Integrated Knowledge Translation Approach Research Articles

Contextually appropriate nurse staffing models: a realist review protocol

IntroductionDecisions about nurse staffing models are a concern for health systems globally due to workforce retention and well-being challenges. Nurse staffing models range from all Registered Nurse workforce to a...

Assessing primary health care provider and organization readiness to address family violence in Alberta, Canada: development of a Delphi consensus readiness tool

BackgroundFamily violence, which includes intimate partner abuse, child abuse, and elder abuse, is a serious public health concern. Primary healthcare (PHC) offers a vital opportunity to identify and address family violence, yet barriers prevent the effective implementation of family violence interventions in PHC settings. The purpose of this study is to improve family violence identification and response in Alberta’s PHC settings by exploring readiness factors.MethodsAn integrated knowledge translation approach, combining implementation science and participatory action research, was employed to develop a readiness assessment tool for addressing family violence within PHC settings in Alberta. The research involved three phases: phase 1 involved a rapid evidence assessment, phase 2 engaged a panel of healthcare and family violence experts to explore readiness components in the Alberta context, and phase 3 utilized a 3-round Delphi consensus-building process to refine readiness indicators.ResultsPhase 1 findings from a rapid evidence assessment highlighted five main models/tools for assessing readiness to implement family violence interventions in PHC settings. In phase 2, additional concepts were identified through exploration with healthcare and family violence expert panel members, resulting in a total of 16 concepts for assessing family violence readiness within the Alberta PHC context. The 3-round Delphi consensus-building process in Phase 3 involved nine panelists, who collectively agreed on the inclusion of all concepts and indicators, yielding a total of 60 items for the proposed readiness assessment tool for addressing family violence in PHC within Alberta.ConclusionThe current study lays the groundwork for future family violence intervention programs, offering insights into key components that promote readiness for implementing comprehensive programs and supporting PHC organizations in effectively addressing family violence.

'I thought we would be cherished and safe here': understanding the multi-faceted nature of mental health among Arab immigrants/refugees in Ontario, Canada- the CAN-HEAL study.

Mental health (MH) is a critical public health issue. Arab immigrants/refugees (AIR) may be at high risk for MH problems owing to various unique stressors, such as post-September/11 demonization. Despite the growing AIR population in Western countries, there is a lack of AIR-MH research in these nations. The CAN-HEAL study examined MH experiences and needs among AIR in Ontario, Canada. This study employed a cooperative community-based participatory research and integrated knowledge translation approach. The study used photovoice, qualitative interviews and a questionnaire survey. Sixty socio-demographically diverse AIR adults partook in this study. The research was informed by the "social determinants of health" framework and the "years since immigration effect" (YSIE) theory. The term "mental health" was deemed offensive for participants aged > 30years. Participants proposed other culturally-appropriate words including "well-being" and "emotional state". The prevalence of poor mental well-being in the sample was alarming (55%). Of first-generation immigrant participants, 86.8% reported negative changes in MH since migration. The negative changes are not straightforward; they are complex and dynamic, and mainly related to micro/macro-aggression, cross-cultural pressures, dissatisfaction with the health and social care system, and poor living conditions. Intersections between different socio-demographic factors (e.g., gender, length of residency, income, parenthood, religion) amplified the negative changes in MH and exacerbated inequities. MH needs among AIR are distinct and intersectionality aggravated inequities. Culturally and structurally competent healthcare and structural/policy reformation are required to tackle MH inequities. This can be fulfilled through intersectoral cooperation and including AIR in decision-making.

The Pediatric Autism Research Cohort (PARC) Study: protocol for a patient-oriented prospective study examining trajectories of functioning in children with autism

IntroductionThe developmentally variable nature of autism poses challenges in providing timely services tailored to a child’s needs. Despite a recent focus on longitudinal research, priority-setting initiatives with stakeholders highlighted the...

