http://www.diva-portal.org
This is the published version of a paper published in Worldviews on Evidence-Based Nursing.
Citation for the original published paper (version of record):
Morténius, H., Hildingh, C., Fridlund, B. (2016)
Strategic communication intervention to stimulate interest in research and evidence-based
practice: A 12-year follow-up study with registered nurses.
Worldviews on Evidence-Based Nursing, 13(1): 42-49
http://dx.doi.org/10.1111/wvn.12109
Access to the published version may require subscription.
N.B. When citing this work, cite the original published paper.
Open Access article
Permanent link to this version:
Strategic Communication Intervention to
Stimulate Interest in Research and
Evidence-Based Practice: A 12-Year
Follow-Up Study With Registered Nurses
Helena Mort ´enius, MD, PhD•Cathrine Hildingh, RNT, PhD•Bengt Fridlund, RNT, PhD Keywords communication, dissemination, research-to-practice gap, intervention, primary care, registered nurses, R & D interestABSTRACT
Background: Bridging the research–practice gap is a challenge for health care. Fostering aware-ness of and interest in research and development (R & D) can serve as a platform to help nurses and others bridge this gap. Strategic communication is an interdisciplinary field that has been used to achieve long-term interest in adopting and applying R & D in primary care.
Aim: The aim of the study was to evaluate the impact of a strategic communication intervention on long-term interest in R & D among primary care staff members (PCSMs) in general and registered nurses (RNs) in particular.
Methods: This prospective intervention study included all members of the PCSMs, including RNs, in a Swedish primary care area. The interest of PCSMs in R & D was measured on two occasions, at 7 and 12 years, using both bivariate and multivariate tests.
Results: A total of 99.5% of RNs gained awareness of R & D after the first 7 years of intervention versus 95% of the remaining PCSMs (p= .004). A comparison of the two measurements ascer-tained stability and improvement of interest in R & D among RNs, compared with all other PCSMs (odds ratio 1.81; confidence interval 1.08–3.06). Moreover, the RNs who did become interested in R & D also demonstrated increased intention to adopt innovative thinking in their work over time (p= .005).
Linking Evidence to Action: RNs play an important role in reducing the gap between theory and practice. Strategic communication was a significant tool for inspiring interest in R & D. Application of this platform to generate interest in R & D is a unique intervention and should be recognized for future interventions in primary care. Positive attitudes toward R & D may reinforce the use of evidence-based practice in health care, thereby making a long-term contribution to the patient benefit.
INTRODUCTION
The World Health Organization (WHO) first highlighted the need to bridge the research–practice gap, also known as the “know–do gap,” 10 years ago, stating that it was one of the biggest challenges in health care (World Health Or-ganization, 2006). Several knowledge translation strategies subsequently emerged, aimed at applying research evidence within public health. Such strategies, which usually foster communication-based relationship building, may help bridge this gap between researchers and practitioners (Orton, Lloyd-Williams, Taylor-Robinson, O’Flaherty, & Capewell, 2011). One knowledge translation (KT) strategy that the Cochrane Pub-lic Health Group (CPHG) promotes is dissemination through strategic communication (Jones et al., 2013). The gap between
research and practice can be bridged through such strategic communication planning, which quantifies goals based on established channels for specific target groups (Windahl, Olson, & Signitzer, 2008) and promotes willingness to em-brace change in the organization (Helfrich et al., 2011). Strate-gic communication is an interdisciplinary research field that has developed during the 1990s and 2000s. It is rooted in various disciplines, such as media and communication sci-ence, business and management, sociology, psychology, and political science, and is constructed around a number of the-ories from these areas. Strategic communication has been de-fined as “the purposeful use of communication by an organiza-tion to fulfill its mission” (Hallahan, Holtzhausen, Van Ruler, Vercic, & Sriramesh, 2007). This strategy has successfully generated both short-term and long-term interest in research
Original Article
as well as a willingness to change work practices based on innovative thinking that will probably benefit evidence-based practice (EBP) among healthcare personnel (Mortenius, Frid-lund, MarkFrid-lund, Palm, & Baigi, 2012a; Mortenius, MarkFrid-lund, Palm, Bjorkelund, & Baigi, 2012).
