Enhancing equity-oriented evidence-based practice in speech and language therapy

Background Evidence-based practice (EBP) is a commonly adopted framework for guiding health professionals’ clinical decision-making, urging the incorporation of scientific evidence, patient preferences and clinical expertise. There are many barriers to EBP, and the mainstream research processes underpinning it are not infallible. Notably, traditional approaches to EBP seldom apply an equity lens, which risks perpetuating harmful practices and inequities. Aims The primary aim of the thesis is to draw together seven prior publications and explicate their role in enhancing research processes, to facilitate EBP. Simultaneously, it aims to demonstrate how these enhancements can support an equity-oriented EBP. Methods Responding to research questions which connect the seven publications and guide this thesis, a grounded theory approach is applied to produce a critical synthesis. Collaborative research priority-setting projects and leveraging of routinely collected data are explored with regards to their capacity to facilitate EBP. Findings The grounded theory highlights that avenues for dialogue between EBP stakeholders may promote the production of meaningful (and equity-oriented) evidence more suited to transfer into practice. The seven studies present two such avenues: (1) co-producing research agendas with those with lived experience of a clinical need, to ensure clinical evidence gaps are filled and (2) leveraging practice-based, routinely collected data, to augment and supplement traditional research approaches, and optimise their relevance for practice. Discussion Systemically embedding dialogic pathways (including co-produced research priorities and use of routinely collected data) between EBP stakeholders is proposed to enhance research and facilitate EBP. This work highlights a new concept: Equity-oriented Dialogic Evidence-Based Praxis (ED-EBP). A radical shift in existing dynamics between researchers, practitioners and service users is required, to collaboratively create evidence that is equity-oriented, and suitable for practice. Further work is required to scrutinise how dialogic pathways can be embedded, and the challenges to doing so mitigated.