‘There’s a dance to be had’ - The interface between UK chiropractors and evidence-based practice. A Reflexive Thematic Analysis

Abstract

Background: Surveys of health care practitioners’ including chiropractors’ attitudes beliefs and knowledge about evidence-based practice (EBP) make assumptions about the understanding of the term. They regularly assume that this paradigm is solely concerned with quantitative research. Furthermore, much of the work in this sphere has taken place outside of the UK. A good understanding of the relationship with evidence-based practice is lacking in the British chiropractic profession.

Methods: As an exploratory question, an inductive research strategy was used. This employed observations of a criterion selected sample of 20 UK chiropractors in the southwest, followed by semi-structured interviews. The data was transcribed by the author and coded using NVivo software. It was subsequently analysed using reflexive thematic analysis.

Results: Four themes were developed from the data; ‘The otherness of EBP’, ‘There’s a dance to be had: performance and EBP’, ‘An incongruence of thought’ and ‘An imbalance of practice knowledge’. These participants found EBP difficult to define. They had an incongruent relationship with the concept, claiming that it was important for the profession but not necessary for practice. An observation was made linking more rigid examination and treatment rituals with a lower regard for the tenets of EBP. These participants maintained that results were more important to their decision making than practice knowledge from other sources.

Discussion: Using a taxonomy of practice knowledge developed by Joy Higgs and Angie Titchen, the incomplete and unresolved conception of EBP was explored. Practice knowledge from practical experience and personal judgement featured heavily in the data. Comments around the unsuitability and unfamiliarity of propositional knowledge balanced claims that ‘results’ were more important when informing decision making. A model showing the relationship between the different aspects of practice-based knowledge, EBP, clinical reasoning and reflection was presented as a way of increasing chiropractors’ relationship with EBP and resolving some of the contentions they feel.

Date of Award	28 Jun 2023
Original language	English
Awarding Institution	University of Bath
Supervisor	David Wainwright (Supervisor) & Simon Igo (Supervisor)