Nurses are one of the most important occupational groups for contributing to EBP for the best interests of the patient (Youngblut & Brooten, 2001). Furthermore, nurses are es-sential members of the EBP team because of their clinical knowledge and expertise (Smith & Donze, 2010). Although their professional knowledge and academic expertise have sig-nificantly increased over the past several decades, continued development of their skills and knowledge also is vital for the future of health care. Two decades have passed since the first studies, which revealed the obstacles found in clinical practice, such as lack of time to read and implement research findings, lack of support, and lack of competent colleagues with whom to discuss research (Funk, Champagne, Tornquist, & Wiese, 1995; Nilsson Kajermo, Nordstr¨om, Krusebrant, & Bj¨orvell, 1998). Research shows that nurses continue to experience these same types of obstacles (Ubbink, Guyatt, & Vermeulen, 2013; Wilhelmsson & Lindberg, 2009). Factors that promote the application of research in nursing have been demonstrated; for example, a positive attitude toward research proved to corre-late with implementation of new research findings (Estabrooks, Floyd, Scott-Findlay, O’Leary, & Gushta, 2003). Several stud-ies have shown that nurses have a positive attitude toward research (Bjorkstrom, Johansson, Hamrin, & Athlin, 2003; Bostrom, Kajermo, Nordstrom, & Wallin, 2009), whereas oth-ers show that despite this attitude they do not commonly im-plement research findings in practice (Fink, Thompson, & Bonnes, 2005). A modest but significant positive correlation between critical thinking and implementation of research find-ings has also been reported (Profetto-McGrath, Hesketh, Lang, & Estabrooks, 2003; Profetto-McGrath, Smith, Hugo, Patel, & Dussault, 2009). According to Profetto-McGrath et al. (2003), nurses with attributes that are consistent with ideal critical thinking, especially those who were open minded, inquisitive, and systematic, were more likely to apply research findings in clinical practice.
Most research centering on nurses and how they use re-search, however, was conducted in the hospital setting rather than in the context of primary care. Historically, primary care research has not been prioritized, for which reason interest in and enthusiasm for this field have been limited (Funk, Champagne, Wiese, & Tornquist, 1991; Whitford, Walker, Jelley, Clarke, & Watson, 2005). Because of the contextual differences between these two settings, research results are not always directly transferable between them (Nilsson Kajermo, Alinaghizadeh, Falk, Wandell, & Tornkvist, 2014). Nurses in primary care play a key role, where their use of relevant and evidence-based knowledge is vital to patient care (Nilsson Kajermo et al., 2014). Lack of interest in research within primary care has been linked to two important factors: lack of a supportive infrastructure and lack of a facilitating research
culture (Jowett, Macleod, Wilson, & Hobbs, 2000). One way to achieve such a supportive infrastructure involves a cohesive communication concept known as strategic communication. This concept can be used to create a positive attitude toward research in order to increase knowledge of research and development (R & D). Studies in primary care have shown that such knowledge also stimulates interest in changing work practices in the long term (Mortenius, Fridlund, et al., 2012; Mortenius, Marklund, Palm, Bjorkelund et al., 2012). However, no specific study has been conducted to explore the impact of strategic communication on long-term attitudes of nurses toward R & D. Therefore, the aim of the study was to evaluate the impact of strategic communication intervention on long-term interest in R & D among primary care staff in general and registered nurses (RNs) in particular. Specifically, the issues studied were:
r
Dissemination of knowledge about R & D in an effortto generate interest in R & D among primary care staff members (PCSMs) and to compare the results for RNs with those of the other PCSMs from a short-term perspective (7 years of follow-up).
r
Improving and sustaining interest in R & D amongRNs from a long-term perspective (12 years of follow-up).
r
Development of innovative thinking among RNs whobecame interested in R & D over time.
r
Impact of communication channels on generatingin-terest in R & D.
METHODS
Design and Settings
This prospective intervention study was aimed at influenc-ing attitudes toward evidence-based platforms in southwest Sweden. The region has about 290,000 inhabitants, including 7,000 healthcare employees, 20% of whom work in primary care. The population has access to publicly funded healthcare at the national, regional, and local levels. The county coun-cils provide care at the regional level, which is the basis of tax-funded healthcare (Glenng ˚ard, Hjalte, Svensson, Anell, & Bankauskaite, 2005).
Primary Care
Primary care is the backbone of health care, with responsibil-ity for medical treatment, preventive health, rehabilitation, and nursing. Legislation introduced in Sweden in 1996 improved scientific expertise within health care through the establish-ment of R & D units (Regeringskansliet, 1996). The goal was to conduct research outside university hospitals, which in the long term was intended to stimulate a research culture, includ-ing at places such as the primary care R & D unit at which the study was conducted. The public sector provides funds for these R & D units in Sweden.
