Search

BACKGROUND Children with disability face long wait times for rehabilitation services. Prior to the pandemic, telehealth adoption was low across most rehabilitation settings, including pediatrics. As a result of the pandemic restrictions, pediatric therapists were asked to rapidly shift to using telehealth without previous experience and often minimal training. To facilitate the behaviour change necessary for telehealth adoption, provision of appropriate evidence-based training and support is required. Evidence to support effective implementation of such training is lacking. The successful real-world implementation of a training intervention and program of support (i.e., TIPS) targeting pediatric therapists to enhance adoption of family-centered telehealth (FCT) requires evaluation of both implementation and effectiveness. OBJECTIVE This study aims to: 1) evaluate TIPS implementation in different pediatric rehabilitation settings, 2) assess TIPS effectiveness, as it related to telehealth adoption on therapists, services, and families, 3) document the impact of telehealth adoption on therapists, services, and families on therapists, services, and families METHODS This 4-year, pan-Canadian study, involving managers, pediatric occupational therapists, physiotherapists, speech and language pathologists, and families from 20 sites in 8 provincial jurisdictions will use a multi-method, prospective, hybrid type 3 implementation-effectiveness design. To examine the implementation, an interrupted time series will assess TIPS implementation. TIPS will be comprised of 1) a one-month training intervention with self-paced learning modules and a webinar, followed by 2) an 11-month support program including monthly site meetings and access to a virtual community of practice. We will use longitudinal mixed modeling to analyze indicators of therapists’ adoption of FCT and fidelity to FCT collected at 9 time-points. To identify barriers and facilitators to adoption and fidelity, qualitative data will be collected during implementation and analysed using a deductive-inductive thematic approach. To evaluate effectiveness, quasi-experimental pre-, post-test design will use questionnaires to evaluate TIPS effectiveness at service, therapist, and family levels. Data will be analysed using generalised linear mixed effect models. Manager, therapist, and family interviews will also be conducted post-implementation and analyzed using reflective thematic analysis. Finally, we will gather cost data and calculate costs to the public system and to society. RESULTS We received ethics approval on February 8, 2022, in one jurisdiction; approval is pending in the others. Twenty sites have been recruited and data collection is anticipated to commence in September 2022 with completion by September 2024. Data analysis will occur concurrently with data collection, with dissemination of results expected throughout the study period. CONCLUSIONS This study will generate knowledge about the effectiveness of TIPS targeting pediatric therapists to enhance adoption of FCT in pediatric rehabilitation settings, identify facilitators and barriers to adoption, and 3) document the impact of telehealth adopti3) document the impact of telehealth adoption on therapists, services, and families on therapists, services, and families. The knowledge gained from this study will refine the training intervention, enhance intervention uptake, and support the integration of telehealth as a consistent pediatric rehabilitation service delivery option for families of children with disability. CLINICALTRIAL Clinicaltrials.gov: NCT05312827

BackgroundSystems transformation for health promotion, involving engagement from multiple disciplines and levels of influence, requires an investment in partnership development. Integrated youth service is a collaborative model that brings organisations together to provide holistic care for youth. Frayme is an international knowledge translation network designed to support the uptake and scaling of integrated youth service. Social network analysis (SNA) is the study of relationships among social units and is useful to better understand how partners collaborate within a network to achieve major objectives. The purpose of this paper is to apply SNA to the Frayme network in order to (1) examine the level and strength of partnerships, (2) identify the strategies being employed to promote the main objectives and (3) apply the findings to current research in youth mental health and system transformation.MethodsThe PARTNER tool includes a validated survey and analysis software designed to examine partner interconnections. This tool was used to perform the SNA and 51 of the 75 partners completed the survey (14 researchers, 2 advisory groups and 35 organisations). A network map was created and descriptive frequencies were calculated.ResultsThe overall network scores for the Frayme network were 20.6% for density, 81.5% for centralisation and 71.7% for overall trust. The Frayme secretariat received a 3.84 out of a possible 4 for value. In addition, the youth and family advisories each received a value score of 4 and all Leadership Team organisations received a score of 2.97 or above.ConclusionsThe Frayme secretariat links many partners who would otherwise be disconnected and acts as a significant conduit for novel information. Frayme may have the opportunity to enhance value perceptions among broader network members by profiling individual organisations and the potential leveraging opportunities that might exist through their work. These findings increase understanding with respect to the mechanisms of network development and will be helpful to inform partnership development in the future. In addition, they contribute to the literature with respect to knowledge translation practice as well as the scaling of collaborative interventions within youth mental health.

