Evidence-based practice and its many competing priorities: a qualitative analysis of substance misuse workers in English third-sector addiction treatment services

Background

Since 2012, addiction treatment in England has been increasingly been delivered by third-sector organisations. Third-sector organisations are run on not-for-profit principles, are distinct from publicly run NHS services and employ both professional and non-professional staff. There is little research that explores how and whether third-sector addiction treatment services in England deliver EBP. There are also few studies that identify the working contexts of third-sector substance misuse workers (SMW), along with their perceived barriers and facilitators to delivering EBP.

Methods

The research was based on principles of user-centred design and identified the needs, perspectives and working contexts of SMW. SMW working in five third-sector organisations in England were recruited using an e-mail invitation sent from their employer. Key stakeholders (KSH) were also recruited whilst liaising with treatment provider organisations. Semi-structured interviews were conducted and covered themes of work-based education and training, use of research and EBP, use of online resources, and working contexts relevant to the delivery of EBP. Data were analysed using iterative categorisation.

Results

31 SMW and 14 KSH were interviewed. Barriers to accessing and implementing research and EBPs included a lack of available time, difficulty accessing EBP resources, difficulty assessing the quality of research and uncertainty about how to implement research findings. Conflicting work priorities that diminished the time available to deliver EBP included administrative tasks, high caseloads, regulatory compliance and data management tasks. Many SMW participants viewed a positive therapeutic relationship to be more important than the delivery of EBP, diminishing the importance placed on research findings. SMW participants sought for treatment related information using Google and by consulting colleagues who were perceived to have specialist knowledge. Published treatment manuals and guidelines such as the Orange Clinical Guidelines were well known but rarely used. KSH discussed incorporating research and EBP into policies and procedures but identified a lack of business incentives for ensuring EBP were delivered. Both KSH and SMW said that research findings often did not meet the immediate clinical needs of SMW.

Conclusions

In English third-sector organisations there remains ambivalence about the benefits of delivering EBP. SMW who do value EBP often struggle to find, interpret and implement them. Delivery of EBP is often considered by SMW to be less important than completing administrative, risk management and regulatory compliance tasks. EBP is also seen as less important than developing a good therapeutic relationship. Future research should consider these competing priorities when disseminating EBPs so that the potential for their delivery can be optimised. Training that improves the perceived importance of using EBP among SMW will aid its dissemination and implementation.