PORTFOLIO OF ACTIVITIES

Topic
Barriers and facilitators: Impact on clinical practice change
In this activity you are required to conduct an analysis of barriers and facilitators which impact on clinical practice change. Reference should be made to peer reviewed literature to support your argument. Your audit proposal should be used as an example (My audit proposal is pressure ulcer), with reference to audit processes and potential outcomes. The analysis should address the following aspects:
•    Discussion of common barriers and facilitators which impact on practice change, why these occur and strategies that can be employed in relation to these. (define barrier and define facilitators)
•    Identification of key players that might be involved in practice change processes and why.
•    The current elements of practice that could assist or hinder your project.
•    Identification of assistance that might be needed by staff involved in order for practice change to be achieved (e.g. development of new skills/knowledge, system or process redesign).
•    Discussion of strategies to sustain the changes in practice.

Note:
•    discuss each question for 200 words
•    All references should be from articles less than 10 years old.

Marking Guide – Portfolio

Structure and Presentation 20%
Structure (15%)
•    Each section of the portfolio is structured in a logical sequence so that the content flows (headings may be used to develop the structure of the portfolio)
•    Where appropriate introduces/outlines/situates the activity/discussion
•    Where appropriate each section of the portfolio ends with a cogent, defendable conclusion that summarises the discussion within the body of the paper
Writing Style (5%)
•    The portfolio is written with clear sentence structure and the spelling and grammar are correct
Content 70%
•    Demonstrates an understanding of the activities/discussions chosen by identifying the main components/issues/focus of the topic area
•    Provides evidence of support from contemporary literature to support argument/points of view
•    Where appropriate for the activity demonstrates critical thought
•    Has completed all activities/discussion points
Referencing  10%
•    The referencing style used throughout the summary paper is congruent with the School Academic Manual
•    The reference list is accurate (i.e. no missing page numbers, volumes, correct title etc.), complete (i.e. no references in the body of the paper are missing from the reference list) and consistent with the School Academic Manual
•    The references cited are contemporary (i.e. less than 10 years old unless seminal papers)
•    Primary references are used predominantly (i.e. the original reference has been cited rather than a secondary source)
•    There is evidence in the summary paper that the student has searched widely for information related to the topic/issue
•    The student has acknowledged all sources of information
•    Direct quotations are only used to make crucial points or to support the discussion/argument

Faculty of Medicine, Department of Family Medicine and Emergency
Medicine; Tier 2, Canada Research Chair in Implementation of Shared Decision
Making in Primary Care, Universit

e Laval, Quebec, QC, Canada
2
Knowledge Transfer and Health Technology Assessment Research Group of
the CHUQ Research Centre (CRCHUQ), Quebec, QC, Canada
Key learning points

Barriers and facilitators to knowledge use are among the most
important elements to be considered by those interested in knowl-
edge implementation.

A number of taxonomies
=
frameworks and instruments for assessing
barriers and facilitators have been developed and should be used
when developing a knowledge-to-action project.

There is a need for a consensus on existing taxonomies
=
frameworks
and instruments to support valid comparison between diverse
contexts.
Knowledge Translation in Health Care: Moving from Evidence to Practice
, Second Edition.
Sharon E. Straus, Jacqueline Tetroe and Ian D. Graham.
Ó
2013 by John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd.
121
Introduction
The
need
for
the
effective
knowledge
translation
in
clinical
practice
is
essen-
tial
if
we
want
to
address
the
following
challenges:
(a)
increased
availability
of
health
information
[1];
(b)
the
expanded
role
of
patients
in
clinical
deci-
sion
making
[2];
(c)
management
of
expectations
regarding
new
treatments
and
technologies
[3];
and
(d)
enhanced
patient
safety
[4].To
date,
there
is
consensus
in
the
implementation
research
community
that
efforts
to
trans-
late
knowledge
at
the
clinical
level
have
met
with
little
success
[5].
Although
each
phase
of
the
knowledge-to-action
cycle
is
important
for
ensuring
the
effective
translation
of
knowledge,
the
aim
of
this
chapter
is
to
highlight
the
specific
challenges
associated
with
the
assessment
of
barriers
and
facilitators
to
knowledge
use.
The
observations
in
this
chapter
are
based
on
a
search
of
the
Knowledge
Translation
Resource
Clearinghouse
of
the
Keenan
Research
Centre, a joint program of St. Michael’s Hospital and the University of
Toronto
’
s
Faculty
of
Medicine
(
http://
k
tclearinghouse.c
a
/
tools/
s
c
i
e
nce
,
accessed September 2012).
The first section of this chapter addresses the importance of barriers and
facilitators to knowledge use in health care. The second section briefly pres-
ents the evolution of a few models in this field in order to highlight the
relevance of using conceptual models to assess barriers and facilitators. The
next section reviews relevant instruments for measuring barriers and facili-
tators, and the last section of the chapter summarizes the lessons learned
from the various research initiatives cited and identifies areas in need of
further research.
Why are barriers and facilitators to knowledge use
important?
A search in PUBMED up to August 7, 2012 using the search terms
“barriers” and “barriers AND implementation” produced 57,665 and 4359
hits, respectively. The literature often refers to barriers and facilitators to
knowledge use in the context of “beliefs about capabilities,” of which they
are key determinants. “Beliefs about capabilities” includes the concept of
perceived behavioral control, a determinant of behavior proposed by the
theory of planned behavior (discussed in Chapter 4.2) [6]. In a review of
78 studies using social cognitive theories (theories where individual
cognitions
=
thoughts are viewed as processes intervening between observ-
able stimuli and responses in real wor
ld situations) to identify factors
influencing health professionals’ behaviors, the authors found that the cog-
nitive factors most consistently asso
ciated with predicting health care
122
Knowledge translation in health care

PORTFOLIO OF ACTIVITIES

Topic
Barriers and facilitators: Impact on clinical practice change
In this activity you are required to conduct an analysis of barriers and facilitators which impact on clinical practice change. Reference should be made to peer reviewed literature to support your argument. Your audit proposal should be used as an example (My audit proposal is pressure ulcer), with reference to audit processes and potential outcomes. The analysis should address the following aspects:
•    Discussion of common barriers and facilitators which impact on practice change, why these occur and strategies that can be employed in relation to these. (define barrier and define facilitators)
•    Identification of key players that might be involved in practice change processes and why.
•    The current elements of practice that could assist or hinder your project.
•    Identification of assistance that might be needed by staff involved in order for practice change to be achieved (e.g. development of new skills/knowledge, system or process redesign).
•    Discussion of strategies to sustain the changes in practice.

