An inductive exploration of the implementation knowledge of research funders.

BACKGROUND: Healthcare research funders may undertake various roles to facilitate implementation of research findings. Their ability to enact such roles depends on several factors, knowledge of implementation being one essential requirement. However, previous studies do not assess the type or level of knowledge about implementation that research funders possess. This paper therefore presents findings from a qualitative, inductive study of the implementation knowledge of research funders. Three aspects of this knowledge are explored, namely how research funders define implementation, their level of self-assessed implementation knowledge and the factors influencing their self-assessment of implementation knowledge. METHODS: Research funders (n = 18) were purposefully selected from a sample of research funding organisations in Sweden (n = 10). In-depth semi-structured interviews were conducted, recorded and transcribed verbatim. An inductive method using a systematic coding procedure was employed to derive the findings. RESULTS: The research funders defined implementation as either an outcome or a process, with the majority believing that implementation of healthcare research results demands a process, although its complexity varied in the research funders' view. They perceived their own level of implementation knowledge as either limited or substantial, with a majority regarding it as limited. Clinical research experience, clinical experience and task relevance were singled out as the clearest factors affecting the self-assessment of their own implementation knowledge. CONCLUSIONS: This study, the first to focus on implementation knowledge of research funders, demonstrates that they are a category of policy-makers who may possess knowledge, based on their previous professional experience, that is comparable to some important findings from implementation research. Consequently, the findings not only pinpoint the relevance of professional experience, but also reveal a lack of awareness and knowledge of the results of implementation research among research funders in charge of healthcare research.

Who knows best? Understanding the use of research-based knowledge in conservation conflicts.

The way in which research-based knowledge is used, interpreted and communicated by different actors can influence the dynamics of conservation conflicts. The conflict that occurs between grouse shooting interests and the conservation of birds of prey in Scotland is notoriously complex, involving multiple actors at multiple levels, and shaped by the values and world views of these actors. This paper explores how research-based knowledge is used in the debate by six key organisations, and looks to understand the drivers that may influence knowledge use and interpretation in this, and other, cases of conservation conflict. Research was used to both legitimise and reinforce certain world views, and to support associated political actions that would cause these to become reality. Actors offered divergent interpretations of the same piece of research, emphasising different findings and outcomes. Research-based knowledge was thus employed by actors to support or counter the 'status quo', and challenge other claims that clashed with their own values. Although the intention of such knowledge use is unclear, the selective reconstruction of research by actors could stem from, and reiterate, divergent value systems. This may pose significant challenges to conflict mitigation efforts; whilst some may look to research-based knowledge as the bringer of truth, its interpretation by different actors may exacerbate existing rifts between stakeholders; promoting polarisation of views. Mitigation strategies should be sensitive to this, and aim to improve the inclusiveness and transparency of the knowledge transfer process.

Just Google it: Measuring schools' use of research evidence with internet search results.

Measuring the use of research evidence (URE) by schools has become a central of education researchers. However, it has proven challenging due to low response rates, social desirability bias, and costly or time consuming data collection methods. To overcome these challenges and meet the needs of research focused on URE, this paper introduces a non-reactive archival measure: Archival Search of Use of Research Evidence (ASURE). ASURE counts references to research or evidence on a school's or school district's website to capture the extent of its rhetorical use of research evidence. After illustrating the collection of ASURE in all public school districts in Michigan (N = 595), we use data on these districts to show that ASURE is reliable and valid, and thus offers a promising new strategy for measuring URE in schools. We conclude by considering future steps for exploring ASURE not simply as a measure of URE in schools, but instead as a measurement strategy for assessing URE in a broad range of organizational contexts.

Nurses' Beliefs Regarding Pain in Critically Ill Children: A Mixed-Methods Study.

The purpose of this study was to provide a current and comprehensive evaluation of nurses' beliefs regarding pain in critically ill children. DESIGN AND METHODS: A convergent parallel mixed-methods design was used. Nurse beliefs were captured via questionnaire and interview and then compared. RESULTS: Forty nurses participated. Most beliefs reported via questionnaire were consistent with effective pain management practices. Common inaccurate beliefs included the need to verify pain reports with physical indicators and the pharmacokinetics of intravenous opioids. Beliefs commonly shared during interviews concerned the need to verify pain reports with observed behavior, the accuracy of pain reports, the need to respond to pain, concerns regarding opioid analgesics, and the need to "start low" with interventions. Convergent beliefs between the questionnaire and interview included the use of physical indicators to verify pain, the need to take the child's word when pain is described, and concerns regarding negative effects of analgesics. Divergent and conflicting findings were most often regarding the legitimacy of a child's pain report. CONCLUSIONS: Findings from this study regarding the accuracy of nurses' pain beliefs for critically ill children are consistent with past research. The presence of divergent and conflicting responses suggests that nurses' pain beliefs are not static and may vary with patient characteristics. PRACTICE IMPLICATIONS: While most nurses appreciate the risks of unrelieved pain in children, many are concerned about the potential adverse effects of opioid administration. Interventions are needed to guide nurses in minimizing both of these risks.

