Evidence-informed Practice Research Articles

Analyzing trends and practices: A survey of procedures performed by nurse practitioners

ABSTRACT Background: Nurse practitioners (NPs) provide essential patient care services. Most (88%) are primary care certified, and 70% practice in primary care settings. National NP organizations and state practice authority regulations influence the training and level of independence of performing procedures common in primary care practice. National standards reference the ability to select and interpret appropriate diagnostic tests related to clinical reasoning or management functions, but not competency in the procedures. Although the blueprint for certification examinations includes procedures as part of evidence-informed practice, none are specifically named. Purpose: There are limited data concerning procedural training for NPs. The study aims were to describe the training practicing NPs received for procedures they perform, define areas of research concerning the development of uniform training, and identify advocacy initiatives for competency acquisition for procedures. Methodology: Practicing NPs completed a survey concerning the procedures they perform in their practice. In addition, they reported their level of perceived competency, independence in performing, and method of training. Results: The majority of respondents (87.8%) hold certifications in primary care specialties. In this sample of practicing NPs, 74% of the respondents perform procedures independently, but only 67% had procedure training as part of their initial NP education. Additional training (60%) was completed through professional development programs. Conclusions: Many NPs surveyed perform procedures independently. Training occurred in their NP programs and through continuing education. Implications: Further studies are needed concerning procedural training and the setting that is most appropriate for competency achievement.

South African occupational therapists' orthotic management of trigger finger and factors influencing their decision regarding splinting type

Background: Orthotic management of trigger finger refers to the use of splints to immobilise affected joints. The prevalence of trigger finger and the management and treatment practices utilised by occupational therapists for this affliction in South Africa, are not yet documented. Aim: To explore occupational therapists' orthotic management for clients with trigger finger in KwaZulu-Natal, and the factors influencing the therapists' decisions when prescribing orthoses. Methods: A quantitative cross-sectional study design was implemented with a sample size of 102 via a stratified random sampling approach. A survey questionnaire was administered. Data were coded using frequencies and then descriptively analysed using SPSS. Results: Findings indicated that trigger finger is common in clinical settings and the majority (99%) of the occupational therapists use splints when managing trigger finger and as a first line of treatment (69.9%). The joint-blocking splint is preferred by 96.6% of the participants with the MCP joint-blocking splint being favoured by 55.0%. The most considered factors when deciding on the splint type are clinical presentation (99.1%) and the client's occupation (92.4%), and the most preferred measures of the effectiveness of treatment are pain (97.1%) and range of motion (97%). Conclusion: The study has demonstrated that the inconsistencies noted in global research also apply in KwaZulu-Natal. Therefore, further investigation on the effectiveness of splinting and a guide on deciding on splint type as well as appropriate outcome measures, are necessary to ensure that cclients receive optimal care through evidence-informed practice. Implications for Practice: This study informs further understanding of the current assessment ptior to splinting and treatment practices that occupational therapist in the South African context provide for their clients with trigger-finger. The study demonstrates that irrespective of the participant's level of experience and their clinical settings, the considerations when deciding on splint types remain the same. The results are consistent with available literature, particularly with which splint type to use. However, the development for a guide regarding the orthotic management of trigger finger covering aspects like the splint regime and the recommendations of exercises is vital, as discrepancies emerged largely fro these areas. The type of exercises, stages at which they may be introduced, duration and requenccy should be considered for deeper engagement. the development of this protocol will ensure consistency of treatment and evidence-informed practice.

