Discussion

In this study we undertook an organisation-wide approach to understand practitioner engagement with research in adult social care. We found that staff in a range of positions held broadly positive views about the role of research in their work and that a substantial proportion could relate aspects of research to their own work experience. However, the lack of agency resources (most notably, staff time) was considered a major barrier to using research to inform decision-making and practice in their team/area of work. Moreover, those who had taken part in training on evidence gathering and appraisal were not, overall, confident in applying these skills. Only a minority of survey respondents recalled service user requests to explain the evidence behind the services and support on offer. Nevertheless, a value of the organisation-wide perspective is that it demonstrates that this is not a uniform situation for all staff. Significant differences between groupings of staff, indicate that the perceptions of the role of evidence-based practice may have gained more traction in some areas of adult social care work than in others, for example amongst occupational therapists more so than social workers. Such differences inform an understanding of where there are opportunities to build upon existing interest, as well as where there are greater needs to address. This reflects a theme in other studies (e.g. Gudjonsdottir et al. 2017; Gray et al. 2014), where it is believed that organisational shifts towards the use of research occur through the influence of groups reflecting leading advocates and early adopters.
Amongst a complex picture, one strong link reported in this study was that social care practitioners were more likely to report applying research in practice if they had themselves been involved in conducting or participating in research. Those with such perceptions reported a more positive outlook towards research more generally and were more confident about the evidence gathering and appraisal skills they had acquired through research training. We cannot be sure how the survey respondents interpreted having ‘conducted’ or ‘participated in’ a research study. However, in line with Wakefield et al. (2022), the implication appears to be that staff benefit from being given opportunities to experience and do research and research-associated activities. More than a range of other factors, it may be that ‘practice at doing research’ informs the use of research evidence in practice more generally. The following discussion considers how this insight may be complemented through attention to how different staff groups are placed to promote change within their organisation.
Given the growing position in recent years of evidence-based practice across curricula of qualifying programmes for regulated professions in social care, we might have anticipated that early career practitioners (and most probably newly registered professionals) would report greater engagement and confidence with research training compared to those generations educated in a less research informed era. However, our study identified no substantive differences linked to more recent education. Indeed, as other studies have found (Di Tommaso et al., 2019; Gleeson et al.,2021; Teater and Chonody, 2018), there are indications that new starters encounter difficulties putting their research-based skills into practice. While caution is needed in the interpretation, this raises a question around how newly qualified staff are supported to apply their learning in the use of research evidence, particularly through protected time.
A related concern is the effectiveness of continuing professional development (CPD). Our study indicated that, while a proportion report being trained in research evidence skills, such staff also report relatively low levels of confidence in applying their learning. This draws attention to the requirements, availability, and utility of the CPD. Ill-fitting and weakly exercised training represents one type of problem, but the challenge of implementation is compounded where there are already constrained resources and competing pressures in the workplace, as participants in this study reported.
While social work and occupational therapy staff share many similarities with respect to engagement with research, our study found that occupational therapy staff respondents reported greater levels of experience with literature searching and critical appraisal. Albeit in a different organisational context, Gudjonsdottir et al. (2017) found profession-based differences, in this case between social work and physical therapists, and attributed this to the greater influence of medical science in physical therapy training. Gudjonsdottir et al. (2017) argues that differences in attitudes towards the use of research evidence between professions may result in poor interprofessional relations and negatively impact the quality of client care. This points towards the importance of interprofessional education and shared learning around the interpretation and use of research evidence.
In addition to profession-based differences, the survey results suggest hierarchical differences in engagement with evidence-based practice. In this respect our research resembles some elements of other studies (see, for example, Bäck et al., 2020; Zardo and Collie, 2015). Those in senior grades (managers, team leaders and registered professionals) were more likely than non-registered professional care staff to report positive views, research training experiences, and application of research evidence. This might be anticipated, given the additional investment in education and training, as well as experiential learning opportunities, for those on senior grades. Given the higher authority of those in senior grades, actors within this group are well placed to shape an organisational culture that promotes the use of research. If this is to be a whole organisational approach, this involves making the use of research evidence meaningful and relevant for staff at all grades. Given that no staff group, including those in higher organisational positions, had a high overall level of confidence about key elements of research evidence use, those in senior roles might also support tools and processes that revise the focus of research evidence training to be more meaningful for staff with a diversity of roles and predispositions. As Gray et al. (2015) found, staff groups can differ whether they prefer to either explore the raw research evidence themselves or to rely on the digests of authoritative others.
Of the staff represented in this study, we are specifically cautious in drawing conclusions about those identified as ‘other’ in the survey. The response rate for this group was low (14% of the total in this group) and therefore highly questionable in its representativeness. Moreover, within this catch all group there is a great diversity of roles. Nevertheless, our research may suggest that more consideration should be given to the use of research in work roles such as brokerage, business support, financial assessment, and lettings, not least because they provide important functions as part of the adult care workforce. Employers in this study designated 20% (n=169/841) of their staff in ‘other’ roles that were outside social work, social care practice, occupational therapy, management and leadership. Reforms to adult social care provision are likely to generate an increasing diversity of new staff roles (e.g. DHSC, 2023). From the positions of equity and effectiveness, such staff stand to benefit from attention to support their research informed decision-making as much as the established professions do.
From an organisational change perspective, many efforts to promote evidence-based decision making employ a form of systems change reasoning. Examples include Normalisation Process Theory and the adoption-of-innovation thesis (Gudjonsdottir et al., 2017; Gray et al., 2014; and Gray et al., 2015), whereby (in both instances) influencers spread new practices as opportunities and conditions allow. While this thinking informed lines of analysis for this baseline study, the follow-up research planned as part of the ConnectED programme provides an opportunity to assess these mechanisms for change and thereby develop a more refined approach to enhance the application of research evidence in adult social care organisations.