Knowledge translation in Uganda : a qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework

BACKGROUND: A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this 'know-do' gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the subelements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting. METHODS: This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data. RESULTS: The sub-elements of organizational context in the PARIHS framework--i.e., receptive context, culture, leadership, and evaluation--also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT. CONCLUSIONS: In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings--resources, community involvement, and commitment and informal payment--should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate subelement of the PARIHS framework as a whole.

Medical students’ knowledge, attitudes, and perceptions on contraceptive use and counselling : a cross-sectional survey in Maharashtra, India

Objectives. This study aimed to investigate the knowledge, attitudes and perceptionstowards contraceptive use and counselling among medical students in Maharashtra, India. Setting. Considerable global maternal mortality and morbidity could be avoided through theuse of effective contraception. In India, contraception services are frequently unavailable or there are obstacles to obtaining modern, reversible contraceptives. Participants. A cross-sectional descriptive study using a self-administered questionnaire was conducted among 1996 medical students in their fifth year of study at 27 medical colleges in the state of Maharashtra, India. Descriptive and analytical statistics interpreted the survey instrument and significant results were presented with 95% CI. Results. Respondents expressed a desire to provide contraceptive services. A few studentshad experienced training in abortion care. There were misconceptions about moderncontraceptive methods and the impact of sex education. Attitudes towards contraceptionwere mainly positive, premarital counselling was supported and the influence of traditional values and negative provider attitudes on services was recognised. Gender, area of upbringing and type of medical college did not change the results. Conclusions. Despite mostly positive attitudes towards modern contraceptives, sex education and family planning counselling, medical students in Maharashtra have misconceptions about modern methods of contraception. Preservice and in-service training in contraceptive counselling should be implemented in order to increase women's access to evidence-based maternal healthcare services.

Computer-aided design decision support: interfacing knowledge and information

Computer-aided design decision support has proved to be an elusive and intangible project for many researchers as they seek to encapsulate information and knowledge-based systems as useful multifunctional data structures. Definitions of ‘knowledge', ‘information', ‘facts', and ‘data' become semantic footballs in the struggle to identify what designers actually do, and what level of support would suit them best, and how that support might be offered. The Construction Primer is a database-drivable interactive multimedia environment that provides readily updated access to many levels of information aimed to suit students and practitioners alike. This is hardly a novelty in itself. The innovative interface and metadata structures, however, combine with the willingness of national building control legislators, standards authorities, materials producers, building research organisations, and specification services to make the Construction Primer a versatile design decision support vehicle. It is both compatible with most working methodologies while remaining reasonably future-proof. This paper describes the structure of the project and highlights the importance of sound planning and strict adhesion to library-standard metadata protocols as a means to avoid the support becoming too specific or too paradigmatic.

Access and attitude of rural allied health professionals to CPD and training

Continuing professional development (CPD) activities for allied health professionals are becoming mandatory as a means for professionals to maintain accreditation or skills. To access CPD activities, rural allied health professionals have the added costs of travel, accommodation and information technology access. It is assumed that health professionals in rural areas want access to training and CPD. In 2003, a survey of allied health professionals was carried out in Southwest Victoria, Australia, with the aim of identifying access and attitudes to CPD. Results showed that allied health professionals in Southwest Victoria were highly qualified, wished to access CPD more than four times a year and were prepared to spend a mean rate of $1000 (1300) per annum on CPD activities.