Policy-based evidence: the schools inspectorate in England, research and school mathematics policy

ABSTRACT Increasingly, debates about school mathematics curriculum and pedagogy refer to evidence. The Office for Standards in Education (Ofsted), the inspection service in England, published a series of research reviews, including one on mathematics. Using features of education review quality, we analyse Ofsted’s departure from scholarly norms, identifying a lack of transparency, weakness of research design and search strategy, and lack of rigour in the selection of evidence. Further, cited research is frequently misinterpreted and unwarranted causal claims made due to overgeneralisation and oversimplification. A specific example of this is the misappropriation of research on problem solving leading to recommendations conflicting with both the National Curriculum in England and the findings of other, more rigorous, research reviews. From this analysis, we argue that the mathematics review is an example of “policy-based evidence” and point to alternative ways that inspection evidence can complement mathematics education research to support evidence-informed policy and practice.

Screening for Adverse Childhood Experiences: A Critical Appraisal.

Adverse childhood experiences (ACEs) are common and can impact health across the life course. Thus, it is essential for professionals in child- and family-serving roles, including pediatric and adult primary care clinicians, to understand the health implications of childhood adversity and trauma and respond appropriately. Screening for ACEs in health care settings has received attention as a potential approach to ACEs identification and response. Careful examination of the existing evidence on ACEs screening and consideration, from a clinical and ethical perspective, of the potential benefits, challenges, and harms is critical to ensuring evidence-informed practice. In this critical appraisal, we synthesize existing systematic and scoping reviews on ACEs screening, summarize recent studies on the ability of ACEs to predict health outcomes at the individual level, and provide a comprehensive overview of potential benefits, challenges, and harms of ACEs screening. We identify gaps in the existing evidence base and specify directions for future research. We also describe trauma-informed, relational care as an orientation and perspective that can help pediatric and primary care clinicians to sensitively assess for and respond to ACEs and other potentially traumatic experiences. Overall, we do not yet have sufficient evidence regarding the potential benefits, challenges, and harms of ACEs screening in health care and other settings. In the absence of this evidence, we cannot assume that screening will not cause harm and that potential benefits outweigh potential harms.

Oral Health Research in the WHO African Region between 2011 and 2022: A Scoping Review.

The status of oral health research in the World Health Organization (WHO) African region is unclear, yet the need for such information is central to moving an oral health agenda forward. Such an agenda is essential for effectively translating research into actionable practices and supporting regional strategies. The aim of this scoping review was to provide data on the scope and output of oral health research in the WHO African region to be used as a starting point for establishing a research agenda that can affect oral health in the region. We conducted a systematic search in PubMed; EMBASE; Epistemonikos; Scopus; the International Association for Dental, Oral, and Craniofacial Research General and Regional Sessions; ProQUEST; PROSPERO; and African regional databases such as Regional African Index Medicus and the African Journal Online. We included primary and secondary studies published in English, French, or Portuguese between January 1, 2011, and December 31, 2022, addressing oral health-related research having individuals, groups, or populations as units of analysis. These reports either addressed a topic relevant to the WHO African region assessed using the title and study objective or were conducted in a country in the region. We excluded in vitro and in vivo studies focusing on cells, biomarkers, or animals. We assessed 24,014 records, and 1,379 proved eligible. Our findings indicate a preference for particular research designs less suitable for evidence-informed practice guidelines and oral policies, a limited scope of oral health research topics, and important regional differences in research capacity. Furthermore, publications by researchers in the WHO African region tend to be published in journals with a limited readership. A discussion of our findings among oral health researchers at academic institutions in the WHO African region on how to create within- and across-country collaborations could potentially improve both health and oral health in the region.