Recommendations to promote mental health in dual career development environments: An integrated knowledge translation approach

A dual career (DC) entails the combination of elite sport with a second career in education or work. Engaging in a DC has considerable short and long-term benefits for elite athletes. Nevertheless, evidence suggests that DC engagement can also be highly demanding and pose a challenge for athletes’ mental health. As such, dual career development environments (DCDEs), aimed to facilitate effective DC engagement, hold a responsibility to promote and safeguard athletes’ mental health within their organization. Given a lack of guidance within the literature to set up effective support systems, the purpose of our paper is to provide a comprehensive set of mental health recommendations for applied DCDEs. Adopting an integrated knowledge translation approach, the recommendations were developed based on a multiple case analysis of seven DCDEs, followed by a two-day working group with applied and academic experts within the fields of mental health and DC. In total, 12 key recommendations are provided across four overarching domains. These four domains include: organizational foundations, monitoring and follow-up, mental health literacy, and preventive well-being interventions.

Adapting TeachABI to the local needs of Australian educators - a critical step for successful implementation.

Background The present study is the foundational project of TeachABI-Australia , which aims to develop and implement an accessible, nation-wide digital resource for educators to address their unmet acquired brain injury (ABI)-related professional learning needs. The aim of the present study was to identify the adaptations required to improve the suitability and acceptability of the TeachABI professional development module within the Australian education system from the perspectives of Australian educators. Methods The research design employed an integrated knowledge translation approach and followed the ADAPT Guidance for undertaking adaptability research. A purposive sample of eight educators eligible to teach primary school in Australia provided feedback on the module through a quantitative post-module feedback questionnaire and a qualitative semi-structured interview. Results Participants rated the acceptability of the module as 'Completely Acceptable ' (Mdn = 5, IQR = 1), and reported 'only Minor' changes were required (Mdn = 2, IQR = 0.25) to improve the suitability to the Australian context. Qualitative analysis of transcripts revealed three broad categories: (1) the usefulness of TeachABI , (2) the local fit of TeachABI , and (3) pathways for implementing TeachABI in the local setting. Recommended adaptations to the module collated from participant feedback included changes to language, expansion of content, and inclusion of Australian resources, legislation, and videos. Conclusions TeachABI is acceptable to Australian educators but requires modifications to tailor the resource to align with the unique schooling systems, needs, and culture of the local setting. The systematic methodological approach to adaptation outlined in this study will serve as a guide for future international iterations of TeachABI .

Supporting children’s participation in active travel: developing an online road safety intervention through a collaborative integrated knowledge translation approach

ABSTRACT Even though regular engagement in physical activity (PA) among children can support their development and encourage the adoption of healthy lifelong habits, most do not achieve their recommended guidelines. Active travel (AT), or any form of human-powered travel (e.g., walking), can be a relatively accessible, manageable, and sustainable way to promote children’s PA. One common barrier to children’s engagement in AT, however, is a reported lack of education and training. To support children’s participation in AT, this paper presents the development of a comprehensive 4-module online road safety education intervention designed to improve children’s knowledge and confidence regarding AT. Using a qualitative integrated knowledge translation (iKT) approach undertaken with community collaborators (n = 50) containing expertise in health promotion, public safety, school administration, and transportation planning, our inductive thematic analysis generated fourth themes which constituted the foundation of the intervention modules: Active Travel Knowledge: Awareness of Benefits and Participation; Pedestrian Safety and Skills: Roles, Responsibilities, and Rules; Signs and Infrastructure: Identification, Literacy, and Behaviour; Wheeling Safety and Skills: Technical Training and Personal Maneuvers. Each theme/module was then linked to an explicit learning objective and connected to complementary knowledge activities, resources, and skill development exercises. Implications for research and practice are discussed.

Sustainability of an outcome measure in outpatient stroke rehabilitation: A realist evaluation.

