A Dialogue between Treatment Integrity Research and Design-Based Implementation Research

Thesis (Master's)--University of Washington, 2016-06

The framework for REVIEWS: an exploration into design principles for an electronic medical early warning system observation chart

The observation chart is for many health professionals (HPs) the primary source of objective information relating to the health of a patient. Information Systems (IS) research has demonstrated the positive impact of good interface design on decision making and it is logical that good observation chart design can positively impact healthcare decision making. Despite the potential for good observation chart design, there is a paucity of observation chart design literature, with the primary source of literature leveraging Human Computer Interaction (HCI) literature to design better charts. While this approach has been successful, this design approach introduces a gap between understanding of the tasks performed by HPs when using charts and the design features implemented in the chart. Good IS allow for the collection and manipulation of data so that it can be presented in a timely manner that support specific tasks. Good interface design should therefore consider the specific tasks being performed prior to designing the interface. This research adopts a Design Science Research (DSR) approach to formalise a framework of design principles that incorporates knowledge of the tasks performed by HPs when using observation charts and knowledge pertaining to visual representations of data and semiology of graphics. This research is presented in three phases, the initial two phases seek to discover and formalise design knowledge embedded in two situated observation charts: the paper-based NEWS chart developed by the Health Service Executive in Ireland and the electronically generated eNEWS chart developed by the Health Information Systems Research Centre in University College Cork. A comparative evaluation of each chart is also presented in the respective phases. Throughout each of these phases, tentative versions of a design framework for electronic vital sign observation charts are presented, with each subsequent iteration of the framework (versions Alpha, Beta, V0.1 and V1.0) representing a refinement of the design knowledge. The design framework will be named the framework for the Retrospective Evaluation of Vital Sign Information from Early Warning Systems (REVIEWS). Phase 3 of the research presents the deductive process for designing and implementing V0.1 of the framework, with evaluation of the instantiation allowing for the final iteration V1.0 of the framework. This study makes a number of contributions to academic research. First the research demonstrates that the cognitive tasks performed by nurses during clinical reasoning can be supported through good observation chart design. Secondly the research establishes the utility of electronic vital sign observation charts in terms of supporting the cognitive tasks performed by nurses during clinical reasoning. Third the framework for REVIEWS represents a comprehensive set of design principles which if applied to chart design will improve the usefulness of the chart in terms of supporting clinical reasoning. Fourth the electronic observation chart that emerges from this research is demonstrated to be significantly more useful than previously designed charts and represents a significant contribution to practice. Finally the research presents a research design that employs a combination of inductive and deductive design activities to iterate on the design of situated artefacts.

Springboards into design : exploring multiple representations of interaction in a dental surgery

This paper demonstrates that in order to understand and design for interactions in complex work environments, a variety of representational artefacts must be developed and employed. A study was undertaken to explore the design of better interaction technologies to support patient record keeping in a dental surgery. The domain chosen is a challenging real context that exhibits problems that could potentially be solved by ubiquitous computing and multi-modal interaction technologies. Both transient and durable representations were used to develop design understandings. We describe the representations, the kinds of insights developed from the representations and the way that the multiple representations interact and carry forward in the design process.

Beating the urge : implications of research into substance-related desires

Despite the advent of improved pharmacological treatments to alleviate substance-related desires, psychological approaches will continue to be required. However, the current psychological treatment that most specifically focuses on desires and their management—cue exposure (CE)—has not lived up to its original promise. This paper argues that current psychological approaches to desire do not adequately incorporate our knowledge about the factors that trigger, maintain, and terminate episodes of desire. It asserts that the instigation and maintenance of desires involve both associative and elaborative processes. Understanding the processes triggering the initiation of intrusive thoughts may assist in preventing some episodes, but occasional intrusions will be inevitable. A demonstration of the ineffectiveness of thought suppression may discourage its use as a coping strategy for desire-related intrusions, and mindfulness meditation plus cognitive therapy may help in accepting their occurrence and letting them go. Competing tasks may be used to reduce elaboration of desires, and competing sensory images may have particular utility. The application of these procedures during episodes that are elicited in the clinic may allow the acquisition of more effective strategies to address desires in the natural environment.