A guide for policy and decision makers on health literacy policies

Abstract Supported by supranational organizations such as the WHO or the European Union, governments across the world have begun to work systematically on developing and implementing action plans, strategies and policies to improve the health literacy of their citizens and the health literacy friendliness/responsiveness of health organizations. In 2023, a first project on evidence-based policies and practices was initiated by the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) and financially supported by the Swiss Ministry of Health. In this project a guide on how health literacy policies can be developed and implemented was developed by an international working group. This guide brings together insights from existing literature on national health literacy strategies, action plans and interventions, including an expert snowball search within the M-POHL network and among other partners, experiences and case examples collected from M-POHL members and other countries. Feedback on the guide was collected in interactive webinars with policy representatives and decision-makers and addressed. The structure of the guide follows an adapted version of the Public Health Action Cycle model, assisting step-by-step action on health literacy policy development: situation analysis; agenda setting; developing policies, strategies and interventions; implementation; evaluation and monitoring. Each phase is described, and best practices and recommendations provided. The guide closes with a checklist for self-assessment which follows the structure of this document. It supports reflection on the state of policies in a country. This innovative guide contributes to supporting evidence-informed policies and practice. This can be of interest to experts and practitioners who have data on challenges relating to the health literacy levels of population groups and who wish to develop or adjust their policies, services and communications accordingly.

4.X.1. Health literacy policies – how can they be developed and implemented?

Abstract In Europe and beyond, there is political recognition of health literacy being an important factor for good health and well-being. As health literacy is considered critical to achieving health and as limited health literacy is still a widespread phenomenon, the topic is steadily attracting more attention among policy and decision makers. To meet growing demand from decision makers, a policy guide was initiated by M POHL, the World Health Organization (WHO) Action Network on Measuring Population and Organizational Health Literacy. The guide aims to support awareness-raising, the building of commitment and the implementation of effective policies to improve health literacy. It mainly addresses decision-makers in health policy and administration, but may also inspire researchers and other relevant stakeholders in the health literacy area. Objectives of the workshop This skills building seminar seeks to contribute to capacity building and to offer time for exchange and discussion on health literacy policy work. More specifically, the objectives of the workshop are to: - provide an overview on national health literacy policy implementation; - increase the knowledge of participants on what countries are doing already and identify needs for further support; - support participants in reflecting, initiating, developing and implementing effective measures to improve population and organizational health literacy. Methods of the workshop The workshop will start off by a presentation introducing the guide “Health literacy policies - how can they be developed and implemented?’ and sharing some national experiences in implementing health literacy policies, strategies, and interventions. After these impulses attendees will be divided into groups to enable exchange. A checklist for self-assessment will be provided as a tool to guide the discussion and to identify and address potential challenges in implementing health literacy policies and interventions. The input and identified needs will be captured. They will support M-POHL’s continuing efforts to support policy makers and administrators in their work. Key messages • Health literacy is steadily gaining more interest from policy- and decision-makers. • In this seminar, participants will learn on how evidence-informed policies and practice can be supported.

Experiences of mental health and poverty in high-income countries during COVID-19: A systematic review and meta-aggregation

Systematic reviews have been published that explore the experiences of living in poverty, yet there are no known studies that have synthesized the findings of research exploring the experiences of mental health and wellbeing of persons living in poverty during COVID-19. To address this gap, we conducted a systematic review and meta-aggregation of qualitative evidence using the method described by the Joanna Briggs Institute (JBI) following the PRISMA guidelines. Of 8391 titles and abstracts screened, we included 23 studies in our review and meta-aggregation. In conducting our meta-aggregation, we generated three synthesized findings: 1) magnification of inequities and marginalization during COVID-19; 2) difficulty accessing resources during the lockdown; and 3) the lockdown causing changes in mental health and wellbeing. The findings of this review suggest that persons living in poverty experienced increased difficulties with mental health and well-being during COVID-19. This was largely influenced by the presence of pandemic restrictions and increasing financial precarity that resulted in rising levels of psychosocial distress. Research regarding the plight of persons living in low income is needed to inform policy and practice for future pandemics in order to decrease the vulnerability of this population. Implementing evidence-informed policies and practices that mitigate the negative psychological effects of physical distancing restrictions on persons living in poverty are needed, and these can be identified through future research efforts.