Only half of newly implemented evidence-based practices are sustained. Though poor sustainment can lead to negative consequences for clinical teams, organizationsand patients, the causal explanations of sustainment are largely unknown. We aimed to ascertain how (mechanisms) and in what circumstances (context) a newly implemented outcome measure in rehabilitation was sustained or not (outcome). Informed by an integrated knowledge translation approach, we conducted a realist evaluation using a mixed method, embedded single case study design with data collection up to 18 months following the implementation of the Mayo-Portland Adaptability Inventory - version 4 (MPAI-4), a rehabilitation outcome measure. Quantitative data (survey and patient charts) was analysed using descriptive statistics, then integrated with qualitative data (interviews with 10 key informants) and analysed using inductive and deductive retroduction. We integrated the data to develop a case description and ultimately, to refine the programme theory to better understand the sustainability of the MPAI-4. We linked context, mechanismsand outcomes, and also emphasized sustainability strategies in 18 explanations of how sustainability works. These explanations provide evidence for four overarching patterns: (1) implementation and sustainability phases are interconnected, (2) outcomes build on each other recursively, with patient benefits as the keystone outcome, (3) sustainment is achieved to varying levels across different sustainability outcomes [e.g., high level (e.g., rate of MPAI-4 scoring: 77.7%) to low level (e.g., rate of MPAI-4 application to clinical decision-making: 3.7%)] and (4) the work of sustaining the MPAI-4 is shared amongst different stakeholders. Implementation teams can draw from this programme theory to improve the sustainment of outcomes measures while researchers could continue to refine the theory. Continued investigation of sustainability, including diverse and continuous sustainability outcomes, is needed to understand how to maintain improvements in quality of care and patient outcomes.

Transforming research systems for meaningful engagement: a reflexive thematic analysis of spinal cord injury researchers’ barriers and facilitators to using the integrated knowledge translation guiding principles

Purpose To develop an in-depth understanding of spinal cord injury (SCI) researchers’ barriers and facilitators to deciding to use 1) a partnered approach to research and, 2) systematically developed principles for guiding Integrated Knowledge Translation (IKT) in spinal cord injury research (IKT Guiding Principles). Methods Qualitative interview study with North American SCI researchers who were interested in using a partnered research approach. The research was conducted using an IKT approach, and interview data were analyzed using reflexive thematic analysis. Results Thirteen SCI researchers whose research focused on prevention, clinical, rehabilitation, and/or community SCI research were interviewed. Three themes were co-constructed with partners: 1) the principles are necessary but not sufficient for the implementation of a partnered approach to research; 2) relational capacity building is needed; and 3) institutional transformation is needed to value, resource, and support meaningful engagement. Conclusions Supporting change that enables SCI researchers to adopt and implement the IKT Guiding Principles will require transformation at the individual (theme 1), relational (theme 2), and institutional levels (theme 3). Findings provide clear, practical, and tangible actions to promote change that can support meaningful engagement in the SCI Research System.

Evaluation of an integrated knowledge translation approach used for updating the Cochrane Review of Patient Decision Aids: a pre-post mixed methods study

BackgroundWhen people who can use or benefit from research findings are engaged as partners on study teams, the quality and impact of findings are better. These people can include patients/consumers and clinicians who do not identify as researchers. They are referred to as “knowledge users”. This partnered approach is called integrated knowledge translation (IKT). We know little about knowledge users’ involvement in the conduct of systematic reviews. We aimed to evaluate team members’ degree of meaningful engagement and their perceptions of having used an IKT approach when updating the Cochrane Review of Patient Decision Aids.MethodsWe conducted a pre-post mixed methods study. We surveyed all team members at two time points. Before systematic review conduct, all participating team members indicated their preferred level of involvement within each of the 12 steps of the systematic review process from “Screen titles/abstracts” to “Provide feedback on draft article”. After, they reported on their degree of satisfaction with their achieved level of engagement across each step and the degree of meaningful engagement using the Patient Engagement In Research Scale (PEIRS-22) across 7 domains scored from 100 (extremely meaningful engagement) to 0 (no meaningful engagement). We solicited their experiences with the IKT approach using open-ended questions. We analyzed quantitative data descriptively and qualitative data using content analysis. We triangulated data at the level of study design and interpretation.ResultsOf 21 team members, 20 completed the baseline survey (95.2% response rate) and 17/20 (85.0% response rate) the follow-up survey. There were 11 (55%) researchers, 3 (15%) patients/consumers, 5 (25%) clinician-researchers, and 1 (5%) graduate student. At baseline, preferred level of involvement in the 12 systematic review steps varied from n = 3 (15%) (search grey literature sources) to n = 20 (100%) (provide feedback on the systematic review article). At follow-up, 16 (94.1%) participants were totally or very satisfied with the extent to which they were involved in these steps. All (17, 100%) agreed that the process was co-production. Total PEIRS-22 scores revealed most participants reported extremely (13, 76.4%) or very (2, 11.8%) meaningful degree of engagement. Triangulated data revealed that participants indicated benefit to having been engaged in an authentic research process that incorporated diverse perspectives, resulting in better and more relevant outputs. Reported challenges were about time, resources, and the logistics of collaborating with a large group.ConclusionFollowing the use of an IKT approach during the conduct of a systematic review, team members reported high levels of meaningful engagement. These results contribute to our understanding of ways to co-produce systematic reviews.

