Table 2 Detailed contextualization of identified barriers of EBP among patient counselors and advocates
Context factor | Exemplary statement | Definiton | Reference (ID/Page/PC;PA) |
|---|---|---|---|
Individual barriers to EBP: Professional rational-emotional attitudes as barriers | |||
Application of EBP | “Every patient has his individual health problems and psychosocial concerns. In my view, EBP is not specific enough to consider these individual factors.” | EBP facilitates the risk of generalization when conveyed by medical laypersons | 7/9/PC; 9/3/PC |
Application of EBP | “I try to use health related information that are evidence based. Patients often react overwhelmed and feel compelled to decide on their own.” | EBP places excessive demands on the patient’s competencies and decision making ability | 9/1/PC; 8/9/PA |
Application of EBP | “Counseling on evidence based medical informations alone is the task of physicians. We as counselors need to develop our own focus on evidence based counseling. | PCs should integrate their own view on EBP information | 3/1/PC; 9/6/PC |
Medical guidelines | “Guidelines change so quickly and sometimes recommendations are even contradicting. That’s why I do not rely on them.” | Distrust regarding medical guidelines | 7/1/PC; 1/1/PA |
Relationship to physicians | “I think that most counselors are careful when using EBP. The reason is as simple as disappointing! We do not want to have trouble with physicians when applying it.” | Concerns of having conflicts with physicians when applying EBP | 3/3/PC; 7/2/PC; 1/4/PA; 8/2/ PA |
“In my view most advocates try to deal with EBP and apply it in daily work but at the end most of them follow the opinion of medical specialists. It is so much easier than causing a dispute.” | |||
Individual barriers to EBP: Cognitive-behavioral barriers (knowledge and skills) | |||
Access to EBP information | “In general, I do support the idea of evidence-based decisions but in my daily practice I cannot even access this information.” | Gathering evidence-based information on health care issues is difficult. | 1/1/PC; 3/1/PC; 7/3/PC; 2/1/PA; 5/2/PA; 6/2/PA |
Assessment of benefits in regard to: | “In my view, the assessment or appraisal of interventions of any kind is the main difficulty I am always faced with and not able to accomplish.” | The assessment of treatment, diagnostic benefits or cost effectiveness, and information quality of an intervention is very difficult due to complexity of the issue or perceived lack of relevance to daily practice. | Treatment benefit: 1/2/PC; 4/2/PC; 7/4/PC; 5/2/PA |
a) diagnostic | “In EBP one has to consider so many factors and always apply these to the individual case. This sounds easy, but is not.” | Diagnostic benefit: 4/2/PC; 7/6/PC; 1/2/PA; 6/3/PA; 8/3/PA | |
b) treatment | |||
c) cost-effectiveness | “I never thought about the cost-effectiveness of a treatment. I mean in the end this information does not matter because in most cases we are dealing with interventions that are already paid for by the sickness funds.” | Cost-effectiveness: 3/2/PC; 4/2/PC; 7/6/PC; 5/2/PA | |
d) quality of information | “Off course, I try to critically appraise the quality but in most cases, I just make sure that It is published in a renowned journal because I do not have the skills to access the quality.” | Information quality: 3/2/PC; 4/3/PC; 7/7/PC; 1/3/PA; 6/4/PA | |
Individual barriers to EBP: Cognitive-behavioral barriers: (knowledge and skills) | |||
Statistical skills | “In most cases, I am not able to comprehend what I am reading. I see odds ratios and p-values without really understanding what it means.” | Statistical skills are limited | 3/2/PC; 4/3/PC; 7/7/PC; 1/3/PA |
Methodological skills | “If you mean the study design I cannot give you an answer because I do not really understand what an evidence grade is and why all studies have to be an RCT. All these aspects are far above what I can apply in my daily work.” | Limited skills in the concepts of EBM/EBP such as study-design and evidence level | 1/2/PA; 6/4/PA |
Institutional barriers to EBP: Resource barriers | |||
Resources | “To be honest I do not have the time to search for scientific medical papers to use them in my daily work. Unfortunately that’s the truth.” | Lack of time for EBP | 3/3/PC; 4/3/PC; 7/16/PC |
Resources | “As many counselors I’m working on a volunteer basis and cannot afford such a workshop. “ | Limited funding | 3/1/PC; 9/6/PC |
Resources | “I cannot travel long distance to participate in such as course.” | Lack of willingness to travel | 9/1/PC; 8/9/PA |
Institutional barriers to EBP: System and process barriers | |||
Participants | “In my view all professions need a basic understanding of EBP. Programs should be designed for an interprofessional audience.” | Specific target groups including representatives counselors, physicians and members of self-help groups | 3/5/PC; 7/16/PC; 9/9/PC; 4/4/PC; 1/5/PA; 8/3/PA; 6/8/PA; 5/3/PA; |
Financial expense | “In my view, an EBP course should be funded in order to set a strong incentive. Otherwise, only institutions with funding possibilities will be able to send their staff to these courses. In counseling these institutions are scarce.” | Preference to funding by a third party | 3/6/PC; 9/11/PC; 5/3/PA; 8/8/PA |
Information dissemination | „I know that there are EBP programs for laypersons but I never participated because in my area offers are scarce.” | Programs should be regionally wide-spread and easily assessable. | 3/5/PC; 4/5/PC; 7/1/PC; 9/9/PC; |
Information dissemination | “It would be most feasible to have both, presence and online courses to make it more compatible with my job.” | Programs should combine compulsory presence and online courses | 3/5/PC; 4/6/PC; 1/6/PA; 2/5/PA; 8/3/PA |