Worldviews on Evidence-Based Nursing, 2016; 13:1, 42–49. 43
C
Strategic Communication Intervention
The strategic communication intervention consisted of quan-tifiable targets for all PCSMs. The goal was to increase knowl-edge and awareness of, as well as interest in, R & D as a step toward fostering a culture that embraces change among PC-SMs. The intervention was structured using a communication plan based on an analysis of the current status (Mort´enius, Marklund, Palm, Bjorkelund, et al., 2012) and mainly involved dissemination of information through three established com-munication channels: oral (research seminars and annual re-search days), written (rere-search bulletins and popular science reports), and digital (intranet and Internet websites). The con-tent of these channels was based on a theoretical and com-munication platform: an information processing theory, and diffusion of innovation and social learning theory (Bandura, 1977; McGuire, 1968; Rogers, 2003). Communication chan-nels were selected based on the message intended for each tar-get group. The oral channel used a popular science approach to disseminate information about research projects within the organization. The written channel (research bulletin) and the digital channel (Internet) informatively demonstrated how em-ployees from clinical practice applied and benefited from R & D strategies. Interactions among the channels were expected to produce synergies that would promote long-term interest in R & D and innovative thinking. Efforts were made to ensure that all three channels met the needs of PCSMs for information on R & D within the organization. Because R & D was a new con-cept in the organization (Ahlenius, 1995; Ovhed, Van Royen, & Hakansson, 2005), the focus was placed on dissemination of information and acceptance of its importance for personal de-velopment, as well as for the organization as a whole. Follow-up and analysis of the effects of the intervention on PCSMs were carried out after 7 and 12 years (Mort´enius, Fridlund, et al., 2012).
Participants
The study population was composed of all PCSMs (n= 1,276), including 346 RNs, distributed among general RNs, public health nurses, and midwives.
Instrument
A questionnaire was constructed based on a literature review and the experience of the research team, which included a communication expert, healthcare communication researcher, healthcare research experts, and a biostatistician (Mort´enius, Marklund, Palm, Bjorkelund, et al., 2012). The questionnaire was designed to determine the influence of R & D-related com-munication on changes in attitudes among PCSMs toward R & D over time. The questions in the current study asked about background (age, sex, profession) and included items on the role of strategic communication: knowledge of R & D activity, interest in R & D, innovative thinking (creation of new ideas) resulting from direct and indirect channels, development of interest in R & D through personal initiative as a result of R &
Table 1. Descriptive Statistics for the Primary Care Staff Members Who Participated on Both Measure-ment Occasions (2004 and 2009; N= 352)
n %
Registered nurses
Public health nurse 74 21
Midwife 12 3
General nurse 10 3
Total 96 27
Other primary care staff members
Dental nurse (assistant) 46 13 Administrative staff 32 9 Dentist 31 9 Assistant nurse 31 9 Physical therapist 28 8 Dental hygienist 22 6 Physician 22 6 Medical secretary 20 6 Occupational therapist 14 4 Psychologist 10 3 Total 256 73 Grand total 352 100
communication with a person exposed to R & D channels. The validity and reliability of the instrument have been adequately tested and described elsewhere (Mort´enius, H., Marklund, B., Palm, L., Fridlund, & Baigi, 2012).
Data Collection
Two sets of questionnaires were sent out, each followed by a reminder. Responses were received at the time of the first measurement from 846 employees, representing 70% of all employees, including 246 RNs (29%). In the final phase, 352 PCSMs participated, including 96 RNs (27%) who had been followed prospectively and who remained in the organization after 12 years (Table 1). Attrition occurred for various reasons, including parental leave, sick leave, incomplete questionnaires, and employees who no longer worked in primary care (lost to follow-up), as well as nonresponders (Mort´enius, H.,
Mark-Original Article
Statistical Methods
Descriptive statistics were used to analyze the number and proportion of the various PCSMs participating in the study. Fisher’s exact test was used to compare creation of awareness of R & D between RNs and the remaining PCSMs, whereas the chi-square test was used to compare interest in R & D between RNs and the remaining PCSMs when analyzing the difference between the two measurement occasions (Fleiss, Levin, & Paik, 2003). Multiple logistic regression (Hosmer & Lemeshow, 1989) with odds ratio (OR) and a 95% confidence interval (CI) was then carried out to analyze the impact on interest among nurses compared with other primary care per-sonnel, taking the variable of age into account. The chi-square test and Fisher’s exact test were also used to compare category variables. The Mann–Whitney U test was used to compare vol-ume of positive exposure (i.e., the impact of reading the R & D bulletin on interest in R & D). The significance level was set at .05.
