Evidence Strength and Quality

Sources of evidence may include published literature, guidelines, anecdotal stories from colleagues, information from a competitor, patient experiences, results from a local pilot, and other sources [1][2]. Though there is no agreed upon measure of “strong evidence”, there is empirical support of a positive association with dissemination [3]. Support for the role of evidence strength and quality in implementation is mixed, however [3]. Though strong evidence is important, it is not always dominant in individual decisions to adopt nor is it ever sufficient [4]. Evidence supporting the use of an intervention may come through external sources (e.g., peer reviewed literature) or internally from other sources that appear to be credible [2]. The PARiHS model lists three sources of evidence as being key for research uptake: research studies, clinical experience, and patient experience [1]. External and internal evidence, including experience through piloting (see Trialability), may be combined to build a case for implementing an intervention [2]. The more sources of evidence used, the more likely innovations will be taken up [5][6]. Credibility of the developers of evidence, transparency of the process used to develop (see Engaging), and intentionally mapping out the implementation (see Planning) to counterbalance negative and positive perceptions of the intervention by potential users are all important for effective implementation [7].