Aim Frayme is a Canadian-based international network designed to accelerate the adoption and scaling up of integrated youth services (IYS). This is done through the synthesis of evidence from a variety of sources and a commitment to integrated knowledge mobilization (KMb) to inform research policy and practice. Frayme is utilizing innovative approaches to stakeholder engagement (youth, families, policy makers, funders, researchers and practitioners) and KMb in order to co-design system change. The purpose of this article describes the overall Frayme strategy and presents findings from a participatory needs assessment implemented to inform policy-related priorities. Methods The Frayme leadership team facilitated a participatory needs assessment with major stakeholder groups that applied a modified problem-solving activity. The needs assessment was on a designed to support diverse stakeholder perspectives on ways to improve knowledge mobilization of IYS. Qualitative data were analysed using a thematic analysis. Results The four themes identified through the needs assessment were: (a) traditional scientific practices, (b) organizational obstacles, (c) change aversion, and (d) pre-established stakeholder hierarchies. Conclusions Through the recognition of these challenges, Frayme has developed a set of major objectives to inform projects, opportunities for knowledge sharing, implementation of evidence and scaling up of efforts. The Frayme integrated KMb model represents a unique applied example of an evidence-informed approach to practice collaboration in KMb to promote system change. The findings from this research also contribute to the expanding knowledge base with regard to complex evaluation and system transformation.

It is generally believed that research evidence, if effectively transferred, could inform policy and practice decisions and subsequently improve health outcomes (1). Evidence-informed decision making (EIDM) involves the incorporation of the best available evidence from a systematically collected, appraised, and analyzed body of knowledge (2–4). Each step of the process requires unique skills and knowledge, which have been shown to be limited among public health professionals (5, 6). Furthermore, barriers such as time greatly reduce the extent to which decision makers engage in EIDM. The literature demonstrates that knowledge translation and exchange (KTE) strategies, which overcome time and limited capacity to identify, appraise, and synthesize evidence, hold promise for promoting EIDM (7–9). The ultimate goal of KTE activities is to facilitate the incorporation of research knowledge into the decision-making process and ultimately policies, practice, and eventually health outcomes. The term implies that effective strategies are all that are needed to achieve this end. It all appears so rational, logical, and, well, simple. So, why has it proved so challenging to achieve EIDM among public health organizations and decision makers? Furthermore, would we know if we had achieved it?

