Research Evidence In Practice Research Articles

Facilitating Evidence-Based Practice among Nurses in a Tertiary General Hospital: A Six-Year Practice of an Implementation Strategy Informed by the i-PARIHS Framework

Aims. To develop an evidence-based practice (EBP) facilitating strategy informed by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and evaluates the strategy’s effectiveness on promoting EBP. Background. Nurses are increasingly expected to use research evidence in practice to improve patients’ outcomes, but the application of such evidence is still unsatisfactory. The facilitation of EBP in nursing needs the organization and the individual levels. Methods. Based on an analysis of EBP-promoting strategies and expert consultation, the core team of the nursing department developed an EBP group-based and project-oriented strategy under the guidance of the i-PARIHS framework. The strategy was implemented for six years and evaluated by a longitudinal design. The validated Chinese version of the self-reported Evidence Based Practice Questionnaire (EBPQ) was used to assess the attitudes, knowledge, and practice of the nurses. Results. The mean score of the total EBPQ was 4.46 (SD = 0.92) after one year of the EBP strategy, and the scores for knowledge, attitudes, and practice of EBP members were higher than those of general nurses p<0.05. After four years, EBP members’ scores continued to increase. EBP groups conducted 51 EBP projects in the areas of emergency nursing, surgical and medical nursing, critical care, and so forth. Of these, 33 projects improved nursing practice by changing nursing procedures, upgrading nursing tools, and developing nursing standards, resulting in improved patient outcomes. Conclusion. The EBP group-based and project-oriented strategy can promote EBP. The composition of the EBP group, the annual audit of EBP projects, and the roles of internal and external facilitators were key components of this EBP-facilitating strategy. Implications for Nursing Management. The strategy is an organizational-level EBP-facilitation approach which can improve nurses’ academic preparation for EBP through ongoing training and sustained EBP behavior that involves annual projects.

Using integrated knowledge translation to address a rurally based time-critical knowledge gap during the COVID-19 pandemic: a multimethods study in Victoria, Australia

ObjectivesThe aim of this study was to explore the intention of health professionals to use evidence generated through an integrated knowledge translation (iKT) activity undertaken during the COVID-19 pandemic to...

Cutting Edge Research? Realistic Expectations of Priorities, Scope and Engagement Comment on "'We're Not Providing the Best Care If We Are Not on the Cutting Edge of Research': A Research Impact Evaluation at a Regional Australian Hospital and Health Service".

While research is linked with informed decision-making and improved healthcare delivery and patient outcomes, the process of generating and translating research evidence in practice and capturing its impact can often be challenging. Based on document and database reviews and interviews in a regional Australian health system, Brown et al discuss the challenges of assessing the impact of research investments over a ten-year period. This commentary explores three inter-related lessons from this article for developing and sustaining a research culture and supporting translation in a health system: (i) achieving a shared definition and expectation of research; (ii) the importance of stakeholder engagement particularly for research prioritisation; and (iii) enabling research across a system. In doing so, it highlights the role and value of engaging knowledge generators and end-users from clinical, management and community domains not only in research development but most importantly in research prioritisation.

How context influences person-centred practice: A critical-creative case study examining the use of research evidence in occupational therapy with people living with dementia

Background Occupational therapists are encouraged to use research evidence to guide therapeutic interventions that holistically address the consequences of dementia. Recent efforts to use research evidence in practice have emphasized the challenges of doing so in ways aligned to person-centred and professional principles. Using research evidence is a complex process influenced by multiple contextual factors and layers. The influence of context in occupational therapy for dementia is currently unclear. Aims To explore the contextual complexities of using research evidence in practice with people with dementia, and to develop knowledge to improve the approach to using evidence in person-centred, occupation-focused practice. Material & methods A case study methodology was used, in which the contextual conditions of practice were clarified through the facilitation of critical and creative reflection using the following methods – Think Aloud, practice observation, creative expression and reflective dialogue. Results Cultural beliefs that affected evidence use included technically-orientated understandings of evidence-based practice. These were underpinned by apprehensions about losing professional identity and taking risks when processes derived from research evidence were adjusted to incorporate a persons’ occupations. These cultural factors were perpetuated at the organizational layers of context, where systemic priorities and other team members’ needs disproportionately influenced occupational therapists’ decisions. Conclusions & significance Occupational therapists’ potential to make reflexive and responsive decisions by adjusting evidence-based processes can be affected by their perceived freedom to address organizational tensions. Raising consciousness of the influence of the organizational context on decision-making about evidence use could adjust occupational therapists’ perceptions of their freedom and ability to be person-centred. Intentionality in reflective processes in practice are required to foster reflexivity.

