In healthcare, a gap exists between what is known from research and what is practiced. Understanding this gap depends upon our ability to robustly measure research utilization.
The objectives of this ...systematic review were: to identify self-report measures of research utilization used in healthcare, and to assess the psychometric properties (acceptability, reliability, and validity) of these measures.
We conducted a systematic review of literature reporting use or development of self-report research utilization measures. Our search included: multiple databases, ancestry searches, and a hand search. Acceptability was assessed by examining time to complete the measure and missing data rates. Our approach to reliability and validity assessment followed that outlined in the Standards for Educational and Psychological Testing.
Of 42,770 titles screened, 97 original studies (108 articles) were included in this review. The 97 studies reported on the use or development of 60 unique self-report research utilization measures. Seven of the measures were assessed in more than one study. Study samples consisted of healthcare providers (92 studies) and healthcare decision makers (5 studies). No studies reported data on acceptability of the measures. Reliability was reported in 32 (33%) of the studies, representing 13 of the 60 measures. Internal consistency (Cronbach's Alpha) reliability was reported in 31 studies; values exceeded 0.70 in 29 studies. Test-retest reliability was reported in 3 studies with Pearson's r coefficients > 0.80. No validity information was reported for 12 of the 60 measures. The remaining 48 measures were classified into a three-level validity hierarchy according to the number of validity sources reported in 50% or more of the studies using the measure. Level one measures (n = 6) reported evidence from any three (out of four possible) Standards validity sources (which, in the case of single item measures, was all applicable validity sources). Level two measures (n = 16) had evidence from any two validity sources, and level three measures (n = 26) from only one validity source.
This review reveals significant underdevelopment in the measurement of research utilization. Substantial methodological advances with respect to construct clarity, use of research utilization and related theory, use of measurement theory, and psychometric assessment are required. Also needed are improved reporting practices and the adoption of a more contemporary view of validity (i.e., the Standards) in future research utilization measurement studies.
Job satisfaction is a predictor of intention to stay and turnover among allied healthcare providers. However, there is limited research examining job satisfaction among allied health professionals, ...specifically in residential long-term care (LTC) settings. The purpose of this study was to identify factors (demographic, individual, and organizational) that predict job satisfaction among allied healthcare providers in residential LTC.
We conducted a secondary analysis of data from Phase 2 of the Translating Research in Elder Care program. A total of 334 allied healthcare providers from 77 residential LTC in three Western Canadian provinces were included in the analysis. Generalized estimating equation modeling was used to assess demographics, individual, and organizational context predictors of allied healthcare providers' job satisfaction. We measured job satisfaction using the Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale.
Both individual and organizational context variables predicted job satisfaction among allied healthcare providers employed in LTC. Demographic variables did not predict job satisfaction. At the individual level, burnout (cynicism) (β = -.113, p = .001) and the competence subscale of psychological empowerment (β = -.224, p = < .001), were predictive of lower job satisfaction levels while higher scores on the meaning (β = .232, p = .001), self-determination (β = .128, p = .005), and impact (β = .10, p = .014) subscales of psychological empowerment predicted higher job satisfaction. Organizational context variables that predicted job satisfaction included: social capital (β = .158, p = .012), organizational slack-time (β = .096, p = .029), and adequate orientation (β = .088, p = .005).
This study suggests that individual allied healthcare provider and organizational context features are both predictive of allied healthcare provider job satisfaction in residential LTC settings. Unlike demographics and structural characteristics of LTC facilities, all variables identified as important to allied healthcare providers' job satisfaction in this study are potentially modifiable, and therefore amenable to intervention.
The Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 is designed to collect the minimum amount of data to guide care planning and monitoring for residents in long-term care settings. ...These data have been used to compute indicators of care quality. Use of the quality indicators to inform quality improvement initiatives is contingent upon the validity and reliability of the indicators. The purpose of this review was to systematically examine published and grey research reports in order to assess the state of the science regarding the validity and reliability of the RAI-MDS 2.0 Quality Indicators (QIs).
We systematically reviewed the evidence for the validity and reliability of the RAI-MDS 2.0 QIs. A comprehensive literature search identified relevant original research published, in English, prior to December 2008. Fourteen articles and one report examining the validity and/or reliability of the RAI-MDS 2.0 QIs were included.