Note:
•    discuss each question for 200 words
•    All references should be from articles less than 10 years old.

Marking Guide – Portfolio

Structure and Presentation 20%
Structure (15%)
•    Each section of the portfolio is structured in a logical sequence so that the content flows (headings may be used to develop the structure of the portfolio)
•    Where appropriate introduces/outlines/situates the activity/discussion
•    Where appropriate each section of the portfolio ends with a cogent, defendable conclusion that summarises the discussion within the body of the paper
Writing Style (5%)
•    The portfolio is written with clear sentence structure and the spelling and grammar are correct
Content 70%
•    Demonstrates an understanding of the activities/discussions chosen by identifying the main components/issues/focus of the topic area
•    Provides evidence of support from contemporary literature to support argument/points of view
•    Where appropriate for the activity demonstrates critical thought
•    Has completed all activities/discussion points
Referencing  10%
•    The referencing style used throughout the summary paper is congruent with the School Academic Manual
•    The reference list is accurate (i.e. no missing page numbers, volumes, correct title etc.), complete (i.e. no references in the body of the paper are missing from the reference list) and consistent with the School Academic Manual
•    The references cited are contemporary (i.e. less than 10 years old unless seminal papers)
•    Primary references are used predominantly (i.e. the original reference has been cited rather than a secondary source)
•    There is evidence in the summary paper that the student has searched widely for information related to the topic/issue
•    The student has acknowledged all sources of information
•    Direct quotations are only used to make crucial points or to support the discussion/argument

Faculty of Medicine, Department of Family Medicine and Emergency
Medicine; Tier 2, Canada Research Chair in Implementation of Shared Decision
Making in Primary Care, Universit

e Laval, Quebec, QC, Canada
2
Knowledge Transfer and Health Technology Assessment Research Group of
the CHUQ Research Centre (CRCHUQ), Quebec, QC, Canada
Key learning points

Barriers and facilitators to knowledge use are among the most
important elements to be considered by those interested in knowl-
edge implementation.

A number of taxonomies
=
frameworks and instruments for assessing
barriers and facilitators have been developed and should be used
when developing a knowledge-to-action project.

There is a need for a consensus on existing taxonomies
=
frameworks
and instruments to support valid comparison between diverse
contexts.
Knowledge Translation in Health Care: Moving from Evidence to Practice
, Second Edition.
Sharon E. Straus, Jacqueline Tetroe and Ian D. Graham.
Ó
2013 by John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd.
121
Introduction
The
need
for
the
effective
knowledge
translation
in
clinical
practice
is
essen-
tial
if
we
want
to
address
the
following
challenges:
(a)
increased
availability
of
health
information
[1];
(b)
the
expanded
role
of
patients
in
clinical
deci-
sion
making
[2];
(c)
management
of
expectations
regarding
new
treatments
and
technologies
[3];
and
(d)
enhanced
patient
safety
[4].To
date,
there
is
consensus
in
the
implementation
research
community
that
efforts
to
trans-
late
knowledge
at
the
clinical
level
have
met
with
little
success
[5].
Although
each
phase
of
the
knowledge-to-action
cycle
is
important
for
ensuring
the
effective
translation
of
knowledge,
the
aim
of
this
chapter
is
to
highlight
the
specific
challenges
associated
with
the
assessment
of
barriers
and
facilitators
to
knowledge
use.
The
observations
in
this
chapter
are
based
on
a
search
of
the
Knowledge
Translation
Resource
Clearinghouse
of
the
Keenan
Research
Centre, a joint program of St. Michael’s Hospital and the University of
Toronto
’
s
Faculty
of
Medicine
(
http://
k
tclearinghouse.c
a
/
tools/
s
c
i
e
nce
,
accessed September 2012).
The first section of this chapter addresses the importance of barriers and
facilitators to knowledge use in health care. The second section briefly pres-
ents the evolution of a few models in this field in order to highlight the
relevance of using conceptual models to assess barriers and facilitators. The
next section reviews relevant instruments for measuring barriers and facili-
tators, and the last section of the chapter summarizes the lessons learned
from the various research initiatives cited and identifies areas in need of
further research.
Why are barriers and facilitators to knowledge use
important?
A search in PUBMED up to August 7, 2012 using the search terms
“barriers” and “barriers AND implementation” produced 57,665 and 4359
hits, respectively. The literature often refers to barriers and facilitators to
knowledge use in the context of “beliefs about capabilities,” of which they
are key determinants. “Beliefs about capabilities” includes the concept of
perceived behavioral control, a determinant of behavior proposed by the
theory of planned behavior (discussed in Chapter 4.2) [6]. In a review of
78 studies using social cognitive theories (theories where individual
cognitions
=
thoughts are viewed as processes intervening between observ-
able stimuli and responses in real wor
ld situations) to identify factors
influencing health professionals’ behaviors, the authors found that the cog-
nitive factors most consistently asso
ciated with predicting health care
122
Knowledge translation in health care