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Evidence-based practice was originally defined by Sackett et al. (1996) as the use of current research evidence, clinical expertise and client wishes in making clinical decisions. To date, several studies have outlined facilitators and barriers to evidence-based practice implementation in mental health treatment settings. Few have studied evidence-based practice implementation in interdisciplinary mental health treatment settings. This research explored how clinicians working in interdisciplinary mental health treatment settings 1) define evidence-based practice, 2) report on factors influencing evidence-based practice implementation, and 3) perceive the promoters and barriers to evidence-based practice implementation. This research analyzed data from three studies. In the quantitative portion 233 clinicians participated in an online survey. Descriptive results indicated that clinician scores for knowledge (understanding of and confidence in evidence based-practice) and attitude (positive opinion about evidence-based practice) were high. However, descriptive results also indicated that scores for outcome (perceived impact of evidence-based practice) were moderate and scores for behaviour (frequency clinicians access research evidence) were low. Further analysis showed that nearly 50% of evidence-based practice outcome was explained by education, profession, knowledge and attitude, and approximately 15% of clinician behaviour was explained by knowledge. In the qualitative portion 8 clinicians were interviewed. The results showed that half of the clinicians defined evidence-based practice as research evidence and the other half defined it as research evidence with clinical expertise and client preferences. The interviews identified four components essential to evidence-based practice implementation: creating conditions; accessing evidence; motivating practice; reflecting critically. The interviews also uncovered four tensions clinicians experienced central to evidence-based practice: valuing research evidence vs. clinical expertise; fidelity vs. customization; defining roles vs. role sharing; implementing evidence-based practice vs. managing clinical workload pressures. The findings across the studies highlighted the importance of knowledge, evidence, access and time to optimize evidence-based practice implementation. The results showed that evidence-based practice implementation could be facilitated by a more unified definition, clearer expectations on the part of clinicians and organizations, and a shift in focus from education to behaviour change and monitoring implementation. / Thesis / Doctor of Philosophy (PhD) / Evidence-based practice involves using research evidence to make decisions about client treatment. The purpose of this project was to examine how different mental health professionals in the same setting define and implement evidence-based practice. This research was conducted using two online surveys of over two hundred clinicians and face-to-face interviews with eight clinicians. The surveys found that clinicians had an understanding of evidence-based practice and positive opinions about evidence-based practices but saw moderate impact of evidence-based practice and infrequency in searching for research evidence. The research found that reasons for impact included: education, profession, knowledge and attitude. One cause for search infrequency was knowledge. The interviews found that about half defined evidence-based practice as only research evidence and the other half as research evidence, clinician experience and client wishes. The interviews also illuminated the process of putting evidence-based practice into place and some areas of tension. Similarities across all of the research were the importance of knowledge, access to evidence and time to engage in evidence-based practice.

Abstract This study sought to understand the differences and similarities between social work practice and evidence-based practice (EBP). As evidence-based practice becomes popularized in areas of professional practice, challenges and tensions arise for social workers. This qualitative research study asked social workers working in the hospital setting how they define and use evidence-based practice in their work, and about the tensions they experience in using EBP. The study revealed that social workers maintain their scope of practice in areas related to advocacy, the use of systems theory and the importance of the therapeutic relationship with clients in the helping process. The social workers in the study identified that social workers understood the value of scientific research and indicated that as a profession, social work practice can use research to influence areas for social change. The participants in the study described that social work practice and evidence-based practice are distinct. Social work practice is intended to understand and respond to social problems, whereas EBP in mental health settings is designed to resolve more narrowly-defined problems of individual coping. The social workers recognized that the two practices could only really co-exist. However, they did note that social workers’ commitments to reinforce self-determination for clients have potentially important overlap with EBP’s attention to patient values and preferences. / Thesis / Master of Social Work (MSW)

