronchiolitis is crucial to highlight misconceptions or issues contributing to the high burden. The objective of this qualitative study was to describe parents' experiences caring for a child with bronchiolitis. METHODS: Qualitative description guided this study. Participants were recruited from the Stollery Children's Hospital emergency department (ED), a specialized pediatric ED in a major Canadian urban center. Semi-structured interviews were conducted with 15 parents. RESULTS: Five major themes were identified: (a) their children's symptoms and behaviors, (b) bronchiolitis affects the entire family, (c) factors influencing parent's decision to go to ED, (d) ED experience for parents and their children, and (e) bronchiolitis treatment and management. Interviews revealed bronchiolitis has significant effects on both children and families and parents are generally unaware of bronchiolitis symptoms, treatment, and management. CONCLUSIONS: Our study highlights that parents have knowledge deficits when it comes to recognizing the presence and severity of bronchiolitis symptoms. Parents would benefit from having more evidence-based resources to enhance their knowledge about the nature of bronchiolitis.

Parents' information needs and preferences related to bronchiolitis: a qualitative study.

BACKGROUND: Bronchiolitis affects more than one-third of children less than age 2 years and can cause substantial anxiety for parents, leading them to seek information on how to care for their sick child. The aim of our qualitative study was to explore the information needs and preferences of parents caring for a child with bronchiolitis. METHODS: We used a qualitative descriptive approach. Participants were recruited by means of purposive sampling from Oct. 1, 2017, to Mar. 15, 2018 from the Stollery Children's Hospital emergency department, a specialized pediatric emergency department in Edmonton. Individual semistructured interviews were conducted. RESULTS: Fifty-three parents were recruited to participate, of whom 30 could not be reached after 4 contact attempts and 8 refused. Thus, 15 parents participated (16 children). Three major themes were identified: 1) parents' information needs about bronchiolitis, 2) parents' preferred information sources and 3) parents' preferred information delivery formats. Participants indicated that they want and require credible, easy-to-understand information about bronchiolitis in a variety of formats, and especially valued information obtained directly from a health care professional or an evidence-based website. INTERPRETATION: This study provides important information about parents' information needs concerning bronchiolitis in children. Identifying the information that parents want and value in relation to acute pediatric illnesses is imperative to developing innovative educational approaches for parents that reflect patient-centred care.

Understanding Parents' Experiences and Information Needs on Pediatric Acute Otitis Media: A Qualitative Study.

BACKGROUND: Acute otitis media (AOM) is the most common pediatric bacterial ear infection, affecting up to 75% of children younger than 5 years. Despite the high incidence of AOM in children, the condition presents a number of challenges to parents. The objectives of this study were to describe parents' experiences of taking care of a child with AOM and to identify their information needs to manage their child with AOM. METHODS: A qualitative, descriptive design was used to gain insight into information needs of parents' of children with AOM. Participants were recruited from a specialized pediatric emergency department in a major Canadian urban center (Edmonton, Alberta). Individual semi structured interviews were conducted with 16 parents. RESULTS: Seven major themes were identified and described: (1) frequency of AOM, (2) symptoms of AOM experienced by children and parents, (3) AOM symptom management strategies used by parents, (4) parent's beliefs about AOM, (5) parent's satisfaction with treatment prescribed by physicians, (6) the effect of AOM on family's quality of life, and (7) parent's information needs about AOM. Findings indicate that AOM has considerable negative outcomes for both children and families and that parents would benefit from having more evidence-based resources. CONCLUSIONS: This study provides important information around parents' experiences and information needs for pediatric AOM. Identifying parents' information needs and developing innovative and communicatively responsive educational approaches for parents are warranted that reflect patient-centered nursing care.

Knowledge Translation Strategies Used by Healthcare Professionals in Child Health Settings: An Updated Systematic Review.

PROBLEM: Strategies assisting healthcare professionals to make evidence-based decisions are crucial for quality patient care and outcomes. To date, there is one systematic review (Albrecht et al., 2016) examining knowledge translation (KT) efforts in child health settings. This systematic review aims to provide an update on current evidence identifying KT interventions implementing research into child health settings. ELIGIBILITY CRITERIA: Nine electronic databases were searched, restricted by date (2011-2018) and language (English). Eligibility included: 1) randomized controlled trials (RCT), controlled clinical trials (CCT), or controlled before-and-after (CBA) studies; 2) interventions implementing research into child health practice; and 3) outcomes were measured at the healthcare professional/process, patient, or economic level. SAMPLE: Health care professionals working in child health settings. RESULTS: 48 studies (38 RCT, 7 CBA, 3 CCT) were included. Studies employed single (n = 34) and multiple (n = 14) interventions. The methodological quality of studies was moderate (n = 18), strong (n = 16) and weak (n = 14). Studies showing significant, positive effects included (n = 9) RCTs, (n = 3) CBAs and (n = 2) CCTs. These studies employed (n = 11) single KT interventions and (n = 3) multiple KT interventions. Interventions included educational (n = 6), reminders (n = 3), computerized decision supports (n = 2), multidisciplinary teams (n = 2) and financial and educational interventions combined (n = 1). CONCLUSIONS: Effective KT strategies used by health care professionals in child health settings were found to be online education curriculums and computerized decision supports or reminders. IMPLICATIONS: This review update serves as an up-to-date 'state of the science' on KT strategies used in pediatric health professionals' clinical practice, assessed by the most rigorous research designs.