An exploration of factors that influence the implementation of evidence into practice

Royal College of Nursing Institute, Oxford, UK.
Journal of Clinical Nursing (Impact Factor: 1.26). 12/2004; 13(8):913-24. DOI: 10.1111/j.1365-2702.2004.01007.x
Source: PubMed


The challenges of implementing evidence-based practice are complex and varied. Against this background a framework has been developed to represent the multiple factors that may influence the implementation of evidence into practice. It is proposed that successful implementation is dependent upon the nature of the evidence being used, the quality of context, and, the type of facilitation required to enable the change process. This study sets out to scrutinize the elements of the framework through empirical enquiry.
The aim of the study was to address the following questions: * What factors do practitioners identify as the most important in enabling implementation of evidence into practice? * What are the factors practitioners identify that mediate the implementation of evidence into practice? * Do the concepts of evidence, context and facilitation constitute the key elements of a framework for getting evidence into practice?
The study was conducted in two phases. Phase 1: Exploratory focus groups (n = 2) were conducted to inform the development of an interview guide. This was used with individual key informants in case study sites. Phase 2: Two sites with on-going or recent implementation projects were studied. Within sites semi-structured interviews were conducted (n = 17).
A number of key issues in relation to the implementation of evidence into practice emerged including: the nature and role of evidence, relevance and fit with organizational and practice issues, multi-professional relationships and collaboration, role of the project lead and resources.
The results are discussed with reference to the wider literature and in relation to the on-going development of the framework. Crucially the growing body of evidence reveals that a focus on individual approaches to implementing evidence-based practice, such as skilling-up practitioners to appraise research evidence, will be ineffective by themselves.
Key elements that require attention in implementing evidence into practice are presented and may provide a useful checklist for future implementation and evaluation projects.

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Available from: Alison Kitson, Sep 30, 2015
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    • "Research shows that improving the quality of resident care is a complex, difficult, and demanding process and does not follow prescribed and linear paths [30]. Therefore, more static structural quality indicators at the institutional level, such as having protocols might be less influential in changing practice outcomes than structural quality indicators at the ward level, which probably are more closely linked to actual care process and more concretely in line with daily practice. "
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    ABSTRACT: Objective The aim of this study is to explore whether structural quality indicators for nutritional care influence malnutrition prevalence in the Netherlands, Germany and Austria. Furthermore differences in malnutrition prevalence and structural quality indicators for nutritional care nursing homes in the three countries are examined. Research methods and procedures A cross-sectional, multi-centre study using a standardised questionnaire at patient, ward and institution level. Malnutrition was assessed by low Body Mass Index, undesired weight loss and reduced intake. Structural quality indicators of nutritional care were measured at ward and institutional level. Results The prevalence of malnutrition differed significantly between the three countries (Netherlands 18.0%, Germany 20.0%, Austria 22.7%). Structural quality indicators related to nutritional care as having a guideline of prevention and treatment of malnutrition were related to malnutrition and explain malnutrition prevalence variance between the Netherlands and Germany. Differences between the Netherlands and Austria in malnutrition prevalence still existed after controlling for these quality structural indicators. Conclusion(s) Structural quality indicators of nutritional care are important in explaining malnutrition variance between the Netherlands and Germany. However they did not explain the difference in malnutrition prevalence between the Netherlands and Austria. Investigating the role of process indicators may provide insight in the role of structural quality indicators of nutritional care in explaining the malnutrition prevalence differences between the Netherlands and Austria.
    Nutrition 11/2014; 30(11-12). DOI:10.1016/j.nut.2014.04.015 · 2.93 Impact Factor
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    • "While earlier studies suggest that learning, in this case implementation of new knowledge, is a process related primarily to the individual [22], more recent studies suggest that context plays an important role [23]. As previously suggested in the PARIHS framework, implementation of evidence must function as a process combining the evidence, the context, and how implementation is facilitated [24]. Our findings suggest that when considering if and how stroke care data from an NQR facilitates EBP, again, the context in which the evidence is introduced, and the way the process is facilitated is fundamental. "
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    ABSTRACT: Background National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. Methods A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR’s criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. Results An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. Conclusion While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.
    BMC Health Services Research 08/2014; 14(1):354. DOI:10.1186/1472-6963-14-354 · 1.71 Impact Factor
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    • "The program’s pedagogy is based on social cognitive theory [8] and adult learning theory [9]. Further, the organizational implementation of research evidence is informed by the Promoting Action on Research Implementation in Health Services (PARiHS) [10] and Knowledge to Action cycle [11] frameworks for knowledge translation (KT). Finally, previous work identifying successful educational models for promoting the use of research in practice were consulted [12-14] as well as useful descriptions of barriers to research implementation [2,5,15]. "
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    ABSTRACT: Background Clinicians need innovative educational programs to enhance their capacity for using research evidence to inform clinical decision-making. This paper and its companion paper introduce the Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program, an educational program designed to promote physical therapists’ integration of research evidence into clinical decision-making. This, second of two, papers reports a mixed methods feasibility study of the PEAK program among physical therapists at three university-based clinical facilities. Methods A convenience sample of 18 physical therapists participated in the six-month educational program. Mixed methods were used to triangulate results from pre-post quantitative data analyzed concurrently with qualitative data from semi-structured interviews and focus groups. Feasibility of the program was assessed by evaluating change in participants’ attitudes, self-efficacy, knowledge, skills, and self-reported behaviors in addition to their perceptions and reaction to the program. Results All 18 therapists completed the program. The group experienced statistically significant improvements in evidence based practice self-efficacy and self-reported behavior (p < 0.001). Four themes were supported by integrated quantitative and qualitative results: 1. The collaborative nature of the PEAK program was engaging and motivating; 2. PEAK participants experienced improved self-efficacy, creating a positive cycle where success reinforces engagement with research evidence; 3. Participants’ need to understand how to interpret statistics was not fully met; 4. Participants believed that the utilization of research evidence in their clinical practice would lead to better patient outcomes. Conclusions The PEAK program is a feasible educational program for promoting physical therapists’ use of research evidence in practice. A key ingredient seems to be guided small group work leading to a final product that guides local practice. Further investigation is recommended to assess long-term behavior change and to compare outcomes to alternative educational models.
    BMC Medical Education 06/2014; 14(1):126. DOI:10.1186/1472-6920-14-126 · 1.22 Impact Factor
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