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OBJECTIVE: This paper was prepared by the National Cancer Institute of Canada (NCIC) Working Group on Translational Research and Knowledge Transfer. The goal was to nurture common ground upon which to build a platform for translating what we know about cancer into what we do in practice and policy. METHODS: Methods included expert panels, literature review, and concept mapping, to develop a framework that built on earlier cancer control conceptualizations of communications that have guided researchers and end users. RESULTS: The concept of 'knowledge integration' is used to describe the resulting refinement and the nature of evidence necessary for decision-making to at the systems level. Current evidence for knowledge integration in cancer control is presented across the levels of individual, organizational and systems level interventions and across basic, clinical and population science knowledge bases. CONCLUSION: A systems-oriented approach to integrating evidence into action assists organizations to conduct research and policy and practice. PRACTICE IMPLICATIONS: Practitioners can use this framework to understand the challenges of implementing and evaluating cancer control strategies. [ABSTRACT FROM AUTHOR]

To develop and pilot-test a feasible and meaningful evaluation framework to support the ongoing improvement and performance measurement of services and systems in Latin America regarding Collaborative Mental health Care (CMHC). This mixed methods study, guided by a developmental evaluation approach, included: (1) a critical review of the literature; (2) an environmental scan at three selected health networks in Mexico, Nicaragua and Chile; (3) a Delphi group with experts; (4) a final consultation in the three sites; and (5) a pilot-test of the framework. A comprehensive evaluation framework was developed and successfully piloted. It considers five levels, 28 dimensions and 40 domains, as well as examples of indicators and an implementation plan. This evaluation framework represents an important effort to foster accountability and quality regarding CMHC in Latin America. Recommendations to build upon current capacity and to effectively address the existing implementation challenges are further discussed., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Aims: Fundamental roadblocks, such as non-use and low electronic health (eHealth) literacy, prevent the implementation of eHealth resources. The aims were to study internet usage for health information and eHealth literacy in patients after percutaneous coronary intervention (PCI). Further, we aimed to evaluate temporal changes and determine whether the use of the internet to find health information and eHealth literacy were associated with coronary artery disease (CAD) risk factors at the index admission and 12-month follow-up of the same population., Methods and Results: This prospective longitudinal study recruited 2924 adult patients with internet access treated by PCI in two Nordic countries. Assessments were made at baseline and 12-month follow-up, including a de novo question Have you used the internet to find information about health? , the eHealth literacy scale, and assessment of clinical, behavioural, and psychological CAD risk factors. Regression analyses were used. Patients' use of the internet for health information and their eHealth literacy were moderate at baseline but significantly lower at 12-month follow-up. Non-users of the internet for health information were more often smokers and had a lower burden of anxiety symptoms. Lower eHealth literacy was associated with a higher burden of depression symptoms at baseline and lower physical activity and being a smoker at baseline and at 12-month follow-up., Conclusion: Non-use of the internet and lower eHealth literacy need to be considered when implementing eHealth resources, as they are associated with behavioural and psychological CAD risk factors. eHealth should therefore be designed and implemented with high-risk CAD patients in mind., Clinical Trial Registration: ClinicalTrials.gov NCT03810612 https://clinicaltrials.gov/ct2/show/NCT03810612., Competing Interests: Conflict of interest: There are no conflicts of interest to disclose., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

National health strategies are integral in defining the vision and strategic direction for ensuring the health of a population or for a specific health area. To facilitate a national coordinated approach in spinal cord injury (SCI) research and care in Canada, Praxis Spinal Cord Institute, with support from national experts and funding from the Government of Canada, developed a national strategy to advance SCI care, health, and wellness based on previous SCI strategic documents. This paper describes the development process of the SCI Care for Canada: A Framework for Strategy and Action . Specifically, it covers the process of building on historical and existing work of SCI in Canada through a thorough review of literature to inform community consultations and co-creation design. Furthermore, this paper describes planning for communication, dissemination, and evaluation. The SCI Care Strategic Framework promotes an updated common understanding of the goals and vision of the SCI community, as well as strengths and priorities within the SCI system regarding care, health, and wellness. Additionally, it supports the coordination and scaling up of SCI advancements to make a sustainable impact nationwide focusing on the needs of people living with SCI., Competing Interests: Authors CN and JL were employed by Cense Ltd. and were contracted by Praxis to develop the SCI Care Strategic Framework but devoted their own time to this manuscript. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Rivera, Yousefi, Cheng, Norman, Legare, McFarlane and Noonan.)