Using mixed-methods in evidence-based nursing: a scoping review guided by a socio-ecological perspective.

Increased pressure for evidence-based practice in nursing necessitates that researchers use effective approaches. Mixed-methods research (MMR) has potential to improve the knowledge and implementation of evidence-based nursing (EBN) by generating outcome-based and contextually-focused evidence. To identify methodological trends in how MMR is used in EBN research. Searches were completed in PubMed, CINAHL, and Google Scholar using the terms "nursing", "mixed-methods", and "evidence-based". Seventy-two articles using MMR to address EBN and published 2000-2021 were reviewed across content themes and methodological domains of the Socio-Ecological Framework for MMR. Mixed-methods research has been used to study how EBN strategies are perceived, developed and assessed, and implemented or evaluated. A few studies provided an MMR definition reflecting the methods perspective, and the dominant MMR rationale was gaining a comprehensive understanding of the issue. The leading design was concurrent, and half of studies intersected MMR with evaluation, action/participatory, and/or case-study approaches. Research quality was primarily assessed using criteria specific to quantitative and qualitative approaches. Mixed-methods research has great potential to enhance EBN research by generating more clinically useful findings and helping nurses understand how to identify and implement the best available research evidence in practice.

Exploring nutritional therapy practitioner perspectives on working with people affected by cancer

Introduction Nutrition can impact significantly on cancer occurrence, recurrence and survival. Many people affected by cancer seek individualised nutrition advice, but globally this remains an unmet need for many. Nutritional therapy (NT) practitioners provide personalised nutritional care, including complementary care for people affected by cancer. Until now, there is little documentation internationally of NT practice with people affected by cancer. This mixed methods study explores NT practitioners’ perspectives, to inform professional development needs to ensure safe evidence-based practice with people affected by cancer. Methods An on-line anonymised survey was open to all UK registered NT practitioners. Data was collected on practitioner characteristics, patterns of practice with people affected by cancer and perceived barriers to that practice, the use of research evidence in practice, and practitioners’ perceived needs for training and support. Data on practitioner characteristics were compared between practitioners who work with people affected by cancer (CP) and those who do (NCP). Preliminary themes emerging from the survey informed the second phase, in which semi-structured individual interviews (n=21) and one group interview were used for in depth exploration of practitioner perspectives on practice with people affected by cancer. Topics explored included rewards and motivation, barriers and challenges to practice, and professional development needs. Interview transcripts were analysed thematically, using Framework methodology. Results 274/888 (31%) UK registrants completed the survey. CPs were more likely than NCPs to have additional health and life science (HLS) qualifications (p=0.009) and to have been in practice for longer (practice for more than 10 years, p=0.012). 80% survey respondents overall, including CPs, worked alone for at least some of the time. Practitioners experienced reward in empowering people affected by cancer to make dietary changes, for some their own cancer journey or witnessing cancer in a loved one was a motivator. Significant challenges and barriers to practice included managing the emotional and psychological demands of working with people affected by cancer, lack of recognised specialist training and resources, and lack of engagement with or perceived opposition from oncologists. To overcome these barriers, professional development needs identified were firstly specialist clinical supervision, mentoring and networking to overcome isolation and share best practice. Secondly, specialist training and resources to facilitate accessing, critically appraising and communicating evidence in practice are required. Thirdly, engagement with mainstream professionals working in cancer care requires improvement. Conclusions This is first detailed exploration of NT practitioner perspectives on working with people affected by cancer and the data have revealed important areas for developing training and support. Findings are informing development of frameworks for practitioner support including clinical supervision and specialist training, to support safe evidence-based practice and better communication and integration with mainstream cancer care. Future exploration of NT practitioners’ perspectives should assess the impact of proposed professional developments highlighted here. Further exploration of perspectives of mainstream healthcare professionals with whom nutritional therapy practitioners may engage is also recommended.

Collaboratively maximizing the impact of human-centered design in psychological and implementation science: Reply to Proctor et al. (2021).

