Barriers and enablers to evidence implementation in Australian complementary medicine practice: a cross-sectional study
-
Matthew J. Leach
Abstract
Objectives
Despite the strong impetus for complementary and integrative medicine (CIM) clinicians to engage with research evidence, the enablers and barriers to evidence implementation for most CIM disciplines remain poorly understood. Identifying these determinants represents a critical first step to facilitating the uptake of research evidence in CIM practice, which this study aimed to examine.
Methods
This cross-sectional study set-out to examine the enablers and barriers to evidence implementation across nine Australian CIM disciplines. Participants were invited to complete the 84-item online Evidence-Based practice Attitude and utilization Survey (EBASE).
Results
Two-hundred-and-three CIM practitioners completed the survey (78 % female; 65 % aged 40–59 years). CIM practitioner engagement in evidence implementation was at a low-moderate level. Attitude did not pose as a barrier, with most practitioners reporting a predominantly positive attitude toward evidence implementation. Similarly, education was not a major barrier, with most practitioners self-reporting a moderately-high skill level across 13 evidence implementation-related activities. The only factors largely reported as moderate or major barriers to evidence implementation were lack of clinical evidence in CIM, and lack of time.
Conclusions
This study offers important insights into the barriers and enablers of evidence implementation within CIM disciplines. While practitioners generally held positive attitudes toward EI, utilisation of evidence-based practices remained low, with structural challenges (i.e. evidence and time) the prevailing issue of concern. Potential solutions, such as decision-support systems and targeted education initiatives, warrant further investigation to ensure their feasibility and effectiveness in enhancing evidence-based practice, improving healthcare efficiency, and optimising patient outcomes in CIM.
Acknowledgments
We would like to acknowledge the Australian complementary and integrative medicine practitioners who completed the survey, and the numerous professional associations and product companies that promoted the study to their members and clients; all of whom made this research possible.
-
Research ethics: The study was reviewed and approved by the University of South Australia Human Research Ethics Committee [App. ID. 202745].
-
Informed consent: Completion of the online survey implied consent to participate.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Use of Large Language Models, AI and Machine Learning Tools: None declared.
-
Conflict of interest: The authors declare no conflicts of interest.
-
Research funding: The authors received no specific funding for this research.
-
Data availability: Data are available within the article.
References
1. Morris, ZS, Wooding, S, Grant, J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med 2011;104:510–20. https://doi.org/10.1258/jrsm.2011.110180.Suche in Google Scholar PubMed PubMed Central
2. Balas, EA, Boren, SA. Managing clinical knowledge for health care improvement. Yearb Med Inform 2000;9:65–70. https://doi.org/10.1055/s-0038-1637943.Suche in Google Scholar
3. Bauer, MS, Damschroder, L, Hagedorn, H, Smith, J, Kilbourne, AM. An introduction to implementation science for the non-specialist. BMC Psychol 2015;3:32. https://doi.org/10.1186/s40359-015-0089-9.Suche in Google Scholar PubMed PubMed Central
4. Leach, MJ, Tucker, B. Current understandings of the research-practice gap from the viewpoint of complementary medicine academics: a mixed method investigation. Explore 2017;13:53–61. https://doi.org/10.1016/j.explore.2016.10.005.Suche in Google Scholar PubMed
