Eames Sally, Bennett Sally, Whitehead Mary, Fleming Jennifer, Low Shanling Olivia, Mickan Sharon, Caldwell Elizabeth
Community, Indigenous and Subacute Services (CISS), Metro North Hospital and Health Services, Brisbane, Queensland, Australia.
School of Health and Rehabilitation Sciences, The University of Queensland, Therapies Annexe, St Lucia, Brisbane, Queensland, Australia.
Aust Occup Ther J. 2018 Dec;65(6):479-493. doi: 10.1111/1440-1630.12483. Epub 2018 May 31.
BACKGROUND/AIM: Knowledge translation (KT) aims to reduce research-practice gaps. Few studies have investigated methods to build clinicians' capacity for KT. To: (i) evaluate the impact of a multifaceted KT capacity-building intervention; (ii) understand barriers and enablers to clinicians' use of KT; and (iii) identify useful strategies.
A pre-post study to develop KT capacity amongst occupational therapy clinicians (n = 46) in a large metropolitan hospital. A customised questionaire (baseline and 18 months) identified KT-related behaviours and barriers and enablers guided by the Theoretical Domains Framework (TDF). McNemar's tests and Wilcoxon signed rank tests were completed on matched data (n = 20). At follow-up additional items explored perceptions of change and usefulness of strategies.
At follow-up, participants had read more clinical guidelines (10 vs. 17) and more participants reported using strategies to increase the use of recommended clinical practices (P = 0.006). The main barriers at baseline were from the TDF domains of 'attention, memory and decision processes', 'knowledge' and 'environmental context and resources', while main enablers were from 'social/professional role and identity', 'reinforcement', 'social influence' and 'beliefs about consequences' domains. At follow-up, significant improvements were seen in 'knowledge' (p < 0.001), 'environmental context & resources' (P < 0.001), 'skills' (P = 0.008) 'beliefs about consequences' (P = 0.011), 'beliefs about capabilities' (P = 0.018), and 'memory, attention & decision processes' (P = 0.048) and participants agreed that KT had become part of the departments' culture. Strategies perceived most useful included working as a team, having a dedicated staff member, mentoring meetings, department leader support, learning about KT over time, and training sessions.
The KT capacity-building intervention changed one clinician-reported behaviour and perceived impact of barriers across six domains. Clinicians reported perceived improvement in understanding of - and confidence in - KT, and changes in the culture to one of engaging with KT as part of clinical practice. Further research into KT capacity building is needed.
背景/目的:知识转化(KT)旨在缩小研究与实践之间的差距。很少有研究调查培养临床医生知识转化能力的方法。目的是:(i)评估多方面知识转化能力建设干预措施的影响;(ii)了解临床医生运用知识转化的障碍和促进因素;(iii)确定有用的策略。
一项前后对照研究,旨在提高一家大型都市医院职业治疗临床医生(n = 46)的知识转化能力。一份定制问卷(基线和18个月时)确定了与知识转化相关的行为、障碍和促进因素,这些均由理论领域框架(TDF)指导。对匹配数据(n = 20)完成了McNemar检验和Wilcoxon符号秩检验。在随访时,其他项目探讨了对变化的看法以及策略的有用性。
随访时,参与者阅读了更多临床指南(10份对17份),更多参与者报告使用策略来增加推荐临床实践的应用(P = 0.006)。基线时的主要障碍来自TDF的“注意力、记忆和决策过程”、“知识”以及“环境背景和资源”领域,而主要促进因素来自“社会/职业角色和身份”、“强化”、“社会影响”以及“对后果的信念”领域。随访时,“知识”(p < 0.001)、“环境背景和资源”(P < 0.001)、“技能”(P = 0.008)、“对后果的信念”(P = 0.011)、“对能力的信念”(P = 0.018)以及“记忆、注意力和决策过程”(P = 0.048)有显著改善,参与者一致认为知识转化已成为科室文化的一部分。被认为最有用的策略包括团队协作、有一名专门工作人员、指导会议、科室领导支持、长期学习知识转化以及培训课程。
知识转化能力建设干预措施改变了临床医生报告的一种行为以及六个领域中障碍的感知影响。临床医生报告称,对知识转化的理解和信心有了明显提高,并且科室文化已转变为将知识转化作为临床实践的一部分。需要对知识转化能力建设进行进一步研究。