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