Evidence-Informed Education and Practice in Collaborative Learning Units: A Mixed-Methods Study

Evidence-Informed Education and Practice in Collaborative Learning Units: A Mixed-Methods Study

Convenings as a tool for enhancing implementation strategies: lessons from the Black Women First initiative

BackgroundThe Expert Recommendations for Implementing Change (ERIC) project identified 73 strategies for supporting the implementation of a novel intervention and evidence-informed practices. In this paper, we explore convenings, which engage stakeholders in proactive dialogues, as a mechanism to deliver multiple strategies that support sites adapting and implementing evidence-informed bundled interventions for Black women with HIV.MethodsWe use an instrumental case study design to explore strategies embedded in biannual convenings hosted by the Black Women First Initiative (BWF) Evaluation and Technical Assistance Provider (ETAP). Data sources including planning documents, direct observation of the convenings and analysis of convening attendee feedback surveys were analyzed.ResultsUsing instrumental case study design, we found that convenings were a helpful tool that allowed for cross-site communication and collaboration. Communal re-examination of implementation strategies, coupled with training and network-weaving, created a rich learning environment to identify potential intervention adaptations and changes, unify on data collection, and prepare to test these adaptations at each respective site.ConclusionsWe discuss lessons learned when using convenings to help health care and community-based settings collectively explore and address adaptation and implementation barriers as they implement evidence-informed interventions to improve health outcomes for populations affected by chronic conditions, such as HIV.

Context factors for implementation of clinical recommendations for chronic musculoskeletal pain.

Implementing evidence-informed clinical practice recommendations is important for managing chronic musculoskeletal pain (CMSP) to address the multidimensional impact of the condition. Successful implementation of recommendations requires understanding the multiple context factors that influence CMSP management in different settings. This study aims to explore contextual factors that could influence the implementation of evidence-informed clinical practice recommendations for the primary health care of adults with CMSP. The study focused on the primary health care (PHC) sector in Cape Town, South Africa. A qualitative descriptive study was conducted. A multidisciplinary panel of 13 local health care professionals participated in focused group discussions. The participants considered multimodal clinical recommendations derived from published clinical practice guidelines. In four focus group discussions (three or four members per group), the panel generated and documented context factors that would influence implementing the recommendations in practice. Inductive content analysis was performed to identify categories and themes. The five contextual themes generated indicated health care system organisation, human resource requirements, provider practice patterns, patient empowerment and integration into policy as imperative for the successful implementation of recommendations. There are diverse context factors that could influence the implementation of clinical recommendations for managing CMSP in PHC settings. Identifying these factors as barriers or facilitators is beneficial for developing effective knowledge translation strategies.Contribution:The study findings indicate that an integrated systems approach supported by health care policy and multisectoral collaboration is needed to successfully implement clinical recommendations to address the impact of CMSP.

Associations of Racial Equity Training, Policies, and Practices With Routine Supervision Strategies in Community Corrections

Community corrections agencies across the United States are adopting racial equity as a priority in their polices, practices, and staff training, though how racial equity can be translated into the routine practices of probation and parole officers has not been widely discussed. This study examines the associations of perceived racial equity priorities on the supervision strategies reported by probation and parole officers in an online survey ( N = 1054). Approximately one-third of officers reported that their agencies prioritized racial equity. Racial equity scores were stronger in juvenile agencies and in agencies that prioritized evidence-informed practices. Racial equity was associated with reduced accountability-oriented case management practices. Results of this study suggest that racial equity policies and practices may impact client outcomes through changes in general supervision strategies. More research is needed to identify race-conscious strategies that community corrections officers can employ to meet the needs of people involved in the legal system.

Reflections on being an insider researcher: a study exploring the experiences of men accessing rural mental health services.

An embedded single case-study design was used to explore the experiences of men in rural New Zealand accessing mental health services. It is essential for researchers to acknowledge positionality in case study research and the lead author used reflexive practice to acknowledge his values and beliefs. To explore and demonstrate the reflexive process of the lead author's position as an inside researcher. Three groups were involved in the research: men with mental health challenges, their partners, and mental health clinicians. The article presents the initial research through memos and diarying in the context of current literature. Reflexivity is essential for ensuring the research process is complete and biases are identified. Positionality exists on a continuum and it is critical for researchers to be honest with themselves, the topic and the group being investigated, to show respect for the participants and the people they represent, as well as to be committed to revealing the truth. Insider research has the potential to bridge the gap between academia and practice. It facilitates the transfer of research knowledge directly to practitioners, leading to more evidence-informed decision-making and practice.

