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 Scott- Findlay 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