Ethics
All participants were invited to complete the questionnaires on the two occasions on a voluntary basis and with guaranteed confidentiality. The study conformed to the principles outlined in the Declaration of Helsinki (The World Medical Association, 2005) and was approved by the Ethics Committee at Lund University, Sweden.
RESULTS
The analysis following the first 7 years showed that 99.5% of RNs had gained awareness of R & D as a result of the commu-nication initiatives. The comparable figure for the rest of the PCSMs at the same point in time was 95% (p= .004). A com-parison of the two measurement occasions at 7 and 12 years ascertained both stability and improvement of interest in R & D among RNs, compared with the remaining PCSMs (55.2% vs. 41.4%; p= .032; Table 2). Results of logistic regression adjusted for the age variable confirmed higher odds of interest over time among RNs compared with the remaining PCSMs (OR, 1.81; 95% CI, 1.08–3.06). Communication channels played a sig-nificant role in this development: annual research days (p = .045), scientific seminars (p= .032), and a research bulletin (p= .003) (Table 3). Statistical analysis of the digital channels was not possible due to an insufficient number of responses. An analysis specifically concerning the role of indirect infor-mation sources found that their impact on interest was stable over time. The greatest impact was achieved when a colleague took note of and informed others about R & D projects (Figure 1). Moreover, the RNs who did become interested in R & D also demonstrated an increased intention to adopt innovative thinking in their work over time (p= .005).
DISCUSSION
The results show the impact of strategic communication on creation and retention of interest in R & D among PCSMs,
Table 2. Stability and Improvement of Interest in Re-search and Development Between Occasion 1 and Occasion 2 (2004 and 2009)
n % p
Registered nurses Yes 48 55.2 No 39 44.8 Other primary care staff members Yes 79 41.4 No 112 58.6
.032 Note. Chi-square test was used to compare registered nurses (RNs) with other primary care staff members (PCSMs). PCSMs,n= 352; RNs, n = 96.
Table 3. Comparison of the Impact of Communica-tion Channels on CreaCommunica-tion of Interest in Research and Development Among Registered Nurses Measured on Two Occasions (2004 and 2009)
Communication Median
Channels % (IQR) p
Annual research days 63.8 .045 Scientific seminars written 57.4 .032 Research bulletins written 4.0 (2–5) .003
with a focus on RNs over time. Interest in R & D among RNs subsequently evolved into innovative thinking in clinical practice. The creation of a positive attitude toward interest and innovation in R & D that extends over a 12-year period is a valuable platform for future implementation of EBP in health care. Previously tried interventions and implementation mod-els aimed at increasing the application of research in clinical practice have highlighted a need for multiple initiatives for structural incorporation of EBP at different levels: worldwide, national, administrators, educators, faculty, researchers, services, local workplace, and culture (Ubbink et al., 2013).
The goal of this intervention was to build long-term aware-ness and interest over time at different levels, rather than to launch a dedicated campaign on which such interventions and implementation models are typically based. This intervention could foster willingness to embrace change within the orga-nization over time (Helfrich et al., 2011; Mortenius, Fridlund, et al., 2012). One example of an implementation platform that does not seem to promote this long-term perspective is PARIHS, an established framework among RNs in which
Worldviews on Evidence-Based Nursing, 2016; 13:1, 42–49. 45
C
Figure 1. Comparison of impact from indirect communication channels (heard from someone who described research) on creation of interest in research and development among registered nurses, measured on two occasions (2004 and 2009).
context, facilitation, and evidence are factors that play a major role in implementation of research findings (Rycroft-Malone, 2004). This framework could be enriched to a greater degree by encouraging interest in R & D in advance. According to this incremental behavior process, the strategy is to first provide awareness and interest that gradually produce innovative thinking, especially critical thinking, as was demonstrated in this study (McGuire, 1968). A positive attitude toward and interest in R & D are important factors for incorporation of research and application of new research findings (Estabrooks et al., 2003). Therefore, it is important to support this attitude so that it persists over time, which is generally the most difficult part of effecting behavioral change. One study has shown that recent nursing graduates in particular lose interest in research after a few years in clinical practice (Forsman, Rudman, Gustavsson, Ehrenberg, & Wallin, 2010). Including R & D and EBP as standing items on the agenda is therefore of great importance (Palm, 2006; Windahl et al., 2008).