Proctor et al.'s (2021) comment "Division 21 Has Been Devoted to Human-Centered Design Since the 1950s" on our article (Lyon et al., 2020) is a welcome addition and useful touchpoint surrounding the historical and current relationship between human-centered design and psychological science. "Siloing" in psychology inhibits the progress of the discipline. We offer a set of recommendations for reducing silos and increasing the integration of engineering psychology with implementation science to advance human-centered design and the use of research evidence in practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Radiographers' involvement in research activities and opinions on radiography research: A Nordic survey

IntroductionRadiographers' engagement in research is important for the development of evidence-based practice in radiography; however, radiographers' interest in research has rarely been reported. This study sought to ascertain radiographers' opinions about radiography research and investigate their involvement in research activities in four Nordic countries. MethodsThis study was conducted in Denmark, Finland, Norway and Sweden. A study-specific questionnaire was developed in English and adapted to each language of the study sample, and the content and face validity of the adaptations were evaluated. An online tool was used to collect the study data. The questionnaire link was distributed in September 2019 to radiographers working in clinical settings in four Nordic countries (n = 4572). ResultsThe overall response rate was 14% (n = 662/4572). Research involvement was reported by 33% of the respondents; data collection was the main type of contribution. Radiographers who contributed to research were more likely to be male, have longer work experience, hold a master's or doctoral degree, work as managers and be employed in university hospitals. Nearly all agreed that radiography research is needed to promote the radiography profession and provide the evidence base for radiographic practice. However, only 14% were aware of the current research evidence regarding their professional field of specialisation, and 19% indicated that they developed current practices based on research evidence. ConclusionThe findings indicate that, although radiographers had positive attitudes towards radiography research, their involvement in research and utilisation of research evidence in practice is low. Implications for practiceStrategies should be developed to improve knowledge and skills related to evidence-based practice and stimulate radiographers' engagement in research.

Effectiveness of Evidence-Based Practice (EBP) Education on Emergency Nurses' EBP Attitudes, Knowledge, Self-Efficacy, Skills, and Behavior: A Randomized Controlled Trial.

Emergency care clinicians are expected to use the latest research evidence in practice. However, emergency nurses do not always consistently implement evidence-based practice (EBP). An educational intervention on EBP was implemented to promote emergency nurses' use of EBP, and the effectiveness of it was evaluated. This study aimed to evaluate the effectiveness of an EBP educational intervention on emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior. The study also examined learners' satisfaction with the EBP educational intervention. A randomized controlled trial with parallel groups with evaluations before the education, immediately after it, and 6 and 12months after the education was conducted at four emergency departments in two university hospitals. The experimental group (N=40) received EBP education while the control group (N=40) completed self-directed EBP education. The primary outcomes were emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior, while the secondary outcome was satisfaction with the EBP education. Thirty-five participants of an experimental and 29 participants of a control group completed the study. There were no statistically significant (p<.05) improvements and differences between groups in EBP attitude, self-efficacy, or behavior immediately after the EBP education. At the 6-month measurement point, the experimental group showed significantly better EBP attitudes, behavior, knowledge, and self-efficacy than the control group. At the 12-month measurement point, the improvements began to decrease. The groups also differed significantly in terms of participant satisfaction with how the teacher encouraged learners to ask clinical questions. The EBP educational intervention implemented in this study had a positive effect on emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior. The effects of the education appeared the best 6months after the education. After this point, the results began to decrease and approached baseline levels. EBP educational interventions designed for emergency nurses should apply various teaching strategies to improve their EBP attitude, knowledge, self-efficacy, skills, behavior, and satisfaction with the education.

How Does Organizational Culture Influence the Adoption of Research Evidence by Management Practitioners?

Using the best available evidence from multiple sources can lead to more effective management practice. However, management practitioners often make decisions based on limited evidence, mostly from personal experience and judgment. Values, beliefs, and practices may conflict with a manager’s ability to use research evidence in practice. This systematic review suggests that an integration of the diffusion of innovations (Rogers, 1995) and planned behavior (Ajzen, 1991) theories may be used to explain the influence of values, beliefs, and practices on the adoption of research evidence by management practitioners. These cultural influence factors may be conceptualized as moderating the effects of innovation diffusion efforts on research evidence adoption behavior. Viewing evidence-based management (EBMgt) as an innovation, organizational managers may employ innovation diffusion strategies to influence values, beliefs, and practices conducive to using research evidence in management practice. This review presents recommendations for both practitioners and scholars to facilitate EBMgt. Practitioners can promote a culture that enables evidence-based practice, use tact when presenting evidence to a skeptical audience, and form partnerships with scholars. Leaders can promote the use of evidence in their organizations, provide evidence-based practice tools and training, and use human resource practices to ensure key positions are proficient in research skills. Scholars can publish more practitioner-friendly evidence and teach business and management students research skills.

