Kirshbaum, Marilyn (2004) Disseminating Research Evidence To Breast Care Nurses: The Case Of Exercise For Breast Cancer Patients. Doctoral thesis, University of Manchester.

Background: Historically, nursing has struggled to introduce researchbased
interventions into routine clinical practice. Reasons for this difficulty
range from poor communication between clinically and academically based
nurses to limitations within organisations that obstruct the implementation of
new ideas.
Aims: To identify the barriers to research utilisation and the preferred
methods of research dissemination amongst breast care nurses (BCNs), to
develop a dissemination intervention for BCNs and to evaluate a
dissemination intervention for BCNs.
Method: The study was conducted in three stages. In Stage 1, a national
survey was conducted using the Barriers to Research Utilisation Scale
(Funk et al. 1991), questions about dissemination preferences and a
demographic questionnaire. In Stage 2, the Conceptual Framework for
Selecting a Targeted Experimental Dissemination Method based on social
interactionalist theory was developed. In Stage 3, a pre-test/post-test
randomised controlled design was used to evaluate the dissemination
method developed in Stage 2; the unit of randomisation and analysis were
hospital clusters of BCNs.
Sample: 263 BCNs from 13 regions within the U.K. comprised the sample
in Stage 1. In Stage 3, the sample consisted of 92 BCNs from 62 hospitals
in the north of England.
Analysis: In Stage 1 analysis was undertaken using descriptive and nonparametric
statistics. In Stage 3, analysis consisted of descriptive statistics
and clustered regression techniques with estimation of robust standard
errors: clustered logistic regression for knowledge items, clustered linear
regression for knowledge scores, ologit for attitude and reported practice
items and clustered multiple regression for paired and multiple variable
Findings: The results from the Barriers Scale revealed ‘statistical analyses
not understandable’, ‘insufficient time on the job to implement new ideas’,
‘facilities inadequate for implementation’, ‘research not reported clearly and
readably’ and ‘no time to read research’ as the greatest barriers to research
utilisation. Free text responses revealed additional problems with
communication and conditions within provider organisations and identified
facilitators for research utilisation and dissemination. These data led to the
selection and production of a targeted information booklet, entitled Exercise
and Breast Cancer: A Booklet for Breast Care Nurses, specifically designed
to be accessible, time efficient, understandable and relevant to the target
audience. In evaluation, the booklet was shown to overcome the perceived
barriers of the sample associated with accessing and understanding
research. A statistically significant increase in knowledge and changes of
reported practice and attitudes were found. Robust variables affecting
knowledge acquisition were identified as the promotion of health, promotion
of exercise and understanding of how exercise can reduce cancer-related
Implications: This study has demonstrated that printed materials can be
used as an effective dissemination method provided that they are developed
in line with the needs, values and context of a target audience. The
Conceptual Framework can be followed to develop similar booklets on
different topics and could provide a purposeful contribution to the promotion
of evidence-based practice for all nurses.

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