Realising evidence based practice: a systemic investigation of core knowledge processes in mental health

Aims To investigate the systemic circumstances required for mental health professionals to engage in the core processes of evidence based practice. Background Successful evidence based practice is the function of inter-related processes including knowledge acquisition, generation, and application, which occur in complex and dynamic circumstances. Dominant models and approaches to facilitating the use of knowledge in practice by health professionals remain based on linear, technical processes which aim to instigate behavioural changes at the individual level. Emergent conceptualisations argue the need for strategies that consider systemic factors which can impede or facilitate the processes underpinning the operation of evidence based practices in mental health. As yet no efforts have been made to actively apply systems thinking in efforts to improve evidence based practice in mental health. Method A collective case-study research design was developed by adapting Soft Systems Methodology. Three cases were examined, each selected due to their ability to provide information about one of the core processes under investigation; knowledge acquisition, knowledge generation and knowledge application. Data was collected iteratively from thirteen participants through focus groups and semi-structured interviews. Analysis was undertaken through the inductive open coding of data into sub-categories, following which key categories were identified and considered against individual, group and organisational systems levels. Findings This study identified twenty-four key categories across the cases and located these against the three systems levels. As anticipated, complex dynamic interactions between different elements at the different levels were identified including, the role of motivation, perception and skill at the individual level, the importance of team wisdom, support and decision making, and the need for organisations to provide adequate infrastructures, ensure access to specialist expertise and a number of elements contributing to a culture of space and support for evidence based practice.awd_pdtunpub1284_ethesesunpu