Part of the communication strategy was to carry out re-current activities such as annual research days and scientific seminars, thereby highlighting what is happening within R & D that could affect RNs and generate interest over time. By simultaneously following up on such activities with a research bulletin that PCSMs read and discuss in the employee break room, the R & D reported therein advances yet another step on the discussion agenda, which this study has shown to be
impor-tant for both direct and indirect communication channels. The results showed that interest in R & D had increased via indi-rect channels, when colleagues discussed their R & D projects or a popular science report. During the intervention, nurses who were active in research were underscored as good exam-ples and could therefore serve as role models. They acted as opinion shapers by describing their R & D projects and as role models by showing that they were able to successfully pursue higher studies. Highlighting role models (Bandura, 1977) and opinion shapers (Rogers, 2003) is one part of the theoretical field of strategic communication used in the intervention. The oral channel is mainly used to modify attitudes (Palm, 2006), which is in line with our results. The use of different channels for the same target group with messages prepackaged in vari-ous ways to suit the type of channel was the part of the concept (Rogers, 2003). Intensification and the attention aimed specif-ically at RNs in general and the role models in particular were probably significant factors for the accelerated positive attitude toward R & D in this group.
There has been criticism in health communication based on linear messenger receiver models that do not use other as-pects of communication theories (Kuruvilla & Mays, 2005); dialogue and interactive communication with distinct uses of communication theories have emerged through communica-tion research (Wilson, Petticrew, Calnan, & Nazareth, 2010). For example, making research findings available in the reader’s
Original Article
native language, such as the study of popular science reports, has proven to be a successful concept to overcome the language barrier so EBP can be applied by nurses (Ubbink et al., 2013). When nurses see that others in their own profession engage in research, they may also become motivated to give research a try.
RNs are one of the largest employee groups in primary care who have daily contact with patients; they have therefore also been considered to be vehicles for EBP (Youngblut & Brooten, 2001). The nurses stated that they consider EBP to be a more important factor than did the other employee groups (Carlfjord & Festin, 2014). This may be because of the strong focus on nursing research and because EBP is discussed in terms of the role of nurses and their responsibility as healthcare providers. The interest generated among nurses that has led to innovative thinking may be viewed as a linear process that leads to greater use of research findings in clinical practice. This finding is in line with Profetto-McGrath, who believes that nurses who exer-cise critical thinking, especially if they are open minded, inquis-itive, and systematic, are more likely to apply research in their work (Profetto-McGrath et al., 2003). Development of critical thinking can equip RNs with the necessary skills and disposi-tions (e.g., habits of mind, attitudes, and traits) to support EBP (Profetto-McGrath et al., 2003). Furthermore, the nursing role has substantially changed in recent years to underscore their responsibility to implement evidence-based care in an effort to ensure that the patient care they deliver is consistent with science and proven experience. Nurses also supervise nursing students in their clinical rotations. This places greater demands on them to remain up to date in R & D, especially for advanced level education. The changing role and great demands placed on nurses could possibly make them more willing to adopt the concept and show increased interest (Campbell & Profetto-McGrath, 2013). Another important factor is that the culture of the organization can be an obstacle to interest in applying knowledge gained through R & D. Professional management can overcome this obstacle by implementing a long-term policy to help integrate theory and practice (Smith, Hampson, Scott, & Bower, 2011). With the aid of strategic communication, EBP can become a common indicator for the formation of criti-cal thinking and an innovative approach to meet both patient demand and new challenges in clinical practice in the future.
STRENGTHS AND LIMITATIONS
The study design was longitudinal and covered a lengthy period of several years. It can therefore be assumed that the results obtained on the two measurement occasions have a higher level of confidence compared with cross-sectional studies. The multivariate analyses performed regarding pos-sible confounders increased the level of confidence (Holford, 2002). The theory-driven methodological implementation process, together with a validated evaluation instrument, should be considered reliable tools for implementation of EBP (Estabrooks, Squires, Cummings, Birdsell, & Norton,
2009; Wilson et al., 2010). In addition, the involvement of a communication strategist in the cohort increased the significance of the intervention (Brownson, Jacobs, Tabak, Hoehner, & Stamatakis, 2013). Moreover, relevant controls for study participants could not be found because approaches used at R & D units in Sweden vary (Tyd´en, 2009), nor were baseline data available. These two factors limit the generalizability of the study to some extent.