The studies fell into two broad categories, those that examined individual quality indicators and those that examined multiple indicators. All studies were conducted in the United States and included from one to a total of 209 facilities. The number of residents included in the studies ranged from 109 to 5758. One study conducted under research conditions examined 38 chronic care QIs, of which strong evidence for the validity of 12 of the QIs was found. In response to these findings, the 12 QIs were recommended for public reporting purposes. However, a number of observational studies (n = 13), conducted in "real world" conditions, have tested the validity and/or reliability of individual QIs, with mixed results. Ten QIs have been studied in this manner, including falls, depression, depression without treatment, urinary incontinence, urinary tract infections, weight loss, bedfast, restraint, pressure ulcer, and pain. These studies have revealed the potential for systematic bias in reporting, with under-reporting of some indicators and over-reporting of others.
Evidence for the reliability and validity of the RAI-MDS QIs remains inconclusive. The QIs provide a useful tool for quality monitoring and to inform quality improvement programs and initiatives. However, caution should be exercised when interpreting the QI results and other sources of evidence of the quality of care processes should be considered in conjunction with QI results.
The current state of evidence regarding measures that assess evidence-informed decision-making (EIDM) competence attributes (i.e., knowledge, skills, attitudes/beliefs, behaviours) among nurses is ...unknown. This systematic review provides a narrative synthesis of the psychometric properties and general characteristics of EIDM competence attribute measures in nursing.
The search strategy included online databases, hand searches, grey literature, and content experts. To align with the Cochrane Handbook of Systematic Reviews, psychometric outcome data (i.e., acceptability, reliability, validity) were extracted in duplicate, while all remaining data (i.e., study and measure characteristics) were extracted by one team member and checked by a second member for accuracy. Acceptability data was defined as measure completion time and overall rate of missing data. The Standards for Educational and Psychological Testing was used as the guiding framework to define reliability, and validity evidence, identified as a unified concept comprised of four validity sources: content, response process, internal structure and relationships to other variables. A narrative synthesis of measure and study characteristics, and psychometric outcomes is presented across measures and settings.
A total of 5883 citations were screened with 103 studies and 35 unique measures included in the review. Measures were used or tested in acute care (
= 31 measures), public health (
= 4 measures), home health (n = 4 measures), and long-term care (
= 1 measure). Half of the measures assessed a single competence attribute (
= 19; 54.3%). Three measures (9%) assessed four competence attributes of knowledge, skills, attitudes/beliefs and behaviours. Regarding acceptability, overall missing data ranged from 1.6-25.6% across 11 measures and completion times ranged from 5 to 25 min (n = 4 measures). Internal consistency reliability was commonly reported (21 measures), with Cronbach's alphas ranging from 0.45-0.98. Two measures reported four sources of validity evidence, and over half (n = 19; 54%) reported one source of validity evidence.
This review highlights a gap in the testing and use of competence attribute measures related to evidence-informed decision making in community-based and long-term care settings. Further development of measures is needed conceptually and psychometrically, as most measures assess only a single competence attribute, and lack assessment and evidence of reliability and sources of established validity evidence.
PROSPERO #CRD42018088754.
Chronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and ...their efficacy when sustained in older adults.
Design: Systematic review with meta-analysis engaging 17 knowledge users using integrated KT.
Randomized controlled trials (RCTs) including adults (> 65 years old) with chronic disease(s), their caregivers, health and/or policy-decision makers receiving a KT intervention to carry out a CDM intervention for at least 12 months (versus other KT interventions or usual care).
We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database's inception to March 2020.
Sustainability, fidelity, adherence of KT interventions for CDM practice, quality of life (QOL) and quality of care (QOC). Data extraction, risk of bias (ROB) assessment: We screened, abstracted and appraised articles (Effective Practice and Organisation of Care ROB tool) independently and in duplicate.
We performed both random-effects and fixed-effect meta-analyses and estimated mean differences (MDs) for continuous and odds ratios (ORs) for dichotomous data.
