Practice-Based Evidence and Qualitative Inquiry
Purpose: Nurses and other healthcare providers continue to underuse interventions demonstrated to be effective at improving health outcomes. We propose in this article that if more evidence-based practice is wanted, greater use must be made of qualitative inquiry to obtain practice-based evidence derived from the experiences and practices of healthcare providers and the contexts of healthcare provision.
Approach: We present a framework for the use of qualitative methods to contribute to the following categories of practice-based evidence: (a) practice-based interventions and implementation strategies, (b) causal mechanisms, (c) approaches to adaptation, (d) how-to guidance, (e) unanticipated effects, and (f) relevant contextual factors.
Conclusions: Qualitative inquiry has an essential role to play in incorporating more practice-based evidence into the evidence base for nursing practice.
Clinical Relevance: This framework can be used by clinicians to plan for the implementation of interventions in practice, by researchers to discuss the practice implications of their findings, and by researchers to launch qualitative studies explicitly designed to capture practice-based evidence.
2008). Translating and disseminating research- and practice-based criteria to support evidence-based intervention planning.
Journal of Public Health Management & Practice, 14(2), 124–130.
2009). Rehabilitation nurses’ practices in relation to urinary incontinence following stroke: A cross-cultural comparison.
Journal of Clinical Nursing, 18(7), 1049–1058.
2009). Dissemination research in cancer control: Where are we and where should we go
Cancer Causes Control, 20(4), 473–485.
2001). A qualitative study of increasing beta-blocker use after myocardial infarction.
JAMA, 285(20), 2604–2611.
2004). Translating research into clinical practice: Making change happen.
Journal of the American Geriatric Society, 52(11), 1875–1882.
2011). Improving cancer control in Canada one case at a time: The “Knowledge Translation in Cancer” casebook.
Current Oncology, 18(2), 76–83.
2009). Bridging the gap: Translating research into policy and practice.
Preventive Medicine, 49(4), 313–315.
2010). Issues and challenges in the design of culturally adapted evidence-based interventions.
Annual Review of Clinical Psychology, 6, 213–239.
Center for Training and Research Translation. (2011). Faithful families eating smart moving more.
2008). Translational research: Essential contributions from interpretive nursing science.
Research in Nursing & Health, 31(4), 381–390.
2008). Searching for the intervention in intervention research reports.
Journal of Nursing Scholarship, 40(1), 52–59.
2008). A new evaluation tool to obtain practice-based evidence of worksite health promotion programs.
Preventing Chronic Disease, 5(4), A118.
2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation.
American Journal of Community Psychology, 41(3–4), 327–350.
2008). What types of evidence are most needed to advance behavioral medicine
Annals of Behavioral Medicine, 35(1), 19–25.
2007). How can we increase translation of research into practice? Types of evidence needed.
Annual Review of Public Health, 28, 413–433.
2011). Still too little qualitative research to shed light on results from reviews of effectiveness trials: A case study of a Cochrane review on the use of lay health workers.
Implementation Science, 6(53). Retrieved from
2001). From research to “best practices” in other settings and populations.
American Journal of Health Behavior, 25(3), 165–178.
2008). Making research relevant: If it is an evidence-based practice, where's the practice-based evidence?
Family Practice, 25(Suppl. 1), i20–24.
2004). From efficacy to effectiveness to community and back: Evidence-based practice vs. practice-based evidence. Paper presented at From Clinical Trials to Community: The Science of Translating Diabetes and Obesity Research,
, January 12–13, 2004, Maryland.
2006). Qualitative health research in the era of evidence-based practice.
Qualitative Health Research, 16(10), 1371–1385.
2004). Complex interventions: How “out of control” can a randomised controlled trial be?
British Medical Journal, 328, 1561–1563.
2010). Why do interventions work in some places and not others: A breastfeeding support group trial.
Social Science & Medicine, 70(5), 769–778.
Institute of Medicine. (2010). Bridging the evidence gap in obesity prevention: A framework to inform decision making.
: The National Academies Press.
2010). The contribution of qualitative research to the development of tailor-made community-based interventions in primary care: A review.
European Journal of Public Health, 20(2), 220–226.
2011). The nurse's medication day.
Qualitative Health Research, 21(10), 1441–1451.
2011). A proposal to speed translation of healthcare research into practice: Dramatic change is needed. American
Journal of Preventive Medicine, 40(6), 637–644.
2009). Recommended community strategies and measurements to prevent obesity in the United States.
Morbidity & Mortality Weekly Reports, 58(RR-7), 1–26.
2008). Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety.
Journal of the American Medical Informatics Association, 15(4), 408–423.
2010). Understanding the challenges encountered and adaptations made by community organizations in translation of evidence-based behavior change physical activity interventions: A qualitative study.
American Journal Health Promotion, 24(6), 427–434.
2007). Developing a theory-based taxonomy of methods for implementing change in practice.
Journal of Advanced Nursing, 58(2), 191–200.
2010). Implementation of antiretroviral therapy adherence interventions: A realist synthesis of evidence.
Journal of Advanced Nursing, 66, 1915–1930.
2010). Evaluability assessment to improve public health policies, programs, and practices.
Annual Review of Public Health, 31, 213–233.
2002). Qualitative researching ( 2nd ed.).
2012). A realist approach for qualitative research.
2007). From evidence-based practice making to practice-based evidence making: Creating communities of (research) and practice.
Health Promotion Practice, 8(2), 140–144.
2006). Adapting evidence-based behavioral interventions to new settings and target populations.
AIDS Education and Prevention, 18, 59–73.
National Institutes of Health. (2009). Dissemination and implementation research in health. Retrieved from
2007). A qualitative study of programs for parents with serious mental illness and their children: Building practice-based evidence.
Journal of Behavioral Health Services Research, 34(4), 395–413.
North Carolina Prevention Partners. (2012). Workhealthy America. Retrieved from
2003). Evidence, hierarchies, and typologies: Horses for courses.
Journal of Epidemiology & Community Health, 57, 527–529.
2003). Diffusion of innovations.
: Free Press.
2004). Using qualitative research.
Qualitative Health Research, 14(10), 1366–1386.
2006). Role of the HIV/AIDS case manager: Analysis of a case management adherence training and coordination program in North Carolina.
AIDS Patient Care and STDs, 20(3), 193–204.
2006). Role of “external facilitation” in implementation of research findings: A qualitative evaluation of facilitation experiences in the Veterans Health Administration.
Implementation Science, 1(23). Retrieved from
2006). The Quality Chasm reports, evidence-based practice, and nursing's response to improve healthcare.
Nursing Outlook, 54(2), 94–101.
2011). Use of qualitative methods in published health services and management research: A 10-year review.
Medical Care Research and Review, 68(1), 3–33.