Introduction: The future of work is characterized by changes that could disrupt all aspects of the nature and availability of work. Our study aims to understand how the future of work could result in conditions, which contribute to vulnerability for different groups of workers., Methods: A horizon scan was conducted to systematically identify and synthesize diverse sources of evidence, including academic and gray literature and resources shared over social media. Evidence was synthesized, and trend categories were developed through iterative discussions among the research team., Results: Nine trend categories were uncovered, which included the digital transformation of the economy, artificial intelligence (AI)/machine learning-enhanced automation, AI-enabled human resource management systems, skill requirements for the future of work; globalization 4.0, climate change and the green economy, Gen Zs and the work environment; populism and the future of work, and external shocks to accelerate the changing nature of work. The scan highlighted that some groups of workers may be more likely to experience conditions that contribute to vulnerability, including greater exposure to job displacement or wage depression. The future of work could also create opportunities for labor market engagement., Conclusion: The future of work represents an emerging public health concern. Exclusion from the future of work has the potential to widen existing social and health inequities. Thus, tailored supports that are resilient to changes in the nature and availability of work are required for workers facing vulnerability., (© 2021 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals LLC.)

Purpose: EatRight Ontario (ERO), a multi-modal dietitian service (phone, email, web), provided the public and health intermediaries with healthy eating advice, professional support, and health promotion tools from 2007 to 2018. An evaluation of ERO was conducted to assess the impact of the model on knowledge, attitudes, and behaviour for consumers, utilization, and support levels and satisfaction provided to health intermediaries. Methods: Consumer clients were sent a survey 1-4 weeks after using the ERO service to capture self-reported dietary changes, intentions, nutritional knowledge, and satisfaction. Health intermediaries were recruited through an electronic ERO newsletter and asked about how ERO supported their practice. Results: Of the 867 consumer respondents, 92% had either made a change or indicated that information from ERO confirmed their present behaviour, and 96% indicated they would recommend the services to others. Of the 337 health intermediaries who responded 71% indicated that ERO provided services they could not deliver. Conclusions: ERO's multi-modal dietitian contact centre provides a model for implementing successful remote service access for consumers and professionals to support healthy eating across diverse demographics and geographies, including those in geographically underserved areas.

Background: Web-based technology has recently become an important source for sharing health information with patients after an acute cardiac event. Therefore, consideration of patients' perceived electronic health (eHealth) literacy skills is crucial for improving the delivery of patient-centered health information., Objective: The aim of this study was to translate and adapt the eHealth Literacy Scale (eHEALS) to conditions in Norway, and to determine its psychometric properties. More specifically, we set out to determine the reliability (internal consistency, test-retest) and construct validity (structural validity, hypotheses testing, and cross-cultural validity) of the eHEALS in self-report format administered to patients after percutaneous coronary intervention., Methods: The original English version of the eHEALS was translated into Norwegian following a widely used cross-cultural adaptation process. Internal consistency was calculated using Cronbach α. The intraclass correlation coefficient (ICC) was used to assess the test-retest reliability. Confirmatory factor analysis (CFA) was performed for a priori-specified 1-, 2-, and 3-factor models. Demographic, health-related internet use, health literacy, and health status information was collected to examine correlations with eHEALS scores., Results: A total of 1695 patients after percutaneous coronary intervention were included in the validation analysis. The mean age was 66 years, and the majority of patients were men (1313, 77.46%). Cronbach α for the eHEALS was >.99. The corresponding Cronbach α for the 2-week retest was .94. The test-retest ICC for eHEALS was 0.605 (95% CI 0.419-0.743, P<.001). The CFA showed a modest model fit for the 1- and 2-factor models (root mean square error of approximation>0.06). After modifications in the 3-factor model, all of the goodness-of-fit indices indicated a good fit. There was a weak correlation with age (r=-0.206). Between-groups analysis of variance showed a difference according to educational groups and the eHEALS score, with a mean difference ranging from 2.24 (P=.002) to 4.61 (P<.001), and a higher eHEALS score was found for patients who were employed compared to those who were retired (mean difference 2.31, P<.001). The eHEALS score was also higher among patients who reported using the internet to find health information (95% CI -21.40 to -17.21, P<.001), and there was a moderate correlation with the patients' perceived usefulness (r=0.587) and importance (r=0.574) of using the internet for health information. There were also moderate correlations identified between the eHEALS score and the health literacy domains appraisal of health information (r=0.380) and ability to find good health information (r=0.561). Weak correlations with the mental health composite score (r=0.116) and physical health composite score (r=0.116) were identified., Conclusions: This study provides new information on the psychometric properties of the eHEALS for patients after percutaneous coronary intervention, suggesting a multidimensional rather than unidimensional construct. However, the study also indicated a redundancy of items, indicating the need for further validation studies., Trial Registration: ClinicalTrials.gov NCT03810612; https://clinicaltrials.gov/ct2/show/NCT03810612., (©Gunhild Brørs, Tore Wentzel-Larsen, Håvard Dalen, Tina B Hansen, Cameron D Norman, Astrid Wahl, Tone M Norekvål, The CONCARD Investigators. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 28.07.2020.)