Analysis of Pediatric Oncology Nursing Research in Mainland China, 2008-2018.

Up-to-date research from low- and middle-income countries is needed to inform local pediatric cancer nursing care and share best practices from these settings. Access to all current Chinese-language publications on pediatric oncology nursing research is limited because of a language barrier. The aim of this study was to document the volume, type of research study, and yearly and geographical distribution of published pediatric oncology nursing research in Mainland China and evaluate their content and quality. A systematic search was performed for published pediatric oncology research conducted by nurses in Mainland China (2008-2018), using 3 English databases and 3 Chinese databases. Included articles were evaluated using the Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal for strength and quality of evidence. A total of 133 articles were included: 106 in Chinese and 27 in English. Most studies showed level III evidence (88/133) and were rated as good quality (81/133). The most frequently researched topics were psychosocial care, clinical nursing practice, and psychometric testing, which accounted for 63.2% of all publications. Progress in pediatric oncology nursing research capacity among Mainland China is promising. To gain higher-quality evidence and make existing evidence transferable for nursing practice, optimization of specific research topics is still needed. In Mainland China, developing interventions to address the symptoms of children with cancer and caregivers' psychosocial issues based on local nursing research should be prioritized. Some synthesized findings of this review may serve as guidance for the future of pediatric oncology nursing science in similar settings.

Challenges and opportunities for re-framing resource use policy with practice theories: The change points approach

Concerns about the climate crisis and the escalating pace of global consumption are accelerating the pressure on governments to moderate public demand for resources like water, food and energy. Notwithstanding their increasing sophistication, standard behavioural change approaches continue to be criticised for a narrow understanding of what shapes behaviour. One alternative theoretical position comes from practice theories, which draw on interpretive and relational understandings to focus on practices rather than people's behaviour, and hence highlight the complex and distributed set of factors shaping resource use. While practice theories have gained considerable interest from policy institutions within and beyond the UK they so far have had limited impact upon policy. It has even been argued that there are insurmountable challenges in reconciling the ontological commitments of practice theories with the realities of policy processes. This article advances academic and policy debates about the practical implications of practice theories. It works with evidence from transdisciplinary research intended to establish whether and how key distinctive insights from social practice research can usefully be brought to bear on policy. We pursued this through co-productive research with four key UK national policy partners, focusing on effective communication of social practice research evidence on agreed issues. A key outcome of collaboratively negotiating challenging social theory to usefully influence policy processes is the ‘Change Points’ approach, which our partners identified as offering new thinking on initiatives promoting reductions in people's use and disposal of resources. The Change Points approach was developed to enable policy processes to confront the complexities of everyday action, transforming both how problems are framed and how practical initiatives for effecting change are developed. We discuss the case of food waste reduction in order to demonstrate the potential of Change Points to reframe behaviour change policy. We end the paper by addressing the potential and limitations of informing policy with insights from practice theories based upon the successes as well as the challenges we have met. This discussion has broader implications beyond practice theories to other fields of social theory, and to debates on the relations between academic research and policy more broadly. We argue that, through a co-productive approach with policy professionals, and so engagement with the practices of policy making, it is possible to provide a partial and pragmatic but nevertheless effective translation of key distinctive insights from practice theories and related research, to reframe policy problems and hence to identify spaces for effecting change for sustainability.

Practitioner tales: possible roles for research evidence in practice

ABSTRACTThis paper discusses, compares, and contrasts 4 different models for bringing evidence from randomised controlled trials (RCTs) into practice and into practical reasoning. I look at what questions the models can and cannot answer, what role they accord to RCT evidence, and what their possible attraction for practitioners might be. The models are those of Philip Davies, Nancy Cartwright, Stephen Toulmin, and Harald Grimen. The first 2 are constructed for the purpose of using evidence in practice, the 3rd is an adapted argumentation model, and the 4th is based on phronesis and represents an alternative to evidence-based education. It is argued that of these, Toulmin’s model has the narrative qualities that make it the most usable and practitioner-friendly model.

Learning to lead: a review and synthesis of literature examining health care managers' use of knowledge.

