Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy


Health and Rehabilitation Sciences


Walton, D

2nd Supervisor

Loh, E



Health care providers are often required to implement evidence-based recommendations into the care they deliver. Resources that support health care providers’ efforts are a useful knowledge translation strategy. This thesis describes the development and usability evaluation of an evidence-informed clinical practice implementation toolkit to support implementation efforts. Two studies were undertaken to provide insight into what was needed to support health care providers, and to inform the development of the toolkit. A retrospective evaluation analyzed the performance of a team implementing a pressure ulcer risk assessment for patients with spinal cord injury. The rates of adherence to the risk assessment and action plan were low at both admission and reassessment. A phenomenology of practice study was conducted to understand the experiences of implementation by health care providers. This study identified five essential themes of the experience: decision making, implementation as a process, lived time, lived human relation, and lived space. The principles of integrated knowledge translation, the Knowledge Exchange Framework, and toolkit development resources were used in this study. This toolkit contains a simplified, phased implementation process based on the Active Implementation Frameworks, and is accompanied by tools. The toolkit received very positive usability ratings: 92% of respondents learned something new from reviewing the toolkit; 100% of respondents said the toolkit was well organized; 92% of respondents said the toolkit was easy to use; 92% of respondents would recommend the toolkit to a colleague; and 92% of respondents showed intention to use the toolkit. This body of work contributes to the fields of knowledge translation and implementation science by generating insight into and appreciation of the process, context, and stakeholders in relation to implementing evidence-based guidelines into routine care delivery practices.

Summary for Lay Audience

Making improvements to care, and how this care is delivered by health care workers, is tough and slow. One of the research studies in this thesis looks at a real-life example of a team effort to improve the care delivered to patients with spinal cord injury. How well the health care workers did the care, patient health outcomes, and the process of improvement is evaluated. The second research study explores how health care workers experience changes and improvements in the care they deliver to patients. The goal was to get a better understanding of their experience in order to know how best to support them in making improvements. The third research study describes the development of a resource by a team to help health care workers make changes or improvements to the care they deliver to patients.

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License