5. Eccles, MP, Mittman, BS. Welcome to implementation science. Implement Sci 2006;1:1. https://doi.org/10.1186/1748-5908-1-1.Suche in Google Scholar
6. Titler, MG. The evidence for evidence-based practice implementation. In: Hughes, RG, editor. Patient safety and quality: an evidence-based handbook for nurses (Chapter 7). Rockville: Agency for Healthcare Research and Quality; 200.Suche in Google Scholar
7. Smith, SMS. Implementation of evidence into practice: the key to improving patient outcomes. Respirology 2019;24:1046–8. https://doi.org/10.1111/resp.13632.Suche in Google Scholar PubMed
8. Leach, MJ, Veziari, Y. Enablers and barriers to evidence implementation in complementary medicine: a systematic review. Integr Med Re 2022;11:100899. https://doi.org/10.1016/j.imr.2022.100899.Suche in Google Scholar PubMed PubMed Central
9. Goorts, K, Dizon, J, Milanese, S. The effectiveness of implementation strategies for promoting evidence informed interventions in allied healthcare: a systematic review. BMC Health Serv Res 2021;21:241. https://doi.org/10.1186/s12913-021-06190-0.Suche in Google Scholar PubMed PubMed Central
10. Roberts, NA, Young, AM, Duff, J. Using implementation science in nursing research. Semin Oncol Nurs 2023;39:151399. https://doi.org/10.1016/j.soncn.2023.151399.Suche in Google Scholar PubMed
11. Jylhä, V, Oikarainen, A, Perälä, ML, Holopainen, A. Facilitating evidence-based practice in nursing and midwifery in the WHO European Region. Copenhagen: World Health Organization; 2017.Suche in Google Scholar
12. Leach, MJ, Foley, H. Evidence implementation among complementary medicine practitioners: a meta-summary. J Compl Integr Med 2022;19:499–511. https://doi.org/10.1515/jcim-2022-0234.Suche in Google Scholar PubMed
13. Taylor, M, Hill, S. Consumer expectations and healthcare in Australia [White paper]. Deakin, Australian Capital Territory: Deeble Institute for Health Policy Research; 2014.Suche in Google Scholar
14. Clark, D, Edwards, E, Murray, P, Langevin, H. Implementation science methodologies for complementary and integrative health research. J Alternative Compl Med 2021;27:S7–13. https://doi.org/10.1089/acm.2020.0446.Suche in Google Scholar PubMed PubMed Central
15. Alcantara, J, Leach, MJ. Chiropractic attitudes and utilization of evidence-based practice: the use of the EBASE questionnaire. Explore 2015;11:367–76. https://doi.org/10.1016/j.explore.2015.06.002.Suche in Google Scholar PubMed
16. Alvarez, G, Justribo, C, Sundberg, T, Thomson, OP, Leach, MJ. A national cross-sectional survey of the attitudes, skills and use of evidence-based practice amongst Spanish osteopaths. BMC Health Serv Res 2021;2. Article 130.10.21203/rs.3.rs-107863/v1Suche in Google Scholar
17. Leach, MJ. Implementation science in New Zealand naturopathic practice: a cross-sectional study. J Compl Integr Med 2021;19:781–90. https://doi.org/10.1515/jcim-2021-0508.Suche in Google Scholar PubMed
18. von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gøtzsche, PC, Vandenbroucke, JP, et al.. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007;335:806–8. https://doi.org/10.1136/bmj.39335.541782.ad.Suche in Google Scholar PubMed PubMed Central
19. Leach, MJ. Profile of the complementary and alternative medicine workforce across Australia, New Zealand, Canada, United States and United Kingdom. Compl Ther Med 2013;21:364–78. https://doi.org/10.1016/j.ctim.2013.04.004.Suche in Google Scholar PubMed
20. Bussieres, AE, Terhorst, L, Leach, MJ, Stuber, KJ, Evans, R, Schneider, MJ. Self-reported attitudes, skills and use of evidence-based practice among Canadian doctors of chiropractic: a national survey. J Can Chiropr Assoc 2015;59:332–48.Suche in Google Scholar