Systems thinking has emerged as a means of conceptualizing and addressing complex public health problems, thereby challenging more commonplace understanding of problems and corresponding solutions as straightforward explanations of cause and effect. Systems thinking tries to address the complexity of problems through qualitative and quantitative modeling based on a variety of systems theories, each with their own assumptions and, more importantly, implicit and unexamined values. To date, however, there has been little engagement between systems scientists and those working in bioethics and public health ethics. The goal of this paper is to begin to consider what it might mean to combine systems thinking with public health ethics to solve public health challenges. We argue that there is a role for ethics in systems thinking in public health as a means of elucidating implicit assumptions and facilitating ethics debate and dialogue with key stakeholders.

Background: Digital mobile technology presents a promising medium for reaching young adults with smoking cessation interventions because they are the heaviest users of this technology., Objective: The aim of this study was to determine the efficacy of an evidence-informed smartphone app for smoking cessation, Crush the Crave (CTC), on reducing smoking prevalence among young adult smokers in comparison with an evidence-informed self-help guide, On the Road to Quitting (OnRQ)., Methods: A parallel, double-blind, randomized controlled trial with 2 arms was conducted in Canada to evaluate CTC. In total, 1599 young adult smokers (aged 19 to 29 years) intending to quit smoking in the next 30 days were recruited online and randomized to receive CTC or the control condition OnRQ for a period of 6 months. The primary outcome measure was self-reported continuous abstinence at the 6-month follow-up., Results: Overall follow-up rates were 57.41% (918/1599) and 60.48% (967/1599) at 3 and 6 months, respectively. Moreover, 45.34% (725/1599) of participants completed baseline, 3-, and 6-month follow-up. Intention-to-treat analysis (last observation carried forward) showed that continuous abstinence (N=1599) at 6 months was not significantly different at 7.8% (64/820) for CTC versus 9.2% (72/779) for OnRQ (odds ratio; OR 0.83, 95% CI 0.59-1.18). Similarly, 30-day point prevalence abstinence at 6 months was not significantly different at 14.4% (118/820) and 16.9% (132/779) for CTC and OnRQ, respectively (OR 0.82, 95% CI 0.63-1.08). However, these rates of abstinence were favorable compared with unassisted 30-day quit rates of 11.5% among young adults. Secondary measures of quit attempts and the number of cigarettes smoked per day at 6-month follow-up did not reveal any significant differences between groups. For those who completed the 6-month follow-up, 85.1% (359/422) of young adult smokers downloaded CTC as compared with 81.8% (346/423) of OnRQ, χ 2 1(N=845) =1.6, P=.23. Furthermore, OnRQ participants reported significantly higher levels of overall satisfaction (mean 3.3 [SD 1.1] vs mean 2.6 [SD 1.3]; t 644 =6.87, P<.001), perceived helpfulness (mean 5.8 [SD 2.4] vs mean 4.3 [SD 2.6], t 657 =8.0, P<.001), and frequency of use (mean 3.6 [SD 1.2] vs mean 3.2 [SD 1.1], t 683 =5.7, P<.001) compared with CTC participants., Conclusions: CTC was feasible for delivering cessation support but was not superior to a self-help guide in helping motivated young adults to quit smoking. CTC will benefit from further formative research to address satisfaction and usage. As smartphone apps may not serve as useful alternatives to printed self-help guides, there is a need to conduct further research to understand how digital mobile technology smoking cessation interventions for smoking cessation can be improved., Trial Registration: ClinicalTrials.gov NCT01983150; http://clinicaltrials.gov/ct2/show/NCT01983150 (Archived by WebCite at http://www.webcitation.org/6VGyc0W0i)., (©Neill Bruce Baskerville, Laura Louise Struik, Godefroy Emmanuel Guindon, Cameron D Norman, Robyn Whittaker, Catherine Burns, David Hammond, Darly Dash, K Stephen Brown. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 23.10.2018.)

Connecting people to useful, actionable health resources is a substantive challenge that sits at the heart of health communication. Digital media provides means of producing, distributing and revising content and creates possibilities for new and multiple channels for reaching and engaging audiences, particularly when combined with social media. While there is much promise of digital media forms to deliver audiences and promote engagement, the health communication landscape is still largely hit-and-miss with few 'best practice' examples to follow. Proof-of-concept studies allow for a structured, focused exploration of ways to leverage the potential of digital media and learn what approaches have the promise to invest resources in amid a sea of possible options. Think You Can Shrink? (TYCS) is a multi-episode web series modelled on a reality TV show format. The show's key objective is to educate men and demonstrate, through modelling, ways men can support other men to encourage help-seeking behaviours and greater health communication, which in turn, may also lead to better health outcomes. Given the newness of the approach, the project was launched as a proof-of-concept study to explore: (a) whether this approach could engage the interest of men, (b) what initial impact this approach might induce and, ((c) the kind of audiences this approach might most appeal to.)

