Using Evidence in Practice: Retrospective

In a landscape where it is now such a constant feature it seems mildly incongruous to record the first appearance of ‘evidence-based practice’ in Health Libraries Review (HLR). Nevertheless we do well to remember that this paradigm which has, to all intents and purposes, transformed the activities and profile of most of our readers has a significantly shorter ongoing lifespan than HLR/HILJ itself. Appropriately enough the first identified mention of evidence-based practice within these pages came from a Canadian health librarian, recently designated, ‘The Evidence-Based Practice Cheerleader’.1 In her 1994 editorial, Evidence-based practice: new opportunities for librarians, Margaret Haines threw down the gauntlet: ‘Are we too modest and content to play only a supporting role? If this is the case, then we are going to lose out on a golden opportunity to demonstrate just how important and relevant our particular information handling skills are ... If librarians are to survive, we must be more assertive about the value of our work.’2 Certainly over the ensuing decade-and–a-half we have seen the emergence of a profession that is more likely to shape, rather than simply to be moulded. Indeed the same issue of HLR (Volume 11, Issue 4, December 1994), featured the NHS R&D Information Systems Strategy,3 the driving force behind national funding for the UK Cochrane Centre and the NHS Centre for Reviews and Dissemination, themselves indispensable contributors to the health information specialists’ toolkit. Furthermore, this special 1994 issue contained invited submissions from Carol Lefebvre,4 Julie Glanville,5 Alison Warburton (now Brettle6) and Gill Needham7—all information professionals who have not only supported the evidence-based practice of other professions but who continue to create the evidence base for our own profession. These dual aspects to the theme of Evidence-Based Library and Information Practice, now the preferred term for our own variant, continue to be reflected in the pages of HILJ. A further contributor to the special 1994 issue, Judy Palmer,8 fittingly inaugurated the Research Column the following year and presided over that feature between 1995 and 1998 before taking on a wider mantle as Editor of HLR/HILJ. The baton for the Research Column passed firstly, for a brief tenure, to Jane Farmer and Dorothy Williams (1999–2000) and then to myself (2000–2002). At this point it became clear that having a single section entitled Research was perverse in a journal seeking to promote a research informed profession and, indeed, increasingly populated with examples of research outputs. At the instigation of incoming Editor, Graham Walton, the column was renamed Using Research In Practice in 2003 and finally Using Evidence in Practice (2007-onwards). Of course research had figured in the pages of HLR long before popularization of the evidence-based practice label. Indeed the first article identified as ‘research’, published in HLR's second year, was a survey of use of Withington Hospital Medical Library.9 Several features of this particular article are significant. First this was research conducted as a Masters’ student project by a sole author. It is therefore indicative of constraints that continue to face the practitioner-researcher in a health information context. Second, notwithstanding a tendency for the so-called ‘hierarchy of evidence’ to promote an unintended snobbery regarding certain types of research, we should acknowledge the contribution of the widest variety of research investigations to our day-to-day practice. Fundamentally as a profession we are pragmatic, principally because we have to be so! This is not to say that HLR/HILJ has not offered access to higher forms of evidence. Highly cited among its outputs are a plethora of systematic reviews covering such topics as information skills training,10 barriers to e-learning11 and reflective practice.12 It is particularly noticeable that systematic reviews are most typically a collaborative enterprise involving multiple partners and multiple professions. One methodological contribution from 1999, for example, involved 10 different collaborators from a wide range of professional backgrounds.13 Unsurprisingly there are also several articles examining the role of information specialists in supporting the systematic review process14–16 while a distinctive feature of HLR/HILJ has been a steady stream of research into methodological filters, either to facilitate systematic reviews or to help in focusing the quest for evidence.17–19 If systematic reviews, with their emphasis on identification, retrieval and evaluation of the published and unpublished literature, are an obvious research method for inclusion in HILJ it is pleasing to see a smattering of other types of research design. A mixed-methods study of information skills training and mediated searching yields a separately published qualitative study although it is perhaps surprising to find so few examples of rigorously conducted qualitative research.20 Solitary, too, among the research outputs from HLR/HILJ is an isolated example of a randomised controlled trial.21 This ongoing absence of RCTs is despite a call to arms (experimental and control!) from international expert, Jonathan Eldredge, also showcased in HILJ.22 The last two above-mentioned articles appeared in a special supplement on Evidence-based Health Information Practice (Volume 20, Supplement 1, June 2003), coedited by Jonathan Eldredge and myself, itself as much a product of the zeitgeist as the Evidence-based Practice supplement a decade earlier. Again Judy Palmer had been an early commentator on the potential for evidence-based practice for our profession. Writing in her 1996 column she commented: ‘Perhaps the stubborn adherence to time-honoured practice is less obviously damaging in, for instance, engineering or in information, but it is no more commendable. In an earlier issue of this Journal I suggested that information professionals in the health sector might learn from what was happening around them and start to critically examine their own practice. In this column we see some indication that this is beginning to happen.’23 Judy Palmer's successors to the Research feature were the first to use the actual phrase ‘evidence-based librarianship’ in the pages of HLR/HILJ24 and, since then, there has been an ongoing pre-occupation with research priorities for our particular sector,25–27 wherein evidence-based librarianship receives frequent allusion. Foremost among research priorities, however, there must be evidence that we, as practitioners, can use to establish the value and impact of the services we provide and it is no surprise to see a systematic review on this topic as HILJ's current most cited article.28 Lest we forget our pragmatic roots, however, second on the most cited list is an Australian study of database use by occupational therapists29 while third is a Using Research in Practice feature.30 So where does this retrospect leave us? First, as the preferred vehicle for our own profession's research, HILJ continues to provide a mirror on trends within health research as a whole, away from the lone practitioner-researcher towards multidisciplinary teams of methodological specialists. Second, it highlights a tension that, notwithstanding commentators such as Palmer (quoting Stephen Wibberley) observing that: ‘unless a significant number of practitioners do research, our field will become so weak that it will lose its standing in universities and we will lose understanding of what we do. Then none of us will be able to do our jobs well!’31 We may have to conclude that research no longer remains the province of the multi-hat wearing practitioner. Resolution seems to lie in ensuring the ongoing relevance of research questions to the needs of information practitioners and in facilitating the implementation of evidence into practice. AB has declared no conflicts.

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