Implementing research evidence into practice: some reflections on the challenges

Background. The ideal of evidence-based practice is not always reflected in day-to-day midwifery care, which may be based more on tradition and clinical experience than research evidence. The history of maternity care shows that, even when evidence is available, it is not always implemented. It may be assumed that implementation will ‘just happen’ and, as a result, this critical research stage of the research process may be overlooked. Aim. To explore the challenges that may be encountered when attempting to implement research evidence into practice, and consider what might enhance implementation. Discussion. Implementation is not always related to the quality of the evidence. Weaker evidence may be implemented, while stronger evidence is neglected. This suggests that, between dissemination of findings and possible implementation, there is a ‘black box’: a complex process whose internal workings are unclear and, at times, puzzling. Drawing on examples from research studies and implementation science, I explore what goes on inside this ‘black box’. Various barriers and facilitators may influence whether evidence is put into practice. These relate to: i) the characteristics of the evidence, including the robustness of the research and its accessibility; ii) the context into which the evidence is to be introduced, such as resource implications and organisational readiness to change; iii) the issue and its significance to the holders of authoritative knowledge; iv) the potential evidence users, and how the evidence fits with other knowledge sources. Implications. It is important that researchers pay attention to the processes within the ‘black box’ between dissemination and implementation, in order to optimise the introduction of evidence into practice. Dissemination strategies should be aimed at reducing the gap between researchers and knowledge users