Background: A changing and cluttered information landscape has put pressure on health organizations to produce consumer information materials that are not only factual but high quality and engaging to audiences. User-centered design methods can be useful in obtaining feedback from consumers; however, they are labor intensive and slow, which is not responsive to the fast-paced communication landscape influenced by social media. EatRight Ontario (ERO), a provincial nutrition and health support program of Dietitians of Canada, develops evidence-based resources for consumers and sought to increase user-centered design activities by exploring whether the standard approach to feedback could be replicated online. While online feedback has been used in marketing research, few examples are available in health promotion and public health to guide programming and policy., Objective: This study compared a traditional in-person approach for recruitment and feedback using paper surveys with an Internet-based approach using Facebook as a recruitment tool and collecting user feedback via the Web. The purpose of the proof-of-concept study was to explore the feasibility of the approach and compare an online versus traditional approach in terms of recruitment issues and response., Methods: An exploratory, two-group comparative trial was conducted using a convenience and purposive sampling. Participants reviewed a handout on healthy eating and then completed an 18-item survey with both forced-choice items and open-ended responses. One group viewed a hard-copy prototype and completed a paper survey and the other viewed a PDF prototype via Web links and completed a Web survey. The total days required to fulfill the sample for each group were used as the primary method of efficiency calculation., Results: In total, 44 participants (22 per condition) completed the study, consisting of 42 women and 2 men over the age of 18. Few significant differences were detected between the groups. Statistically significant (P≤.05) differences were detected on four attitudinal variables related to the document reviewed and include perceived length of the document, perceived attractiveness, likelihood of contacting ERO for food and nutrition questions in the future, and likelihood of recommending ERO to a friend. In all cases, the responses were more favorable to the document or ERO with the online group. All other variables showed no difference between them. A content review of the qualitative feedback found relative consistency in word use and number of words used, indicating relative parity in the amount of data generated between conditions. The online condition achieved its sampling target in 9 days, while the in-person method took 79 days to achieve the target., Conclusions: An online process of recruitment through Facebook and solicitation of online feedback is a feasible model that yields comparable response levels to in-person methods for user feedback. The online approach appears to be a faster and less resource-intensive approach than traditional in-person methods for feedback generation.

Background: Inadequate functional health literacy is a common problem in immigrant populations. The aim of this study was to investigate the association between oral (dental) health literacy (OHL) and participation in oral health care among Brazilian immigrants in Toronto, Ontario, Canada., Methods: The study used a cross-sectional design and a convenience sample of 101 Brazilian immigrants selected through the snowball sampling technique. Data were analyzed using descriptive statistics and logistic regression modeling., Results: Most of the sample had adequate OHL (83.1 %). Inadequate/marginal OHL was associated with not visiting a dentist in the preceding year (OR = 3.61; p = 0.04), not having a dentist as the primary source of dental information (OR = 5.55; p < 0.01), and not participating in shared dental treatment decision making (OR = 1.06; p = 0.05; OHL as a continuous variable) in multivariate logistic regressions controlling for covariates. A low average annual family income was associated with two indicators of poor participation in oral health care (i.e., not having visited a dentist in the previous year, and not having a dentist as regular source of dental information)., Conclusion: Limited OHL was linked to lower participation in the oral health care system and with barriers to using dental services among a sample of Brazilian immigrants. More effective knowledge transfer will be required to help specific groups of immigrants to better navigate the Canadian dental care system.

