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Appears in Collections:Faculty of Health Sciences and Sport eTheses
Title: A Critical Analysis of Evidence-Based Practice in Healthcare: The Case of Asthma Action Plans
Authors: Ring, Nicola A
Supervisor(s): Paley, John
Jepson, Ruth
Keywords: evidence based practice
asthma action plans
cross-study synthesis
systematic review
randomised controlled trials
Issue Date: 6-Feb-2013
Publisher: University of Stirling
Citation: Ring N, Malcolm C, Wyke S, MacGillivray S, Dixon D, Hoskins G, Pinnock H, Sheikh A. (2007) Promoting the use of Personal Asthma Action Plans: a systematic review. Primary Care Respiratory Journal 16(5):271-283.
Ring N., Pinnock H, Wilson C, Hoskins G, Jepson R, Wyke S, Sheikh A. (2011) Understanding what asthma plans mean: a linguistic analysis of terminology used in published texts. Primary Care Respiratory Journal 20(2) 170-177.
Ring N., P Jepson R, Hoskins G, Wilson C, Pinnock H, Sheikh A, Wyke S. (2011) Understanding what helps or hinders asthma action plan use: a systematic review and synthesis of the qualitative literature. Patient Education and Counselling 85(2) e131-e143.
Ring N, Jepson R, Ritchie K. (2011) Methods of synthesising qualitative research studies for health technology assessment. International Journal of Technology Assessment in Healthcare 27(4) 384-390.
Ring N, Jepson R, Pinnock H, Wilson C, Hoskins G, Wyke S, Sheikh A. (2012) Developing novel evidence-based interventions to promote asthma action plan use: a cross-study synthesis of evidence from randomised controlled trials and qualitative studies. Trials Nov 20;13: c216.
Abstract: Evidence-based practice is an integral part of multi-disciplinary healthcare, but its routine clinical implementation remains a challenge internationally. Written asthma action plans are an example of sub-optimal evidence-based practice because, despite being recommended, these plans are under-issued by health professionals and under-used by patients/carers. This thesis is a critical analysis of the generation and implementation of evidence in this area and provides fresh insight into this specific theory/practice gap. This submission brings together, in five published papers, a body of work conducted by the candidate. Findings report that known barriers to action plan use (such as a lack of practitioner time) are symptomatic of deeper and more complex underlying factors. In particular, over-reliance on knowledge derived from randomised controlled trials and their systematic review, as the primary and sole source of evidence for healthcare practice, hindered the implementation of these plans. A lack of evidence reflecting the personal experience of using these plans in the real world, rather than in trial settings, contributed to a mismatch between what patients/carers want from asthma action plans and what they are currently being provided with by professionals. This submission illustrates the benefits of utilising a broader range of knowledge as a basis for clinical practice. The presented papers report how new and innovative research methodologies (including meta-ethnography and cross-study synthesis) can be used to synthesise individual studies reporting the personal experiences of patients and professionals and how such findings can then be used to better understand why interventions can be implemented in trial settings rather than everyday practice. Whilst these emerging approaches have great potential to contribute to evidence-based practice by, for example, strengthening the ‘weight’ of experiential knowledge, there are methodological challenges which, whilst acknowledged, have yet to be fully addressed.
Type: Thesis or Dissertation
Affiliation: School of Nursing, Midwifery and Health

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Submitted thesis NRing 240513.pdfmain thesis (linking narrative for PhD by publication)805.32 kBAdobe PDFView/Open
Ring et al 2007.pdfPaper 1 Ring et al. 2007 PCRJ316.72 kBAdobe PDFUnder Embargo until 1/1/2099     Request a copy
Ring et al 2011 PCRJ.pdfRing et al 2011 PCRJ732.48 kBAdobe PDFUnder Embargo until 1/1/2099     Request a copy
Ring et al 2011 PEC v1.pdfRing et al 2011 PEC455.8 kBAdobe PDFUnder Embargo until 1/1/2099     Request a copy
Ring et al 2011 IJHTA.pdfRing et al 2011 IJHTA78.04 kBAdobe PDFUnder Embargo until 1/1/2099     Request a copy
Ring et al 2011 IJHTA Supplementary Table 1.pdfRing et al 2011 IJHTA supplementary file61.28 kBAdobe PDFUnder Embargo until 1/1/2999     Request a copy
Ring et al 2012 Trials.pdfRing et al 2012 Trials295.08 kBAdobe PDFUnder Embargo until 1/1/2999     Request a copy

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