Designing and Developing Online Training for Diabetes Prevention Program Coaches Using an Integrated Knowledge Translation Approach: Development and Usability Study.

e-Learning has rapidly become a popular alternative to in-person learning due to its flexibility, convenience, and wide reach. Using a systematic and partnered process to transfer in-person training to an e-learning platform helps to ensure the training will be effective and acceptable to learners. This study aimed to develop an e-learning platform for Small Steps for Big Changes (SSBC) type 2 diabetes prevention program coaches to improve the viability of coach training. An integrated knowledge translation approach was used in the first 3 stages of the technology-enhanced learning (TEL) evaluation framework to address the study objective. This included three steps: (1) conducting a needs analysis based on focus groups with previously trained SSBC coaches, meetings with the SSBC research team, and a review of research results on the effectiveness of the previous in-person version of the training; (2) documenting processes and decisions in the design and development of the e-learning training platform; and (3) performing usability testing. Previously trained SSBC coaches and the SSBC research team were included in all stages of this study. Step 1 identified components from the in-person training that should be maintained in the e-learning training (ie, a focus on motivational interviewing), additional components to be added to the e-learning training (ie, how to deliver culturally safe and inclusive care), and mode of delivery (videos and opportunities to synchronously practice skills). Step 2 documented the processes and decisions made in the design and development of the e-learning training, including the resources (ie, time and finances) used, the content of the training modules, and how coaches would flow through the training process. The design and development process consisted of creating a blueprint of the training. The training included 7 e-learning modules, the learning modalities of which included narrated demonstration videos and user-engaging activities, a mock session with feedback from the research team, and a final knowledge test. Step 3, usability testing, demonstrated high levels of learnability, efficiency, memorability, and satisfaction, with minor bugs documented and resolved. Using an integrated knowledge translation approach to the technology-enhanced learning evaluation framework was successful in developing an e-learning training platform for SSBC coaches. Incorporating end users in this process can increase the chances that the e-learning training platform is usable, engaging, and acceptable. Future research will include examining the satisfaction of coaches using the SSBC coach e-learning training platform, assessing coach learning outcomes (ie, knowledge and behavior), and estimating the cost and viability of implementing this training.

Co-Producing the International Pediatric Oncology Exercise Guidelines (iPOEG) Toolkit with End-Users

