Communicating Health Information and Research into Practice and Policy (CHIRPP)
The following studies are part of a project on ‘Communicating Health Information and Research into Practice and Policy’ (CHIRPP) funded by the MRC's Population Health Sciences Research Network on the challenges faced by nurse practitioners of translating evidence into practice.
Negotiating the challenges of communicating research evidence within the changing patient-practitioner relationship
Over the years greater emphasis has been placed on increasing the effectiveness of research evidence in clinical decision-making and including patients’ perspectives and preferences in those health decisions. Whilst this shift is valuable to ensure practice concurs with best evidence, it can pose substantial challenges for practitioners working in direct contact with the public. A balance needs to be achieved between using and communicating best evidence alongside respecting individual preferences that are contrary to evidence. This focus group study provides insights from nurse practitioners on how they negotiate the challenges of communicating about research evidence within the changing patient-practitioner relationship. Practitioners believed that communicating about evidence was an important but challenging part of their job. Practitioners considered that increased emphasis on patient involvement has led many patients to become more drawn into assessing evidence for themselves. This in turn, has led to a greater number of patients questioning the evidence, and correspondingly, greater expectations being placed on health care providers to offer explanations about the evidence. Practitioners often displayed a lack of confidence in their own capabilities to critically appraise evidence and spoke of there being a power vacuum in the relationship. In particular, practitioners found it difficult to know how to deal with patients who use anecdotal evidence to back up their health decisions. Often, persuading patients to accept evidence-based practices was seen as secondary to maintaining the integrity of the patient-practitioner relationship. If practitioners are to be effective at communicating research evidence in the current healthcare system, more research and resources need to be focused on contextual factors such as how research evidence is negotiated within the dynamic of the changing patient-practitioner relationship. Further research in this area might usefully contribute towards the development of a resource which helps practitioners communicate about research evidence. The published paper is available from PubMed.
The challenges of bridging the gap between evidence, practice and the media: views from community nurse practitioners
The mass media play an important role in communicating the latest health related information to people and are influential in shaping public perceptions and decisions about health. Health practitioners also play a pivotal role in providing people with up-to-date, accurate information on a wide range of health care issues. The increasing availability of health information and media reporting on health means that patients’ and practitioners’ needs may extend beyond simply reading that information, to seeking help with the interpretation and clarification of information. This focus group study explores community practitioners’ experiences of the challenges and influence of the news media on evidence related practice. We found that practitioners working at the frontline of patient care can find it difficult when media stories report evidence which appears to undermine existing practice. Some blamed such stories for causing unnecessary patient worry and undermining practitioners’ confidence in current practice. However, it was also common for practitioners to regard the news media as a helpful information source for patients and practitioners alike, keeping them abreast of healthcare developments. In general, practitioners expressed concern about their lack of confidence in judging how to make sense of and communicate about new discoveries or conflicting news reports and suggested a need for additional educational resources to help practitioners. There is a need to help practitioners and their patients make better sense of media messages. The development of a resource which helps practitioners understand and communicate with patients about how the media frame health risks and report healthcare developments may bridge the gap between evidence, practice and the media. The published paper is available from PubMed.
Competency, confidence and conflicting evidence: key issues affecting health visitors’ use of research evidence in practice
Health visitors have an important role in providing parents with information on child health care and are increasingly expected to keep up-to-date with a growing body of research. Using childhood immunisation as a case study we explored how health visitors find out about new research evidence and examined the barriers and facilitators to using evidence in practice. We surveyed health visitors attending their annual professional conference (n=185, 81.1% response rate) to find out the sources they use to obtain new research evidence and to identify what makes research evidence most useful in practice. The most commonly cited reason for not using research in their practice was ‘conflicting research evidence’, and the main facilitator in helping change practice in light of new research evidence was ‘understanding the evidence’. Health visitors used a wide range of community practitioner and general nursing/medical journals and magazines, particularly the editorial and news (update) sections. These sections, that distil the evidence and offer evaluative comment about newly published research, are important in equipping HVs to respond to public concerns, particularly when there is conflicting evidence. This paper has been widely disseminated to health professional audiences and to policymakers.
van Bekkum JE, Hilton S. Primary care nurses' experiences of how the mass media influence frontline healthcare in the UK. BMC Family Practice 2013;14:178open access
van Bekkum JE, Hilton S. The challenges of communicating research evidence in practice: perspectives from UK health visitors and practice nurses. BMC Nursing 2013;12:17open access
Hilton S, Bedford H, Calnan M, Hunt K. Competency, confidence and conflicting evidence: key issues affecting health visitors’ use of research evidence in practice. BMC Nursing 2009;8:4pubmed open access