Bounded and unbounded knowledge : teaching and learning in a web 2 world

beginning of serious problems for the business models of publishers. The ease with which content can be accessed, copied and distributed disrupts the control of those whose role has been to manage and profit from the intellectual property rights of content producers. In effect, the number of “publishers” increased many fold as the Web and other Internet-based technologies became the dominant mode of content distribution. In education, and in other fields, matters of intellectual property, copyright and quality control came to the fore. More recently, with the advent of web based software that makes publishing online available to anyone with access to the Internet the number of “publishers” and modes of publication have increased massively. The shift from a Web which was, for many a read only environment to a read/write Web poses not only ongoing problems for the traditional distributors of content but also now, for the traditional producers of content and knowledge. In this respect, the role of universities as designers and producers of learning materials for credentialed learning is also under challenge. Just as publishers explore alternative business models to adapt to the new digital environment, now universities have begun to explore new ways of working with so-called Web2 software to support teaching and learning online. In particular, some Web2 software affords new opportunities for and different modes of collaboration, which in the view of some points to student participation in knowledge production. While these developments represent important and significant shifts for universities, this paper draws attention to the lack of empirical data and situated contextual knowledge concerning intellectual property rights for knowledge constructed in a collaborative context. In addition, we explore issues in relation to the maintenance of academic integrity and quality where knowledge building takes place in a collaborative, online environment.

The availability of information in knowledge-based economies

The use of information is preceded by its availability. For post-industrial economies to exploit information to full potential it is important for knowledge to be free of vested-interest censorship and manipulation. History suggests that a range of vested-interests have manipulated explicit> information availability through various forms of sectarian, state and business manipulation of the systems of information storage and transfer. The OECD 1996 report "The Knowledge-Based Economy" recognized that the diffusion of knowledge was as significant as its creation, and that knowledge distribution networks were crucial to innovation, production processes and product development. The success of enterprises and national economies is considered reliant on the effectiveness of their ability to gather, distribute and utilize knowledge. The increasing need for ready access (of information that might become knowledge) in accordance with the OEDC definition is particularly relevant to this paper as it assumes infrastructures capable of providing that need. Wherever there are infrastructures there are opportunities to benefit from them, either for profit or power. This paper considers the implications of sectarian, state and business-model control over the selective content, storage and dissemination of information and knowledge, both from historical and current perspectives. The advent of new technologies and how they have enabled the flow of information adds new dimensions to knowledge control but the quality of knowledge is less certain and who controls or influences distribution of knowledge less transparent. It could be argued that at each step in the development of knowledge distribution networks, knowledge and its distribution, is not free of the possibility of third-party vested interest.

Job satisfaction versus office environment : influences on academic knowledge worker productivity

This research paper provides a more encompassing review of self-assessment of a variety of knowledge worker activities, as well as providing the basis for these self assessments. A novel aspect is the inclusion of motivational affects which are considered alongside work environment influences on productivity. A questionnaire was administered on 25 academics. The group was questioned for their perceptions of their productivity for a range of their everyday activities and what areas of their work environment enhanced or disrupted their productivity. Job satisfaction was also assessed. The results from a series of self-assessments show that on the whole, the sample perceive themselves to be reasonably to very productive in all tasks undertaken. Staff satisfaction measures are generally very positive with collaboration and job enjoyment being motivational factors for this group. Noise levels, thermal conditions, poor lighting and a lack of storage seem to be the biggest inhibitors of productivity. Having a window to look out of and access to natural light seem to enhance an academics view of their productivity.