The effect of scientific evidence on conservation practitioners' management decisions.

A major justification of environmental management research is that it helps practitioners, yet previous studies show it is rarely used to inform their decisions. We tested whether conservation practitioners focusing on bird management were willing to use a synopsis of relevant scientific literature to inform their management decisions. This allowed us to examine whether the limited use of scientific information in management is due to a lack of access to the scientific literature or whether it is because practitioners are either not interested or unable to incorporate the research into their decisions. In on-line surveys, we asked 92 conservation managers, predominantly from Australia, New Zealand, and the United Kingdom, to provide opinions on 28 management techniques that could be applied to reduce predation on birds. We asked their opinions before and after giving them a summary of the literature about the interventions' effectiveness. We scored the overall effectiveness and certainty of evidence for each intervention through an expert elicitation process-the Delphi method. We used the effectiveness scores to assess the practitioners' level of understanding and awareness of the literature. On average, each survey participant changed their likelihood of using 45.7% of the interventions after reading the synopsis of the evidence. They were more likely to implement effective interventions and avoid ineffective actions, suggesting that their intended future management strategies may be more successful than current practice. More experienced practitioners were less likely to change their management practices than those with less experience, even though they were not more aware of the existing scientific information than less experienced practitioners. The practitioners' willingness to change their management choices when provided with summarized scientific evidence suggests that improved accessibility to scientific information would benefit conservation management outcomes.

PICU Nurses' Pain Assessments and Intervention Choices for Virtual Human and Written Vignettes.

The purpose of this concurrent mixed-methods study was to 1) examine the factors pediatric intensive care unit nurses consider when assessing and intervening for children who report severe pain and to 2) determine the effect of child behavior and diagnosis on the nurses' pain ratings and intervention choices for written and virtual human vignettes. Quantitative and qualitative results substantiated that despite recommendations to use self-report, many PICU nurses use behavior as the primary indicator to assess and treat pain, even when a child is old enough to articulate pain intensity and there is sufficient cause for pain to be present.

Exploring appropriateness criteria for informing the total knee arthroplasty decision-making process: An interpretive descriptive study.

RATIONAL: The Hawker appropriateness criteria for total knee arthroplasty (TKA) are: osteoarthritis symptoms impacting quality of life, evidence of osteoarthritis, trial of conservative treatments, patient's realistic expectations, patient/surgeon agree benefits outweigh risks, and readiness for surgery. Little is known about the barriers and facilitators of using the Hawker et al. appropriateness criteria for TKA in clinical practice. AIMS AND OBJECTIVES: Explore the barriers and facilitators to using appropriateness criteria for TKA in making decisions for adults with knee osteoarthritis. METHODS: Interpretive descriptive qualitative study at an academic hospital. Purposive sampling aimed to recruit: (1) healthcare team members at all levels influencing care delivery, and (2) adults with TKA assessed at the hospital clinic. Semi-structured interviews asked about the barriers/facilitators to using the Hawker appropriateness criteria. Data analysis consisted of inductive thematic analysis with themes mapped to the Consolidated Framework for Implementation Research domains. RESULTS: Nine healthcare professionals and 14 adults with TKA participated and identified common barriers to using the Hawker appropriateness criteria: (a) intervention characteristics domain: difficulty to assess criteria, patients expecting healthcare professionals to decide, limited accessibility to conservative treatments; (b) individuals characteristics domain: no need to change current TKA process, clinical judgement limited to OA severity/age, implicit assessment of subjective criteria; (c) inner setting domain: TKA information received after decision made; and (d) outer setting domain: no timely access to TKA. A facilitator of use was evidence/buy-in fosters programme changes. CONCLUSION: Barriers to using the criteria relevant to clinical practice and the healthcare system were identified while only one facilitator was revealed. Interventions tailored to these barriers are needed to support the use of the Hawker appropriateness criteria in TKA decision-making.

Chagas Disease across Contexts: Scientific Knowledge in a Globalized World.

Chagas is the most important endemic disease in Latin America. It was progressively constructed as a relevant public issue, starting as a medical problem, focusing later on housing conditions, poverty, or vector agents. In recent decades, research has mainly focused on the parasite's biological characterization. In the meanwhile, both Chagas disease and knowledge about it spread out geographically. We analyze the worldwide scientific production on Chagas, showing that countries' research strategies depend on two main factors: endemicity and research traditions. This approach complements previous studies, allowing us to better understand the construction of Chagas disease as a social and scientific problem.

