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.