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A number of research studies have highlighted the importance of using empirically supported treatment (evidence-based practices (EBPs)) as the most effective means to reduce addiction. Even though significant federal funding has been committed to support implementation of EBPs in community-based treatment organizations (CBOs) (Glasner-Edwards & Rawson, 2010; NIDA, 2006; IOM, 2003) systematic study of the policy-components of EBP implementation is limited to date. This study examined whether the federal-funder-specific activities (measured as: recommending specific EBPs rather than promoting CBO selection of EBPs, activities associated with specific funding mechanisms, and providing training through ATTCs) were associated with staff perception of level of barriers to implementing federally-funded EBPs. Data sources included interviews with 510 clinical staff from CBOs nationwide who received SAMHSA funding (2003-2008) to implement EBPs. Bivariate analysis and regression modeling methods examined the relationship between federal-funder specific activities and three dependent variables: level of barriers experienced when implementing the EBP, level of modifications made to the EBP that was implemented, and a series of questions regarding attitudes about the usefulness of EBPs. In the regression models, the study controlled for staff, geographic and treatment unit characteristics. It also controlled for variables related to organizational capacity. Findings include: 1. whether or not federal-funders promoted the use of a specific EBP or whether the organization self-selected the EBP to implement was not significantly associated with the level of barriers experienced, the modifications made to the EBP or the attitudes about EBPs. 2. Staff receiving funding from different federal funding mechanisms was associated with reporting different levels of barriers, modifications and attitudes toward EBP implementation. 3. Finally, having received ATTC training was not significantly associated with having more positive attitudes about specific EBPs or the level of modifications or barriers to EBP implementation.

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In the past decade the push for utilization of evidence-based practice (EBP) in mental health has increased dramatically. Due to managed healthcare, lowered spending on state and federal mental health budgets, and requirements by funding agencies such as Medicaid, it is imperative that mental health clinicians (MHCs) be trained in and utilize EBPs to improve funding and ensure continuity of best practice in clinical interventions with clients. Minimal research exists on MHCs and their knowledge and use of EBPs. The present study examined MHCs' perceptions, knowledge, training, and utilization of EBPs, with a specific focus on Dialectical Behavior Therapy (DBT). To date, it is the most prominent and effective EBP for treating Borderline Personality Disorder (BPD) and associated parasuicidal and suicidal behaviors. Current research supports its effectiveness in treating a myriad of other commonly treated disorders. The exploratory study provides insight into MHCs level of interest in receiving more EBP awareness and DBT training. Results indicate that though clinicians have received training in EBP and DBT, most of that training has been encouraged through career settings. Age of the clinician, years in practice, and type of training background are predictors of level of education, knowledge and training. Results show the majority of clinicians are interested in EBP, aware of the impact EBP can have on treatment effects, and report desire to have more training in EBPs and DBT specifically. These results could provide a necessary bridge between disciplines to allow clinicians, irrespective of training, to provide the most clinically effective treatments to clients. / Ph. D.

Nursing is a permanently developing field of activity. Research plays an irreplaceable role in this field. We moreover more and more often see the term Evidence Based Practice nowadays. However a lot of general nurses do not know that this term also relates to the field of nursing, where it is called Evidence Based Nursing. Quantitative research was chosen for this thesis. The research was performed in South Bohemian and Central Bohemian regions among general nurses with bachelor degree. The aim of the questionnaire research was to confirm or refute the hypotheses set for this thesis. The first goal of the thesis was to find out whether general nurses with bachelor degree were willing to participate in research in nursing. The second goal was to find out whether general nurses with bachelor degree had come across the term Evidence Based Practice. The third goal was focused on finding whether general nurses with bachelor degree knew the names of databases that might be used in planning nursing care based on evidence. The fourth goal was to find out whether general nurses with bachelor degree were willing to participate on application of research results to nursing practice. The fifth goal was to find out whether general nurses with bachelor degree had met with application of research results to nursing practice. The goals of the thesis have been met. Five hypotheses were set for achievement of the above goals. H1: General nurses with bachelor degree are willing to participate in research in nursing. H2: General nurses with bachelor degree are able to define the term Evidence Based Practice. H3: General nurses with bachelor degree know the names of databases they may use in planning nursing care based on evidence. H4: General nurses with bachelor degree are willing to participate in introduction and application of research results to nursing practice. H5: General nurses with bachelor degree meet application of research results to nursing practice. The first, second and fourth hypotheses were confirmed, the third and fifth ones were not confirmed. Although the issues of Evidence Based Practice appear more and more often in literature, and we might expect nurses with tertiary education to apply the practice based on evidence in nursing, there are still general nurses who have lack of information in this sphere. Nevertheless there are a lot of general nurses with tertiary education who would like to participate in research and application of the research results to nursing practice. A proposal for a whole-life educational course focused on application of Evidence Based Practice to nursing was elaborated upon the research results. The results may also be used in hospital seminars and in education of nursing students.

