Dr M Clare Taylor Coventry University, UK

 What really guides your practice?  The nature of ‘evidence’ in EBP  Perspectives on levels and hierarchies of evidence utilising qualitative evidence2

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? utilising qualitative evidence3

 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 utilising qualitative evidence4

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 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 utilising qualitative evidence6

 Levels and hierarchies of evidence ◦ Interventions ◦ Experiences utilising qualitative evidence7

 Guidelines  Systematic reviews & meta analysis of RCTs  RCTs  Other experimental designs  Descriptive studies  Expert consensus  Respected opinion utilising qualitative evidence8

Experiences:  Qualitative research ◦ Is an hierarchy possible? ◦ The question to ask when appraising a qualitative research paper? utilising qualitative evidence9

 Qualitative research ◦ including qualitative systematic reviews  Experiential evidence  The client’s perspective ◦ Client knowledge & experience ◦ Satisfaction surveys utilising qualitative evidence10

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 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? utilising qualitative evidence12

 Studies to establish consensus ◦ Delphi studies ◦ Nominal group studies utilising qualitative evidence13

 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 utilising qualitative evidence14

Concrete art in an abstract world Capturing the service user’s perspective Acknowledgement – Annette Roebuck utilising qualitative evidence15

Project Aims:  to evaluate the extent to which the Individual Budget project has been effective in empowering service users to make decisions for themselves. utilising qualitative evidence16

 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 evidence17

 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 utilising qualitative evidence18

 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 utilising qualitative evidence19

 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 utilising qualitative evidence20

Participants chose to tell their stories in different ways..... On the computer Using art On film In books utilising qualitative evidence21

 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 utilising qualitative evidence22

 Art was a popular form of self expression  Most service users chose to include pictures of valued activities to illustrate their everyday lives utilising qualitative evidence23

Dean J., Goff F., Roebuck A., Taylor M.C., Daly G. Bournemouth 2008

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 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 utilising qualitative evidence26

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 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 utilising qualitative evidence28

 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 utilising qualitative evidence29

 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 utilising qualitative evidence30

 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 utilising qualitative evidence31

Tusen takk for deres oppmerksomhet utilising qualitative evidence32

utilising qualitative evidence33 Dr M Clare Taylor +44 (0)