Background: Tobacco use remains the number one cause of preventable chronic disease and death in developed countries worldwide. In North America, smoking rates are highest among young adults. Despite that the majority of young adult smokers indicate wanting to quit, smoking rates among this age demographic have yet to decline. Helping young adults quit smoking continues to be a public health priority. Digital mobile technology presents a promising medium for reaching this population with smoking cessation interventions, especially because young adults are the heaviest users of this technology., Objective: The primary aim of this trial is to determine the effectiveness of an evidence-informed mobile phone app for smoking cessation, Crush the Crave, on reducing smoking prevalence among young adult smokers., Methods: A parallel randomized controlled trial (RCT) with two arms will be conducted in Canada to evaluate Crush the Crave. In total, 1354 young adult smokers (19 to 29 years old) will be randomized to receive the evidence-informed mobile phone app, Crush the Crave, or an evidence-based self-help guide known as "On the Road to Quitting" (control) for a period of 6 months. The primary outcome measure is a 30-day point prevalence of abstinence at the 6-month follow-up. Secondary outcomes include a 7-day point prevalence of abstinence, number of quit attempts, reduction in consumption of cigarettes, self-efficacy, satisfaction, app utilization metrics, and use of smoking cessation services. A cost-effectiveness analysis is included., Results: This trial is currently open for recruitment. The anticipated completion date for the study is April 2016., Conclusions: This randomized controlled trial will provide the evidence to move forward on decision making regarding the inclusion of technology-based mobile phone interventions as part of existing smoking cessation efforts made by health care providers. Evidence from the trial will also inform the development of future apps, provide a deeper understanding of the factors that drive change in smoking behavior using an app, and improve the design of cessation apps. This trial is among the first to assess the effect of a comprehensive and evidence-informed mHealth smoking cessation app on a large sample of young adult smokers. Strengths of the trial include the high-quality research design and in-depth assessment of the implementation of the intervention. If effective, the trial has the potential to demonstrate that including mHealth technology as a population-based intervention strategy can cost-effectively reach a greater proportion of the population and help young adult smokers to quit., Trial Registration: ClinicalTrials.gov NCT01983150; http://clinicaltrials.gov/ct2/show/NCT01983150 (Archived by WebCite at http://www.webcitation.org/6VGyc0W0i).

Background: Refugees experience multiple health and social needs. This requires an integrated approach to care in the countries of resettlement, including Canada. Perhaps, interactive eHealth tools could build bridges between medical and social care in a timely manner. The authors developed and piloted a multi-risk Computer-assisted Psychosocial Risk Assessment (CaPRA) tool for Afghan refugees visiting a community health center. The iPad based CaPRA survey was completed by the patients in their own language before seeing the medical practitioner. The computer then generated individualized feedback for the patient and provider with suggestions about available services., Methods: A pilot randomized trial was conducted with adult Afghan refugees who could read Dari/Farsi or English language. Consenting patients were randomly assigned to the CaPRA (intervention) or usual care (control) group. All patients completed a paper-pencil exit survey. The primary outcome was patient intention to see a psychosocial counselor. The secondary outcomes were patient acceptance of the tool and visit satisfaction., Results: Out of 199 approached patients, 64 were eligible and 50 consented and one withdrew (CaPRA=25; usual care=24). On average, participants were 37.6 years of age and had lived 3.4 years in Canada. Seventy-two percent of participants in CaPRA group had intention to visit a psychosocial counselor, compared to 46% in usual care group [X2 (1)=3.47, p=0.06]. On a 5-point scale, CaPRA group participants agreed with the benefits of the tool (mean=4) and were 'unsure' about possible barriers to interact with the clinicians (mean=2.8) or to privacy of information (mean=2.8) in CaPRA mediated visits. On a 5-point scale, the two groups were alike in patient satisfaction (mean=4.3)., Conclusion: The studied eHealth tool offers a promising model to integrate medical and social care to address the health and settlement needs of refugees. The tool's potential is discussed in relation to implications for healthcare practice. The study should be replicated with a larger sample to generalize the results while controlling for potential confounders.

Social media and the multimedia networks that they support provide a platform for engaging youth and young adults across diverse contexts in a manner that supports different forms of creative expression. Drawing on more than 15 years of experience using eHealth promotion strategies to youth engagement, the Youth Voices Research Group (YVRG) and its partners have created novel opportunities for young people to explore health topics ranging from tobacco use, food security, mental health, to navigation of health services. Through applying systems and design thinking, the YVRG approach to engaging youth will be presented using examples from its research and practice that combine social organizing with arts-informed methods for creative expression using information technology. This presentation focuses on the way in which the YVRG has introduced interactive blogging, photographic elicitation, and video documentaries, alongside real-world social action projects, to promote youth health and to assist in research and evaluation. Opportunities and barriers including literacy and access to technology are discussed and presented along with emerging areas of research including more effective use of smartphones and social networking platforms such as Twitter, Facebook, and YouTube in health promotion and public health.

Telemedicine and telehealth programs are generally more complex than their traditional on-site health care delivery counterparts. A few organizations have developed sustainable, multispecialty telemedicine programs, but single service programs, such as teleradiology and teledermatology, are common. Planning and maintaining a successful telemedicine program is challenging, and there are often barriers to developing sustainable telehealth programs. This article reviews some important aspects of developing a telehealth program, and provides two examples of currently operating successful model programs., (Copyright © 2011 Elsevier Inc. All rights reserved.)