21. Leach, MJ, Gillham, D. Are complementary medicine practitioners implementing evidence based practice? Complement. Ther Med 2011;19:128–36. https://doi.org/10.1016/j.ctim.2011.04.002.Suche in Google Scholar PubMed
22. Leach, MJ, Sundberg, T, Fryer, G, Austin, P, Thomson, OP, Adams, J. An investigation of Australian osteopaths’ attitudes, skills and utilisation of evidence-based practice: a national cross-sectional survey. BMC Health Serv Res 2019;19:498. https://doi.org/10.1186/s12913-019-4329-1.Suche in Google Scholar PubMed PubMed Central
23. Leach, MJ, Shaw, R, Austin, P, Fryer, G, Thomson, OP, Adams, J, et al.. Attitudes, skills, and use of evidence-based practice: a cross-sectional survey of Swedish osteopaths. Int J Osteopath Med 2020;38:41–9. https://doi.org/10.1016/j.ijosm.2020.10.006.Suche in Google Scholar
24. Leach, MJ, Palmgren, PJ, Thomson, OP, Fryer, G, Eklund, A, Lilje, S, et al.. Skills, attitudes and uptake of evidence-based practice: a cross-sectional study of chiropractors in the Swedish chiropractic Association. Chiropr Man Ther 2021;29. Article 2. https://doi.org/10.1186/s12998-020-00359-w.Suche in Google Scholar PubMed PubMed Central
25. Schneider, MJ, Evans, R, Haas, M, Leach, M, Hawk, C, Long, C, et al.. US chiropractors’ attitudes, skills and use of evidence-based practice: a cross-sectional national survey. Chiropr Man Ther 2015;23:16. https://doi.org/10.1186/s12998-015-0060-0.Suche in Google Scholar PubMed PubMed Central
26. Snow, JE, Leach, MJ, Clare, BA. Attitudes, skill and use of evidence-based practice among US Western herbal medicine providers: a national survey. J Compl Integr Med 2017;14: np. https://doi.org/10.1515/jcim-2015-0101.Suche in Google Scholar PubMed
27. Sullivan, M, Leach, M, Snow, J, Moonaz, S. Understanding North American yoga therapists’ attitudes, skills and use of evidence-based practice: a cross-national survey. Compl Ther Med 2017;32:11–8. https://doi.org/10.1016/j.ctim.2017.03.005.Suche in Google Scholar PubMed
28. Sundberg, T, Leach, MJ, Thomson, OP, Austin, P, Fryer, G, Adams, J. Attitudes, skills and use of evidence-based practice among UK osteopaths: a national cross-sectional survey. BMC Muscoskelet Disord 2018;19:439. https://doi.org/10.1186/s12891-018-2354-6.Suche in Google Scholar PubMed PubMed Central
29. Leach, MJ, Gillham, D. Evaluation of the evidence-based practice attitude and utilization SurvEy for complementary and alternative medicine practitioners. J Eval Clin Pract 2008;14:792–8. https://doi.org/10.1111/j.1365-2753.2008.01046.x.Suche in Google Scholar PubMed
30. Terhorst, L, Leach, M, Bussières, A, Evans, R, Schneider, MJ. Evaluating the psychometric properties of the evidence-based practice attitude and utilization survey. J Altern Compl Med 2016;22:328–35. https://doi.org/10.1089/acm.2015.0221.Suche in Google Scholar PubMed PubMed Central
31. Konstan, JA, Rosser, BRS, Ross, MW, Stanton, J, Edwards, WM. The story of subject naught: a cautionary but optimistic tale of internet survey research. J Comput Mediat Commun 2005;10:00.10.1111/j.1083-6101.2005.tb00248.xSuche in Google Scholar
32. Cohen, J. Statistical power analyses for the social sciences. New Jersey: Lawrence Erlbauni Associates; 1988.Suche in Google Scholar
33. McArthur, C, Bai, Y, Hewston, P, Giangregorio, L, Straus, S, Papaioannou, A. Barriers and facilitators to implementing evidence-based guidelines in long-term care: a qualitative evidence synthesis. Implement Sci 2021;16:70. https://doi.org/10.1186/s13012-021-01140-0.Suche in Google Scholar PubMed PubMed Central
34. Harding, KE, Porter, J, Horne-Thompson, A, Donley, E, Taylor, NF. Not enough time or a low priority? Barriers to evidence-based practice for allied health clinicians. J Continuing Educ Health Prof 2014;34:224–31. https://doi.org/10.1002/chp.21255.Suche in Google Scholar PubMed
