All ETDs from UAB

Advisory Committee Chair

Larry Hearld

Advisory Committee Members

Nathaniel Carroll

Allyson G Hall

Jasvinder Singh

Allyson Varley

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


It is increasingly evident that seemingly good ideas do not always result in changes in practice, and it is challenging to sustain evidence-based innovations, even if they are backed by substantial research. Long-term use of innovations seems more likely where favorable contextual conditions are in place, yet relatively little empirical research has taken up the question of how evidence-based practices are sustained and become established in day-to-day practice. This question of sustainability is crucial if the gains in patient care that derive from organizational innovations are to be maintained. The purpose of this dissertation was to examine the relationship between the learning climate, change readiness climate, psychological safety and perceived permanence of a culturallycompetent, electronic decision-aid for lupus patients in 15 geographically diverse clinics in the United States. A concurrent mixed methods approach was used to answer the study questions. Quantitative data were used to identify patterns across study participants and sites, while qualitative data were used to examine in greater depth the underlying reasons for these patterns by examining clinic personnel’s’ and patients’ perspectives on the perceived permanence of the DA and why the clinic climate may influence the likelihood of sustained use of the DA.



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