Browsing by Author "Noseworthy, Thomas"
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Item Open Access Attributes of context relevant to healthcare professionals’ use of research evidence in clinical practice: a multi-study analysis(2019-05-22) Squires, Janet E; Aloisio, Laura D; Grimshaw, Jeremy M; Bashir, Kainat; Dorrance, Kristin; Coughlin, Mary; Hutchinson, Alison M; Francis, Jill; Michie, Susan; Sales, Anne; Brehaut, Jamie; Curran, Janet; Ivers, Noah; Lavis, John; Noseworthy, Thomas; Vine, Jocelyn; Hillmer, Michael; Graham, Ian DAbstract Background To increase the likelihood of successful implementation of evidence-based practices, researchers, knowledge users, and healthcare professionals must consider aspects of context that promote and hinder implementation in their setting. The purpose of the current study was to identify contextual attributes and their features relevant to implementation by healthcare professionals and compare and contrast these attributes and features across different clinical settings and healthcare professional roles. Methods We conducted a secondary analysis of 145 semi-structured interviews comprising 11 studies (10 from Canada and one from Australia) investigating healthcare professionals’ perceived barriers and enablers to their use of research evidence in clinical practice. The data was collected using semi-structured interview guides informed by the Theoretical Domains Framework across different healthcare professional roles, settings, and practices. We analyzed these data inductively, using constant comparative analysis, to identify attributes of context and their features reported in the interviews. We compared these data by (1) setting (primary care, hospital-medical/surgical, hospital-emergency room, hospital-critical care) and (2) professional role (physicians and residents, nurses and organ donor coordinators). Results We identified 62 unique features of context, which we categorized under 14 broader attributes of context. The 14 attributes were resource access, work structure, patient characteristics, professional role, culture, facility characteristics, system features, healthcare professional characteristics, financial, collaboration, leadership, evaluation, regulatory or legislative standards, and societal influences. We found instances of the majority (n = 12, 86%) of attributes of context across multiple (n = 6 or more) clinical behaviors. We also found little variation in the 14 attributes of context by setting (primary care and hospitals) and professional role (physicians and residents, and nurses and organ donor coordinators). Conclusions There was considerable consistency in the 14 attributes identified irrespective of the clinical behavior, setting, or professional role, supporting broad utility of the attributes of context identified in this study. There was more variation in the finer-grained features of these attributes with the most substantial variation being by setting.Item Open Access Data Stewardship in Electronic Medical Records and the Policy Challenges for Research Programs: A Canadian Perspective(2013-04-29) Dong, Allen; Godlovitch, Glenys; Noseworthy, ThomasResearch access to personal health information presents a challenge to policy makers and researchers alike. It is usually framed as a conflict between data access for the benefit of society and the protection of privacy. This thesis examines the policy challenge by studying the data access policies of several organizations that are affiliated with academic institutions and provide research access to personal health information. By applying a policy ethics framework that combines the Veatch matrix and the Accountability for Reasonableness conditions of Daniels and Sabin the data access policies reveal an ethically justifiable resolution of the policy challenge. A case study conducted on one of the organizations yields a policy model that interviewees report, worked well in practice in the years 1996 to 2002. The policy options that emerged from the model could be adapted for use in any jurisdiction whose legal regime is similar to that of Canada’s provinces and territories.Item Open Access Enhancing the uptake of systematic reviews of effects: what is the best format for health care managers and policy-makers? A mixed-methods study(2018-06-22) Marquez, Christine; Johnson, Alekhya M; Jassemi, Sabrina; Park, Jamie; Moore, Julia E; Blaine, Caroline; Bourdon, Gertrude; Chignell, Mark; Ellen, Moriah E; Fortin, Jacques; Graham, Ian D; Hayes, Anne; Hamid, Jemila; Hemmelgarn, Brenda; Hillmer, Michael; Holmes, Bev; Holroyd-Leduc, Jayna; Hubert, Linda; Hutton, Brian; Kastner, Monika; Lavis, John N; Michell, Karen; Moher, David; Ouimet, Mathieu; Perrier, Laure; Proctor, Andrea; Noseworthy, Thomas; Schuckel, Victoria; Stayberg, Sharlene; Tonelli, Marcello; Tricco, Andrea C; Straus, Sharon EAbstract Background Systematic reviews are infrequently used by health care