Investigation of educator adoption of knowledge media

Human development has occurred against a timeline that has seen the creation of and diffusion of one innovation after another. These innovations range from language to complex computing and information technologies. The latter are assisting with the distribution of information, and extend to the distribution of the human species beyond the planet Earth. From early times, information has been published and mostly for a fee to the publisher. The absorption and use of information has had a high priority in most societies from early times, and has become institutionalised in universities and institutes of technical learning. For most in Western societies, education is now a matter of ‘lifelong learning’. Today, we see higher education institutions, worldwide, adapting their organisational structures and operating procedures and forming strategic alliances with communications content providers and carriers as well as with information technology companies. Modern educational institutes seek productivity and efficiency. Many also seek to differentiate themselves from competitors. Technological convergence is often seen by management to be a saviour in many educational organisations. It is hoped that lower capital and recurrent costs can be achieved, and that competitors in an increasingly globalised industry can be held at bay by strategic use of knowledge media (Eisenstadt, 1995) commonly associated with distance education in the campus setting. Knowledge media set up costs, intellectual property costs and training costs for staff and students are often so high as to make their use not viable for Australian institutes of higher education. Against this backdrop, one might expect greater educator and student use of publisher produced textbooks and digital enhancements to the textbook, particularly those involved in distance education. A major issue is whether or not the timing of instructor adoption of converging information technology and communications technologies aligns with the wishes of both higher education management and government, and with those who seek commercial gain from the diffusion and adoption of such technologies. Also at issue is whether or not it is possible to explain variance in stated intentions to recommend adoption of new learning technologies in higher education and implementation. Will there occur educator recommendation for adoption of individual knowledge media such as World Wide Web access to study materials by students? And what will be the form of this tool and others used in higher education? This thesis reports on more recent changes in the technological environment and seeks to contribute to an understanding of the factors that lead to a willingness, or unwillingness, on the part of higher education instructors, as influencers and content providers, to utilise these technologies. As such, it is a diffusion study which seeks to fill a gap in the literature. Diffusion studies typically focus on predicting adoption based on characteristics of the potential adopter. Few studies examine the relationship between characteristics of the innovation and adoption. Nearly all diffusion studies involve what is termed discontinuous innovation (Robertson, 1971). That is, the innovation involves adoptees in a major departure from previous practice. This study seeks to examine the relationship between previous experience of related technologies and adoption or rejection of dynamically continuous innovation. Continuous and dynamically continuous innovations are the most numerous in the real world, yet they are numerically the least scrutinised by way of academic research. Moreover, the three-year longitudinal study of educators in Australian and New Zealand meets important criteria laid down by researchers Tornatzky and Klein (1982) and Rogers (1995), that are often not met by similar studies. In particular the study examines diffusion as it is unfolding, rather than selectively examining a single innovation and after the fact, thus avoiding a possible pro-innovation bias. The study examines the situation for both ‘all educators’ and ‘marketing / management educators’ alone in seeking to meet the following aim: Establish if intended adopters of specific knowledge media have had more experience of other computer-based technologies than have those not intending to adopt said knowledge media. The analytical phase entails use of factor analysis and discriminant analysis to conclude that it is possible to discriminate adopters of selected knowledge media based on previous use of related technologies. The study does not find any generalised factor that enables such discrimination among educators. Thus the study supports the literature in part, but fails to find generalised factors that enable unambiguous prediction of knowledge media adoption or otherwise among each grouping of educators examined. The implications are that even in the case of related products and services (continuous or dynamically continuous innovation), there is not statistical certainty that prior usage of related products or technologies is related to intentions to use knowledge media in the future. In this regard, the present study might be said to confirm the view that Rogers and Shoemaker's (1971) conceptualisation of perceived innovation characteristics may only apply to discontinuous innovations (Stratton, Lumpkin & Vitell, 1997). The implications for stakeholders such as higher education management is that when seeking to appoint new educators or existing staff to knowledge media project teams, there is some support for the notion that those who already use World Wide Web based technologies are likely to take these technologies into teaching situations. The same claim cannot be made for computer software use in general, nor Internet use in general.

Reconceptualising access in education policy : method and mindset

Enhancing access to education and knowledge is a long-held principle enshrined in education policy. Access to education offers leverage for educational attainment and achievement, at the individual and social levels. In policy, the term equates with concepts of inclusion, social justice and equity. Over the last decades, as education policy has responded to global social, cultural and economic reforms, concepts such as access have also undergone revision. This article revisits the relationship between access, education and knowledgemaking, in order to clarify the meaning of access in current education policies by reevaluating how access is constructed in policy and how the concept associates with other aspects of education. The research examines the concept of access in order to improve the efficacy of policy, opening the way for more systematic and transparent policy analysis and policy making centred on defining and delineating conceptual meanings such as access, as a basis for more targeted policy. Using evidence-based policy research, the article proposes a research process model based on the hierarchy of abstraction, to show that education policy requires systematic examination of key concepts as a fundamental step towards more clearly defined policy postulates that recognise and deal with contextual complexity of education policy. Defining and delineating the meaning of concepts such as access can help in the way that education policy contributes to guiding innovative knowledge construction.

Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals

Background

Theories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore.
Methods

Nurses were surveyed to identify their perceptions regarding barriers to implementation of clinical practice guidelines in their practice setting. The validated questionnaire, 'Barriers and facilitators assessment instrument', was administered to nurses (n = 1830) working in the medical, surgical, geriatric units, at five acute care hospitals in Singapore.
Results

An 80.2% response rate was achieved. The greatest barriers to implementation of clinical practice guidelines reported included: knowledge and motivation, availability of support staff, access to facilities, health status of patients, and, education of staff and patients.
Conclusion

Numerous barriers to the use of the Fall Prevention Clinical Practice Guideline have been identified. This study has laid the foundation for further research into implementation of clinical practice guidelines in Singapore by identifying barriers to change in acute care settings.

Health literacy : what is it and why is it important to measure?

This report summarizes the proceedings of the first Outcome Measures in Rheumatology Clinical Trials (OMERACT) Health Literacy Special Interest Group workshop at the OMERACT 10 conference. Health literacy refers to an individual’s capacity to seek, understand, and use health information. Discussion centered on the relevance of health literacy to the rheumatology field; whether measures of health literacy were important in the context of clinical trials and routine care; and, if so, whether disease-specific measures were required. A nominal group process involving 27 workshop participants, comprising a patient group (n = 12) and a healthcare professional and researcher group (n = 15), confirmed that health literacy encompasses a broad range of concepts and skills that existing scales do not measure. It identified the importance and relevance of patient abilities and characteristics, but also health professional factors and broader contextual factors. Sixteen themes were identified: access to information; cognitive capacity; disease; expression/communication; finances; health professionals; health system; information; literacy/numeracy; management skills; medication; patient approach; dealing with problems; psychological characteristics; social supports; and time. Each of these was divided further into subthemes of one or more of the following: knowledge, attitude, attribute, relationship, skill, action, or context. There were virtually no musculoskeletal-specific statements, suggesting that a generic health literacy tool in rheumatology is justified. The detailed concepts across themes provided new and systematic insight into what needs to be done to improve health literacy and consequently reduce health inequalities. These data will be used to derive a more comprehensive measure of health literacy.

I would like to change the world, but they wouldn't let me have the source code

In this paper we present the findings of a group problem-solving task involving eight randomly selected students. The focus of this study was to identify and explore students' application of generic skills, cross-disciplinary knowledge and skills, innovative thinking and engineering disciplinary knowledge. While this was the main aim of this study, we also used the findings of this study to triangulate the findings of a broader study which aims to identify and explore students' perceptions of problem based learning (PBL) in first year electrical engineering. The broader qualitative study of learners in a problem based engineering context will identify, explore and report on the factors that influence student learning behaviours and their attitudes as future engineers. Studying the learning cultures from the students' view point in a diverse student group should provide evidence to further theorize about the models of self-regulation in autonomous learners. For this group problem solving activity, we designed a problem (advanced lift controller system) and allowed students one hour to work on a solution for this problem. The eight students from a number of actual PBL groups were divided into two groups depending upon their availability. Both groups were given the same problem. The researcher played the role of a facilitator and collected the data simultaneously. Students were given access to books relevant to the problem, computer access and access to the Internet. They were also provided with links to sample websites such as the University's electronic library and other technology related websites on the World Wide Web. The activity was designed such that students were not required to arrive at a definite outcome. However, they were asked to brainstorm ideas, and as a group, to decide on ways that they would obtain and share information and to formulate and suggest possible innovative solutions to the problem. Data for this activity was collected by means of observation. The activity was audio and video recorded in order to help revisit the data at any stage. At the time this study was conducted, students had completed two PBL units in their first year of an electronic and electrical engineering undergraduate degree course. This study also provided insight into students' attitudes and their behaviours towards learning in a group setting, learning approaches and outcomes, different responses to the heterogeneity of the students in the group, and their responsibility and accountability in an autonomous learning setting such as PBL.