Healthcare facilities are dynamic, long-term investments that must be able to respond to change in order to avoid obsolescence. Flexibility is a response used in healthcare facility design and construction to counter uncertainties, such as changing medical technologies, medical science and regulations. Flexible infrastructure design offers healthcare facilities the opportunity to combat obsolescence stemming from uncertainties. Interstitial Building Space (IBS) is one of many flexible infrastructure design options that assists with both mid-range and long-term flexibility. IBS is an unfinished and unoccupied horizontal space between a building's floors, fully accessible to people for the purpose of service and maintenance. The advent of Evidence Based Design (EBD) introduced a new dimension to the already dynamic healthcare facility. "EBD represents a body of science that links elements of the built environment with patient, staff and resource outcomes" (Malone et al. 2007 p.5). The incorporation of EBD increases the complexity for the design and construction of healthcare facilities. A framework was developed that articulates the dependent relationships between flexibility, IBS and EBD. The framework is comprised of three key elements: 1) a comprehensive "IBS Spectrum of Benefits" matrix resulting from a systematic literature review 2) a "Flexibility-EBD Conceptual Model" illustrating the relationship between flexibility and EBD, while identifying a continuum of flexibility enabled by this relationship; and 3) a "IBS-EBD Component Mapping Framework" articulating direct matches between the "IBS Spectrum of Benefits" and EBD components. The framework and the key elements within provide a foundational resource for stakeholders and researchers alike, navigating the interrelated intricacies associated with flexibility, EBD and IBS. / Master of Science / Healthcare facilities are dynamic, long-term investments that must be able to respond to change in order to avoid obsolescence. Flexibility is one response which enables facilities to combat changes and/ or uncertainties. This thesis explores the relationships between flexibility, Interstitial Building Space and Evidence Based Design, documents each relationship, and depicts their interrelated nature with the establishment of an overarching framework.

Background: Efficacious pediatric weight management (PWM) programs have existed for over two decades, but there is limited evidence that these programs have been translated into regular practice. There is even less evidence that they have reached communities experiencing health disparities where access to care is limited. The purpose of this project was to use a community-engaged approach to select an evidence-based PWM program that could be delivered with the available resources in a community that is experiencing health disparities. Methods: The project was developed by the Partnership for Obesity Planning and Sustainability Community Advisory Board (POPS-CAB) in the Dan River Region of southwest Virginia. The POPS-CAB included representatives from a local pediatric health care center, the Danville/Pittsylvania Health Department, Danville Parks and Recreation, the Boys and Girls Club, and the Fralin Center for Translational Obesity Research (n=15). Three PWM programs were identified that met the criteria of demonstrating short and longer-term efficacy, across multiple studies and diverse populations, in reducing childhood obesity for children between the ages of 8 to 12 years across multiple studies. The programs included the Traffic Light Diet, Bright Bodies, and Golan and colleagues' Home Environmental Change Model. All three programs included a high frequency of in-person sessions delivered over a 6-month period, but one included an adapted version that delivered the content via interactive technology and could be delivered with far fewer resources (Family Connections adapted from the Home Environmental Change Model). A mixed-methods approach was used to determine program selection. This approach included individual POPS-CAB member rating of each program, followed by small group discussions, a collective quantitative rating, and, once all programs were reviewed a rank ordering of programs across characteristics. Finally, a large group discussion was conducted to come to agreement on the selection of one program for future local adaptation and implementation. All small and large group discussions were audio recorded and transcribed verbatim to identify themes that influenced the program selection decision. The quantitative results were averaged across individuals and across the groups. Qualitative results were reduced to meaning units, and then grouped into categories, and lastly, themes. Results: Individual ratings across Bright Bodies, Family Connections, and Traffic Light were 3.9 (0.3), 3.6 (0.5), and 3.4 (0.4), respectively. The ratings differed slightly between community and academic partners demonstrated by a higher rating for Bright Bodies by community members and a higher rating for Family Connections by academic members. After small group discussions the average group ratings across the programs was 3.8 (0.4) for Bright Bodies, 3.5 (0.6) for Family Connections, and 3.4 (0.6) for Traffic Light. Finally, the rank order of programs for potential implementation was Bright Bodies, Family Connections, and Traffic Light. Qualitative information for each program was broken down into four main themes of discussion, (1) the importance for the chosen program to have a balance of nutrition and physical activity, (2) negative perceptions of calorie counting, (3) a desire to target both the parent and the child, as well as (4) the need for practicality and usability the target settings. During the final large group discussion, the above themes suggest that the primary reasons that Bright Bodies was selected included the availability of nutrition information, structured physical activity sessions, presence of a usable workbook, as well as the balance of parent and child involvement. Conclusion: Key considerations in program selection were related more to the program content, delivery channel, and available resources for replication rather than simply selecting a program that was less resource intensive. / Master of Science