The international Pediatric Oncology Exercise Guidelines (iPOEG) support physical activity among children and adolescents affected by cancer. Knowledge translation efforts are needed to ensure that those who will use and/or benefit from the iPOEG have access to it. This mixed-methods study followed co-production principles as guided by an integrated knowledge translation approach within the Knowledge to Action (KTA) Framework, to engage end-users (i.e., professionals and patients/caregivers) to: (1) identify the types of resources needed; (2) co-produce an iPOEG brand; (3) co-produce resources and content; and (4) co-produce dissemination plans to distribute the iPOEG Toolkit (i.e., resources and content). End-users indicated requiring resources such as posters, infographics, social media posts, and videos, and co-created resource content covering quick tips to get active and movement-related education and information. Generated strategies to disseminate the iPOEG Toolkit included: (1) academic presentations; (2) brief education sessions and facilitated discussions to different end-user groups; (3) engaging champions from different end-user groups; (4) emails and email reminders; (5) mainstream news outlets (e.g., newspaper, magazines, or segments on the television [i.e., local news]); and (6) social media. Co-production of the iPOEG Toolkit and dissemination plan were guided by two phases within the KTA framework to build tools that can promote the reach of the iPOEG, ultimately increasing physical activity in this population.

Dissemination of the Women-Centred HIV Care Model: A Multimodal Process and Evaluation.

Using data from a national cohort study and focus groups, the Women-Centred HIV Care (WCHC) Model was developed to inform care delivery for women living with HIV. Through an evidence-based, integrated knowledge translation approach, we developed 2 toolkits based on the WCHC Model for service providers and women living with HIV in English and French (Canada's national languages). To disseminate, we distributed printed advertising materials, hosted 3 national webinars and conducted 2 virtual capacity-building training series. A total of 315 individuals attended the webinars, and the average WCHC knowledge increased by 29% (SD 4.3%). In total, 131 service providers engaged in 22 virtual capacity-building training sessions with 21 clinical cases discussed. Learners self-reported increased confidence in 15/15 abilities, including the ability to provide WCHC. As of December 2023, the toolkits were downloaded 7766 times. We successfully developed WCHC toolkits and shared them with diverse clinical and community audiences through various dissemination methods.

Spontaneous Scaling of a Primary Care Innovation in Real-Life Conditions: Protocol for a Case Study.

Scaling effective primary care innovations to benefit more people is of interest to decision makers. However, we know little about how promising innovations are being scaled "spontaneously," that is, without deliberate guidance. We aim to observe, document, and analyze how, in real-life conditions, 1 primary care innovation spontaneously scales up across Quebec, Canada. We will conduct a participative study using a descriptive single-case study. It will be guided by the McLean and Gargani principles for scaling and reported according to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. Informed by an integrated knowledge translation approach, our steering committee will include patient users throughout the project. Inspired by the Quebec College of Family Physician's "Dragons' Den" primary care program, we will identify a promising primary care innovation that is being or will be scaled spontaneously. We will interview the innovation team about their scaling experiences every month for 1 year. We will conduct interviews and focus groups with decision makers, health care providers, and end users in the innovation team and the target site about their experience of both scaling and receiving the scaled innovation and document meetings as nonparticipant observers. Interview transcripts and documentary data will be analyzed to (1) compare the spontaneous scaling plan and implementation with the McLean and Gargani principles for scaling and (2) determine how it was consistent with or diverged from the 4 McLean and Gargani guiding principles: justification, optimal scale, coordination, and dynamic evaluation. This study was funded in March 2020 by the Canadian Institutes of Health Research. Recruitment began in November 2023 and data collection began in December 2023. Results are expected to be published in the first quarter of 2024. Our study will advance the science of scaling by providing practical evidence-based material about scaling health and social care innovations in real-world settings using the 4 guiding principles of McLean and Gargani. PRR1-10.2196/54855.

Primary Care Physician Engagement in Integrated Health System Transformation: A Case Study 

