Using non-participant observation as a method to understand implementation context in evidence-based practice

Background. The uptake of evidence-based knowledge in practice is influenced by context. Observations are suggested as a valuable, but under-used approach in implementation research for gaining a holistic understanding of contexts. The aim of this paper is to demonstrate how data from observations can provide insights about context and evidence use in implementation research. Methods. Data were collected over 24 months in a randomised trial with an embedded realist evaluation in 24 nursing homes across 4 European countries; notes from 183 observations (representing 335 hours) were triangulated with interview transcripts and context survey data (from 357 staff interviews, and 725 questionnaire responses, respectively). Results. While there were similarities in several elements of context within survey, interview and observation data, the observations provided additional features of the implementation context. In particular, observations demonstrated if and how the resources (staffing and supplies), leadership (formal and informal, teamwork and professional autonomy) affected knowledge use and implementation. Further, the observations illuminated the influence of standards and the physical nursing environment on evidence-based practice, and the dynamic interaction between different aspects of context. Linking evidence to action. Although qualitative observations are resource intensive, they add value when used with other data collection methods: further enlightening the understanding of the implementation context, and to how evidence use and sharing is influenced by context elements. Observations can enhance an understanding of the context, evidence use, and knowledge sharing triad in implementation research.