Dr M Clare Taylor Coventry University, UK. What really guides your practice? The nature of...

Dr M Clare TaylorCoventry University, UK

What really guides your practice? The nature of ‘evidence’ in EBP Perspectives on levels and hierarchies of

evidence

utilising qualitative evidence 2

Talk to your neighbour: What sorts of information/knowledge/

evidence might you use to guide your professional practice and intervention decisions?◦ How do you know an intervention or action will

be effective?


Past experience Custom & practice/

always done things that way

Things taught during pre-registration education & training

Discussion with colleagues

Clinical guidelines Care pathways Departmental policy Government policy

Attendance at a short course/workshop

Presentation by an expert

Information from a professional special interest group

Professional reading Research evidence Critically appraised

research evidence Evidence-based

clinical guidelines


Effectiveness of interventions:◦ Systematic reviews of RCTs◦ RCTs◦ Other experimental designs e.g. controlled

clinical trials◦ Single subject design studies ◦ Qualitative research – to give the patient’s

perspective

Client’s experiences & perceptions:◦ Qualitative research studies◦ Descriptive research studies e.g. surveys◦ Systematic reviews of qualitative research


Levels and hierarchies of evidence◦ Interventions◦ Experiences


Guidelines Systematic reviews & meta analysis of

RCTsRCTsOther experimental designsDescriptive studiesExpert consensusRespected opinion


Experiences: Qualitative research

◦ Is an hierarchy possible?◦ The question to ask when appraising a qualitative

research paper?


Qualitative research◦ including qualitative systematic reviews

Experiential evidence The client’s perspective

◦ Client knowledge & experience◦ Satisfaction surveys


problem intervention e.g. how can research evidence guide

and inform the organisation and planning of a fatigue management programme for a group of clients with various degrees of MS-related fatigue?


Studies to establish consensus◦ Delphi studies◦ Nominal group studies


Critical reflections & supervision◦ Is there any evidence to underpin the intervention

decisions I made in this situation?◦ Am I using evidence to underpin the decisions I made

in this situation?◦ Are there any professional, national or local standards

and guidelines that a relevant to this intervention and situation?

◦ Am I involving the client in the decisions about intervention?

◦ Am I informing the client of the evidence-base for these interventions?

Critical case studies Critical issue analysis


Concrete art in an abstract world

Capturing the service user’s perspective

Acknowledgement – Annette Roebuck


Project Aims: to evaluate the extent to which the

Individual Budget project has been effective in empowering service users to make decisions for themselves.


30 participants:◦ 22 – learning disability◦ 7 - severe physical impairment◦ 1 – enduring mental health issues

Service users with a learning disability or cognitive impairment will require particular consideration within qualitative research◦ augmented communication techniques using

visual material widely used with people with a learning disability

-utilising qualitative evidence 17

That service users were to be fully involved in process of evaluation

That service users were given choices about the way in which they would like to engage in the research project

Communication techniques that were responsive to individuals’ needs and adapted to the abilities of the service users


Service users with moderate to severe learning disability had little to no formal language

Service users with learning disability had difficulty in grasping abstract concepts

Some service users with physical disability had communication difficulties

Researchers would need to have a wide range of communication and practical skills

Occupational Therapy students were selected to undertake the project as their final years’ placement


The abstract concept of an individual budget was hard to grasp

Needed to translate this into concrete ideas◦ What do you do during a day/week◦ What did you do before…?’

Researchers explored the daily routines, hopes and aspirations of service users, and any changes that had occurred

Where formal language was problematic, researchers liaised with support workers/ carers


Participants chose to tell their stories in different ways.....

On the computer

Using art

On film

In books


Photographs and thematic text were developed into PowerPoint presentations

Presentations included use of voice over and text to accommodate different communication needs

Service users decided to hold their own conference to present their experiences◦ Some service users chose to introduce these in

person in a lecture theatre


Art was a popular form of self expression Most service users chose to include pictures

of valued activities to illustrate their everyday lives


Dean J., Goff F., Roebuck A., Taylor M.C., Daly G.

Bournemouth 2008

A formal focus group was not possible due to language and conceptual difficulties

Some service users chose to attend an art group at the university to create a larger piece of artwork

The group activity enabled some sharing of ideas in a concrete format with minimal use of formal language

The art work formed the centrepiece of the conference


Some service users chose to film aspects of their daily lives and use this to accompany a narrative incorporating key themes

One service user who chose this method was visually impaired

At the conference, film came over as a powerful and emotive medium


Observation of the service user undertaking activities

Interpretation and analysis of how the activity was performed [including body language]

Triangulated carer and service user information


The range of data collection techniques enabled service users to select communication methods that suited them and allowed their voices to be heard to tell their own stories

Being involved in the project help the OT students to clearly articulate their sense of being an OT


There is a breadth of qualitative evidence

Quantitative evidence cannot answer every question

As OTs we have an affinity with qualitative research & evidence

Qualitative evidence allows the client’s voice to be heard, in the way that best suits the client


Tusen takk for deres oppmerksomhet



Dr M Clare [email protected]

+44 (0)24 7688 7068

Dr M Clare Taylor Coventry University, UK. What really guides your practice? The nature of...

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