Implementing Partnering for Change in Québec: Occupational Therapy Activities and Stakeholders' Perceptions.

BACKGROUND.: The occupational therapy school-based Partnering for Change (P4C) model has mostly been documented in Ontario. PURPOSE.: This implementation study describes the implementation of P4C in two Québec elementary schools (P4C-Q), as well as therapy practices, their impacts, factors perceived to influence implementation, and recommendations. METHOD.: A sequential mixed-methods design was applied. Therapists (n=2) completed daily journals, describing activities by P4C-Q level. Therapists and other school-stakeholders (n=11) participated in semi-structured interviews, analyzed through a content analysis framework. FINDINGS.: Daily journals illustrated that the majority of therapy time was spent on activities targeting the entire classroom, and on collaboration with educators. Interviews illustrated how coaching was used across different practices and the impact of these practices for schools (e.g., capacity-building) and children (e.g., increased functioning), and highlighted how relationship-building is key to facilitating the implementation of this model. IMPLICATIONS.: Lessons learned may be helpful for others implementing P4C in their own contexts.

Preschoolers' Developmental Profiles and School-Readiness in a Low-Income Canadian City: A Cross-Sectional Survey.

A joint initiative between community and public health stakeholders in a low-income Canadian city was created to describe the developmental profiles of children aged 2-5 years. A two-phase, cross-sectional design was used. Children's development was assessed using an online screening procedure. Those at risk of delays were invited for a school-readiness face-to-face brief assessment. Descriptive and exploratory analyses were conducted. In Phase 1, 223 families were screened; 100 children were at risk of delays (45%); 13% were at risk in ≥3 developmental domains; 26% were at risk in the fine motor domain. Risk of delay was associated with parental concerns, accessing more healthcare professionals, and using fewer public health/community programs. Lower incomes, and not attending day care showed trends towards an increased risk of delay. In Phase 2, 49 children were assessed; 69% were at risk of school-readiness delays; 22% had potential motor delays; 37% were at risk in the social domain. This study found a higher proportion of children at risk of delay than typically reported. Creating community partnerships could help identify all children needing developmental and school-readiness support. More research is needed to ensure these community-based partnerships are integrated into health/community programs responding to children's needs and parental concerns.

Understanding parental concerns related to their child's development and factors influencing their decisions to seek help from health care professionals: Results of a qualitative study.

BACKGROUND: Early identification of children at risk of developmental delay is crucial to promote healthy development. Assessing parental concerns about development is often part of identification processes. However, we currently do not understand well how and why parents become concerned and how and why they access early identification and intervention services. The purpose of this study was to explore parental perceptions about their child's development and the factors influencing their reported professional help-seeking behaviours. METHODS: This exploratory study was part of a larger study describing child development in children aged 2-5 in a small Canadian city. We conducted semistructured interviews with 16 parents whose children were at risk of developmental delay to examine their perceptions of their child's development, their use of community services promoting development, and their recommendations to optimize those services. RESULTS: Four themes were identified: (a) Vision of child development influencing help-seeking behaviours: Natural or Supported?, (b) Internal and external sources contributing to parents' level of developmental concern, (c) Using internal resources and struggling to access external resources, and (d) Satisfaction with services accessed and recommendations to access more support. Parents' vision of child development along with sources of parental concern appeared to influence the level of concern, enhancing our understanding of how parents become concerned. The level of concern and parents' knowledge and perceived access to resources seemed to influence their decision whether or not to consult health care professionals. Parents provided many suggestions to improve services to promote child development and support families. DISCUSSION: Results highlight the importance of supporting parents in recognizing if their child is at risk of delay and increasing awareness of available resources. It appears particularly important to ensure that health care professionals and community-based support services are accessible to provide parents with the support they need, especially when they have concerns.

Exploring engagement in a virtual community of practice in pediatric rehabilitation: who are non-users, lurkers, and posters?

