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Fostering a culture of evidence-based physiotherapy practice: a qualitative analysis of the influence of health care leaders in Sweden
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
2015 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Research in physiotherapy has increased rapidly over the last decade, yet studies have shown that many practice decisions continue to be based on knowledge obtained during initial physiotherapy education and/or personal experience, rather than findings from research. Both barriers and facilitators to achieving a more evidence-based practice (EBP) in physiotherapy have been identified. Leadership is one facilitator that has been recognized to have an important influence on the implementation of EBP in various settings. Our aim was to explore how physiotherapy leaders in Sweden influence the culture for implementation of evidence-based physiotherapy practice.

Methods: Nine interviews with managers of physiotherapy clinics were conducted in various settings in Sweden. Data were analysed using qualitative analysis and a framework developed by Schein (Schein EH. Organizational culture and leadership. 4th ed. San Francisco, CA: Jossey-Bass; 2010) was applied.

Results: The framework identifies a number mechanisms by which leaders can influence the culture of an organization and/or groups within an organization. The mechanisms of paying attention to, measuring and controlling on a regular basis as well as deliberate role modelling, teaching and coaching did have some relevance. However, EBP issues seemed to depend on committed individuals, often younger physiotherapists, who were interested in research.

Conclusions: Overall, there was limited relevance for most of the embedding mechanisms. The findings suggest that physiotherapy leaders in Sweden contribute to a modest degree to establishing a culture conducive to implementation of an evidence-based physiotherapy practice.

Place, publisher, year, edition, pages
2015.
Keyword [en]
Leadership; Culture; Evidence-based practice; Implementation; Physiotherapy
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:liu:diva-122171OAI: oai:DiVA.org:liu-122171DiVA: diva2:862649
Available from: 2015-10-23 Created: 2015-10-23 Last updated: 2015-10-23Bibliographically approved
In thesis
1. Evidence-Based Practice in Practice: Exploring Conditions for Using Research in Physiotherapy
Open this publication in new window or tab >>Evidence-Based Practice in Practice: Exploring Conditions for Using Research in Physiotherapy
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Research developments have led to increased opportunities for the use of improved diagnostic and treatment methods in physiotherapy and other areas of health care. The emergence of the evidence-based practice (EBP) movement has led to higher expectations for a more research-informed health care practice that integrates the best available research evidence with clinical experience and patient priorities and values. Physiotherapy research has grown exponentially, contributing to an increased interest in achieving a more evidence-based physiotherapy practice. However, implementation research has identified many individual and contextual barriers to research use. Strategies to achieve a more EBP tend to narrowly target individual practitioners to influence their knowledge, skills and attitudes concerning research use. However, there is an emerging recognition that contextual conditions such as leadership and culture are critical to successfully implementing EBP.

Against this background, the overall aim of this thesis was to explore conditions at different levels, from the individual level to the organizational level and beyond, for the use of research and implementation of an evidence-based physiotherapy practice. The thesis consists of four interrelated papers that address various aspects of the aim. Individual and focus group interviews were conducted with physiotherapists and managers within physiotherapy in various county councils in Sweden between 2011 and 2014. Data were analysed using qualitative content analysis, direct content analysis and hermeneutics.

It was found that many different types of motivation underlie physiotherapists’ use of research in their clinical practice, from amotivation (i.e. a lack of intention to engage in research use) to intrinsic motivation (research use is perceived as interesting and satisfying in itself). Most physiotherapists tend to view research use in favourable terms. Physiotherapists’ participation in a research project can yield many individual learning experiences that might contribute to a more research-informed physiotherapy practice. However, organizational learning was more limited. Numerous conditions at different levels (individual, workplace and extra-organizational levels) provide support for physiotherapists’ use of research in their clinical practice. However, physiotherapy leaders appear to contribute to a modest degree to establishing a culture that is conducive to implementing EBP in physiotherapy practice. Instead, EBP issues largely seem to depend on committed individual physiotherapists who keep to up to date with research in physiotherapy and inform colleagues about the latest research findings.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 78 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1471
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-122172 (URN)10.3384/diss.diva-122172 (DOI)978-91-7519-019-8 (print) (ISBN)
Public defence
2015-11-06, Belladonna, Hus 511-001, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-10-23 Created: 2015-10-23 Last updated: 2015-10-23Bibliographically approved

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Dannapfel, PetraNilsen, Per
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