Urban designers do not typically include research or evidence in practice, though the need for an evidence-based approach is becoming increasingly apparent. The way our built environment is constructed affects our health, well-being, and sense of place, as prior research has uncovered. Historically, urban design practice has negatively affected the well-being of urban residents by reinforcing inequitable social and power structures through the design of public space. Some theorists and designers have proposed evidence-based approaches as a response to these concerns. However, the emerging approaches can be disjointed. Tensions arise when deciding between the many types of evidence urban designers can use, and the different ethics they represent. In this thesis, I analyze three existing approaches to evidence-based urban design, including their benefits and their concerns, and ultimately argue that a convergent method is necessary. The conceptual framework I develop is one that responds to concerns of equity and accountability in the built environment, while also maintaining the significance of good design and acknowledging the inevitable integration of technology into society today. / Master of Urban and Regional Planning / Urban design is typically an artistic profession, and conducting or referencing research is not necessarily part of an urban designer's day-to-day. However, the need for a research-backed, or evidence-based, approach to public space design is becoming increasingly apparent. Prior researchers have suggested that the way our cities, neighborhoods, parks, roadways and other public spaces are constructed has an effect on our mental and physical health. Historically, these spaces have been designed to reinforce patterns of social inequity, which has negatively affected the well-being of urban residents. Some theorists and designers have proposed evidence-based approaches as a response to these concerns. However, the emerging approaches towards evidence-based urban design sometimes have conflicting physical and social goals. In this thesis, I analyze three existing approaches to evidence-based urban design, including their benefits and their concerns. I ultimately argue that a new method, which converges the existing methods, is necessary. The conceptual framework I develop is one that responds to concerns of equity and accountability in urban space, maintains the significance of artistry and good design, and acknowledges the inevitable integration of technology into society today.

No / This essay critically evaluates the recent phenomenon of `evidence-based management' in public services that is especially prominent in health care. We suggest that the current approach, broadly informed by evidence-based health care, is misguided given the deeply contested nature of `evidence' within the discipline of management studies. We argue that its growing popularity in spite of the theoretical problems it faces can be understood primarily as a function of the interests served by the universalization of certain forms of managerialist `evidence' rather than any contribution to organizational effectiveness. Indeed, in a reading informed by the work of French geographer Henri Lefebvre, we suggest that in the long term the project is likely to inhibit rather than encourage a fuller understanding of the nature of public services. We conclude with a call for forms of organizational research that the current preoccupations of the evidence-based project marginalize if not write out altogether.

Thesis (Ph. D.)--West Virginia University, 2009. / Title from document title page. Document formatted into pages; contains ix, 174 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 140-150).

Nurses face ongoing difficulties in using evidence and making a reality of evidence-based practice. Studies of the factors that facilitate or impede evidence-based practice suggest that nurse managers should have a key role, but the nature of this role has not yet been fully articulated. This study aimed to explore and explain the roles of nurse managers in relation to evidence-based practice implementation. Four case studies in Scottish NHS Acute Trusts provide rich data on evidence-based practice implementation, drawing on interviews (n = 51), observation and documentary analysis. A wide literature on evidence use in nursing suggests that implementation is hindered by confusion and debate about what counts as evidence, and by an incomplete understanding by staff of the complexity of implementation processes. This study confirms such conclusions. Moreover, the study reveals that the roles of nurse managers in facilitating evidence use are currently limited, largely passive and under-articulated. As such, the findings expose significant discrepancies between nurse managers' roles in practice and those espoused in much of the literature. Partial explanation for this can be found in the organisational contexts in which nurses and their managers work (e.g. competing demands; confused communication; diffuse and overloaded roles and limits to authority and autonomy). In particular, the role of the contemporary nurse manager is one that places considerable emphasis on aspects of general management to the detriment of clinical practice issues. More positively, the study uncovered genuine facilitation in two study sites where hybrid roles of nurse manager and clinical nurse specialist were in place. In both sites, these roles had been successful in supporting and progressing implementation in discrete areas of practice and show some potential for advancing evidence-based practice more widely. These findings have significant implications for research, policy and practice in relation to evidence-based practice in nursing.

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.