Background The World Health Organization estimates that 1.9 million deaths worldwide are attributable to physical inactivity. Chronic diseases associated with physical inactivity include cancer, diabetes and coronary heart disease. Objectives The purpose of this systematic review is to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents. Search strategy The search strategy included searching several databases. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information. Selection criteria To be included, the intervention had to be relevant to public health practice, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, report on outcomes for children and adolescents (aged 6 to 18 years), and use a prospective design with a control group. Data collection and analysis Standardized tools were used by two independent reviewers to rate each study's methodological quality and for data extraction. Where discrepancies existed discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated and outcomes measured. Main results 13,841 titles were identified and screened and 482 articles were retrieved. Multiple publications on the same project were combined and counted as one project, resulting in 395 distinct project accounts (studies). Of the 395 studies 104 were deemed relevant and of those, four were assessed as having strong methodological quality, 22 were of moderate quality and 78 were considered weak. In total 26 studies were included in the review. There is good evidence that school-based physical activity interventions have a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally school-based interventions had no effect on leisure time physical activity rates, systolic and diastolic blood pressure, body mass index, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity result in positive effects. Authors' conclusions Given that there are no harmful effects and that there is some evidence of positive effects on lifestyle behaviours and physical health status measures, ongoing physical activity promotion in schools is recommended at this time. Plain Language Summary School-based interventions for promoting physical activity and fitness in children and adolescents Current evidence suggests that school-based physical activity interventions may be effective in the development of healthy lifestyle behaviours among children and adolescents that will then translate into reduced risk for many chronic diseases and cancers in adulthood. The evidence also suggests that the best primary strategy for improving the long-term health of children and adolescents through exercise may be creating lifestyle patterns of regular physical activity that carry over to the adult years. It is estimated that as many at 1.9 million deaths worldwide are attributable to physical inactivity, and that inactivity is a key risk factor in the development of most chronic diseases and cancers. This is alarming particularly because it is known that physical activity patterns track from childhood into adulthood; that children are increasingly exhibiting risk factors for cardiovascular disease, such as obesity, elevated blood lipids, and hypertension, conditions which are known to track into adulthood; and that atherosclerotic fatty streaks in the coronary arteries, which are indicative of coronary heart disease, have been found postmortem in children. This review included 26 studies that evaluated the impact of combinations of school-based interventions focused on increasing physical activity among children and adolescents. Participants were between the ages of 6 to18 living in Australia, South America, Europe and North America. There is good evidence that school-based physical activity interventions are effective in increasing duration of physical activity, reducing blood cholesterol and time spent watching television and increasing VO2 max. VO2 max, known as maximal oxygen uptake or aerobic capacity, reflects the physical fitness level of an individual and generally increases as fitness levels improve. These interventions are not effective in increasing the percentage of children and adolescents who are physically active during leisure time, or in reducing systolic and diastolic blood pressure, body mass index, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity result in positive effects for four of the nine outcomes.

A case of an infant who had morphine exposure during and following pregnancy while her mother was treated with intrathecal (IT) morphine is presented along with a review of the relevant literature. Successful maternal pain management was achieved during pregnancy and while breastfeeding. Minimal maternal serum and breast milk levels in the first 7 postpartum weeks were found. Also, infant sleep and arousal behavior and general development at 2 and 7 months were unremarkable, illustrating the possible safe and efficacious use of IT morphine during and following pregnancy. Further work is required to understand opioid pharmacology during breastfeeding, which will be used to develop an empirical approach to breastfeeding and morphine use.

Background Evidence-informed decision making is accepted in Canada and worldwide as necessary for the provision of effective health services. This process involves: 1) clearly articulating a practice-based issue; 2) searching for and accessing relevant evidence; 3) appraising methodological rigor and choosing the most synthesized evidence of the highest quality and relevance to the practice issue and setting that is available; and 4) extracting, interpreting, and translating knowledge, in light of the local context and resources, into practice, program and policy decisions. While the public health sector in Canada is working toward evidence-informed decision making, considerable barriers, including efficient access to synthesized resources, exist. Methods In this paper we map to a previously developed 6 level pyramid of pre-processed research evidence, relevant resources that include public health-related effectiveness evidence. The resources were identified through extensive searches of both the published and unpublished domains. Results Many resources with public health-related evidence were identified. While there were very few resources dedicated solely to public health evidence, many clinically focused resources include public health-related evidence, making tools such as the pyramid, that identify these resources, particularly helpful for public health decisions makers. A practical example illustrates the application of this model and highlights its potential to reduce the time and effort that would be required by public health decision makers to address their practice-based issues. Conclusions This paper describes an existing hierarchy of pre-processed evidence and its adaptation to the public health setting. A number of resources with public health-relevant content that are either freely accessible or requiring a subscription are identified. This will facilitate easier and faster access to pre-processed, public health-relevant evidence, with the intent of promoting evidence-informed decision making. Access to such resources addresses several barriers identified by public health decision makers to evidence-informed decision making, most importantly time, as well as lack of knowledge of resources that house public health-relevant evidence.

