Widening the Knowledge Base of Evidence-Based Practice

We examine two responses by EBP institutions to the charge that they marginalize qualitative knowledge. First, we address the British Medical Research Council’s (2000) framework for research into complex healthcare interventions. The Framework recommends that the traditional RCT should be supplemented by an initial phase that can use qualitative research to identify the underlying mechanisms that will influence outcomes; and a final phase to determine whether the intervention can be used effectively in uncontrolled settings. From our experience of implementing the framework (Blackwood 2006), we examine the benefits and problems of this mixed-methods approach.

Second, we examine the recent acceptance by the Cochrane Collaboration that evidence from qualitative studies can play an important role in adding value to systematic reviews (Noyes et al. 2008). We look at how it is proposed to incorporate qualitative data, and at the limitations put upon reliance on qualitative date. We report on our current work revising a previous review that relied solely on trials with qualitative data in order to illuminate the processes involved in complex interventions.Blackwood B., 2006. Methodological issues in evaluating complex health care interventions. Journal of Advanced Nursing 54 (5): 612-622.

McGaughey, J., Alderdice, F., Fowler, R., Kapila, A., Mayhew, A., Moutray, M., 2007. Outreach and Early Warning Systems (EWS) for the prevention of Intensive Care admission and death of critically ill adult patients on general hospital wards. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD005529. DOI: 10.1002/14651858.CD005529.pub2.

Medical Research Council, 2000. Framework for development and evaluation RCTs for complex interventions to improve health. MRC, London.

Noyes, J., Popay, J., Pearson, A., Hannes, K., Booth, A., 2008. Qualitative research and Cochrane reviews. In Higgins, J., Green, S. (Eds.), 2008. Cochrane handbook for systematic reviews of interventions, version 5.0.0. The Cochrane Collaboration, London, sections 20-20.6.7.