35. Leach, MJ, Tucker, B. Current understandings of the research-practice gap in nursing: a mixed-methods study. Collegian 2017;25:171–9. https://doi.org/10.1016/j.colegn.2017.04.008.Suche in Google Scholar
36. Grimshaw, JM, Shirran, L, Thomas, R, Mowatt, G, Fraser, C, Bero, L, et al.. Changing provider behavior: an overview of systematic reviews of interventions. Med Care 2001;39:II2–45. https://doi.org/10.1097/00005650-200108002-00002.Suche in Google Scholar
37. South, A, Bailey, JV, Parmar, MKB, Vale, CL. The effectiveness of interventions to disseminate the results of non-commercial randomised clinical trials to healthcare professionals: a systematic review. Implement Sci 2024;19:8. https://doi.org/10.1186/s13012-023-01332-w.Suche in Google Scholar PubMed PubMed Central
38. Sutton, RT, Pincock, D, Baumgart, DC, Sadowski, DC, Fedorak, RN, Kroeker, KI. An overview of clinical decision support systems: benefits, risks, and strategies for success. npj Digit Med 2020;3:17. https://doi.org/10.1038/s41746-020-0221-y.Suche in Google Scholar PubMed PubMed Central
39. Ayoubian, A, Nasiripour, AA, Tabibi, SJ, Bahadori, M. Evaluation of facilitators and barriers to implementing evidence-based practice in the health services: a systematic review. Galen Med J 2020;9:e1645. https://doi.org/10.31661/gmj.v9i0.1645.Suche in Google Scholar PubMed PubMed Central
40. Pereira, VC, Silva, SN, Carvalho, VKS, Zanghelini, F, Barreto, JOM. Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews. Health Res Pol Syst 2022;20:13. https://doi.org/10.1186/s12961-022-00815-4.Suche in Google Scholar PubMed PubMed Central
41. Black, AT, Balneaves, LG, Garossino, C, Puyat, JH, Qian, H. Promoting evidence-based practice through a research training program for point-of-care clinicians. J Nurs Adm 2015;45:14–20. https://doi.org/10.1097/nna.0000000000000151.Suche in Google Scholar
42. Leach, MJ, Hofmeyer, A, Bobridge, A. The impact of research education on student nurse attitude, skill and uptake of evidence-based practice: a descriptive longitudinal survey. J Clin Nurs 2016;25:194–203. https://doi.org/10.1111/jocn.13103.Suche in Google Scholar PubMed
43. Schneider, M, Evans, R, Haas, M, Leach, M, Delagran, L, Hawk, C, et al.. The effectiveness and feasibility of an online educational program for improving evidence-based practice literacy: an exploratory randomized study of US chiropractors. Chiropr Man Ther 2016;24:27. https://doi.org/10.1186/s12998-016-0109-8.Suche in Google Scholar PubMed PubMed Central
44. Portela Dos Santos, O, Melly, P, Hilfiker, R, Giacomino, K, Perruchoud, E, Verloo, H, et al.. Effectiveness of educational interventions to increase skills in evidence-based practice among nurses: the EDITcare systematic review. Healthcare 2022;10:2204. https://doi.org/10.3390/healthcare10112204.Suche in Google Scholar PubMed PubMed Central
45. Vaajoki, A, Kvist, T, Kulmala, M, Tervo-Heikkinen, T. Systematic education has a positive impact on nurses’ evidence-based practice: intervention study results. Nurse Educ Today 2023;120:105597. https://doi.org/10.1016/j.nedt.2022.105597.Suche in Google Scholar PubMed
46. Naturopaths & Herbalists Association of Australia. Participate in the APREECOM project [online]. https://nhaa.org.au/participate-in-the-national-centre-for-naturopathic-medicine-apreecom-project/[Accessed 11 Feb 2025].Suche in Google Scholar
47. Australian Bureau of Statistics. Census of population and housing 2021, TableBuilder [Online]. https://www.abs.gov.au/statistics/microdata-tablebuilder/tablebuilder [Accessed 7 Feb 2025].Suche in Google Scholar
48. Althubaiti, A. Information bias in health research: definition, pitfalls, and adjustment methods. J Multidiscip Healthc 2016;9:211–7. https://doi.org/10.2147/jmdh.s104807.Suche in Google Scholar
© 2025 Walter de Gruyter GmbH, Berlin/Boston
