Table 4 Understanding the barriers and enablers of regional physiotherapists in evidence application
TDF domain (construct) | Quantitative data | Qualitative data | Theme |
|---|---|---|---|
Skills | Not reported as a barrier - 51% either disagreed or strongly disagreed with the statement, “It’s hard to apply evidence because It’s hard to know what good quality research evidence is.” | Reported barrier “There’s so much noise coming from all of the research that happens, both good quality and certainly less quality, that it is hard to see how that fits in with the clinical practice guidelines for treatment of different conditions.” | Volume of evidence Critical appraisal is difficult in the context of an ever-increasing amount of evidence. |
“Unfortunately, the thing about evidence is it’s always changing and so keeping up with that, then you know, you get people to follow one thing and then a few years down the line you tell them something else.” | Keeping up to date with changing recommendations is difficult. | ||
Beliefs about capabilities (perceived behavioural control) | Reported barrier - 60% either agreed or strongly agreed to the statement, “It’s hard to apply research evidence because my patients expect certain treatments that aren’t evidence based.” | Reported barrier “The patient can often be very confused around what to believe or pursue for treatment. So often trying to bring that back into some sort of order and structure for creating a management plan for them can be a bit challenging if they come with a lot of those pre-conceived ideas of what they think they need or what they’ve been told with good intention from others.” | Patient expectations Patients may expect non-evidence-based treatment |
Beliefs about consequences | Reported barrier “I think inevitably we’ll have to deal with it. Because you’ve got the patient who comes with those preconceived beliefs and past experiences and current situation that, again if you’re not building that rapport and trust initially, everything else you do isn’t gunna [going to] be taken on board.” | Choosing one treatment over another may have consequences on the therapeutic alliance. | |
Environmental context and resources | Reported barrier and enabler Barrier: “But right now, it doesn’t work like that. So, we have the clinicians who choose to deliver largely what they want and if it’s loosely physiotherapy, most of it is paid for.” | System factors Lack of incentive to provide evidence-based care | |
Enabler: “If you wanna [want to] get at this issue then it needs to be addressed, um, we need to be putting the effort in so the information to the payers of healthcare, so that they demand high value care or only pay for high value care” | Funding evidence-based care would enable better evidence-based care provision | ||
“And I don’t know how you can stamp out that practice without some sort of accountability structure on a more systemic level.” “I work at a multidisciplinary clinic. And talking to the doctors. They’re audited very heavily by Medicare and every practice, every investigation, every diagnosis they make, even down to the amount of minutes that they spend in the consult is all audited by Medicare. And that’s a systemic thing, that covers an auditor.” | Creating a general system of accountability. | ||
“But I wonder if it’s about how you can incentivise but create the structure around making the right thing to do easy.” “That is systemic that doesn’t require practitioners to have to consciously make a decision all the time to behave this way. That it’s built in to their, more than culture, the system somehow.” (In relation to Medical Officers) | Systemic supports to make evidence-based care easier | ||
Social influences | Reported enabler 86% either ‘agreed’ or ‘strongly agreed’ with the statement, “It would make it easier to apply research evidence if I were able to connect with other like-minded clinicians to discuss applying evidence in practice.” | Reported barrier and enabler Barrier: “We are first contact practitioners, so we do have that responsibility and yet we don’t necessarily, whether it’s public or private, have the infrastructure and maybe the really deep-seeded culture of accountability.” | A culture of accountability A lack of a culture of accountability is a barrier to evidence application |
Enabler: “Like I think about it in relation to medicine and of course the stakes are so completely different in medicine as well, in terms of saving lives and they have much more ability to cause harm. But it’s really in bred, much more, in them about that accountability for their practice maybe.” | A culture of accountability, which may be more present in other professional cultures, may enable evidence application. | ||
Barrier: “If bosses are pretty set in their ways, in – you know – using or not, maybe not staying up to date and then are educating new grads on traditional ways of physio, then – you know – it’s not quite likely that things are gunna [going to] move forwards.” | Mentorship Senior physiotherapists, or supervisors, may make it harder to apply evidence in practice. | ||
Enabler: “I’d like my staff to hear the same things that I would say from somebody else as well.” “But then of course with mentors or other clinicians to be able to discuss it and then learn how to put that into practice.” | However, mentors can also enable the application of evidence in practice | ||
Reported barriers and enablers that are not informed by the TDF | |||
Reported barrier and enabler Barrier: - 65% of participants either agreed (47%) or strongly agreed to the statement, “It’s hard to apply evidence because a lot of evidence doesn’t answer my clinical problems.” 29% of participants either disagreed or strongly disagreed with the statement. | Reported barrier and enabler Barrier: “Researchers are really good at asking questions, but sometimes the questions aren’t that relevant for us.” | Research relevance Clinical relevance issues | |
“The other area is that it’s not always relevant to the population that you’re dealing with in the clinic. Whether it’s studies on knees or hamstrings or whatever in elite athletes and I’m trying to treat a social soccer player or something like that. Or someone who’s workin’ full time and got kids and hasn’t got time to spend every day in the gym or do these certain things or like return to running programs and like that sort of stuff.” | Generalisability issues | ||
“There’s some really good, high-quality research out there but you can’t implement it, because it’s so controlled and it’s so sterile and it’s got nothing to do with what we do in our clinic or practice.” | Implementability issues | ||
Enabler: - 78% either ‘agreed’ or ‘strongly agreed’ with the statement, “It would make it easier to apply research evidence if I get support to answer questions relevant to my patients/clinic.” | Enabler: “Like I think if there were a much closer relationships between the people who are doin’ the research and the people who are running the clinics, then researchers are asking more relevant questions to clinical life.” “I sort of need researchers to better understand what clinic life is like. So that they’re asking better questions.” | Making research questions more relevant | |