PURPOSE: Communities of practice are increasingly recognized in rehabilitation as useful knowledge transfer tools; however, little is known about their users. This exploratory study describes the characteristics of participants and non-participants invited to engage in a pediatric rehabilitation virtual community of practice. In addition, we explored virtual community of practice utilization behaviors, engagement predictors, and the impact of strategies designed to foster engagement. MATERIALS AND METHODS: Participants' demographics including information-seeking style and organization e-readiness, as well as online platform frequency of use data were collected and analyzed using descriptive, comparative, and predictive statistics. RESULTS: Seventy-four percent of those invited used the virtual community of practice. Users had less years of experience in pediatric rehabilitation than non-users. Among the users, 71% were classified as "lurkers," who engaged through reading content only; while 29% were classified as "posters," editing online content. Predictive factors were not uncovered, however an increased number of forum visits correlated with being a poster, a non-information seeker, an employee of an organization demonstrating e-readiness, and regularly working with children with the virtual community of practice specific condition. User-engagement strategies increased visits to the forum. CONCLUSIONS: These findings will assist rehabilitation leaders in leveraging rehabilitation-specific virtual community of practice to improve knowledge transfer and practice in pediatric rehabilitation and disability management. Implications for Rehabilitation Communities of practice are increasingly recognized as useful knowledge transfer tools for rehabilitation professionals and are made more accessible thanks to virtual technologies. Our virtual community of practice was found to be optimized in health care organizations with an electronic culture, when the topic area had daily relevance to its target audience, and was particularly beneficial for those who have limited years of experience in pediatric rehabilitation. A strongly committed, selected leadership team with the technological skills, content expertise, and designated time to maintain the site and to nurture discussion was deemed vital in fostering knowledge exchange in this context. User-focused engagement strategies showed promise in increasing visits to the virtual community of practice. Our study supports the importance of multi-pronged approaches in enhancing health care professional knowledge and skills Findings from this study will assist rehabilitation leaders in optimally leveraging rehabilitation-specific virtual community of practice to improve knowledge transfer in pediatric rehabilitation and disability management.

Can a Community of Practice Improve Physical Therapists' Self-Perceived Practice in Developmental Coordination Disorder?

BACKGROUND: Communities of practice (CoPs) are useful knowledge translation (KT) strategies, but little is known about their impact on physical therapists' self-perceived practice. PURPOSE: The impact of a CoP on physical therapists' self-perceived practice was evaluated, and factors influencing changes in self-perceived knowledge, skills, and practice related to developmental coordination disorder (DCD) were explored. DESIGN: An explanatory sequential mixed-methods design was used, guided by the Theory of Reasoned Action and Theory of Planned Behavior. METHODS: Physical therapists participated in a DCD physical therapist CoP, which included 2 full-day, face-to-face workshops, with access to a 5-month online forum between the workshops, and completed questionnaires at 3 time-points: before the first workshop, before accessing the online forum, and following the second workshop. Measures completed before and after the CoP included closed-ended questions providing global scores on therapists' self-perceived knowledge, skills, and practice. Physical therapists' sociodemographic characteristics, information-seeking style, use of the online forum, and behavioral change goals were also collected. Paired t-tests, ANCOVAs, and linear regression models were used to analyze the data. RESULTS: Forty-one physical therapists completed all questionnaires. Their self-perceived knowledge, skills, and practice change scores were significantly higher (+0.47, +1.23, and +2.61, respectively; P < .001) at the end of the CoP compared with the beginning. Few of the factors explored significantly influenced therapists' self-reported change scores. LIMITATIONS: No observational data on practice change was collected. The small sample may have limited the ability to identify factors influencing self-perceived practice changes. CONCLUSIONS: The CoP increased physical therapists' self-perceived knowledge, skills, and practice. More research is needed to explore CoP impact on physical therapist practices and how behavioral changes influence patient outcomes.

Virtual Knowledge Brokering: Describing the Roles and Strategies Used by Knowledge Brokers in a Pediatric Physiotherapy Virtual Community of Practice.

