JMIR Publications

ABSTRACT

Background:

Evidence-based practice refers to building clinical decisions on credible research evidence, besides relying on professional experience and judgement. However, there is a growing concern that evidence in the context of eHealth is not sufficiently used when forming policies and practice of healthcare. In this context, evaluation and its instrumental use in clinical decision or policy making dominate the discourse. However, there are additional types of evidence, such as professional experience and existing research, and more ways to use the evidence than the instrumental use.

Objective:

To analyze how different types of evidence, generated through the development and evaluation of an eHealth intervention, are used by diverse stakeholders. An additional aim is to identify ways to increase the value of the evidence in order to support its use.

Methods:

This study is built on a case of the multi-national and interdisciplinary eHealth intervention funded by the European Union. Four care centers, two research and development companies that provided the eHealth solutions, and two science institutions took part in the project. The qualitative data collection includes nine semi-structured interviews conducted eight months after the evaluation was concluded. The data analysis concerned (1) the types of activities and decisions that were made based on evidence after the project ended, (2) the types of evidence used for those activities and decisions, (3) in what way the evidence was used, (4) the barriers for the use of evidence from the intervention.

Results:

Evidence generated from eHealth interventions can be used by various stakeholders for clinical implementations, policymaking, scientific publishing and dissemination, research funding applications, eHealth product and service improvement, and teaching. Evaluation evidence can have low instrumental value for decision-makers when deciding to implement an eHealth intervention or not. Learning whether and how an eHealth solution could fit in a local context provides key information for local decision making. When designing and evaluating eHealth interventions, it is suggested to create possibilities for healthcare professionals to gain experience, assess a few rather than including a large number of variables, and design for shorter iterative cycles of evaluation. Research evidence relevant to the intervention and found in other contexts can be problematic to translate directly for making decisions, although it has value for scientific dissemination.

Conclusions:

The delimited focus of research on the decision making for eHealth implementations in the clinical settings or policymaking does not capture the actual realities of evidence use. In order to achieve a better uptake of evidence in practice, scientific and practical discussions around the evidence-based practice in the context of eHealth should include different sorts of evidence and options of use, and to consider that various stakeholders benefit from the evidence differently.