Evidence into Practice? An exploratory analysis of the interpretation of evidence

This chapter draws on a pair of research projects, using similar methodologies which seek to explore the processes by which innovations diffuse into clinical practice. The research sets out to understand, inform and improve the processes of evidence-based medicine. Evidencebased medicine (EBM) involves the diffusion of evidence, particularly new or updated evidence, into clinical practice. As such, it includes complex processes of understanding, deciding, evaluating, communicating and agreeing. At the outset one would also stress that EBM involves change and change processes. We hope this briefly emphasises the first tenet of this chapter, that we are investigating and describing complex processes. This chapter will focus on one problematic aspect of EBM which, with a few notable exceptions (Williamson, 1992; Dawson, 1995; Berg, 1997), has been particularly neglected: the nature of ‘the evidence’ itself. Do we understand what is meant by scientific evidence? Closely associated with the nature of the evidence are the meanings ascribed to it by professionals. What are their perceptions of evidence? Are they uniform? Finally, in considering the diffusion of evidence and its use in practice, what are the attributes of evidence which make it credible and, therefore, potentially, used?