Scholarship cites health care managers (HCMs) as not using research evidence in their management practice. The purpose of this review was to evaluate the effectiveness of interventions to enhance HCMs use of research evidence in practice. We carried out a systematic review and focus groups to validate the review findings. We searched 10 electronic databases for studies reporting on interventions for HCMs to enhance research utilization in their practice. Qualitative studies were analysed using Hoon's approach to meta-synthesis. Seven, primarily qualitative, studies of varying quality (reported in 11 articles) met our inclusion criteria. Interventions to enhance research use by HCMs included: informal and formal training, computer-based application, executive-level knowledge translation activities and residency programmes. Studies did not report efficacy of interventions or impacts of increasing managers' use of research on staff or patient outcomes. Meta-synthesis yielded four contextual factors influencing the perceived effectiveness of interventions to enhance research use by HCMs: organizational culture, competing priorities, time as a resource and capacity building. Included studies differed in how they defined research and demonstrated varying understandings of research among HCMs, limiting the generalizability of work in this field. Healthcare managers are increasingly called upon to make evidence-based decisions in practice, but the small number of studies and diverse strategies employed hinder our ability to identify any intervention to increase use of evidence as superior. Future studies in this area should clearly articulate the definition of research evidence they base their decisions on. Registration: PROSPERO (CRD42014006256).

A qualitative study of research priorities among representatives of Canadian Provincial Sport Organizations

ObjectivesThe overall purpose of this study was to examine Canadian Provincial Sport Organization representatives' research priorities in order to provide directions for future research and knowledge translation initiatives in youth sport. DesignQualitative description methodology. MethodInterviews were conducted with 60 representatives of Canadian PSOs from five provinces. Analysis followed the process of data condensation, data display, and drawing conclusions. ResultsThe most frequently reported research priorities were athlete development systems, participation and retention, parenting, benefits of sport, and coaching. ConclusionsResearch that addresses the priorities of stakeholders may increase the adoption of research evidence in practice, program, and policy contexts. This study provides directions that may help inform future research agendas in youth sport. Conversely, the study also revealed that extensive previous research exists in several of the priority areas identified. These findings suggest that knowledge translation research is required in these areas. Knowledge tailoring may be a useful strategy for improving knowledge translation in these areas. Ultimately, it appears that efforts to increase connections between researchers and other stakeholders in youth sport are important.

PYDSportNET: A knowledge translation project bridging gaps between research and practice in youth sport

ABSTRACTGenerating a common understanding of knowledge translation among stakeholders is a key issue for increasing the use of research evidence in practice. The purpose of this article is to create a better understanding of knowledge translation in youth sport by providing a framework and guidelines for facilitating knowledge translation. We present PYDSportNET, a knowledge translation project designed to enhance the use of research evidence to promote positive youth development (PYD) through sport. This project is guided by the Knowledge to Action framework, which has two components (knowledge creation and the action cycle). For the knowledge creation component, we completed a meta-synthesis and created knowledge products. For the action cycle, we completed two studies with key sport stakeholders. Simultaneously, we created a knowledge dissemination and exchange network. Having described these activities, we go on to highlight some lessons learned to date and next steps for the project.

\u201cLayers of translation\u201d - evidence literacy in public health practice: a qualitative secondary analysis

BackgroundStrengthening public health systems has been a concern in Canada in the wake of public health emergencies. In one Canadian province, British Columbia, a high priority has been placed on the role of evidence to guide decision making; however, there are numerous challenges to using evidence in practice. The National Collaborating Centre for Methods and Tools therefore developed the Evidence Informed Public Health Framework (EIPH), a seven step guide to assist public health practitioners to use evidence in practice. We used this framework to examine the evidence literacy of public health practitioners in BC.MethodsWe conducted a secondary analysis of two separate qualitative studies on the public health renewal process in which the use and understanding of evidence were key interview questions. Using constant comparative analysis, we analyzed the evidence-related data, mapping it to the categories of the EIPH framework.ResultsParticipants require both data and evidence for multiple purposes in their daily work; data may be more important to them than research evidence. They are keen to provide evidence-based programs in which research evidence is balanced with community knowledge and local data. Practitioners recognise appraisal as an important step in using evidence, but the type of evidence most often used in daily practice does not easily lend itself to established methods for appraising research evidence. In the synthesis stage of the EIPH process, synthesized evidence in the form of systematic reviews and practice guidelines is emphasized. Participants, however, need to synthesize across the multiple forms of evidence they use and see the need for more skill and resources to help them develop skill in this type of synthesis.ConclusionsPublic health practitioners demonstrated a good level of evidence literacy, particularly at the collective level in the organization. The EIPH framework provides helpful guidance in how to use research evidence in practice, but it lacks support on appraising and synthesizing across the various types of evidence that practitioners consider essential in their practice. We can better support practitioners by appreciating the range of evidence they use and value and by creating tools that help them to do this.