BACKGROUND: The World Health Organization (WHO) estimates that 1.9 million deaths worldwide are attributable to physical inactivity and at least 2.6 million deaths are a result of being overweight or obese. In addition, WHO estimates that physical inactivity causes 10% to 16% of cases each of breast cancer, colon, and rectal cancers as well as type 2 diabetes, and 22% of coronary heart disease and the burden of these and other chronic diseases has rapidly increased in recent decades. OBJECTIVES: The purpose of this systematic review was to summarize the evidence of the effectiveness of school‐based interventions in promoting physical activity and fitness in children and adolescents. SEARCH METHODS: The search strategy included searching several databases to October 2011. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information. SELECTION CRITERIA: To be included, the intervention had to be relevant to public health practice (focused on health promotion activities), not conducted by physicians, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, included all school‐attending children, and be implemented for a minimum of 12 weeks. In addition, the review was limited to randomized controlled trials and those that reported on outcomes for children and adolescents (aged 6 to 18 years). Primary outcomes included: rates of moderate to vigorous physical activity during the school day, time engaged in moderate to vigorous physical activity during the school day, and time spent watching television. Secondary outcomes related to physical health status measures including: systolic and diastolic blood pressure, blood cholesterol, body mass index (BMI), maximal oxygen uptake (VO(2)max), and pulse rate. DATA COLLECTION AND ANALYSIS: Standardized tools were used by two independent reviewers to assess each study for relevance and for data extraction. In addition, each study was assessed for risk of bias as specified in the Cochrane Handbook for Systematic Reviews of Interventions. Where discrepancies existed, discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated, and outcomes measured. MAIN RESULTS: In the original review, 13,841 records were identified and screened, 302 studies were assessed for eligibility, and 26 studies were included in the review. There was some evidence that school‐based physical activity interventions had a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO(2) max, and blood cholesterol. Generally, school‐based interventions had little effect on physical activity rates, systolic and diastolic blood pressure, BMI, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity resulted in positive effects. In this update, given the addition of three new inclusion criteria (randomized design, all school‐attending children invited to participate, minimum 12‐week intervention) 12 of the original 26 studies were excluded. In addition, studies published between July 2007 and October 2011 evaluating the effectiveness of school‐based physical interventions were identified and if relevant included. In total an additional 2378 titles were screened of which 285 unique studies were deemed potentially relevant. Of those 30 met all relevance criteria and have been included in this update. This update includes 44 studies and represents complete data for 36,593 study participants. Duration of interventions ranged from 12 weeks to six years. Generally, the majority of studies included in this update, despite being randomized controlled trials, are, at a minimum, at moderate risk of bias. The results therefore must be interpreted with caution. Few changes in outcomes were observed in this update with the exception of blood cholesterol and physical activity rates. For example blood cholesterol was no longer positively impacted upon by school‐based physical activity interventions. However, there was some evidence to suggest that school‐based physical activity interventions led to an improvement in the proportion of children who engaged in moderate to vigorous physical activity during school hours (odds ratio (OR) 2.74, 95% confidence interval (CI), 2.01 to 3.75). Improvements in physical activity rates were not observed in the original review. Children and adolescents exposed to the intervention also spent more time engaged in moderate to vigorous physical activity (with results across studies ranging from five to 45 min more), spent less time watching television (results range from five to 60 min less per day), and had improved VO(2)max (results across studies ranged from 1.6 to 3.7 mL/kg per min). However, the overall conclusions of this update do not differ significantly from those reported in the original review. AUTHORS' CONCLUSIONS: The evidence suggests the ongoing implementation of school‐based physical activity interventions at this time, given the positive effects on behavior and one physical health status measure. However, given these studies are at a minimum of moderate risk of bias, and the magnitude of effect is generally small, these results should be interpreted cautiously. Additional research on the long‐term impact of these interventions is needed.