LINKING EVIDENCE TO ACTION
r
Build platform to promote research, thenimple-ment research findings.
r
Establish strategic communication as a tool tomodify attitudes and behavior.
r
Adopt a strategic communication plan withquan-tifiable goals based on established channels for specific target groups to inspire interest in R & D.
r
Measure improvement within the cohort followingthe intervention over time.
CONCLUSIONS
Strategic communication is a significant tool for creation of interest in R & D within primary care, especially among RNs. This process contributes to the creation of positive attitudes toward R & D for the long term and, to a certain extent, even permanently. The benefit of interest in R & D among RNs compared with other professionals is a relevant finding that deserves special attention in this context. As the largest per-sonnel group, nurses should be in the vanguard of primary care, because basing clinical practice on research evidence will improve patient outcomes. WVN
ACKNOWLEDGMENTS
This work was supported by the Department of Research, De-velopment and Education, Region Halland, Sweden. The au-thors are grateful to the cohort team for valuable support during the study process.
Author information
Helena Mort´enius, Research Supervisor, Department of Re-search, Development and Education, Region Halland, Swe-den and Department of Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Sweden; Cathrine Hild-ingh, Professor, School of Social and Health Sciences, Halm-stad University, HalmHalm-stad, Sweden and Department of Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Sweden; Bengt Fridlund, Professor, Department of Primary Healthcare, University of Gothenburg, Gothenburg, Sweden, Department of Primary Health Care, Sahlgrenska Academy,
Worldviews on Evidence-Based Nursing, 2016; 13:1, 42–49. 47
C
University of Gothenburg, Sweden, and School of Health Sci-ences, J¨onk¨oping University, J¨onk¨oping, Sweden
Address correspondence to Dr. Helena Mort´enius, De-partment of Research and Development, Region Halland, Halland Hospital, SE-301 85 Halmstad, Sweden; he-lena.mortenius@regionhalland.se
Accepted 25 April 2015
CopyrightC 2015, Sigma Theta Tau International
References
Ahlenius, D. (1995). FoU, forskning och utveckling [Research and
development]. Halmstad: Landstinget Halland (County Council
of Halland).
Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice Hall.
Bjorkstrom, M. E., Johansson, I. S., Hamrin, E. K., & Athlin, E. E. (2003). Swedish nursing students’ attitudes to and awareness of research and development within nursing. Journal of Advanced
Nursing, 41(4), 393–402. doi:10.1046/j.1365-2648.2003.02557.x
Bostrom, A. M., Kajermo, K. N., Nordstrom, G., & Wallin, L. (2009). Registered nurses’ use of research findings in the care of older people. Journal of Clinical Nursing, 18(10), 1430–1441. doi:10.1111/j.1365-2702.2008.02370.x
Brownson, R. C., Jacobs, J. A., Tabak, R. G., Hoehner, C. M., & Stamatakis, K. A. (2013). Designing for dissemination among public health researchers: Findings from a national survey in the United States. American Journal of Public Health, 103(9), 1693– 1699. doi:10.2105/AJPH.2012.301165.
Campbell, T. D., & Profetto-McGrath, J. (2013). Skills and at-tributes required by clinical nurse specialists to promote evidence-based practice. Clinical Nurse Specialist, 27(5), 245–254. doi:10.1097/NUR.0b013e3182a0ba68
Carlfjord, S., & Festin, K. (2014). Primary health care staff’s opin-ions about changing routines in practice: A cross-sectional study.
BMC Family Practice, 15. doi:10.1186/1471-2296-15-2.