We included 158 RCTs (973,074 participants 961,745 patients, 5540 caregivers, 5789 providers) and 39 companion reports comprising 329 KT interventions, involving patients (43.2%), healthcare providers (20.7%) or both (10.9%). We identified 16 studies described as assessing sustainability in 8.1% interventions, 67 studies as assessing adherence in 35.6% interventions and 20 studies as assessing fidelity in 8.7% of the interventions. Most meta-analyses suggested that KT interventions improved QOL, but imprecisely (36 item Short-Form mental SF-36 mental: MD 1.11, 95% confidence interval CI - 1.25, 3.47, 14 RCTs, 5876 participants, I
= 96%; European QOL-5 dimensions: MD 0.01, 95% CI - 0.01, 0.02, 15 RCTs, 6628 participants, I
= 25%; St George's Respiratory Questionnaire: MD - 2.12, 95% CI - 3.72, - 0.51 44 12 RCTs, 2893 participants, I
= 44%). KT interventions improved QOC (OR 1.55, 95% CI 1.29, 1.85, 12 RCTS, 5271 participants, I
= 21%).
KT intervention sustainability was infrequently defined and assessed. Sustained KT interventions have the potential to improve QOL and QOC in older adults with CDM. However, their overall efficacy remains uncertain and it varies by effect modifiers, including intervention type, chronic disease number, comorbidities, and participant age.
PROSPERO CRD42018084810.
Understanding context: A concept analysis Squires, Janet E.; Graham, Ian; Bashir, Kainat ...
Journal of advanced nursing,
December 2019, 2019-Dec, 2019-12-00, 20191201, Letnik:
75, Številka:
12
Journal Article
Recenzirano
Odprti dostop
Aims
To conduct a concept analysis of clinical practice contexts (work environments) in health care.
Background
Context is increasingly recognized as important to the development, delivery, and ...understanding of implementation strategies; however, conceptual clarity about what comprises context is lacking.
Design
Modified Walker and Avant concept analysis comprised of five steps: (1) concept selection; (2) determination of aims; (3) identification of uses of context; (4) determination of its defining attributes; and (5) definition of its empirical referents.
Methods
A wide range of databases were systematically searched from inception to August 2014. Empirical articles were included if a definition and/or attributes of context were reported. Theoretical articles were included if they reported a model, theory, or framework of context or where context was a component. Double independent screening and data extraction were conducted. Analysis was iterative, involving organizing and reorganizing until a framework of domains, attributes. and features of context emerged.
Result
We identified 15,972 references, of which 70 satisfied our inclusion criteria. In total, 201 unique features of context were identified, of these 89 were shared (reported in two or more studies). The 89 shared features were grouped into 21 attributes of context which were further categorized into six domains of context.
Conclusion
This study resulted in a framework of domains, attributes and features of context. These attributes and features, if assessed and used to tailor implementation activities, hold promise for improved research implementation in clinical practice.
目标
对卫生保健的临床实践环境(工作环境)进行概念分析。
背景
环境对实施战略的制定、实施和理解越来越重要;然而,关于什么组成环境的概念缺乏清晰度。
设计
改进的Walker和Avant概念分析包括五个步骤:(1)概念选择;(2)目标的确定;(3)识别环境用途;(4)确定定义属性;(5)实证指示物的定义。
方法
从数据库启用到2014年8月,对大范围的数据库进行系统检索。如果报告了背景的定义和/或属性,那么实证文章就被包括在内。如果理论文章报告了背景的模型、理论或框架或者背景是其中的一个组成部分,那么它们就被包括在内。进行了双独立筛选和数据提取。分析是迭代的,包括组织和重新组织,直到出现一个领域、属性和背景特性的框架。
结果
我们确定了15972篇参考文献,其中70篇符合我们的纳入标准。总共有201个独特的环境特征被识别出来,其中89个是共享的(在两个或更多的研究中有报道)。89个共享特征被分为21个环境属性,并进一步划分为6个环境领域。
结论
本研究建立了一个包含环境领域、属性和特征的框架。如果这些属性和特征得到评估并用于定制实施活动,将有望改善临床实践中的研究实施。
Premature and sick neonates may require weeks of hospitalization in a noisy neonatal intensive care unit (NICU) environment with sound levels that may reach 120 decibels. The American Academy of ...Pediatrics recommends a maximum sound level of 45 decibels.
To measure sound levels in a level III NICU and to describe contributing environmental factors.
Descriptive quantitative study. Sound levels were measured using a portable sound meter in an open-bay level III NICU. Contributing environmental factors were recorded and analyzed.