Quick and dirty or rapid and informative? Exploring a participatory method to facilitate implementation research and organizational change.

PURPOSE: The purpose is explore an approach to acquire, analyze and report data concerning an organizational change initiative that combines knowledge generation and knowledge use, and contrast that with a method where knowledge generation and use is separated. More specifically, the authors contrast a participatory group workshop with individual interviews analyzed with thematic analysis, focusing on information about the change process and its perceived practical relevance and usefulness. DESIGN/METHODOLOGY/APPROACH: Participants were managers responsible for implementing a broad organizational change aiming to improve service quality (e.g. access and equity) and reduce costs in a mental health service organization in Sweden. Individual interviews were conducted at two points, six months apart (i1: n = 15; i2: n = 18). Between the interviews, a 3.5-h participatory group workshop was conducted, during which participants (n = 15) both generated and analyzed data through a structured process that mixed individual-, small- and whole-group activities. FINDINGS: Both approaches elicited substantive information about the content, purpose and process of change. While the content and purpose findings were similar across the two data sources, the interviews described how to lead a change process, whereas the workshop yielded concrete information about what to do. Benefits of interviews included personal insights about leading change while the workshop provided an opportunity for collective sense-making. ORIGINALITY/VALUE: When organizational stakeholders work through the change process through a participatory workshop, they may get on the same page, but require additional support to take action.

Intentions and knowledge shaping local safety policy: A comparison of two Swedish cities.

INTRODUCTION: This article explores how intentions and knowledge shape two Swedish cities' local safety policy (LSP). METHOD: The applied framework is derived from the integration of governance and implementation research and the theory of knowledge and its use. RESULTS: The study shows that LSPs are shaped by a mix of intentions and different kinds of knowledge, and intentions and knowledge interplay and intertwine in many ways. Key-persons construct LSPs when they work out solutions to urgent safety problems and take departure in the local context, its pre-conditions, and their experience-based and professional knowledge. The state governs LSP softly through management by objectives in the background, but more often key-actor intentions and commitments, local safety problems, and events initiated and influenced LSPs. CONCLUSIONS: The article contributes to a better understanding of conditions for LSPs in multi-level governance. PRACTICAL APPLICATIONS: The article can be used to improve governance, identify implementation problems and knowledge needs that will improve LSPs and the overall safety situation in the community. The study has implications for how LSPs should be evaluated; many different evaluation criteria can be appropriate, such as relevance, legitimacy, achievement of key actors' objectives, sustainability of policy solutions, and creation of a local safety culture.

Development of a measure of knowledge use by stakeholders in rehabilitation technology.

OBJECTIVES: Uptake of new knowledge by diverse and diffuse stakeholders of health-care technology innovations has been a persistent challenge, as has been measurement of this uptake. This article describes the development of the Level of Knowledge Use Survey instrument, a web-based measure of self-reported knowledge use. METHODS: The Level of Knowledge Use Survey instrument was developed in the context of assessing effectiveness of knowledge communication strategies in rehabilitation technology. It was validated on samples representing five stakeholder types: researchers, manufacturers, clinician-practitioners, knowledge brokers, and consumers. Its structure is broadly based on Rogers' stages of innovation adoption. Its item generation was initially guided by Hall et al's Levels of Use framework. Item selection was based on content validity indices computed from expert ratings (n 1 = 4; n 2 = 3). Five representative stakeholders established usability of the web version. The version included 47 items (content validity index for individual items >0.78; content validity index for a scale or set of items >0.90) in self-reporting format. Psychometrics were then established for the version. RESULTS: Analyses of data from small (n = 69) and large (n = 215) samples using the Level of Knowledge Use Survey instrument suggested a conceptual model of four levels of knowledge use-Non-awareness, Awareness, Interest, and Use. The levels covered eight dimensions and six user action categories. The sequential nature of levels was inconclusive due to low cell frequencies. The Level of Knowledge Use Survey instrument showed adequate content validity (≈ 0.88; n = 3) and excellent test-retest reliability (1.0; n = 69). It also demonstrated good construct validity (n = 215) for differentiating among new knowledge outputs (p < 0.001) and among stakeholder types (0.001 < p ≤ 0.013). It showed strong responsiveness to change between baseline and follow-up testing (0.001 < p ≤ 0.002; n = 215). CONCLUSION: The Level of Knowledge Use Survey instrument is valid and reliable for measuring uptake of innovations across diffuse stakeholders of rehabilitation technologies and therefore also for tracking changes in knowledge use.