Implementation of evidence-informed practice through central network actors; a case study of three public health units in Canada

BackgroundWorkforce development is an important aspect of evidence-informed decision making (EIDM) interventions. The social position of individuals in formal and informal social networks, and the relevance of formal roles in relation to EIDM are important factors identifying key EIDM players in public health organizations. We assessed the role of central actors in information sharing networks in promoting the adoption of EIDM by the staff of three public health units in Canada, over a two-year period during which an organization-wide intervention was implemented.MethodsA multi-faceted and tailored intervention to train select staff applying research evidence in practice was implemented in three public health units in Canada from 2011 to 2013. Staff (n = 572) were asked to identify those in the health unit whom they turned to get help using research in practice, whom they considered as experts in EIDM, and friends. We developed multi-level linear regression models to predict the change in EIDM behavior scores predicted by being connected to peers who were central in networks and were engaged in the intervention.ResultsOnly the group of highly engaged central actors who were connected to each other, and the staff who were not engaged in the intervention but were connected to highly engaged central actors significantly improved their EIDM behavior scores. Among the latter group, the staff who were also friends with their information sources showed a larger improvement in EIDM behavior.ConclusionsIf engaged, central network actors use their formal and informal connections to promote EIDM. Central actors themselves are more likely to adopt EIDM if they communicate with each other. These social communications should be reinforced and supported through the implementation of training interventions as a means to promoting EIDM.

Dissemination and Implementation Science Training Needs: Insights From Practitioners and Researchers

Dissemination and implementation research training has great potential to improve the impact and reach of health-related research; however, research training needs from the end user perspective are unknown. This paper identifies and prioritizes dissemination and implementation research training needs. A diverse sample of researchers, practitioners, and policymakers was invited to participate in Concept Mapping in 2014-2015. Phase 1 (Brainstorming) gathered participants' responses to the prompt: To improve the impact of research evidence in practice and policy settings, a skill in which researchers need more training is… The resulting statement list was edited and included subsequent phases. Phase 2 (Sorting) asked participants to sort each statement into conceptual piles. In Phase 3 (Rating), participants rated the difficulty and importance of incorporating each statement into a training curriculum. A multidisciplinary team synthesized and interpreted the results in 2015-2016. During Brainstorming, 60 researchers and 60 practitioners/policymakers contributed 274 unique statements. Twenty-nine researchers and 16 practitioners completed sorting and rating. Nine concept clusters were identified: Communicating Research Findings, Improve Practice Partnerships, Make Research More Relevant, Strengthen Communication Skills, Develop Research Methods and Measures, Consider and Enhance Fit, Build Capacity for Research, and Understand Multilevel Context. Though researchers and practitioners had high agreement about importance (r =0.93) and difficulty (r =0.80), ratings differed for several clusters (e.g., Build Capacity for Research). Including researcher and practitioner perspectives in competency development for dissemination and implementation research identifies skills and capacities needed to conduct and communicate contextualized, meaningful, and relevant research.

Barriers and facilitators to the implementation of evidence-based practice by pediatric surgeons

Background/PurposeEvidence-based practice (EBP) has been identified as a foundation of mainstream medical practice, yet pediatric surgery has been slow in the acceptance and implementation of EBP. MethodsSemi-structured interviews of 14 pediatric surgeons were conducted to determine barriers and facilitators to EBP. Resulting data were analyzed using a systematic 3-step approached of coding, generation of specific beliefs, and identification of domains relevant to practice change. ResultsSix domains were identified as relevant to changing pediatric surgeons' use of evidence in practice: environmental context and resources, goals, knowledge, skills, social influence, and social/professional role and identity. Important barriers to EBP implementation included time constrains and resource limitations, the general poor quality of evidence in pediatric surgery, a lack of required skills, and a culture that continues to rely on an apprenticeship style of teaching. Facilitators include working in a research hospital, and having a local champion/ peers that support EBP implementation. There were conflicting thoughts as to whether working as a group facilitated or impeded EBP. ConclusionsPediatric surgeons' use of research evidence in practice is influenced by a number of domains. These results may be used to inform the design of behavior change interventions intended to encourage EBP implementation. Levels of evidenceLevel V.