This article discusses consumer-directed technologies for health care and promotion in light of the rapid expansion of consumer-oriented tools and technologies, which has redefined telehealth. The difference between traditional telehealth services focused on supporting or augmenting institutional-based health care activities, and consumer-directed telehealth activities more linked to individuals are presented, the 3 orders of consumer-directed telehealth are described, and technical issues inherent in telehealth programs are discusses., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Almost a decade ago, public health initiated a number of innovative ventures to attract investments from multinational drug companies for the development of new drugs and vaccines to tackle neglected diseases (NDs). These ventures - known as product development public-private partnerships (PD PPPs) - represent the participation of the public and private actors toward the discovery and development of essential medicines to reduce the suffering of over one billion people worldwide living with NDs. This systematic review aimed to identify empirical-based descriptive articles to understand critical elements in the partnership process, and propose a framework to shed light on future guidelines to support better planning, design and management of existing and new forms of PPPs for public health. Ten articles met the inclusion criteria and were analyzed and synthesized using qualitative content analysis. The findings show that the development stage of PD PPPs requires a careful initiation and planning process including discussion on values and shared goals, agreement on mutual interests & equality of power relation, exchange of expertise & resources, stakeholder engagement, and assessment of the local health capacity. The management stage of PD PPPs entails transparency, extensive communication and participatory decision-making among partner organizations. This review illustrates the difficulties, challenges and effective responses during the partnering process. This model of collaboration may offer a way to advance population health at present, while creating streams of innovation that can yield future social and financial dividends in enhancing the public's health more widely., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objectives: To pilot test a newly developed breastfeeding self-efficacy intervention., Design: Pilot randomized controlled trial (RCT)., Setting: An acute care hospital located in Northwestern Ontario that is the sole provider of maternity care for the city and referral center for the region., Participants: One-hundred-and-fifty primiparous women intending to breastfeed their healthy, term, singleton infant., Intervention: A standardized, individualized nursing intervention protocol was designed and administered to increase mothers' breastfeeding self-efficacy. Participants were randomly allocated to the intervention group or control group using sealed, opaque envelopes. Participants in the intervention group received three individualized, self-efficacy enhancing sessions with the researcher: two in-hospital and one by telephone. Participants in the control group received standard in-hospital and community care., Main Outcome Measures: Feasibility, compliance, and the acceptability of the breastfeeding self-efficacy intervention. Other outcomes assessed were breastfeeding self-efficacy, duration, and exclusivity., Results: Findings suggest that the intervention was feasible; there was a high degree of protocol compliance, and the majority of mothers reported that the intervention was beneficial. Mothers in the intervention group had higher rates of breastfeeding self-efficacy, duration, and exclusivity at 4 and 8 weeks postpartum. However, the differences between groups were not statistically significant., Conclusion: The pilot RCT provided valuable information in examining the feasibility of the trial design and intervention., (© 2011 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Rationale, Aims and Objectives: Complex problems require strategies to engage diverse perspectives in a focused, flexible manner, yet few options exist that fit with the current health care and public health system constraints. The Complex Network Electronic Knowledge Translation Research model (CoNEKTR) brings together complexity science, design thinking, social learning theories, systems thinking and eHealth technologies together to support a sustained engagement strategy for social innovation support and enhancing knowledge integration., Methods: The CoNEKTR model adapts elements of other face-to-face social organizing methods and combines it with social media and electronic networking tools to create a strategy for idea generation, refinement and social action. Drawing on complexity science, a series of networking and dialogue-enhancing activities are employed to bring diverse groups together, facilitate dialogue and create networks of networks., Results: Ten steps and five core processes informed by complexity science have been developed through this model. Concepts such as emergence, attractors and feedback play an important role in facilitating networking among participants in the model., Conclusions: Using a constrained, focused approach informed by complexity science and using information technology, the CoNEKTR model holds promise as a means to enhance system capacity for knowledge generation, learning and action while working within the limitations faced by busy health professionals., (© 2010 Blackwell Publishing Ltd.)

The timely incorporation of health research into the routine practice of individual health practitioners and interprofessional teams is a widely recognized and ongoing challenge. Health professional engagement and learning is an important cog in the wheel of knowledge translation; passive dissemination of evidence through journals and clinical practice guidelines is inadequate when used alone as an intervention to change the practices of the health professionals.An evolving body of research suggests that communities of practice can be effective in facilitating the uptake of best practices by individual health professionals and teams. Modern information technologies can extend the boundaries and reach of these communities, forming electronic communities of practice (eCoP) that can be used to promote intra- and interprofessional continuing professional development (CPD) and team-based, patient-centered care. However, examples of eCoPs and examination of their characteristics are lacking in the literature. In this paper, we discuss guidelines for developing eCoP. These guidelines will be helpful for others considering the use of the eCoP model in interprofessional learning and practice.

