This issue of Family & Community Health, 35.3, describes a range of interesting and useful programs that provide evidence about their effectiveness. Evidence-based practice (EBP) is a problem-solving approach for delivering health care that relies on well-designed studies, patient data and preferences, and the values and expertise of the person providing the care.1 "As a process, EBP requires a systematic series of activities to locate, critique, synthesize, translate, and evaluate evidence. As a product, EBP is the translation of evidence in an innovative practice change."2(p3) As the issue editors say in the Foreword, EBPs are increasingly important as we look at ways to provide quality, accessible, and affordable health care. Evidence-based practices aim to provide programs and practices that fit the needs of the patients and family members who receive them in a way that they can accept and benefit from. Evidence, as seen in Figure 2 of the Foreword, aims to help practitioners in a variety of health care fields improve the quality and effectiveness of the care and services that they deliver by basing that care on what is currently known, that is, the evidence that a program has been effective and could be effective for the population being served.
Since it seems intuitive and logical to base health care actions on known evidence, why do some people avoid doing so? Clearly, there are many reasons why people do not consistently use evidence to guide their practice. Let me start first by mentioning some of the skills that are typically associated with people who are eager adopters of EBP. Adopters of EBP tend to have a spirit of inquiry. They are curious to find a new and better way to provide care, and they generally work in an environment that supports curiosity and innovation.
Assuming that the health care professional or lay health worker has a spirit of inquiry and works in a setting that encourages trying new things based on evidence, what then gets in the way of consistent EBP? A big intervener is a lack of sufficient time to implement a new program or way of doing something. Sometimes we think it is easier to do what we are doing the old way rather than take the time to try a new approach. Other deterrents include insufficient numbers of staff, lack of resources, or staff members who lack the knowledge and skills or fear that they cannot learn what they must to practice in a new way.
What is needed to use EBP to provide "best practices" care? First, knowledge and skill, or the time, ability, and motivation to learn, are important components that support implementing EBP. Good mentors are essential to teach, coach, and support new learning.1 Managerial support for using EBPs is essential. The programs described in this issue reflect the way in which EBP was used in a variety of programs across the life span beginning with the Safe N' Sound program, which is a computer-based tool to identify priority risks for infants and children and tailor feedback to their caregivers, and including 3 articles that describe fall prevention programs for older adults. You will also read about an arthritis self-help program, a youth suicide prevention intervention, tobacco cessation for unionized workers, and hand washing teaching for school children in Ghana. You will learn from the authors what some of their challenges and success were and how they overcame barriers to implement their programs. Consider how you include EBP in your practice and what changes you can make to enable you to deliver even better informed care.
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