Oral health among refugees and asylum seekers utilizing Médecins du Monde clinics in mainland Greece, 2016–2017

BackgroundThe oral health of refugees and asylum seekers is understudied. However, oral health has important implications for overall health and wellbeing. This study addresses this gap by characterizing oral health care utilization in Médecins du Monde (MdM) clinics across mainland Greece from 2016 – 2017.MethodsA retrospective cross-sectional study design was used to estimate proportional morbidities for caries, extraction, developmental, periodontal disease, preventive, and other oral health outcomes. The association between physical health conditions and consultations of interest – upper respiratory tract infections (URTIs) and reproductive health consultations – and oral health were compared using odds ratios (OR) and 95% confidence intervals (CIs). Oral health outcomes between Afghans and Syrians were compared using odds ratios and 95% CIs.ResultsCaries (39.44%) and extractions (28.99%) were highly prevalent in our study population. The utilization of preventive dental consultations (37.10%) was high, particularly among males. Individuals with at least one upper respiratory tract infection (OR = 1.52; 95% CI: 1.30 – 1.77; Or = 1.90; 95% CI: 1.53 – 2.36) and women and girls with reproductive health consultations (OR = 1.30; 95% CI: 1.03 – 1.66; OR = 2.03; 95% CI: 1.49 – 2.76) were more likely to have any dental or caries specific consultations. The observed patterns in oral health needs differed between Afghans and Syrians, with Afghans more likely to have preventive screenings and less likely to have caries, extractions, or other conditions.ConclusionsDisplaced populations utilizing MdM dental clinics had high levels of oral health needs, particularly for caries and extractions. The connection between oral and overall health was seen in the study population, and these findings reinforce the public health importance of oral health for improving health and wellbeing of displaced populations. Evidence-informed policy, practice, and programming inclusive of oral health are needed to address both oral and overall health of refugees and asylum seekers in Greece. Future research should investigate not only oral health care needs but also knowledge and beliefs that inform utilization patterns among displaced populations.

A survey of nutritional education within the Holiday Activities and Food programme across England.

Nutritional education is a mandatory component of the Holiday Activities and Food (HAF) programme in England, yet there is a paucity of literature exploring how this component is delivered. The aim of this study was therefore to explore the delivery, content, dose and perceived impacts of nutritional education, at the HAF club level, across England. A self-completion, cross-sectional online survey design was adopted. Non-probability purposive sampling was used to collect data from HAF club leads (n = 147) from across England. Data were analysed using descriptive statistics and frequencies. Face-to-face nutritional education was the most common mode of delivery, with sessions mostly comprising of discussing food and nutrition. However, whilst the majority of clubs delivered the required number of nutritional education sessions per week, according to the Department for Education's guidelines, the time spent delivering individual nutritional education activities may not be sufficient to drive change in related skills and behaviours. Moreover, many clubs did not adopt a whole-family approach, and some did not deliver any nutritional education activities at all, which club leads attributed to a lack of material resources and ambiguity in the national HAF guidance. Nutritional education is delivered in a variety of ways across HAF clubs, based upon available local assets, resources and venues. Policy and practice recommendations include increased HAF funding to support clubs that lack material resources, national training in nutritional education, and evidence-informed guidance and practice.