Knowledge exchange systems for youth health and chronic disease prevention: a tri-provincial case study.

INTRODUCTION: The research teams undertook a case study design using a common analytical framework to investigate three provincial (Prince Edward Island, New Brunswick and Manitoba) knowledge exchange systems. These three knowledge exchange systems seek to generate and enhance the use of evidence in policy development, program planning and evaluation to improve youth health and chronic disease prevention. METHODS: We applied a case study design to explore the lessons learned, that is, key conditions or processes contributing to the development of knowledge exchange capacity, using a multi-data collection method to gain an in-depth understanding. Data management, synthesis and analysis activities were concurrent, iterative and ongoing. The lessons learned were organized into seven "clusters." RESULTS: Key findings demonstrated that knowledge exchange is a complex process requiring champions, collaborative partnerships, regional readiness and the adaptation of knowledge exchange to diverse stakeholders. DISCUSSION: Overall, knowledge exchange systems can increase the capacity to exchange and use evidence by moving beyond collecting and reporting data. Areas of influence included development of new partnerships, expanded knowledge-sharing activities, and refinement of policy and practice approaches related to youth health and chronic disease prevention.

TITRE: Étude sur les systèmes d'échange des connaissances pour la santé des jeunes et la prévention des maladies chroniques : étude de cas menée dans trois provinces. INTRODUCTION: Les équipes de recherche ont adopté un modèle d'étude de cas utilisant un cadre d'analyse commun dans le but d'étudier trois systèmes provinciaux (Île-du-Prince-Édouard, Nouveau-Brunswick et Manitoba) d'échange des connaissances. Ces trois systèmes visent à générer et utiliser des données probantes lors de l'élaboration des politiques, de la planification des programmes et des évaluations afin d'améliorer la santé des jeunes et de prévenir les maladies chroniques. MÉTHODOLOGIE: Nous avons appliqué un modèle d'étude de cas pour examiner en profondeur les leçons apprises (c.-à-d. les principales conditions ou les principaux processus contribuant au développement de la capacité d'échange des connaissances) à l'aide d'une méthode de collecte de données multiples. Les activités de gestion, de synthèse et d'analyse des données ont été simultanées, itératives et continues. Les leçons apprises ont été classées en sept catégories. RÉSULTATS: L'échange des connaissances est un processus complexe, qui exige des champions et des partenariats de collaboration, une adaptation aux divers intervenants et qui exige aussi que les régions soient préparées. ANALYSE: Dans l'ensemble, les systèmes d'échange des connaissances peuvent accroître la capacité d'échange et d'utilisation des données probantes en allant au-delà de la collecte et de la transmission de données. Leurs aires d'influence sont l'établissement de nouveaux partenariats, des activités élargies d'échange des connaissances et le perfectionnement des approches axées sur les politiques et les pratiques liées à la santé des jeunes et à la prévention des maladies chroniques.

Capital social y uso del conocimiento en el sector salud: una revisión narrativa de la literatura / Social capital and use of the knowledge in the health sector: a narrative review of the literature

En el sector salud, las brechas entre la generación del conocimiento científico y su uso para la toma de decisiones comprometen la calidad de la atención brindada. Estas brechas se han relacionado con diferentes factores, entre ellos el capital social. Este trabajo explora el papel del capital social en el uso del conocimiento en el sector salud. Para hacerlo se recurrió a una revisión de la literatura de los últimos veinte años. Los hallazgos reportaron que las tres dimensiones del capital social, es decir, el capital estructural, el capital relacional y el capital cognitivo, se han relacionado teóricamente con la gestión y el uso del conocimiento y que el capital social se considera un predictor significativo de la práctica basada en evidencias. Se concluye que fomentar la confianza y los lazos de comunicación entre los empleados, así como buscar relaciones con investigadores, potencian el uso de las evidencias científicas en la toma de decisiones. Estas acciones se traducen en beneficios para los usuarios finales del sistema de salud(AU)

In the health sector, gaps persist between scientific knowledge´s production and its use for decision-making; and these gaps compromise the quality of provided care. These gaps have been related to different factors, including social capital. This paper explores the role of social capital in the use of knowledge in the health sector. To do so, a review of the literature of the last twenty years was conducted. Among the main findings, three dimensions of social capital (i.e. structural capital, relational capital and cognitive capital) have been theoretically related to knowledge use and management; and social capital is highlighted as a significant predictor of evidence-based practice. Encouraging trust and strengthening communication links among employees, as well as seeking relationships with researchers have the potential to foster scientific knowledge use in decision-making. These actions can be translated into benefits for final health system´s users(AU)