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.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/21450 |
| Date | 06 1900 |
| Creators | DiGiacomo, Anthony |
| Contributors | Law, Mary, Rehabilitation Science |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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