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What is Evidence based practice (EBP)?Evidence based practice is about using the best available evidence on the effectiveness of healthcare interventions as a basis for professional decision making in practice. The evidence from the research should be used in conjunction with clinician expertise and patient choice.
There are different models and stages of EBP discussed in the literature. The 5 stages below have been adapted from de Groot et al. (2013, pp. 217-218).
For Evidence Based Practice (EBP) searches, you will also often be expected to break down your question into its key concepts using a framework or formula such as PICO, PIO or PEO.
Developing a focused question is an important stage of EBP and you will often be expected to break down your question into its key concepts using a framework or a formula. These elements then form the basis of the search terms used in the databases.
There are several frameworks or formulas that can be used to assist in developing a search strategy, one of the most popular is PICO, PIO or PEO.
If you are unsure what PICO, PIO or PEO is, this written guide below explains it in more detail and includes some example questions, question structures and search strategies.
Some research does not fit into the PICO, PIO or PEO formula, and there are other formulas, frameworks or tools that you could consider instead.
These include:
Some further reading on these frameworks can be found on the Searching for information in health and life sciences reading list.
You should consult your supervisor regarding your choice of framework and bear in mind that the more elements it includes, the more difficult it can be to retrieve relevant research.
Systematic reviews are at the heart of evidence based practice as they are considered one of the highest levels of evidence. They assess the quality of research, providing a summary and synthesis of all relevant, available research on a topic. A comprehensive search strategy is usually included in the review, as it should be transparent and replicable. Rigorous methods are used to limit bias in identifying or rejecting studies. Each study is assessed and the results of the individual studies are synthesised in an unbiased way, and an impartial summary of the findings is presented.
Inclusion and exclusion criteria
Inclusion and exclusion criteria are usually defined before starting a systematic review. These criteria will be used to assess the relevance and quality of the research found in the searches and will help determine whether they will be included in the final review.
Using a framework can be useful to develop which concepts need to be included in the research and this will form the basis of your inclusion and exclusion criteria. This can help your search strategy become more focused, targeting the papers which will help to answer your review question and excluding others.
You might consider the types of study design which will be included/excluded in the review. For example, will the review include Randomised Controlled Trials and Clinical Controlled Trials but exclude qualitative studies or case studies?
Other inclusion/exclusion criteria might cover:
Stages
There are different stages/steps to take into account when undertaking a systematic review. Khan et al. (2003) outline 5 main steps:
There is more detailed guidance for the steps involved in systematic reviews available from the The Cochrane Collaboration, The Centre for Reviews and Dissemination (University of York), PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and The Joanna Briggs Institute (JBI) Collaboration.
Useful sources for locating systematic reviews include: the Cochrane Library, the Campbell Collaboration and Prospero.
Evidence comes in various forms and some is more reliable than others. Research may collect data using a quantitative or qualitative approach. If two or more types of approach are included and appraised, this is called using mixed-methods.
If you are searching for quantitative research, you may be looking for studies which:
Examples of quantitative research are:
Some key features of quantitative research are: random sampling, descriptive or inferential statistics, p-values, confidence intervals, risk ratios and odd ratios.
If you are searching for qualitative research, you may be looking for studies which:
Examples of qualitative research approaches are:
If several data types (both quantitative and qualitative) are combined in research, it is known as mixed methods approach. An example of this could be bringing together findings of effectiveness (quantitative evidence) and patient, family, staff or others' experiences (qualitative evidence) to enhance the usefulness of the recommendations to decision makers (taken from JBI, 2020).
Not all evidence is the same and therefore cannot be treated as equal. Greenhalgh (2019, p.42-43) lists the traditional hierarchy of evidence in the following order:
Cardiff University Library Services (no date) have also created an evidence pyramid, which illustrates the hierarchy of evidence based on quality. At the top of the pyramid is the most reliable and current evidence (evidence based guidelines and systematic reviews) and at the bottom is the evidence which is regarded as the lowest quality, which includes background information or expert opinion. Click on the image to see more.