Using a design led disruptive innovation approach to develop new services : practising innovation in times of discontinuity

Organisations face increasing competition from new firms in emerging markets and their past superior products may no longer provide competitive advantage in markets based on different cost and value differentials. A shift in design practices from product solutions to health services which are accessible and affordable by all is required. This paper explores a design led approach to innovation to assist medical device companies develop new services and experiences and reshape their notions of the nature, development and deployment of health care services. This approach uses design tools and methodologies that are grounded in the authentic understandings of stakeholder experiences, to assist an organisation create a vision of likely future health care scenarios. Through this process, organisations can explore the complexities in the delivery of future health care services in new and emerging markets allowing them to tailor product and service solutions which focus on being accessible and affordable by all. The industry based case study for the design of health services in carried out in emerging economies. The contribution of this work in advancing research into design innovation and future research directions are also presented.

New research literacies for contemporary research into literacy and new media?

The term literacy remains highly contested and debates continue about how literacy might best be researched and to what ends. For some, literacy is simply a matter of acquiring the technical competence which enables people to read and write. Literacy research conducted from this point of view does not usually concern itself with the new media but rather focuses on how people learn to code and decode print text. For others, however, literacy is more complex and involves learning a repertoire of practices for communicating and getting things done in particular social and cultural contexts. Literacy research conducted from this sociocultural point of view accepts that the new media are central to the field because in everyday cultural practice people are using the new media to make meaning, to express themselves and to communicate and work with others. Socio-cultural approaches to literacy research have already provided rich material which has assisted educators to understand literacy practices in everyday use (e.g. Barton & Hamilton, 1998; Barton, Hamilton and Ivanic, 2000) including children’s appropriation of the media in school-based writing (Dyson, 1997). However, the changing semiotic and cultural practices associated with new media and online participation have less frequently been the object of study...

Arts-based research in design education

There is an urgent need in terms of changing world conditions to move beyond the dualist paradigm that has traditionally informed design research, education and practice. Rather than attempt to reduce uncertainty, novelty and complexity as is the conventional approach, an argument is presented in this article that seeks to exploit these qualities through a reconceptualisation of design in creative as well as systematic, rigorous and ethical terms. Arts-based research, which 'brings together the systematic and rigorous qualities of inquiry with the creative and imaginative qualities of the arts', is presented as being central to this reconceptualisation. This is exemplified in the application of art-informed inquiry in a research unit for graduating tertiary-level interior design students. The application is described in this article and is shown to rely substantially on the image and its capacity to open up and reveal new possibilities and meaning.

Preventing injuries on a state-wide basis : researchers and parliamentary committees are partners in turning injury prevention and safety research into practice and policy

Context: Parliamentary committees established in Westminster parliaments, such as Queensland, provide a cross-party structure that enables them to recommend policy and legislative changes that may otherwise be difficult for one party to recommend. The overall parliamentary committee process tends to be more cooperative and less adversarial than the main chamber of parliament and, as a result, this process permits parliamentary committees to make recommendations more on the available research evidence and less on political or party considerations. Objectives: This paper considers the contributions that parliamentary committees in Queensland have made in the past in the areas of road safety, drug use as well as organ and tissue donation. The paper also discusses the importance of researchers actively engaging with parliamentary committees to ensure the best evidence based policy outcomes. Key messages: In the past, parliamentary committees have successfully facilitated important safety changes with many committee recommendations based on research results. In order to maximise the benefits of the parliamentary committee process it is essential that researchers inform committees about their work and become key stakeholders in the inquiry process. Researchers can keep committees informed by making submissions to their inquiries, responding to requests for information and appearing as witnesses at public hearings. Researchers should emphasise the key findings and implications of their research as well as considering the jurisdictional implications and political consequences. It is important that researchers understand the differences between lobbying and providing informed recommendations when interacting with committees. Discussion and conclusions: Parliamentary committees in Queensland have successfully assisted in the introduction of evidence based policy and legislation. In order to present best practice recommendations, committees rely on the evidence presented to them including the results of researchers. Actively engaging with parliamentary committees will help researchers to turn their results into practice with a corresponding decrease in injuries and fatalities. Developing an understanding of parliamentary committees, and the typical inquiry process used by these committees, will help researchers to present their research results in a manner that will encourage the adoption of their ideas by parliamentary committees, the presentation of these results as recommendations within the report and the subsequent enactment of the committee’s recommendations by the government.

Towards participatory action design research : adapting action research and design science research methods for urban informatics

This paper proposes a new research method, Participatory Action Design Research (PADR), for studies in the Urban Informatics domain. PADR supports Urban Informatics research in developing new technological means (e.g. using mobile and ubiquitous computing) to resolve contemporary issues or support everyday life in urban environments. The paper discusses the nature, aims and inherent methodological needs of Urban Informatics research, and proposes PADR as a method to address these needs. Situated in a socio-technical context, Urban Informatics requires a close dialogue between social and design-oriented fields of research as well as their methods. PADR combines Action Research and Design Science Research, both of which are used in Information Systems, another field with a strong socio-technical emphasis, and further adapts them to the cross-disciplinary needs and research context of Urban Informatics.

