Contextualizing the
findings of a croup
guideline knowledge
translation study
Shannon Scott-Findlay, RN, PhD (c)
Ian Graham, PhD
Rena Pandya, MPH
Terry Klassen, MSc, MD
David Johnson, MD
Acknowledgements
 Post-doctoral funding provided to ScottFindlay by:
 Canadian Institutes of Health Research and
 the Alberta Heritage Foundation for Medical
Research
OVERALL OBJECTIVES
 To increase understanding of how a
croup CPG is transferred into practice in
the context of an implementation trial.
Recapping the cRCT Trial
 Objectives
 determine which of the three knowledge
translation (KT) intervention strategies was
most effective at lowering the rate of hospital
days per 1,000 disease episodes.
 determine which of the three dissemination
strategies was most effective at increasing
the use of therapies (e.g., dexamethasone &
epinephrine) of known benefit.
Recapping the Croup Trial
(cont.)
 The KT strategies that were compared were:
 a) mailing of printed CPG – (Standard);
 b) CPG plus a combination of interactive
educational meetings, educational outreach visits
conducted by a self-selected local champion, and
reminders, and
 c) a combination of mailing, interactive sessions,
outreach visits, reminders plus identification of
local opinion leaders and establishment of local
consensus processes
Purpose
 better understand the determinants of the
use of the croup guidelines.
 increase understanding of the process of
research transfer
 provide useful contextual information that
may inform the findings from the croup
CPG cRCT.
Theoretical Framework:
Ottawa Model of Research
Use
Sampling
 Purposeful sampling
 12 hospitals chosen in equal numbers from
each of the three arms,
 Sampling based on:
 representation from both smaller and larger
hospitals.
 representation from both poor and better performers
 ‘Maximizing variation’
Methods
 A qualitative case study research
methodology (n=12) used to explore and
describe the process of research use that
occurred during the Croup cRCT.
Data collection
 Personal or telephone interviews with key
informants and/or focus groups
 Review of policy documents related to
institutional practices for treating croup
 Completion of a brief questionnaire on
health care professionals’ perceptions of
the guideline and practice setting
Analysis
 Data collection and analysis proceeded
concurrently
 Constant comparative approach (Glaser &
Strauss)
 Phases:
 Coding
 Categorizing
 Developing themes
Findings
 Passive dissemination is not as effective as
more active strategies
 Positive feedback about the guideline
 Simple guideline – easy to follow
 “it works”
 Guideline makes healthcare professionals’ work more
predictable as well as increase certainty for the
parents
 Each hospital has different dynamics that
shape how the CPG is implemented or not
Findings
 Focus on uni-disciplinary transfer is not
effective
 Nurses are important facilitators in
transferring information
 The need for consistent “up keep” of
education
Findings
 Barriers
 nurses were not consistently involved in the
process
 constant changes in staff composition
 Facilitator
 Standard orders
 CPG ‘works’ and is easy to use
Conclusions
 Increased knowledge was developed
about how a CPG was transferred or not
into practice
 Acquired a deeper and richer
understanding of the barriers and
supports to the uptake of a croup clinical
practice guideline