managers (HCMs) and policy-makers (PMs) in decision-making. HCMs and PMs co-developed and tested novel systematic review of effects formats to increase their use. Methods A three-phased approach was used to evaluate the determinants to uptake of systematic reviews of effects and the usability of an innovative and a traditional systematic review of effects format. In phase 1, survey and interviews were conducted with HCMs and PMs in four Canadian provinces to determine perceptions of a traditional systematic review format. In phase 2, systematic review format prototypes were created by HCMs and PMs via Conceptboard©. In phase 3, prototypes underwent usability testing by HCMs and PMs. Results Two hundred two participants (80 HCMs, 122 PMs) completed the phase 1 survey. Respondents reported that inadequate format (Mdn = 4; IQR = 4; range = 1–7) and content (Mdn = 4; IQR = 3; range = 1–7) influenced their use of systematic reviews. Most respondents (76%; n = 136/180) reported they would be more likely to use systematic reviews if the format was modified. Findings from 11 interviews (5 HCMs, 6 PMs) revealed that participants preferred systematic reviews of effects that were easy to access and read and provided more information on intervention effectiveness and less information on review methodology. The mean System Usability Scale (SUS) score was 55.7 (standard deviation [SD] 17.2) for the traditional format; a SUS score < 68 is below average usability. In phase 2, 14 HCMs and 20 PMs co-created prototypes, one for HCMs and one for PMs. HCMs preferred a traditional information order (i.e., methods, study flow diagram, forest plots) whereas PMs preferred an alternative order (i.e., background and key messages on one page; methods and limitations on another). In phase 3, the prototypes underwent usability testing with 5 HCMs and 7 PMs, 11 out of 12 participants co-created the prototypes (mean SUS score 86 [SD 9.3]). Conclusions HCMs and PMs co-created prototypes for systematic review of effects formats based on their needs. The prototypes will be compared to a traditional format in a randomized trial.Item Open Access How Ready are the Stakeholders in the Palestinian Health Care System in the Gaza Strip to Adopt e-Health?(2008) Baroud, Radwan Mahmoud; Scott, Richard E.; Noseworthy, ThomasItem Open Access Understanding patient engagement in health system decision-making: a co-designed scoping review(2019-04-18) McCarron, Tamara L; Moffat, Karen; Wilkinson, Gloria; Zelinsky, Sandra; Boyd, Jamie M; White, Deborah; Hassay, Derek; Lorenzetti, Diane L; Marlett, Nancy J; Noseworthy, ThomasAbstract Background With healthcare striving to shift to a more person-centered delivery model, patient and family involvement must have a bigger role in shaping this. While many initiatives involving patients and family members focus on self-care, a broader understanding of patient participation is necessary. Ensuring a viable and sustainable critical number of qualified patients and family members to support this shift will be of utmost importance. The purpose of this study was to understand how health systems are intentionally investing in the training and skill development of patients and family members. Methods Patient co-investigators and researchers conducted a scoping review of the existing literature on methods adopted by healthcare systems to build the skills and capacity of patients to participate in healthcare decision-making using a recognized methodological framework. Six electronic databases were searched to identify studies. Two independent reviewers screened titles and abstracts and full-text papers for inclusion. The research team independently extracted data. Any disagreements were resolved by achieving consensus through discussion. Quantitative and qualitative content synthesis, as well as a quality assessment, was conducted. Results After eliminating duplicates, the search resulted in 9428 abstracts. Four hundred fifty-eight articles were reviewed and 15 articles were included. Four themes emerged: forums (33%), patient instructors (20%), workshops (33%), and co-design (13%). Four of the identified studies measured the impact and overall effectiveness of the respective programs. Examples of how patient and family members were supported (invested in) included advocacy training to support future involvement in engagement activities, a training program to conduct patient-led research, involvement in an immersive experience-based co-design initiative, and involvement in training pharmacy students. Overall, these studies found positive outcomes when patients and family members were recipients of these opportunities. Conclusions The results of this scoping review demonstrate that an evidence base around programs to advance patient engagement is largely absent. An opportunity exists for further research to identify strategies and measures to support patient engagement in healthcare decision-making.