Knowledge and Use of Evidence-based Practice by Allied Health and Health Science Professionals in the United Kingdom

Journal of Allied Health, Fall 2006 by Upton, Dominic, Upton, Penney

Clinical effectiveness (CE) and evidence-based practice (EBP) are the cornerstone of modern-day health care. Although many studies have explored attitudes and perceived knowledge of individual professions, few have compared these factors between professional groups, especially in the allied health professions (AHP) and health science services (HSS). We report a study comparing the knowledge and practice of 14 different professional groups from the AHP and HSS in terms of EBP and CE. The aim was to highlight any differences between the 14 professional groups along with the needs of the groups. A postal questionnaire survey was completed by a random sample of 1,000 members of AHP and HSS across the United Kingdom. There were significant differences between professional groups with, in general, professionals from the HSS groups rating their knowledge and application of CE and EBP as lower than members of the AHP. Differences were also noted between individual professional groups. For example, podiatrists, radiographers, and orthoptiste reported having less knowledge of CE and EBP than physiotherapists, occupational therapists, dietitians, speech and language therapists, and psychologists. Barriers to implementing EBP were similar for all groups, with lack of both time and money cited as the main issues. A number of differences between professions were recorded that highlight the difference in educational and policy approach required for greater uptake of EBP. J Allied Health 2006; 35:127-133.

CLINICAL EFFECTIVENESS (CE) and evidence-based practice (EBP) have become increasingly important in health care because they provide a framework for clinical problem solving that allows practitioners to keep up to date with current best practice in their field. Clinical decisions should be informed by up-to-date, relevant, and robust evidence rather than outdated primary training or overinterpretation of individual patient experiences.1 A number of studies have explored the views and knowledge of health care professionals toward EBP. Most of these studies have concentrated on medical practitioners. For example, studies have suggested that family or general practitioners report mainly positive attitudes,2,3 although barriers such as lack of time2,4 and understanding of terminology5 have hindered the progression of EBP and CE.

There have been fewer studies with other professional groups,6 although those that do exist present a picture similar to that reported in the medical profession. McCaughan et al.7 reported a lack of research and interpretation skills that hindered the development of EBP in nurses, and Iqbal and Glenny8 reported comparable findings with dental practitioners. Studies with physiotherapists,9 radiographers,10 and podiatrists11 have reported similar trends. Bristow and Dean11 described a survey in which most podiatrists were supportive of EBP but reported a lack of skill and time as the major barriers; this finding was also reported by Thomas et al.12 in pediatric dietitians, Kamwendo13 in physiotherapists, Curtin and Jaramazovic14 in occupational therapists, and Jette et al.15 in physical therapists.

While studies reporting similar findings in a number of individual professions are useful, few have compared professions. One exception was a study by Palfreyman et al.9 that reported differences and similarities between physiotherapists and nurses in their use of EBP. Both professions cited a lack of time as preventing a greater uptake of EBP, although both groups reported using a wide range of evidence-based resources. Nurses were more likely than physiotherapists to rate themselves as having poor EBP skills compared with physiotherapists. Metcalfe et al.16 reported on the research views of four professions and found that lack of time, research skills, training, and funding were the main barriers to EBP for dieticians, occupational therapists, physiotherapists, and speech and language therapists. As Metcalfe et al. rightly argue, barriers identified in nursing may not be the same as those identified for therapists. It is also likely that those barriers will not be the same for all therapists, a finding hinted at by Metcalfe et al.16 although obscured by the data collection method.

Group studies are therefore relatively rare and usually limited in their scope. Furthermore, the viewpoint of certain professional groups (e.g., medical physicists and pathology assistants) has rarely been considered. The aim of this study was to address these deficits by comparing the knowledge and practice of EBP by a range of health care professionals, including a number of allied health professions (AHP) along with those sometimes referred to as health science services (HSS). Those in AHP play a key role in providing the full spectrum of care for patients and caregivers from primary prevention to specialist disease management and palliative care. They include physiotherapists, occupational therapists, dietitians, podiatrists, speech and language therapists, radiographers, and psychologists. HSS professionals are involved in the prevention, diagnosis, and treatment of illness. They include pharmacists, physiological scientists, biomedical scientists (e.g., pathology), and laboratory and technical assistants (e.g., dental technologists and operating room assistants).