Recherche uO, le dépôt numérique de l'Université d'Ottawa, réunit le matériel de recherche et d'enseignement créé par notre communauté universitaire et nos partenaires. Le savoir de l'Université est ainsi disponible à long terme et en accès libre, ce qui lui procure de la visibilité et facilite sa diffusion.
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Type d'Item : Item , Trends in behaviour change techniques for implementing and de-implementing healthcare practices using audit and feedback(2026-07-28) Duncan, Hamish; Patey, Andrea M.; Crawshaw, Jacob; Presseau, Justin; Grimshaw, Jeremy M.; Ivers, Noah; Lorencatto, Fabiana; Antonopoulou, ViviAbstract Background Audit and feedback (A&F) is a widely used quality improvement strategy in which a summary of healthcare professionals’ (HCPs) practice is provided to support behaviour change. However, its application and effectiveness within randomized controlled trials (RCTs) of practice-change interventions vary considerably. Examining variation in the behaviour change techniques (BCTs) used within A&F interventions and the contexts in which they are applied may help optimise their design and delivery. Therefore, this study explored associations between the BCTs used in A&F interventions, the direction of behaviour change (implementation versus de-implementation), and target behaviour type. Methods An exploratory secondary analysis was conducted using data from 261 RCTs of A&F interventions, originally extracted as part of a Cochrane systematic review. Binary logistic regression models investigated whether different BCTs were more frequent in interventions for the implementation versus de-implementation of HCP practice. These analyses were repeated in subgroups of different behaviour types (e.g. prescribing, testing/examinations). Results Descriptive analyses of 261 RCTs (942 target behaviours) indicated that BCTs were used with broadly similar frequency for implementation (n = 732 behaviours) and de-implementation (n = 179 behaviours). Due to substantial clustering within studies, regression model estimates were unstable and not interpreted inferentially. Across the full sample, most BCTs showed minimal differences in use between implementation and de-implementation. Subgroup analyses by behaviour type suggested some variation, with certain BCTs (e.g. feedback on outcomes of behaviour) appearing to be used differentially depending on the type of practice being modified. However, overall patterns were largely consistent across behaviour categories. Conclusions These findings suggest that A&F interventions typically use similar BCTs regardless of whether they aim to increase or decrease HCP behaviours, and largely irrespective of behaviour type. This may indicate that current A&F intervention design does not systematically account for the direction or nature of behaviour change. While some variation was observed by behaviour type, the absence of clear differentiation highlights a potential mismatch between theoretical expectations and practice. Future research should use theory-informed designs to determine whether tailoring BCTs to behaviour change direction or type improves A&F intervention effectiveness.Type d'Item : Item , Real-World Effectiveness of Mavacamten in Canada: Insights from the MAVEN Study(2026-10-22) Ward, Michael R.; Crean, Andrew M.; Desplantie, Olivier; Tyrrell, Benjamin D.; Corriveau, Stéphanie; Brellier, Florence; Ong, Kevin C.Abstract Introduction Previous studies have demonstrated the efficacy and safety of mavacamten in patients with symptomatic obstructive hypertrophic cardiomyopathy (oHCM), primarily outside of Canada, with limited Canadian real-world data evidence. The MAVEN study aimed to describe the real-world effectiveness of mavacamten in Canadian patients with oHCM. Methods This multi-center, retrospective physician survey of patient charts included 115 patients with oHCM who initiated mavacamten between January 2023 and November 2024 across five Canadian sites. Effectiveness was assessed by changes in clinical characteristics and outcomes, including New York Heart Association (NYHA) functional class, resting and Valsalva left ventricular outflow tract (rLVOT and vLVOT, respectively) gradients, and left ventricular ejection fraction (LVEF), from treatment initiation to the most recent available assessment. Results Baseline demographic and clinical characteristics were consistent with previously published data (median age 63.0 years; 66.1% aged ≥ 60 years; 51.3% male, 48.7% female patients; 57.4% NYHA class II, 42.6% NYHA class III). Median baseline rLVOT and vLVOT gradients were 44.0 and 78.0 mmHg, respectively, and median LVEF was 65.0%. Overall, 72.7% of patients improved by ≥ 1 NYHA functional class. Median reductions in rLVOT and vLVOT gradients were − 25.5 (interquartile range [IQR]: − 61, − 8) mmHg and − 51.0 (IQR: − 83, − 24) mmHg, respectively, while median LVEF changed by − 3.0% (IQR: − 8, 0). Mavacamten was discontinued in 8.7% of patients, including 2.6% due to treatment-emergent adverse events. Reductions in LVEF < 50% were observed in 6.1% of patients, and no patient experienced an LVEF < 30%. Conclusions In this first Canadian real-world study of mavacamten effectiveness, treatment was associated with improvements in symptoms and LVOT obstruction. Reductions in LVEF < 50% were observed in a minority of patients, with no cases of LVEF < 30%. Given the retrospective design and heterogeneous follow-up of this study, these findings should be interpreted cautiously. Graphical abstract available for this article. Graphical AbstractType d'Item : Item , Scoping review of instruments measuring organizational context in implementation studies within healthcare(2026-07-28) Squires, Janet E.; Graham, Ian D.; Santos, Wilmer J.; de Candido, Ligyana K.; Watkins, Vanessa J.; Greenough, Megan; Hutchinson, Alison M.Abstract Background Healthcare providers’ use of research in practice is suboptimal. In Learning Health Systems, using the best available research evidence to guide practice is fundamental to continuous improvement. Whilst there is a growing body of evidence that context modifies the effects of implementation strategies to promote research use, knowledge on how best to measure context is lacking. As part of a larger research programme, which involved development of the Implementation in Context (ICON) framework comprising six domains and 22 attributes (Fig. 1), we conducted a scoping review to identify psychometrically sound and pragmatic instruments for measuring