Rationale: Health promotion is where clinical practice and prevention science intersect to address complex or 'wicked' problems that have multiple sources and require a broad perspective to address. This means focusing on the social determinants of health and the complex individual, community and environmental interactions that influence health and wellbeing. Health promotion research and practice recognizes that social change is not linear and involves multiple communities of interest working together in a coordinated manner in order to address health problems. An approach that acknowledges this non-linear system of interaction in its data gathering, strategic planning, and program implementation is necessary to addressing this complexity in practice., Methods: Concepts such as chaos theory, self-organization, social emergence can inform how health promotion is practiced at multiple levels. Evaluation approaches such as social network analysis, system dynamics modeling combined with social organizing strategies like communities of practice and unconferences provide opportunities to leverage social capital effectively to promote health in complex environments with diverse populations., Conclusion: Health promotion's focus on the multi-layered, complex interactions that create or limit health and wellbeing require knowledge and action that match this complexity. Approaches to engagement and evaluation that are based on systems theories and methodologies provide the means of addressing this complexity, while framing health promotion as a systems science and practice.

Purpose: This paper aims to describe methods and models designed to build a comprehensive, integrative framework to guide the research to policy and practice cycle in health care., Design/methodology/approach: Current models of science are summarised, identifying specific challenges they create for knowledge to action (KTA). Alternative models for KTA are outlined to illustrate how researchers and decision makers can work together to fit the KTA model to specific problems and contexts. The Canadian experience with the evolving paradigm shift is described, along with recent initiatives to develop platforms and tools that support the new thinking. Recent projects to develop and refine methods for embedded research are described. The paper concludes with a summary of lessons learned and recommendations that will move the KTA field towards an integrated science., Findings: Conceptual models for KTA are advancing, benefiting from advances in team science, development of logic models that address the realities of complex adaptive systems, and new methods to more rapidly deliver knowledge syntheses more useful to decision and policy makers., Practical Implications: KTA is more likely when co-produced by researchers, practitioners, and policy makers. Closer collaboration requires shifts in thinking about the ways we work, capacity development, and greater learning from practice., Originality/value: More powerful ways of thinking about the complexities of knowledge to action are provided, along with examples of tools and priorities drawn from systems thinking.

Objective: To evaluate the impact of a classroom-based, Web-assisted tobacco intervention addressing smoking prevention and cessation with adolescents., Design: A two-group randomized control trial with 1,402 male and female students in grades 9 through 11 from 14 secondary schools in Toronto, Canada. Participants were randomly assigned to a tailored Web-assisted tobacco intervention or an interactive control condition task conducted during a single classroom session with e-mail follow-up. The cornerstone of the intervention was a five-stage interactive Web site called the Smoking Zine (http://www.smokingzine.org) integrated into a program that included a paper-based journal, a small group form of motivational interviewing, and tailored e-mails., Main Outcome Measure: Resistance to smoking, behavioral intentions to smoke, and cigarette use were assessed at baseline, postintervention, and three- and six-month follow-up. Multilevel logistic growth modeling was used to assess the effect of the intervention on change over time., Results: The integrated Smoking Zine program helped smokers significantly reduce the likelihood of having high intentions to smoke and increased their likelihood of high resistance to continued cigarette use at 6 months. The intervention also significantly reduced the likelihood of heavy cigarette use adoption by nonsmokers during the study period., Conclusion: The Smoking Zine intervention provided cessation motivation for smokers most resistant to quitting at baseline and prevented nonsmoking adolescents from becoming heavy smokers at 6 months. By providing an accessible and attractive method of engaging young people in smoking prevention and cessation, this interactive and integrated program provides a novel vehicle for school- and population-level health promotion.

Since 1995, TeenNet Research (www.teennet.ca) has been a leader in developing strategies for involving youth and adults in co-creating e-health-promotion Web sites and behavior-change programs. In this article we review TeenNet's experience and lessons learned from more than a decade of action research with youth, with an emphasis on the guiding frameworks for participatory action research and Web-site creation and evaluation. The models are applied to the Smoking Zine (www.smokingzine.org), a 5-stage Web-assisted tobacco intervention, which is profiled with regards to its development, evaluation, and dissemination, including results from a school-based randomized, controlled trial. The prospects for using information technology to engage youth in health promotion are discussed in relation to TeenNet's past work and future interests in new Web 2.0 technologies.