Estabrooks, C. A., Floyd, J. A., Scott-Findlay, S., O’Leary, K. A., & Gushta, M. (2003). Individual determinants of research uti-lization: A systematic review. Journal of Advanced Nursing, 43(5), 506–520. doi:10.1046/j.1365-2648.2003.02748.x
Estabrooks, C. A., Squires, J. E., Cummings, G. G., Birdsell, J. M., & Norton, P. G. (2009). Development and assessment of the Alberta context tool. BMC Health Services Research, 9, 234. doi:10.1186/1472-6963-9-234
Fink, R., Thompson, C. J., & Bonnes, D. (2005). Overcoming barri-ers and promoting the use of research in practice. Journal of
Nurs-ing Administration, 35(3), 121–129.
doi:00005110-200503000-00005
Fleiss, J. L., Levin, B., & Paik, M. C. (2003). Statistical methods for
rates and proportions (3rd ed.). Hoboken, NJ: Wiley.
Forsman, H., Rudman, A., Gustavsson, P., Ehrenberg, A., & Wallin, L. (2010). Use of research by nurses during their first two years after graduating. Journal of Advanced Nursing, 66(4), 878–890. doi:10.1111/j.1365-2648.2009.05223.x
Funk, S. G., Champagne, M. T., Tornquist, E. M., & Wiese, R. A. (1995). Administrators’ views on barriers to research utilization.
Applied Nursing Research, 8(1), 44–49.
Funk, S. G., Champagne, M. T., Wiese, R. A., & Tornquist, E. M. (1991). Barriers to using research findings in practice: The clinician’s perspective. Applied Nursing Research, 4(2), 90–95. Glenng ˚ard, A., Hjalte, F., Svensson, M., Anell, A., & Bankauskaite,
V. (2005). Health systems in transition. Copenhagen: World Health Organization, regional office for Europe on be-half of the European Observatory on Health Systems and Policies.
Hallahan, K., Holtzhausen, D., VanRuler, B., Vercic, D., & Sri-ramesh, K. (2007). Defining strategic communication.
Interna-tional Journal of Strategic Communication, 1(1), 3–35.
Helfrich, C. D., Blevins, D., Smith, J. L., Kelly, P. A., Hogan, T. P., Hagedorn, H., & Sales, A. E. (2011). Predicting implemen-tation from organizational readiness for change: A study pro-tocol. Implementation Science, 6, 76. doi:10.1186/1748-5908-6-76
Holford, T. (2002). Multivariate methods in epidemiology. New York, NY: Oxford University Press.
Hosmer, D. W., & Lemeshow, S. (1989). Applied logistic regression. New York, NY: Wiley.
Jones, K., Baker, P., Doyle, J., Armstrong, R., Pettman, T., & Wa-ters, E. (2013). Increasing the utility of systematic reviews find-ings through strategic communication. Journal of Public Health,
35(2), 345–349. doi:10.1093/pubmed/fdt054
Jowett, S., Macleod, J., Wilson, S., & Hobbs, F. (2000). Research in primary care: Extent of involvement and perceived determinants among practitioners from one English region. British Journal of
General Practice, 50, 387–399.
Kuruvilla, S., & Mays, N. (2005). Reorienting health-research communication. Lancet, 366(9495), 1416–1418. doi:S0140-6736(05)67580-0
McGuire, W. J. (1968). Personality and attitude change: An information-processing theory. In A. G. Greenwald (Ed.),
Psy-chological foundations of attitudes. New York, NY: Academic
Press.
Mortenius, H., Fridlund, B., Marklund, B., Palm, L., & Baigi, A. (2012). Utilisation of strategic communication to create will-ingness to change work practices among primary care staff: A long-term follow-up study. Primary Health Care Research &
De-velopment, 13(2), 130–141. doi:10.1017/S1463423611000624
Mortenius, H., Marklund, B., Palm, L., Bjorkelund, C., & Baigi, A. (2012). Implementation of innovative attitudes and behaviour in primary health care by means of strategic communication: A 7-year follow-up. Journal of Evaluation in Clinical Practice, 18(3), 659–665. doi:10.1111/j.1365-2753.2011.01653.x
Mort´enius, H., Marklund, B., Palm, L., Fridlund, B., & Baigi, A. (2012c). The utilization of knowledge of and interest in re-search and development among primary care staff by means of strategic communication - a staff cohort study. Journal of
Evaluation in Clinical Practice, 18(4), 768–775.
doi:10.1111/j.1365-2753.2011.01672.x
Nilsson Kajermo, K., Alinaghizadeh, H., Falk, U., Wandell, P., & Tornkvist, L. (2014). Psychometric evaluation of a questionnaire and primary healthcare nurses’ attitudes towards research and use of research findings. Scandinavian Journal of Caring Sciences,
28(1), 173–185. doi:10.1111/scs.12037
Nilsson Kajermo, K., Nordstr¨om, G., Krusebrant, ˚A., & Bj¨orvell, H. (1998). Barriers to and facilitators of research utilization, as perceived by a group of registered nurses in Sweden. Journal of
Original Article
Orton, L., Lloyd-Williams, F., Taylor-Robinson, D., O’Flaherty, M., & Capewell, S. (2011). The use of research evidence in public health decision making processes: Systematic review. PloS One,
6(7), e21704. doi:10.1371/journal.pone.0021704
Ovhed, I., VanRoyen, P., & Hakansson, A. (2005). What is the future of primary care research? Probably fairly bright, if we may believe the historical development.