Teachers’ detecting and reporting child abuse and neglect : research into the determinants of complex professional behavior

Child abuse and neglect is prevalent and entails significant costs to children, families and society. Teachers are responsible for significant proportions of official notifications to statutory child protection agencies. Hence, their accurate and appropriate reporting is crucial for well-functioning child protection systems. Approximately one-quarter of Australian teachers indicate never detecting a case of child maltreatment across their careers, while a further 13-15% admit to not reporting suspected cases in some circumstances. The detection and reporting of child abuse and neglect are complex decision-making behaviors, influenced by: the nature of the maltreatment itself; the characteristics of the teacher; the school environment; and the broader legislative and policy environment. In this chapter, the authors provide a background to teachers’ involvement in detecting and reporting child abuse and neglect, and an overview of the role of teachers is provided. Results are presented from three Australian studies that examine the unique contributions of: case; teacher; and contextual characteristics to detection and reporting behaviors. The authors conclude by highlighting the key implications for enhancing teacher training in child abuse and neglect, and outline future research directions.

Navigating the muddy waters of the research into single sex classrooms in co-educational middle years settings

Establishing single sex classes within co-educational sites is an option that Australian schools are again exploring. To date Australia has experienced three ‘waves’ of interest in establishing single sex classes, the first focused on equitable education opportunities for girls (Alloway & Gilbert, 1997), the second centered on boys’ literacy and engagement (Gilbert & Gilbert, 1998) and this current wave focuses on perceived difference between the sexes in co-educational classrooms (Protheroe, 2009; Gurian, Stevens & Daniels, 2009). With the intersection of middle schooling movement, focusing on learner centered classrooms (Pendergast & Bahr, 2010) and current educational agendas aimed at improving student performance and measurable learning outcomes (Ministerial Council on Education, Employment, Training and Youth Affairs, 2008), it is understandable that schools are exploring such student grouping options. However, after thirty years of international research into the efficacy of single sex classes in co-educational settings, the results still remain unclear. This paper seeks to navigate the ‘muddy waters’ of this body of research and suggests a framework to help guide school communities through the decision-making process associated with considering single sex classes.

A comparison of new and existing mild traumatic brain injury vignettes : recommendations for research into post-concussion syndrome

OBJECTIVE: To review and compare the mild traumatic brain injury (mTBI) vignettes used in postconcussion syndrome (PCS) research, and to develop 3 new vignettes. METHOD: The new vignettes were devised using World Health Organization (WHO) mTBI diagnostic criteria [1]. Each vignette depicted a very mild (VM), mild (M), or severe (S) brain injury. Expert review (N = 27) and readability analysis was used to validate the new vignettes and compare them to 5 existing vignettes. RESULTS: The response rate was 44%. The M vignette and existing vignettes were rated as depicting a mTBI; however, the fit-to-criteria of these vignettes differed significantly. The fit-to-criteria of the M vignette was as good as that of 3 existing vignettes and significantly better than 2 other vignettes. As expected, the VM and S vignettes were a poor fit-to-criteria. CONCLUSIONS: These new vignettes will assist PCS researchers to test the limits of important etiology factors by varying the severity of depicted injuries.

Translating vision research into policy and practice to improve visibility, and hence safety, of road workers at night

This case study report describes the stages involved in the translation of research on night-time visibility into standards for the safety clothing worn by roadworkers. Vision research demonstrates that when lights are placed on the moveable joints of the body and the person moves in a dark setting, the phenomenon known as “biological motion or biomotion” occurs, enabling rapid and accurate recognition of the human form although only the lights can be seen. QUT was successful in gaining funding from the Australian Research Council for a Linkage grant due to the support of the predecessors of the Queensland Department of Transport and Main Roads (TMR) to research the biomotion effect in on-road settings using materials that feature in roadworker clothing. Although positive results were gained, the process of translating the research results into policy, practices and standards relied strongly on the supportive efforts of TMR staff engaged in the review and promulgation of national standards. The ultimate result was the incorporation of biomotion marking into AS/NZS 4602.1 2011. The experiences gained in this case provide insights into the processes involved in translating research into practice.