Background: Electronic health resources are helpful only when people are able to use them, yet there remain few tools available to assess consumers' capacity for engaging in eHealth. Over 40% of US and Canadian adults have low basic literacy levels, suggesting that eHealth resources are likely to be inaccessible to large segments of the population. Using information technology for health requires eHealth literacy-the ability to read, use computers, search for information, understand health information, and put it into context. The eHealth Literacy Scale (eHEALS) was designed (1) to assess consumers' perceived skills at using information technology for health and (2) to aid in determining the fit between eHealth programs and consumers., Objectives: The eHEALS is an 8-item measure of eHealth literacy developed to measure consumers' combined knowledge, comfort, and perceived skills at finding, evaluating, and applying electronic health information to health problems. The objective of the study was to psychometrically evaluate the properties of the eHEALS within a population context. A youth population was chosen as the focus for the initial development primarily because they have high levels of eHealth use and familiarity with information technology tools., Methods: Data were collected at baseline, post-intervention, and 3- and 6-month follow-up using control group data as part of a single session, randomized intervention trial evaluating Web-based eHealth programs. Scale reliability was tested using item analysis for internal consistency (coefficient alpha) and test-retest reliability estimates. Principal components factor analysis was used to determine the theoretical fit of the measures with the data., Results: A total of 664 participants (370 boys; 294 girls) aged 13 to 21 (mean = 14.95; SD = 1.24) completed the eHEALS at four time points over 6 months. Item analysis was performed on the 8-item scale at baseline, producing a tight fitting scale with alpha = .88. Item-scale correlations ranged from r = .51 to .76. Test-retest reliability showed modest stability over time from baseline to 6-month follow-up (r = .68 to .40). Principal components analysis produced a single factor solution (56% of variance). Factor loadings ranged from .60 to .84 among the 8 items., Conclusions: The eHEALS reliably and consistently captures the eHealth literacy concept in repeated administrations, showing promise as tool for assessing consumer comfort and skill in using information technology for health. Within a clinical environment, the eHEALS has the potential to serve as a means of identifying those who may or may not benefit from referrals to an eHealth intervention or resource. Further research needs to examine the applicability of the eHEALS to other populations and settings while exploring the relationship between eHealth literacy and health care outcomes.

Health education and health promotion have a tradition of using information and communication technology (ICT). In recent years, the rapid growth of the Internet has created innovative opportunities for Web-based health education and behavior change applications-termed eHealth promotion. However, many eHealth promotion applications are developed without an explicit model to guide the design, evaluation, and ongoing improvement of the program. The spiral technology action research (STAR) model was developed to address this need. The model comprises five cycles (listen, plan, do, study, act) that weave together technological development, community involvement, and continuous improvement. The model is illustrated by a case study describing the development of the Smoking Zine (www.SmokingZine.org), a youth smoking prevention and cessation Web site.

Background: Health services and population health innovations advance when knowledge transfer and exchange (KTE) occurs among researchers, practitioners, policy-makers and consumers using high-quality evidence. However, few KTE models have been evaluated in practice. Communities of practice (CoP) - voluntary, self-organizing, and focused groups of individuals and organizations - may provide one option. This paper outlines an approach to lay the foundation for a CoP within the area of Web-assisted tobacco interventions (WATI). The objectives of the study were to provide a data-driven foundation to inform decisions about organizing a CoP within the geographically diverse, multi-disciplinary WATI group using evaluation and social network methodologies., Methods: A single-group design was employed using a survey of expectations, knowledge, and interpersonal WATI-related relationships administered prior to a meeting of the WATI group followed by a 3-week post-meeting Web survey to assess short-term impact on learning and networking outcomes., Results: Twenty-three of 27 WATI attendees (85%) from diverse disciplinary and practice backgrounds completed the baseline survey, with 21 (91%) of those participants completing the three-week follow-up. Participants had modest expectations of the meeting at baseline. A social network map produced from the data illustrated a centralized, yet sparse network comprising of interdisciplinary teams with little trans-sectoral collaboration. Three-week follow-up survey results showed that participants had made new network connections and had actively engaged in KTE activities with WATI members outside their original network., Conclusion: Data illustrating both the shape and size of the WATI network as well as member's interests and commitment to KTE, when shared and used to frame action steps, can positively influence the motivation to collaborate and create communities of practice. Guiding KTE planning through blending data and theory can create more informed transdisciplinary and trans-sectoral collaboration environments.

Electronic health tools provide little value if the intended users lack the skills to effectively engage them. With nearly half the adult population in the United States and Canada having literacy levels below what is needed to fully engage in an information-rich society, the implications for using information technology to promote health and aid in health care, or for eHealth, are considerable. Engaging with eHealth requires a skill set, or literacy, of its own. The concept of eHealth literacy is introduced and defined as the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem. In this paper, a model of eHealth literacy is introduced, comprised of multiple literacy types, including an outline of a set of fundamental skills consumers require to derive direct benefits from eHealth. A profile of each literacy type with examples of the problems patient-clients might present is provided along with a resource list to aid health practitioners in supporting literacy improvement with their patient-clients across each domain. Facets of the model are illustrated through a set of clinical cases to demonstrate how health practitioners can address eHealth literacy issues in clinical or public health practice. Potential future applications of the model are discussed.