Research Utilization & the Individual What do we know? Carole A. Estabrooks, RN, PhD

1. Research Utilization & the Individual What do we know? Carole A. Estabrooks, RN, PhD University of Alberta Edmonton, Canada 2nd Annual Knowledge Utilization Colloquium Oxford, July 2002

2. Acknowledgements • AHFMR, Alberta Heritage Foundation for Medical Research • CIHR, Canadian Institutes of Health Research

3. Centre for Knowledge Transfer Graduate training Research Collaboration with policy makers To increase research-based decision-making in KT through:

4. Summer UG students Kristin Brigidear* Sara Katz Kathy O’Leary* Graduate Margaret Milner Shannon Scott-Findlay* Kim Fraser Greta Cummings* Anastasia Mallidou STAFF Huey Chong Katie Hesketh Kylie Hugo Jarmila Sazavsky Connie Winther James Kropfreiter Selena Wong POST-DOC Joanne Profetto-McGrath

5. Outline • Some background • Individual vs. organizational • Conclusions

6. History of Evidence Based Practice? 1920 - 1960 2002 1903 G.Tardé 1992 EBM 1997 NFH Canada 1955 Menzel & Katz Agricultural extension model 1993 Cochrane Collaboration 1970s CURN Project 1943 Ryan & Gross 1985 Conceptual Papers in Nursing

7. KNOWLEDGE UTILIZATION STUDIES PROGRAM Professionalization and … Evidence-based medicine Evidence-based nursing Evidence-based practice Evidence-based policy Evidence-based decision-making

8. RU Research Publications (Nursing)

9. Individual v/s Organizational (Nursing)

10. RU Models in Nursing • WICHEN (Krueger, et al.) • CURN (Horsley, et al.) • NCAST (Barnard, King & Hoehn) • RNABC • Goode • Horn (Goode, et al.) • Iowa (Titler, et al.) • Stetler • CRU (Dufault) • Ottawa (Logan, et al.) • Kitson, et al. • Change to EBP (Rosswurm & Larrabee)

11. Common Features • Generally premised on individual, rational actor assumptions • Good decision-makers use research • Research makes it better • Tend to be prescriptive • Frequently use Rogers’ theory • Generally have not been developed as interdisciplinary

12. Individual v/s Organizational • Systematic review • KUSP RU studies(Estabrooks, PI)

13. Research utilisation and the individual nurse: A systematic review Carole A. Estabrooks, RN, PhD Judith A. Floyd, RN, PhD Shannon Scott-Findlay, RN, MN Katherine A. O’Leary, BA Matthew Gushta, BA

14. Search and retrieval process Online database yield 1063 Articles requested and screened for inclusion/exclusion 104 Studies meeting inclusion criteria 20(representing 22 articles) Studies excluded 82

15. Systematic ReviewIncluded Studies(N=22) Barta (1995) Logsdon et al. (1998) Bostrum & Suter (1993) Kirchoff (1982) Brett (1989) Lacey (1994) Butler (1995) Parahoo (1998; 1999) Champion & Leach (1989) Michel & Sneed (1995) Coyle & Sokop (1990) Rodgers (2000) Davies (1999) Rutledge et al. (1996) Estabrooks (1999a; 1999b) Tsai (2000) Hatcher & Tramner (1997) Varcoe & Hilton (1995) Lia-Hoagberg et al. (1999) Winter (1990)

16. Individual Determinants Six categories of predictors were identified: • Beliefs & attitudes • Information seeking • Education • Involvement in research activities • Professional characteristics • Other socio-economic factors

18. Beliefs & Attitudes • Most frequently assessed determinant (N=10) was attitude toward research • significant in 5 out of 6 studies • most frequently replicated result in all categories • only predictor with a consistent pattern of positive effect

19. Results • Methodological problems • Only 2 studies considered ‘strong’ • Unit of analysis issues • Little to suggest that individual determinants influence RU

20. Implications • Design/analysis • Theoretical framing • Predictors • Dependant variable • Solo work

21. The Determinants of Research Utilization Studies Pain Management in Adults & Pain Management in Infants & Children Funded by: CIHR and AHFMR

22. Study Team University of Alberta Carole Estabrooks, RN, PhD (PI) Janice Lander, RN, PhD Judy Norris, RN, PhD Charles K. Humphrey, MA Karen Golden-Biddle, PhD Francis Lau, PhD University of Toronto Bonnie Stevens, RN, PhD Judy Watt-Watson, RN, PhD Linda O’Brien-Pallas, RN, PhD Gail Donner, RN, PhD J. I. (Jack) Williams, PhD University of Calgary Geertje Boschma, RN, PhD

23. RU Studies • Ethnographic case studies (n=7)* • Multi-site (6 mo./unit) • Qualitative data(interviews, focus groups, observation) • Quantitative data (2 weeks in each unit) • Documentary data (~ 600 total) * two adult and five pediatric units

24. RU StudiesSources of Practice Knowledge • Prefer socially driven sources • Co-workers • Patients • Experiential Learning • Traditional dissemination methods rank poorly e.g., Medical/Nursing journals

25. Sources of Practice Knowledge

26. KUSP RU Studies7 Unit Archetype Conceptualized factors from the RU literature which also existed in our datasets Social & organizational environmental characteristics became paramount Comparison analysis across units which reduced variables to only those of significance

27. KUSP RU Studies Social Interaction Archetype

28. Environment

29. Conclusions • Impact of organizational context • Future directions

30. Organizational Determinants • Kitson, Harvey & McCormack, 1998 • McCormack, Kitson, Harvey, Rycroft-Malone, Titchen & Seers, 2002

31. Stages and phases • 1950s Science push • 1970s Demand pull • 1980s Dissemination • 1990s Linkages & interactions • 2000s Situated knowledge use?

32. KNOWLEDGE UTILIZATION STUDIES PROGRAM We know . . . • Insufficient theorizing • Measurement problems • Lack of causal analyses • Over reliance on rational actor models • Lack of models that include organizational interests, interaction and linkage • Over examination KU as product • Fragmentation …Knowledge in Practice

33. KNOWLEDGE UTILIZATION STUDIES PROGRAM We need . . . • Organizational approaches Practice environment, context, climate & culture addressed • Linkages, interactions, social & relational capitol • KU as an independent variable • Sustainable, interdisciplinary programs of research …Knowledge in Practice

34. E-Mail us at: kusp@ualberta.ca Visit our web site: http://www.ualberta.ca/~kusp/