INTRODUCTION: Knowledge transfer in pediatric rehabilitation is challenging and requires active, multifaceted strategies. The use of knowledge brokers (KBs) is one such strategy noted to promote clinician behavior change. The success of using KBs to transfer knowledge relies on their ability to adapt to ever-changing clinical contexts. In addition, with the rapid growth of online platforms as knowledge transfer forums, KBs must become effective in virtual environments. Although the role of KBs has been studied in various clinical contexts, their emerging role in specific online environments designed to support evidence-based behavior change has not yet been described. Our objective is to describe the roles of, and strategies used by, four KBs involved in a virtual community of practice to guide and inform future online KB interventions. METHODS: A descriptive design guided this study and a thematic content analysis process was used to analyze online KB postings. The Promoting Action on Research in Health Sciences knowledge transfer framework and online andragogical learning theories assisted in the coding. A thematic map was created illustrating the links between KBs' strategies and emerging roles in the virtual environment. RESULTS: We analyzed 95 posts and identified three roles: 1) context architect: promoting a respectful learning environment, 2) knowledge sharing promoter: building capacity, and 3) linkage creator: connecting research-to-practice. Strategies used by KBs reflected invitational, constructivism, and connectivism approaches, with roles and strategies changing over time. DISCUSSION: This study increases our understanding of the actions of KBs in virtual contexts to foster uptake of research evidence in pediatric physiotherapy. Our results provide valuable information about the knowledge and skills required by individuals to fulfill this role in virtual environments.

Associations between atmospheric concentrations of spores and emergency department visits for asthma among children living in Montreal.

The authors carried out a time-series study to determine whether short-term increases in the concentrations of spores were associated with emergency department visits from asthma among children 0 to 9 years of age in Montreal, 1994-2004. Concentrations of spores were obtained from one sampling monitor. The authors used parametric Poisson models to model the association between daily admissions to emergency rooms for asthma and ambient exposures to a variety of spores, adjusting for secular trends, changes in weather, and chemical pollutants. For first admissions and exposures to Basidiomycetes, the authors found positive associations at all lags but the concurrent day. For Deuteromycetes and Cladosporium, risks were positive starting at lag 3 days and diminished at lag 6 days. There was little evidence of associations for readmissions, except for Basidiomycetes. The results indicate that Basidiomycetes and Cladosporium spores may be implicated in the exacerbation of asthma among children, most notably in the case of first-time visits to emergency departments, and that the effects appear to be delayed by several days.

Associations between grass and weed pollen and emergency department visits for asthma among children in Montreal.

CONTEXT AND OBJECTIVE: Asthma among children is a major public health problem worldwide. There are increasing number of studies suggesting a possible association between allergenic pollen and exacerbations of asthma. In the context of global climate change, a number of future climate and air pollution scenarios predict increases in concentrations of pollen, an extension of the pollen season, and an increase in the allergenicity of pollen. The goal of the present study is to evaluate the short-term effects of exposure to grass and weed pollen on emergency department visits and readmissions for asthma among children aged 0-9 years living in Montreal between April and October, 1994-2004. METHODOLOGY AND RESULTS: Time-series analyses were carried out using parametric log-linear overdispersed Poisson models that were adjusted for temporal variations, daily weather conditions (temperature, atmospheric pressure), and gaseous air pollutants (ozone and nitrogen dioxide). We have found positive associations between emergency department visits and concentrations of grass pollen 3 days after exposure. The effect of grass pollen was higher on emergency department readmissions as compared to initial visits. Weak negative associations were found between weed pollen (including ragweed pollen) and emergency department visits 2 days after exposure. CONCLUSION: The data indicate that among children, emergency department visits increased with increasing concentrations of grass pollen.

The short-term influence of weather on daily mortality in congestive heart failure.

The authors' purpose in this study was to determine whether changes in weather conditions were associated with daily mortality among people aged 65 years and older diagnosed as having congestive heart failure in Montreal, Canada, and who died in the urban area between 1984 and 1993. The authors used a time-stratified case-crossover design and adjusted the models for nitrogen dioxide and ozone. They found a strong nonlinear association with maximum temperature in the warmer months of the year, with a threshold at about 25 degrees C. The authors observed no associations after lag 3 days. In the cold period, they found that risks increased linearly with increasingly colder temperatures, but only after lag 2 days. The authors found no associations with relative humidity. For change in barometric pressure from the previous day, they found no associations in the cold period, but an increase in pressure from the previous day increased risk for lags 0 or 1 days. The authors found some differences between men and women.