Scan-dinavian Journal of Primary Health Care, 23(4), 248–253.
doi:10.1080/02813430500316692
Palm, L. (2006). Kommunikationsplanering. en handbok p ˚a
veten-skaplig grund [Communication planning. A handbook on evidence-based practice]. Lund, Sweden: Stundentlitteratur.
Profetto-McGrath, J., Hesketh, K. L., Lang, S., & Estabrooks, C. A. (2003). A study of critical thinking and research utilization among nurses. Western Journal of Nursing Research, 25(3), 322– 337.
Profetto-McGrath, J., Smith, K. B., Hugo, K., Patel, A., & Dussault, B. (2009). Nurse educators’ critical thinking dispositions and research utilization. Nurse Education in Practice, 9(3), 199–208. doi:10.1016/j.nepr.2008.06.003
Regeringskansliet. (1996). H¨also-och sjukv ˚ardslagen 26b§ 1996:1289 [The law of the health care system in Sweden]. Stockholm, Swe-den.
Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press.
Rycroft-Malone, J. (2004). The PARIHS framework—A frame-work for guiding the implementation of evidence-based practice.
Journal of Nursing Care Quality, 19(4), 297–304.
Smith, J. R., & Donze, A. (2010). Assessing environmental readi-ness: First steps in developing an evidence-based practice imple-mentation culture. Journal of Perinatal & Neonatal Nursing, 24(1), 61–73. doi:10.1097/JPN.0b013e3181ce1357
Smith, P., Hampson, L., Scott, J., & Bower, K. (2011). Introducing innovation in a management development programme for a UK primary care organisation. Journal of Health Organization and
Management, 25(3), 261–280.
Tyd´en, T. (2009). Gott & blandat. om FoU-milj¨oer i kommuner,
landsting och regioner [About R & D environments in munici-palities, county councils and regions]. Falun, Sweden: Intellecta
Infolog.
Ubbink, D. T., Guyatt, G. H., & Vermeulen, H. (2013). Framework of policy recommendations for implementation of evidence-based practice: A systematic scoping review. BMJ Open, 3(1). doi:10.1136/bmjopen-2012-001881
Whitford, D., Walker, C., Jelley, D., Clarke, C., & Watson, B. (2005). Developing R & D capacity in a primary care trust: Use of the R & D culture index. Primary Health Care Research Development, 6, 110–116.
Wilhelmsson, S., & Lindberg, M. (2009). Health promotion: Facil-itators and barriers perceived by district nurses. International
Journal of Nursing Practice, 15(3), 156–163.
doi:10.1111/j.1440-172X.2009.01740.x
Wilson, P. M., Petticrew, M., Calnan, M. W., & Nazareth, I. (2010). Disseminating research findings: What should re-searchers do? A systematic scoping review of conceptual frame-works. Implementation Science, 5. doi:10.1186/1748-5908-5-91
Windahl, S., Olson, J. T., & Signitzer, B. (2008). Using
communica-tion theory: An introduccommunica-tion to planned communicacommunica-tion (2nd ed.).
London, England: Sage.
World Health Organization. (2005). Bridging the “know-do” gap:
Meeting on knowledge translation in global health. Retrieved from
http://www.who.int/kms/WHO_EIP_KMS_2006_2.pdf The World Medical Association. (2005). Ethical principles for
med-ical research involving human subjects. World Medmed-ical Association Declaration of Helsinki. Washington, DC: Author.
Youngblut, J. M., & Brooten, D. (2001). Evidence-based nursing practice: Why is it important? AACN Clinical Issues,12(4), 468– 476.
doi 10.1111/wvn.12109 WVN 2016;13:42–49
Worldviews on Evidence-Based Nursing, 2016; 13:1, 42–49. 49
C