Evidence-based practice, whose roots emanate from the mid-1960s, aims to provide fair, high-quality, and soundly researched health care with patients' best interests as a priority. Clinical practice guidelines are evidence-based and designed to assist clinicians with sound decision making. Despite the importance of evidence-based practice and the efforts invested into its development and dissemination, its uptake and implementation are poor. The disconnect between evidence-based practice and its translation into clinical practice was previously reported in low-to-middle income countries. This study investigated South African audiologists' and otorhinolaryngologists' (ear, nose and throat specialists') self-reported orientation to evidence-based practice. Second, adherence to evidence-based clinical practice guidelines was assessed with reference to the diagnosis and management of benign paroxysmal positional vertigo, a common vestibular condition for which a firm evidence base supporting treatment exists. A two-part quantitative approach was adopted. Part one surveyed South African audiologists and otorhinolaryngologists with the Evidence-Based Practice Profile Questionnaire and an additional researcher-developed questionnaire pertaining to the diagnosis and management of benign paroxysmal positional vertigo. A total of 130 survey responses were included in this study. Independent sample t-tests, one-way ANOVAs and Fisher's Exact tests were used to analyse the survey data. Part two used a retrospective record review at a tertiary academic hospital in the Western Cape of South Africa. Medical folders of patients diagnosed with benign paroxysmal positional vertigo, between 2010 – 2018 (n = 80), were analysed. The diagnosis and management strategies were recorded and compared against a gold standard evidence based guideline for congruence. Descriptive statistics were used to analyse and understand the data. Survey scores showed a positive association between increased years of experience and healthcare professionals' knowledge (p = .008) and confidence (p = .003) in evidence-based practice. Otorhinolaryngologists might be more knowledgeable than audiologists in evidence-based practice due to their increased training and exposure to evidence-based practice in their specialising years. Findings from the retrospective record review suggested adherence to the clinical practice guidelines in the diagnosis and management of posterior semi circular canal benign paroxysmal positional vertigo. The study outcomes propose that evidence-based clinical practice guidelines developed in the Global North may not be appropriate for the different health contexts that exist in low-to-middle income South Africa (e.g., rural settings). However, the benign paroxysmal positional vertigo clinical practice guidelines were adhered to at a tertiary, academic hospital in Cape Town. The results also support the notion that increased exposure to evidence-based practice reinforces its approach. Outcomes from this study raise implications for the development and dissemination of context-appropriate, evidence-based clinical practice guidelines.

The use of research evidence to improve the practices of teachers is considered one of the ways of improving the educational outcomes for children. This study was focussed on determining how an online approach could be used to increase knowledge mobilisation in education, by giving teachers better access to research knowledge that they could use to support and develop their practices. This study had two aims. The first aim was to investigate what research knowledge and research practices teachers were using and what value they ascribed to those practices; the second was to explore teachers' views and opinions of a new online approach to the presentation of research knowledge. This was a mixed method study using questionnaires, interviews and focus groups to gather a range of both qualitative and quantitative data. The findings of this study show that practitioners value research practices more than they are able to participate in them, and that there is a consistent valuepractice gap across the range of research practices. Exploratory factor analysis revealed five underlying factors; engagement with research, engagement with the research community, promotes professional discussion of research, promotes teacher knowledge generation, and promotes wider engagement of the school with research and the research community. These factors showed that teachers and their schools want to engage both with research knowledge and with the wider research community so that the use of research knowledge can be enhanced in education. The findings also show that practitioners were receptive to the use of an online approach to the delivery of research knowledge and the piloted approach was accessible and intuitive. Practitioners exhibited interest in using the approach in a range of collaborative interactions with colleagues. Overall this study revealed that online approaches to knowledge mobilisation have potential but that teachers need to be supported in their engagement with research and the wider research community. This thesis is a contribution to the knowledge of how online approaches can be developed and deployed to enhance knowledge mobilisation towards teaching being an evidence informed profession. Equally school leaders and policy-makers need to create environments that are supportive of teachers' use of research, if they want teachers to use research knowledge to inform their practices.