Challenges in institutionalizing evidence-informed priority setting for health service packages: a qualitative document and interview analysis from Iran

BackgroundSetting and implementing evidence-informed health service packages (HSPs) is crucial for improving health and demonstrating the effective use of evidence in real-world settings. Despite extensive training for large groups on evidence generation and utilization and establishing structures such as evidence-generation entities in many countries, the institutionalization of setting and implementing evidence-informed HSPs remains unachieved. This study aims to review the actions taken to set the HSP in Iran and to identify the challenges of institutionalizing the evidence-informed priority-setting process.MethodsRelevant documents were obtained through website search, Google queries, expert consultations and library manual search. Subsequently, we conducted nine qualitative semi-structured interviews with stakeholders. The participants were purposively sampled to represent diverse backgrounds relevant to health policymaking and financing. These interviews were meticulously audio-recorded, transcribed and reviewed. We employed the framework analysis approach, guided by the Kuchenmüller et al. framework, to interpret data.ResultsEfforts to incorporate evidence-informed process in setting HSP in Iran began in the 1970s in the pilot project of primary health care. These initiatives continued through the Health Transformation Plan in 2015 and targeted disease-specific efforts in 2019 in recent years. However, full institutionalization remains a challenge. The principal challenges encompass legal gaps, methodological diversity, fragile partnerships, leadership changeovers, inadequate financial backing of HSP and the dearth of an accountability culture. These factors impede the seamless integration and enduring sustainability of evidence-informed practices, hindering collaborative decision-making and optimal resource allocation.ConclusionsTechnical aspects of using evidence for policymaking alone will not ensure sustainability unless it achieves the necessary requirements for institutionalization. While addressing all challenges is crucial, the primary focus should be on required transparency and accountability, public participation with an intersectionality lens and making this process resilience to shocks. It is imperative to establish a robust legal framework and a strong and sustainable political commitment to embrace and drive change, ensuring sustainable progress.

Health policy and systems research priority-setting exercise in Ethiopia: a collaborative approach

IntroductionHealth policy and systems research (HPSR) is a multi-disciplinary approach of generating health system and policy-level evidence. Setting HPSR agendas is considered as an efficient strategy to map and identify policy and cost-effective research topics, but its practice in developing countries is limited. This paper aimed to conduct a collaborative health policy and system research priority-setting exercise in Ethiopia.MethodThe WHO’s plan, implement, publish, and evaluate (PIPE) framework and the Delphi technique were used to conduct the priority-setting exercise. The PIPE model was used to lead the priority-setting process from planning to evaluation, while the Delphi technique was used to run the rating and ranking exercise with the aim of reaching a consensus. Two rounds of expert panel workshops supplemented with an online survey were used for the HPSR agenda setting, rating and ranking purposes. Groups were formed using the WHO health system building blocks as a base framework to identify and prioritize the HPSR topics.ResultUnder 8 themes, 32 sub-themes and 182 HPSR topics were identified. The identified research themes include leadership management and governance, health policy, health information system, healthcare financing, human resource for health, medical products and supply, service delivery and cross-cutting issues.ConclusionsPriority HPSR topics focussing on national health priority issues were identified. The identified topics were shared with policymakers and academic and research institutions. Evidence generation on the identified priority topics will guide future research endeavours and improve evidence-informed decision-making practice, health system performance and national health goals and targets.

Development and psychometric evaluation of the Implementation Support Competencies Assessment