macro- or meso-level ICON attributes. Methods The review was conducted in two phases: (1) identification of instruments that align with the 20 meso- and macro-level attributes in ICON and (2) assessment of their psychometric and pragmatic properties. Instruments and psychometric papers were identified through five electronic databases. The COnsensus-based Standards for selecting health Measurement INstruments (COSMIN) criteria guided the psychometric evaluation. A modified GRADE approach was used to summarize the quality of the evidence for each instrument. In this paper, we report the properties of the included instruments measuring one of the macro- or meso-level attributes. Results We identified 38 instruments (and assessed 169 psychometric papers) that captured nine of 15 meso-level ICON attributes; instruments measuring macro-level ICON attributes were not located. Most of the 38 instruments were rated as inadequate or doubtful (n = 31) on content validity. Using the COSMIN recommendation ratings, 13 instruments are recommended for measuring five meso-level ICON attributes: organizational climate, organizational change processes, receptivity to change, evaluation activity, and leadership. The remaining 25 instruments have the potential for use. All 38 instruments were rated to be at least adequate on pragmatic criteria. Conclusions We identified 13 instruments that measure meso-level ICON attributes that influence research implementation and meet psychometric quality criteria. Future work will include: (1) additional psychometric assessments of the 25 instruments not yet recommended for use, (2) psychometric and pragmatic assessments of instruments that assess multiple attributes in ICON, and (3) the development of instruments to measure ICON attributes for which instruments were not identified. Registration Open Science Framework, 21 June 2022, https://doi.org/10.17605/OSF.IO/B2Z8KType d'Item : Item , Drivers of health equity in the Americas: a scoping review(2026-09-16) Chapman, Evelina; Araujo, Miguel; Maylen, Rojas-Botero; Pardo, Jordi P.; Mujica, Oscar J.Abstract Background The term “driver” is often used inconsistently in the literature, referring to diverse analytical levels, from structural determinants to individual risk factors, frequently without a clear distinction. This lack of precision challenges theoretical consistency and health equity operationalization. This scoping review aims to harmonize the conceptual meanings of “drivers,” their relationship with social determinants of health (SDoH), methodological strategies, and research gaps within the Americas. Methods Following PRISMA-ScR guidelines, 286 documents (2008–2026) were analyzed. The review utilized the JBI PCC framework to address four research questions on the global and regional application of “drivers”. The general population was analyzed across PROGRESS-Plus axes, treated as relational dimensions of inequality that structure social positions. Data synthesis integrated descriptive mapping with conceptual analysis of drivers and their interplay with SDoH. Results Findings reveal a conceptual evolution toward “Social Drivers of Equity in Health” (SDEH) as operational engines of power. While 36.4% of the literature uses “driver” and “determinant” interchangeably, 38.5% identifies drivers as independent forces putting SDoH in motion. Methodologically, 33.3% were primary quantitative studies; 46 utilized multivariate modeling to isolate structural effects. In the Americas, structural racism (80.0%) and socioeconomic status (79.3%) predominate as primary engines. PROGRESS-Plus analysis identified emerging axes, such as digital and commercial dimensions, mediating geographic inequities. A significant “research inequity” persists, with 79.3% of the regional evidence concentrated in the United States, leaving substantial knowledge gaps regarding the structural drivers specific to Latin America and the Caribbean. Conclusions While the term “driver” presents tensions with established SDoH models, adopting a “hierarchy of drivers” (Upstream-Midstream-Downstream) could offer a pragmatic framework for identifying precise levers of power, such as legal reforms and social protection. The term should be used cautiously, ensuring its articulation with robust theoretical frameworks to act as an operational catalyst for structural intervention. Registration The protocol was registered on the Open Science Framework platform under ID 48azj.Type d'Item : Item , Implementation strategies used in clinical practice guidelines in older adults’ mental health and neurocognitive conditions: a scoping review(2026-07-25) Hatch, Stacey; Halane, Fardowsa; McGowan, Jessie; Watt, Jennifer; Seitz, Dallas P.Abstract Background Caring for older adults with mental health conditions including neurocognitive conditions is complex. Clinical practice guidelines (CPGs) are intended to improve care for such conditions in older adults. This scoping review sought to systematically identify, synthesize, map evidence and identify the gaps in implementation strategies used in the implementation of CPGs for mental health conditions in older adults including neurocognitive conditions. Methods This scoping review was conducted using the JBI Manual for Evidence Synthesis methods for scoping reviews. Six research databases (Ageline, MEDLINE, Cochrane Library, EMBASE, PsycINFO, JBI EBP) and grey literature were searched. Inclusion criteria for the articles were adults 65 and older and focused on older adults mental health and neurocognitive conditions. Strategies to the implementation of CPGs were categorized using the Effective Practice and Organization of Care (EPOC) framework. Results A total of three articles were identified in this scoping review. Reported implementation strategies were tailored to providers, were educational, and interdisciplinary collaboration. CPGs length, perceived weakness of evidence, and providers’ perception of relevance to patients were noted as challenges to implementing CPGs. Our search results demonstrated a paucity of literature with only three peer reviewed studies located. Conclusions Despite the limited available literature, this review contributes to guideline to practice gap literature by synthesizing and identifying potentially effective implementation strategies. We make recommendations about how to potentially improve adherence to clinical practice guidelines that could be implemented by researchers, healthcare providers, and health systems policy decision makers to improve our healthcare systems.