Background: Primary care physician (PCP) engagement is essential in enhancing health system performance, efficacy and collaboration, however; limited research exists in terms of how PCPs are engaged in health system reform. 
 Aims & Methods: Ontario is undergoing a healthcare transformation with the introduction of Ontario Health Teams (OHTs). OHTs provide a new way of organizing and delivering care that is more connected to patients in their local communities. In response to the need for a coordinated sector approach, a group of PCPs in Southwestern Ontario formed a primary care organization: London-Middlesex Primary Care Alliance (LMPCA). This grassroots organization aims to support unified PCP engagement within the health system reform. The aim of our study is to explore the development of the grassroots LMPCA organization and understand how physicians are engaged within the regional health system. The first phase of our study consisted of a literature review which identified that PCP engagement is critical to the success of OHTs. 
 Using an integrated knowledge translation approach (i.e.: in collaboration with members of the LMPCA and Middlesex-London OHT), the second phase of our study involves a case study to explore the development of a regional primary care organization and physician engagement. We will use key informant interviews with physicians, nurse practitioners (NPs) and health care administrators to explore the LMPCA development and understand PCP engagement. The objectives of the overall study are to 1) plot key junctures in the development of the regional organization, 2) explore PCP engagement at local and regional levels and 3) discuss the barriers and facilitators to PCP engagement.
 Results: Despite PCP engagement being recognized as an important aspect of health systems integration, several barriers exist: ineffective communication within organizations, administrative and legal hurdles, remuneration and reimbursement and other local contextual factors. Results from our literature review indicate that greater levels of PCP engagement can lead to improved primary care performance and efficacy. Engagement in primary care settings has been facilitated both top-down and bottom-up; however, empirical evidence on bottom-up approaches is limited. Three over-arching themes were evident: lack of physician voice, insufficient renumeration, and unsuitable strategies. 
 We anticipate that results of our interviews can provide recommendations to increase physician voice, compensate appropriately, suggest alternative strategies for PCP engagement and gain physician buy-in. Moreover, we expect our results to help shape the LMPCA and the Middlesex-London OHT with their physician engagement efforts within the region. 
 Implications: Findings of our study will benefit researchers, PCPs, NPs, and health care administrators by highlighting barriers and recommendations to support and improve physician engagement efforts. The findings may encourage the international audience to use similar PCP engagement strategies within their organization. 
 Next Steps: We will provide a rich narrative of the development of a grassroots primary care organization as well as an empirical example of PCP engagement in health system reform. We anticipate our results will describe effective strategies for engaging physicians and by extension, provide recommendations to improve organizational efficacy and patient care.

Examining Individualized Participatory Approaches to Care for Individuals with Intellectual and Developmental Disabilities

Background: Patient-centred care plans (PCPs) have been identified as a favourable upstream intervention for community-care populations to improve client outcomes, client and provider experiences, and reduce costly and preventable health service utilization; however, there is limited evidence on implemented approaches.
 Aim: Our study aims to address this gap by exploring individualized participatory approaches to care planning as a means to improving health and social care. We intend to understand the key components and impacts of the approach utilized by a community-care organization including the types, features, and factors that support or hinder the use of participatory approaches for developing PCPs.
 Methods: Our study utilizes an integrated knowledge translation approach (iKT) and as such involves a collaboration between the knowledge users, PHSS, a provincial community-care organization based out of London, Ontario, Canada, and a Western University research team. Members of PHSS and Western University were involved in all aspects of the research design, starting from developing the research question, creating the interview guide, and recruiting participants. Research team members will be actively involved in the analysis of findings and knowledge dissemination. Using a convergent parallel design, we are conducting a mixed-methods study consisting of two parts: 1) qualitative interviews (n=11) with PHSS staff, and 2) a scoping review. The scoping review will be guided by Arksey and O’Malley’s methodological framework for scoping reviews.
 Results: The study is currently ongoing. For the qualitative interviews, we anticipate that the organization’s culture (including their mission and values) and implemented practices that allow for flexibility and adaptability, alongside large support from upper management are important factors that support the utilization of PCPs. It is expected that the benefits of PCPs for persons-supported and their families are inclusivity and the opportunity to lead a full and meaningful life. Moreover, it is expected that PCPs provide motivation for staff to plan and implement the preferences and activities outlined in a PCP. For the scoping review, based on a preliminary search we ran on the MEDLINE (OVID) database, we anticipate finding a small body of evidence that is relevant to our aim. We expect that the literature will demonstrate diversity in the definition of PCPs, community-care services, and implemented practices that are considered person-centred, and participatory. As such, we anticipate that the findings from our scoping review will provide a wide range of data in identifying types and features of PCPs. Implications: The outcomes of this research project will be utilized to inform PHSS and support the spread of their participatory, person-centred approach to care. The findings will also encourage professionals of an international audience to implement PCP practices for similar vulnerable populations.
 Next Steps: We believe that this project will demonstrate the link between PCPs and improved standards of care and health equity for community-care clients. As we anticipate a wide variety in many aspects of PCPs in community-care services, future research can focus on developing a framework for PCPs to standardize the patient-centred practices to improve health and social care for community-care clients.