The rising population of older people in the UK (Office for National Statistics 2010) and pressure on healthcare services to reduce costs indicate the necessity of developing strategies that enable coping and independence. Loss through death of close family members, partners and friends is a key factor that inhibits physical, emotional and social well being of older people. The research carried out for this thesis explored bereavement in healthcare settings where contacts with bereaved older people commonly occur, and used data collected to develop guidelines for practice. The guidelines provide research informed enhancement to bereavement care and develop opportunities for meaningful interactions. They complement current policy development work on bereavement in healthcare settings (The Scottish Government 2011). A qualitative design drawing on phenomenological methodology was used to explore healthcare staffs’ experiences of caring for bereaved older people, and older people’s experiences of being bereaved and bereavement care. Theoretical sampling took place to recruit staff from a range of roles in general practice and community nursing, hospital wards and care homes, as well as a small sample of bereaved older people. Thirty nine participants took part in in-depth interviews that yielded four key themes: bereavement care depends on a relationship between healthcare staff and relatives; preparation for a relative’s death may not equate to preparedness for bereavement; the ‘Open Door’ to bereavement care is only slightly ajar, and bereavement care supports progression of the ‘Rolling Ball’ of life. The themes informed development of the guidelines in terms of structure and content. Recommendation statements consider bereavement care before the death; at the time of the death; and follow up in the weeks and months afterwards. Criteria in the recommendations provide suggestions for enhancements to practice that facilitate appropriate response to bereavement in older people. Consultation on the guidelines provided positive feedback that identified the potential to promote consistent interactions with bereaved older people, respond to needs and support coping.

Systematic reviews and meta-analyses have been a central pillar of evidence-based practice and policy-making in healthcare over recent years. Traditionally, this has focused on effectiveness evidence from trials.. There is increasing understanding, however, that other study designs also provide essential information and this has led to interest in developing ways to review and synthesis such evidence. Qualitative research has unique potential to illuminate the patient experience. This research has three aims: 1) To review and compare the proposed methods of systematic review and synthesis of qualitative research. 2) To develop and assess two methods of systematic review and synthesis of qualitative research. 3) To compare these two methods and suggest how they might be used in a policy-making context. In addressing these aims, this thesis substantially contributes to debates about the purpose and practice of systematic review and synthesis of qualitative research, particularly in the context of health technology assessment and related pOlicy-making. I undertake a unique critical comparison of the methods suggested for reviewing and synthesising qualitative research, based on their approach to key stages of systematic review. This is used to produce a comprehensive framework for good practice~ I use the framework in two systematic reviews, one about heavy menstrual bleeding using meta-ethnography, and one about hysterectomy using meta-study. These two reviews allow a comparison of the two methods, and in particular explore the impact of expanding the meta-ethnography approach through meta-study, which adds explicit steps to assess the impact of study methodology and theory on findings. The ability of meta-study to unpack the procedures and theories that produce particular findings is key and illuminates the importance of theory in systematic reviews of qualitative research. Through the two systematic reviews, my thesis also contributes to understanding of these reproductive health topic areas through the creation of new insights and concepts from the synthesis. The synthesis of heavy menstrual bleeding studies produced a detailed patient illness model based on women's experiences. In addition, it allowed an understanding of elements that contribute to women's certainty or uncertainty about whether or not their periods could be seen as problematic and requiring medical help. This helps to establish the limitations of the medical model for doctors, as well as women who suffer from heavy menstrual bleeding. The synthesis of hysterectomy studies produced a detailed description of the journey that women make to, and through, hysterectomy, based on their experiences. I also created a theoretical framework, which shows that hysterectomy needs to be understood in the context of personal, physical experiences, together with sociocultural forces that affect the way in which hysterectomy is experienced, and that the interaction of these micro- and macro-concerns mediate through, and affect, relationships with key other people. Methodology affected the research questions posed and the conclusions of research. Comparing the two methods of review and synthesis showed the importance of taking account of the methods and theories that produce research findings. However this additional detail may be at the expense of certainty and requires additional resources.

Given the importance of client characteristics and preferences, and therapist expertise to evidence-based practice in psychology, the current study sought to contribute to the literature concerning the role of values in psychotherapy. Personal values of clients and trainee therapists in 29 dyads were examined for relationships between client and therapist values and associations with working alliance and outcomes. Although previous literature in this area has suggested that successful therapy is characterized by an increase in similarity of client and therapist values, the current study did not replicate this finding. However, client perceptions of therapist values were found to be important to working alliance and outcome. Findings are discussed in terms of suggestions for future research as well as implications for clinical practice, including the importance of discussing expectations and preferences with clients.