Using e-learning to increase the preparedness and confidence of nurses to perform buttonhole cannulation

Arteriovenous fistulae are considered the gold standard for haemodialysis vascular access. Their use can be fraught with complications for both the patient and cannulator, with knowledge, expertise and skills being key factors in reducing access associated morbidity. There is mounting evidence demonstrating the efficacy of the buttonhole technique. One disturbing problem noted with the buttonhole experience has been an increased rate in site infections, anecdotally attributed to poor buttonhole site preparation. Enhanced knowledge and skills for nurses are crucial in increasing patient comfort and improving outcomes.

Although knowledge and skill acquisition related to vascular access are often the focus of individual institutional educational initiatives, a national evidence based program that provides free equitable access to all nurses does not exist in Australasia. A survey of Australasian Nephrology Educators’ identified the need for more effective and consistent delivery of clinical education for nurses using innovative, web‐based approaches that support the tenets of e-learning methodologies. This paper will discuss the development and implementation of an e-learning program for buttonhole cannulation. The preparedness of participants to professionally engage with buttonhole cannulation and their self-efficacy (estimates) in undertaking learning about the clinical procedure using e-learning will be evaluated. In addition it will highlight the benefits of inter‐organizational partnerships and how they can facilitate positive change in teaching and learning practices aimed at improving patient outcomes. This project has unique characteristics that collectively provide value, distinction and innovation to patients, nurses, and renal departments across Australasia. As the e-learning program is founded on evidence based practice this project is easily transferable to an international context.

Can eLearning provide tools for capacity-building to improve performance in the nonprofit sector?

Can E-learning 2.0 provide a platform for improving performance in nonprofit organizations? It is argued that Web 2.0 technologies provide the tools that today’s students rely on in the learning environment. As such they may be the means to attract and retain learners in training and education programs designed to improve performance. E-learning delivered through a blended learning model has proven to be effective in corporate training and higher education. Can the interactive, collaborative model offered in E-learning 2 prove to be as effective? This paper reviews the literature on blended learning and capacity-building as background for a discussion of the potential that e-learning models enhanced by web 2.0 technologies have for expanding access to education and training and facilitating implementation of skills and knowledge gained in the workplace. We suggest that increasing training opportunities for staff and making nonprofit management education more accessible through online programs is not enough to meet the challenge. What is needed at this point is practicable education and training delivered in today’s user’s environment, that is online and “on the go.”

The association between investigative interviewers' knowledge of question type and adherence to best-practice interviewing

It is well established that not all investigative interviewers adhere to ‘best-practice’ interview guidelines (i.e., the use of open-ended questions) when interviewing child witnesses about abuse. However, little research has examined the sub skills associated with open question usage. In this article, we examined the association between investigative interviewers' ability to identify various types of questions and adherence to open-ended questions in a standardized mock interview. Study 1, incorporating 27 trainee police interviewers, revealed positive associations between open-ended question usage and two tasks; a recognition task where trainees used a structured protocol to guide their response and a recall task where they generated examples of open-ended questions from memory. In Study 2, incorporating a more heterogeneous sample of 40 professionals and a different training format and range of tests, positive relationships between interviewers' identification of questions and adherence to best-practice interviewing was consistently revealed. A measure of interviewer knowledge about what constitutes best-practice investigative (as opposed to knowledge of question types) showed no association with interviewer performance. The implications of these findings for interviewer training programs are discussed.