A Framework to Support the Progressive Implementation of Integrated Team-Based Care for the Management of COPD: A Collective Case Study

Background: In Canada, there is consensus about the need for integrated, team-based care in primary care settings to help manage chronic conditions such as chronic obstructive pulmonary disease (COPD). Currently, there is limited understanding on how to support the continued growth and spread of such models; this is coupled with the fact that there is limited empirical evidence to support this process within chronic disease management. There is a need to understand how to support the implementation and spread of integrated, team-based chronic disease management programs in primary care settings, a process that we call progressive implementation.
 Methods: We studied the supporting and mitigating factors required to successfully implement and spread an integrated, team-based program for COPD management in primary care. We conducted a collective case study using an integrated knowledge translation approach involving key informants and our patient partner throughout the entire research process. Data collection included interviews, living documents, and a focus group. Our study explored an integrated, team-based model of care for COPD known as Best Care COPD (BCC). The BCC program has been implemented in primary care settings across Southwestern Ontario. BCC is a quality improvement initiative that was developed to enhance the quality of care for patients with COPD. Participants in our research included healthcare providers involved in the delivery of the BCC program.
 Results: We identified mechanisms influencing the spread of BCC and categorized them as foundational (evidence-based program, readiness to implement and a peer-led implementation team), transformative (adaptive process, provider empowerment and embedded evaluation), and enabling mechanisms (provider training, administrative support, role clarity, and patient outcomes) across three different implementation phases. We developed a framework to inform the progressive implementation of integrated, team-based care for chronic disease management within primary care settings.
 Conclusions: This study explores the implementation and spread of an integrated team-based COPD management program in primary care settings. Despite using COPD management program in Ontario, Canada as an exemplar, we believe the findings can be applied in other chronic disease contexts in primary care settings around the world. We provide a framework to support progressive implementation of integrated team-based care for chronic diseases with the potential to support patients and providers by understanding how to facilitate the continued growth of appropriate models of care. 
 Next Steps: The rapidly increasing prevalence of chronic diseases emphasizes the need to understand how to spread and sustain appropriate models of care to better support patients and providers. The next phase of this study will seek to understand how to support the sustainability of integrated, team-based chronic disease management programs in a primary care setting.
 Information on Financial Support: This study has received financial support from the Asthma Research Group Inc. and Canadian Institutes of Health Research.

Creating synergies among education/research, practice, and policy environments to build capacity for the scholar role in occupational therapy and physiotherapy in the Canadian context.

Scholarly practice (SP) is considered a key competency of occupational therapy and physiotherapy. To date, the three sectors-education/research, practice, and policy/regulation-that support SP have been working relatively independently. The goals of this project were to (a) understand how representatives of the three sectors conceptualize SP; (b) define each sector's individual and collective roles in supporting SP; (c) identify factors influencing the enactment of SP and the specific needs of how best to support SP; and (d) co-develop goals and strategies to support SP across all sectors. We used interpretive description methodology. Consistent with an integrated knowledge translation approach, partners representing the three sectors across Canada recruited individuals from each sector, developed the content and questions for three focus groups, and collected and analyzed the data. Inspired by the Consolidated Framework for Implementation Research, we developed the questions for the second focus group. We analyzed the data using an inductive thematic analysis method. Thirty-nine participants from the three sectors participated. Themes related to participants' conceptualization of SP included (a) ongoing process, (b) reflective process, (c) broad concept, and (d) collective effort. Themes describing factors influencing and supporting SP were (a) recognition, (b) appropriate conceptualization, (c) social network, (d) accessibility to resources, and (e) forces outside of practitioners' effort. Goals to support SP included (a) further recognizing SP, (b) sustaining SP competency, and (c) ensuring access to information. SP requires collaborative and integrated intersectoral support and further recognition of its importance through the collaboration of multiple stakeholders.

