Chalk and cheese? Reflections on the use of focus group and interview data to uncover perceptions of evidence-based practice Carly Reagon, Dept of Occupational Therapy

Evidence-based practice … the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. (Sackett et al 1996) The government has come up with an exciting and revolutionary idea; doctors should concentrate on providing treatments that work. (Timmins 1998 in The Financial Times)

Move towards EBP in the 90s Changing attitudes towards expertise Challenge and cost of an ageing population Rising consumer interests in standards Media horror stories of medical error A culture of evidence- based practice

Traditional hierarchy of evidence

Aim of the research To explore the meanings attributed to evidence-based practice by a group of occupational therapists

Case Study NHS OT service in England Qualitative Grounded theory Observation of group meetings Series of focus groups (N=4) with 9 participants Series of interviews (N= 18) with 10 OTs

Focus groups and interviews Focus groups: - To generate themes for the research - Insight into culture of group - Insight into culture of EBP in group Interviews: - To develop themes - Explore personal experiences of EBP in individual practice

Focus groups Group discussions exploring a specific set of issues and focused on a particular activity Rely on group interaction to generate data (rather than individual responses). Includes immediate feedback, challenge or support of other participants Provide access to a wide range of opinions Provide access to shared meanings of a group (relies on a degree of homogeneity) (Barbour and Kitzinger 1999, Green and Hart 1999)

Analysing focus groups - Identify commonalities and differences -Identify silenced members -Identify how accounts are articulated, censored, opposed, and changed through group interaction -Application of Conversation Analysis principles

AndrewEvidence is not infallible AmyIt can be much of an opinion cant it? AndrewIt can be very much an opinion. A lot of old occupational therapy is just traditional and theres no evidence for it at all MartinYes

MartinEvidence is a form of information is it not? AndrewThere is a difference. You can have information but no actual evidence for it. So theres information but no evidence. AmyYeah, like information could be picking up the newspaper, just reading something. Its facts, whereas evidence, theres a bit more to it than that. AndrewLike you say information is something even if theres no truth in it. LouiseIts about justification. The information side is probably evidence without the justification. AndrewYeah, doesnt necessarily have any at all.

In-depth interviews Highly versatile with varying degrees of structure Interviewer and interviewee wander together as travellers on a journey A speech event in common with ordinary conversation A social event in its own right (Spradley 1979, Mishler 1991, Kvale 1996, Coffey and Atkinson 2002)

Examples of interview data Lengthy monologues Disclosure of a disciplinary procedure Asking advise on own research Am I right? Is that what you wanted me to say?

Focus groupsInterviews General experiences Topical Working it out (evolutionary) Challenges Short individual anecdotes with collective applicability Leaders Quieter members Negative Personal experiences and disclosures Confessions Lengthy personal accounts Seeking assurance from interviewer

Results Tension between EBP and client-centred practice EBP enables professional survival EBP enables OTs to develop their profession Multiple sources of evidence in OT EBP needs to be redefined for OTs

Conclusions Construction of a story through different methods of data collection Methods produce data with a distinct flavour Is one method better than another? Does one method lead to more natural data?

Social life is performed and narrated, and we need to recognise the performance qualities of social life and talk. In doing so, we shall no longer find it necessary to juxtapose talk and events as if they occupied different spheres of meaning. (Coffey and Atkinson 2002:802)