자연주의적 탐구조사(Naturalistic Inquiry)

Basics of qualitative research: Grounded theory procedures and techniques

Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

There is confusion and misunderstanding about the concepts of knowledge translation, knowledge transfer, knowledge exchange, research utilization, implementation, diffusion, and dissemination. We review the terms and definitions used to describe the concept of moving knowledge into action. We also offer a conceptual framework for thinking about the process and integrate the roles of knowledge creation and knowledge application. The implications of knowledge translation for continuing education in the health professions include the need to base continuing education on the best available knowledge, the use of educational and other transfer strategies that are known to be effective, and the value of learning about plannedaction theories to be better able to understand and influence change in practice settings.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/chp.47

Lost in knowledge translation: time for a map?

OBJECTIVE: Selective serotonin reuptake inhibitors (SSRIs) are widely used to treat depression, but the rates, timing, and baseline predictors of remission in “real world” patients are not established. The authors’ primary objectives in this study were to evaluate the effectiveness of citalopram, an SSRI, using measurement-based care in actual practice, and to identify predictors of symptom remission in outpatients with major depressive disorder. METHOD: This clinical study included outpatients with major depressive disorder who were treated in 23 psychiatric and 18 primary care “real world” settings. The patients received flexible doses of citalopram prescribed by clinicians for up to 14 weeks. The clinicians were assisted by a clinical research coordinator in the application of measurement-based care, which included the routine measurement of symptoms and side effects at each treatment visit and the use of a treatment manual that described when and how to modify medication doses based on these measures....

/pdf/evaluation-of-outcomes-with-citalopram-for-depression-using-53pglcs9e0.pdf

Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice

A large gulf remains between what we know and what we practise. Eisenberg and Garzon point to widespread variation in the use of aspirin, calcium antagonists, βblockers, and anti-ischaemic drugs in the United States, Europe, and Canada despite good evidence on their best use.1 Such variation is common not only internationally but within countries.2 Large gaps also exist between best evidence and practice in the implementation of guidelines. Failure to follow best evidence highlights issues of underuse, overuse, and misuse of drugs3 and has led to widespread interest in the safety of patients.4

Not surprisingly, many attempts have been made to reduce the gap between evidence and practice. These have included educational strategies to alter practitioners' behaviour5 and organisational and administrative interventions. We explore three constructs: continuing medical education (CME), continuing professional development (CPD), and (the newest of the three) knowledge translation (box). Knowledge translation both subsumes and broadens the concepts of CME and CPD and has the potential to improve understanding of, and overcome the barriers to, implementing evidence based practice.

### Continuing medical education

CME refers to education after certification and licensure. It is arguably the most complex, and clearly the longest, phase of medical education. Most physicians think of continuing medical education in terms of the traditional medical conference, with rows of tables, pitchers of ice water, green table cloths, and a lecturer at the front of the room.7 Many accreditation systems in the United States, United Kingdom, and Canada value attendance at such activities. This reinforces the teacher driven nature of continuing medical education, which gives little attention to the concept of professional development.

“Knowledge translation is defined as the exchange, synthesis and ethically sound application of knowledge—within a complex system of interactions among researchers and users—to accelerate the capture of …

https://www.bmj.com/content/bmj/327/7405/33.full.pdf

The case for knowledge translation: shortening the journey from evidence to effect.

Background and Purpose: The purpose of this study was to identify practitioner barriers (education, attitudes and beliefs, interest and perceived role, and self-efficacy) and organizational barriers (perceived support and resources) to physical therapists’ implementation of evidence-based practice (EBP) for people with stroke.

Subjects: The participants were 270 physical therapists providing services to people with stroke in Ontario, Canada.

Methods: A cross-sectional mail survey was conducted.

Results: Only half of respondents had learned the foundations of EBP in their academic preparation or received training in searching or appraising research literature. Although 78% agreed that research findings are useful, 55% agreed that a divide exists between research and practice. Almost all respondents were interested in learning EBP skills; however, 50% indicated that physical therapists should not be responsible for conducting literature reviews. Average self-efficacy ratings were between 50% and 80% for searching and appraising the literature and below 50% for critically appraising psychometric properties and understanding statistical analyses. Despite Internet access at work for 80% of respondents, only 8% were given protected work time to search and appraise the literature.

Discussion and Conclusion: Lack of education, negative perceptions about research and physical therapists’ role in EBP, and low self-efficacy to perform EBP activities represent barriers to implementing EBP for people with stroke that can be addressed through continuing education. Organizational provision of access to Web-based resources is likely insufficient to enhance research use by clinicians.

Practitioner and Organizational Barriers to Evidence-based Practice of Physical Therapists for People With Stroke

This paper, the first of two examining the concept of occupational justice, presents the findings of a scoping review of how occupational justice and its associated concepts (occupational deprivation, marginalization, alienation, imbalance or apartheid) have been conceptualized. Its purpose is to examine potential avenues and barriers for development and application of these concepts. The results indicate that perspectives on occupational justice emphasize individuals' unique sets of occupational needs and capacities within particular environments. Based on the idea that participation in occupation can affect health, occupational justice is underpinned by a belief in the right to engage in diverse and meaningful occupations to meet people's individual needs and develop their potential. In the literature, barriers to engagement in meaningful occupation are considered injustices. One impediment to enabling occupational justice in practice is the lack of conceptual clarity about occupational justice and its ...

Occupational Justice: A Conceptual Review

Introduction:Rehabilitation therapists are strongly encouraged to apply research to their practices, but relatively little is known about the processes therapists use for continuing their education. This study examines the strategies used by a sample of therapists to gather new knowledge, ev

How rehabilitation therapists gather, evaluate, and implement new knowledge

Though some argue that medical power is declining, others disagree. In particular, Freidson assets that medicine is being restratified with medical elites retaining control over health care though practitioners are losing their individual autonomy to these elites. We use the case of state-medicine relationships in Ontario to examine the restratification thesis. Our findings indicate that the state partially controls medicine through restratification. There is partial state co-option of medical organisations and elites. This case also implies that control over the context of care and over the content of medical practice is not as separate as assumed, that profession-practitioner relationships are increasingly problematic, that the concept of autonomy itself requires theoretical and empirical specification, and that the existence of self-regulatory and representative organisations cannot be equated with actual professional self-regulation. The contingent nature of medical power is underlined.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-9566.1997.tb00013.x

Susan Rappolt

Papers

The case for knowledge translation: shortening the journey from evidence to effect.

Practitioner and Organizational Barriers to Evidence-based Practice of Physical Therapists for People With Stroke

Occupational Justice: A Conceptual Review

How rehabilitation therapists gather, evaluate, and implement new knowledge

Decline vs. retention of medical power through restratification: an examination of the Ontario case