BackgroundImplementation support practitioners (ISPs) are professionals that support others to implement evidence-informed practices, programs, and policies in various service delivery settings to achieve population outcomes. Measuring the use of competencies by ISPs provides a unique opportunity to assess an understudied facet of implementation science—how knowledge, attitudes, and skills used by ISPs affects sustainable change in complicated and complex service systems. This study describes the development and validation of a measure—the Implementation Support Competencies Assessment (ISCA)—that assesses implementation support competencies, with versatile applications across service contexts.MethodsRecently developed practice guide materials included operationalizations of core competencies for ISPs across three domains: co-creation and engagement, ongoing improvement, and sustaining change. These operationalizations, in combination with recent empirical and conceptual work, provided an initial item pool and foundation on which to advance measurement development, largely from a confirmatory perspective (as opposed to exploratory). The measure was further refined through modified cognitive interviewing with three highly experienced ISPs and pilot-testing with 39 individuals enrolled in a university-based certificate program in implementation practice. To recruit a sample for validation analyses, we leveraged a listserv of nearly 4,000 individuals who have registered for or expressed interest in various events and trainings focused on implementation practice offered by an implementation science collaborative housed within a research-intensive university in the Southeast region of the United States. Our final analytic sample included 357 participants who self-identified as ISPs.ResultsAssessments of internal consistency reliability for each competency-specific item set yielded evidence of strong reliability. Results from confirmatory factor analyses provided evidence for the factorial and construct validity of all three domains and associated competencies in the ISCA.ConclusionsThe findings suggest that one’s possession of high levels of competence across each of the three competency domains is strongly associated with theorized outcomes that can promote successful and sustainable implementation efforts among those who receive implementation support from an ISP. The ISCA serves as a foundational tool for workforce development to formally measure and assess improvement in the skills that are required to tailor a package of implementation strategies situated in context.

Is There a Problem With Evidence in Health Professions Education?

What constitutes evidence, what value evidence has, and how the needs of knowledge producers and those who consume this knowledge might be better aligned are questions that continue to challenge the health sciences. In health professions education (HPE), debates on these questions have ebbed and flowed with little sense of resolution or progress. In this article, the authors explore whether there is a problem with evidence in HPE using thought experiments anchored in Argyris' learning loops framework.From a single-loop perspective ("How are we doing?"), there may be many problems with evidence in HPE, but little is known about how research evidence is being used in practice and policy. A double-loop perspective ("Could we do better?") suggests expectations of knowledge producers and knowledge consumers might be too high, which suggests more system-wide approaches to evidence-informed practice in HPE are needed. A triple-loop perspective ("Are we asking the right questions?") highlights misalignments between the dynamics of research and decision-making, such that scholarly inquiry may be better approached as a way of advancing broader conversations, rather than contributing to specific decision-making processes.The authors ask knowledge producers and consumers to be more attentive to the translation from knowledge to evidence. They also argue for more systematic tracking and audit of how research knowledge is used as evidence. Given that research does not always have to serve practical purposes or address the problems of a particular program or institution, the relationship between knowledge and evidence should be understood in terms of changing conversations and influencing decisions.

Assessing the role and impact of research in clinical practice among acupuncturists in western countries: a multinational cross-sectional survey.

Evidence-informed practice is crucial to perform safe and efficient health interventions. In recent years, the evidence base of acupuncture continuously increased leading to the integration of acupuncture into clinical guidelines by various leading medical associations worldwide. At the same time, recent studies showed that licensed acupuncturists are rarely utilizing scientific research to inform their practice. This descriptive study using an online survey assessed the role of evidence-informed practice of acupuncturists in Austria, Germany, the United States of America, Australia, and New Zealand and aimed to determine critical factors relevant for promoting research literacy including demographical data, data about the clinical practice patterns, and the role and value of different information sources of traditional, complementary and integrative medicine (TCIM) practitioners. In total, 404 acupuncturists completed the online survey that included questions about demographic characteristics, the role and value of research in clinical practice, and details about the amount and type of continuing professional education. Univariate and multivariate analysis was used to determine significant predictors of the outcome variable "importance of research in clinical practice" (numerical rating scale, 0 to 100). The results showed that the majority of acupuncturists use certified courses as primary source of continuing professional education and value experts' opinions as the most reliable source of information. Multivariate analysis showed that the importance of research is dependent on the interest in research, an interdisciplinary learning environment, and positive experiences with research including if an acupuncture study ever changed the clinical practice of practitioners. Future educational programs should therefore focus on an interactive format aiming to promote skills to critically assess the value and practical use of research studies to improve the general practice of acupuncture.