Background The ultimate goal of knowledge translation and exchange (KTE) activities is to facilitate incorporation of research knowledge into program and policy development decision making. Evidence-informed decision making involves translation of the best available evidence from a systematically collected, appraised, and analyzed body of knowledge. Knowledge management (KM) is emerging as a key factor contributing to the realization of evidence-informed public health decision making. The goal of health-evidence.ca is to promote evidence-informed public health decision making through facilitation of decision maker access to, retrieval, and use of the best available synthesized research evidence evaluating the effectiveness of public health interventions. Methods The systematic reviews that populate health evidence.ca are identified through an extensive search (1985-present) of 7 electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, Sociological Abstracts, BIOSIS, and SportDiscus; handsearching of over 20 journals; and reference list searches of all relevant reviews. Reviews are assessed for relevance and quality by two independent reviewers. Commonly-used public health terms are used to assign key words to each review, and project staff members compose short summaries highlighting results and implications for policy and practice. Results As of June 2010, there are 1913 reviews in the health-evidence.ca registry in 21 public health and health promotion topic areas. Of these, 78% have been assessed as being of strong or moderate methodological quality. Health-evidence.ca receives approximately 35,000 visits per year, 20,596 of which are unique visitors, representing approximately 100 visits per day. Just under half of all visitors return to the site, with the average user spending six minutes and visiting seven pages per visit. Public health nurses, program managers, health promotion workers, researchers, and program coordinators are among the largest groups of registered users, followed by librarians, dieticians, medical officers of health, and nutritionists. The majority of users (67%) access the website from direct traffic (e.g., have the health-evidence.ca webpage bookmarked, or type it directly into their browser). Conclusions Consistent use of health-evidence.ca and particularly the searching for reviews that correspond with current public health priorities illustrates that health-evidence.ca may be playing an important role in achieving evidence-informed public health decision making.

Context Significant resources and time are invested in the production of research knowledge. The primary objective of this randomized controlled trial was to evaluate the effectiveness of three knowledge translation and exchange strategies in the incorporation of research evidence into public health policies and programs. Methods This trial was conducted with a national sample of public health departments in Canada from 2004 to 2006. The three interventions, implemented over one year in 2005, included access to an online registry of research evidence; tailored messaging; and a knowledge broker. The primary outcome assessed the extent to which research evidence was used in a recent program decision, and the secondary outcome measured the change in the sum of evidence-informed healthy body weight promotion policies or programs being delivered at health departments. Mixed-effects models were used to test the hypotheses. Findings One hundred and eight of 141 (77%) health departments participated in this study. No significant effect of the intervention was observed for primary outcome (p < 0.45). However, for public health policies and programs (HPPs), a significant effect of the intervention was observed only for tailored, targeted messages (p < 0.01). The treatment effect was moderated by organizational research culture (e.g., value placed on research evidence in decision making). Conclusion The results of this study suggest that under certain conditions tailored, targeted messages are more effective than knowledge brokering and access to an online registry of research evidence. Greater emphasis on the identification of organizational factors is needed in order to implement strategies that best meet the needs of individual organizations. Trial Registration The trial registration number and title are as follows: ISRCTN35240937 -- Is a knowledge broker more effective than other strategies in promoting evidence-based physical activity and healthy body weight programming?

Background A knowledge broker (KB) is a popular knowledge translation and exchange (KTE) strategy emerging in Canada to promote interaction between researchers and end users, as well as to develop capacity for evidence-informed decision making. A KB provides a link between research producers and end users by developing a mutual understanding of goals and cultures, collaborates with end users to identify issues and problems for which solutions are required, and facilitates the identification, access, assessment, interpretation, and translation of research evidence into local policy and practice. Knowledge-brokering can be carried out by individuals, groups and/or organizations, as well as entire countries. In each case, the KB is linked with a group of end users and focuses on promoting the integration of the best available evidence into policy and practice-related decisions. Methods A KB intervention comprised one of three KTE interventions evaluated in a randomized controlled trial. Results KB activities were classified into the following categories: initial and ongoing needs assessments; scanning the horizon; knowledge management; KTE; network development, maintenance, and facilitation; facilitation of individual capacity development in evidence informed decision making; and g) facilitation of and support for organizational change. Conclusion As the KB role developed during this study, central themes that emerged as particularly important included relationship development, ongoing support, customized approaches, and opportunities for individual and organizational capacity development. The novelty of the KB role in public health provides a unique opportunity to assess the need for and reaction to the role and its associated activities. Future research should include studies to evaluate the effectiveness of KBs in different settings and among different health care professionals, and to explore the optimal preparation and training of KBs, as well as the identification of the personality characteristics most closely associated with KB effectiveness. Studies should also seek to better understand which combination of KB activities are associated with optimal evidence-informed decision making outcomes, and whether the combination changes in different settings and among different health care decision makers.