Mean sound levels for day, evening, and night shifts were 83.5, 83, and 80.9 decibels, respectively. Each period of time exceeded the recommended guidelines 90% of the time and was almost double the American Academy of Pediatrics' recommendation. Multiple linear regression findings demonstrated significant factors associated with elevated sound levels including number of neonates, number of people, number of alarms, acuity level, and shift type. Observational data explain 14.5% of elevated sound levels.
An understanding of baseline sound levels and contributing environmental factors is the first step in developing strategies to mitigate excessive noise in the NICU.
Research should focus on effective and sustainable ways to reduce sound levels in the NICU, including inside the isolette, in order to provide an environment that is conducive to optimal growth and neurodevelopment for preterm and sick infants.
Organizational context has the potential to influence the use of new knowledge. However, despite advances in understanding the theoretical base of organizational context, its measurement has not been ...adequately addressed, limiting our ability to quantify and assess context in healthcare settings and thus, advance development of contextual interventions to improve patient care. We developed the Alberta Context Tool (the ACT) to address this concern. It consists of 58 items representing 10 modifiable contextual concepts. We reported the initial validation of the ACT in 2009. This paper presents the second stage of the psychometric validation of the ACT.
We used the Standards for Educational and Psychological Testing to frame our validity assessment. Data from 645 English speaking healthcare aides from 25 urban residential long-term care facilities (nursing homes) in the three Canadian Prairie Provinces were used for this stage of validation. In this stage we focused on: (1) advanced aspects of internal structure (e.g., confirmatory factor analysis) and (2) relations with other variables validity evidence. To assess reliability and validity of scores obtained using the ACT we conducted: Cronbach's alpha, confirmatory factor analysis, analysis of variance, and tests of association. We also assessed the performance of the ACT when individual responses were aggregated to the care unit level, because the instrument was developed to obtain unit-level scores of context.
Item-total correlations exceeded acceptable standards (> 0.3) for the majority of items (51 of 58). We ran three confirmatory factor models. Model 1 (all ACT items) displayed unacceptable fit overall and for five specific items (1 item on adequate space for resident care in the Organizational Slack-Space ACT concept and 4 items on use of electronic resources in the Structural and Electronic Resources ACT concept). This prompted specification of two additional models. Model 2 used the 7 scaled ACT concepts while Model 3 used the 3 count-based ACT concepts. Both models displayed substantially improved fit in comparison to Model 1. Cronbach's alpha for the 10 ACT concepts ranged from 0.37 to 0.92 with 2 concepts performing below the commonly accepted standard of 0.70. Bivariate associations between the ACT concepts and instrumental research utilization levels (which the ACT should predict) were statistically significant at the 5% level for 8 of the 10 ACT concepts. The majority (8/10) of the ACT concepts also showed a statistically significant trend of increasing mean scores when arrayed across the lowest to the highest levels of instrumental research use.
The validation process in this study demonstrated additional empirical support for construct validity of the ACT, when completed by healthcare aides in nursing homes. The overall pattern of the data was consistent with the structure hypothesized in the development of the ACT and supports the ACT as an appropriate measure for assessing organizational context in nursing homes. Caution should be applied in using the one space and four electronic resource items that displayed misfit in this study with healthcare aides until further assessments are made.
IntroductionAs adults age, their senses tend to decline and a large portion of those most affected by sensory decline reside in long-term care. At present, the creation of a sense-sensitive ...environment in long-term care is a difficult task as there is minimal evidence or tools available to guide this process. The 5Senses screening tool was developed to measure the sense-sensitivity of a particular environment, with a focus on long-term care. The purpose of this paper is to describe a study protocol to assess the psychometric properties of the newly developed 5Senses screening tool.Methods and analysisWe will conduct a psychometric evaluation of the 5Senses screening tool in long-term care based on the Standards for Educational and Psychological Testing Framework. In phase I, we will seek input from international content experts (n=20) to assess the content validity of all sections of the tool. In phase II, we will invite auditors (n=3-9), residents (n=3-9) and staff (n=3-9) to partake in think-aloud sessions to assess response process validity. In phase III, we will conduct field testing of the revised 5Senses screening tool with auditors (n=100), residents (n=100) and staff (n=100) to evaluate additional measures including acceptability, inter-rater reliability, internal structure validity and internal consistency reliability, where possible.Ethics and disseminationEthical approval was obtained from the University of Ottawa Research Ethics Board. Findings will be disseminated through a peer-reviewed manuscript, through a dedicated website, through presentations in long-term care communities and through presentations at research conferences.
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