Designing Implementation Strategies for a Digital Suicide Safety Planning Intervention in a Psychiatric Emergency Department: Protocol for a Multimethod Research Project.

Suicide prevention is currently a national health priority in Canada. Emergency departments (EDs) are critical settings for suicide prevention, and in our local psychiatric ED at the Centre for Addiction and Mental Health, we plan to embed an app-based tool called the Hope app to support suicide safety planning intervention. The app is free and available on app stores, and usability tests have been completed. As a next step to embed this new tool into the routine clinical workflow, research is needed to assess determinants of and design strategies for implementation with the end goal of routinization. The purpose of this 2-phased research is to implement the app in the routine clinical workflow in our local psychiatric ED. The specific objectives are as follows: (1) understanding ED clinicians' perceptions and experience of implementing the app in routine practice and identifying barriers to and facilitators of implementation (phase 1) and (2) using findings and outputs from phase 1 and collaborating with service users, families, and ED clinicians to co-design implementation strategies for the app (phase 2). We will use an integrated knowledge translation approach throughout this project. In phase 1, we will conduct interviews with ED clinicians to identify implementation determinants using a behavior change framework. In phase 2, a co-design team comprising clinicians, ED service users, and families will design implementation strategies that align with the determinants identified in phase 1. This protocol presents detailed information about the entire structure of the 2-phased research project. Ethics approval for conducting the qualitative descriptive study (phase 1) has been obtained, and the recruitment and data collection processes will be completed no later than December 2023. Ethics approval for phase 2 is underway. Involving multiple knowledge user groups early in the research and decision-making process is crucial for successful implementation. Although co-designing is commonly practiced during innovation development, there is often a misconception that the responsibility for implementing what has been designed falls on others. This research aims to fill this methodological gap in the health informatics literature. By the end of this project, we will have developed theory-informed implementation strategies to support Centre for Addiction and Mental Health ED clinicians in adopting the Hope app to complete safety planning intervention. These strategies, guided by a behavior change framework, will target clinicians' behavior change and seamlessly integrate the app into the routine clinical workflow. In addition, this research project will provide recommendations on how to involve multiple knowledge user groups and offer insights into how the methodology used can be adapted to other areas within the health informatics literature. PRR1-10.2196/50643.

Development of a virtual reality-based intervention for community walking post stroke: an integrated knowledge translation approach

Purpose To develop a virtual reality (VR) based intervention targeting community walking requirements. Methods Two focus groups each involving 7 clinicians allowed exploring optimal features, needed support and perceived favorable/unfavorable factors associated with the use of the VR-based intervention from the clinicians’ perspective. Three stroke survivors and 2 clinicians further interacted with the intervention and filled questionnaires related to acceptability and favorable/unfavorable perceptions on the VR intervention. Stroke participants additionally rated their perceived effort (NASA Tax Load Index), presence (Slater-Usoh-Steed) and cybersickness (Simulator Sickness Questionnaire). Results Results identified optimal features (patient eligibility criteria, task complexity), needed support (training, human assistance), as well as favorable (cognitive stimulation, engagement, representativeness of therapeutic goals) and unfavorable factors (misalignment with a natural walking pattern, client suitability, generalization to real-life) associated with the intervention. Acceptability scores following the interaction with the tool were 28 and 42 (max 56) for clinicians and ranged from 43 to 52 for stroke participants. Stroke participants reported moderate perceptions of effort (range:20-33/max:60), high levels of presence (29-42/42) and minimal cybersickness (0-3/64). Conclusion Findings collected in the early development phase of the VR intervention will allow addressing favorable/unfavorable factors and incorporating desired optimal features, prior to conducting effectiveness and implementation studies.