Qualitative research and the take-up of evidence-based practice

In this paper it is argued that evidence-based medicine (EBM) is a social movement as well as a scientific enterprise, and that as such it requires qualitative investigation of its various activities to understand its impact and take-up. Randomised controlled trials (RCTs) are a blunt instrument of assessing whether interventions achieve intended or unintended outcomes, or whether they are acceptable to those they are aimed at. To understand the success or failure of evidence-based interventions, it is necessary to investigate practitioners’ acceptance of, or resistance to, EBM. This involves exploration of the perceived relationships between practical clinical knowledge derived from everyday practice and scientific knowledge. The implementation of best evidence also requires the acknowledgement of local contextual factors. The goals of EBM will not be achieved if patients do not accept the advice and prescriptions they are given by professionals. One of the reasons that some professionals find it difficult to use the results of RCTs in their clinical practice is because they are aware of patients’ differing priorities and life experiences. If we accept that EBM is a social movement, then the methods needed to investigate its activities are those of the social sciences, including qualitative methods.