my first 5 sources, and specifically how they relate to and are usable in the context of my growing literature review project

What is your topic? Or what are your key words thus far?

Evidence-based practice
complexity
RCT
actor-network theory

What is your research question? Have you decided to change it at all? And, if you have, how do I know that the way in which this question is formulated is appropriate to conduct a literature review with a systematic approach? 

My research question is: What theories have practitioners in the field of public health turned to to think past the limits of evidence-based practice, and why? 

And what are the definitions on which it depends?

My question depends on four key terms, all of which are linked to the literature. Those terms are:

Evidence-based practice = *Note* this was written a a much later point in the research process. I am now starting to think that EBP might itself be a theory.
Theory = a basis or ground on which practitioners make decisions; whatever self-conscious, widely available rationale informs their decision-making processes
Practitioner = people who are not doing research and who are in the clinic or public health service field
Public health = I mean this very broadly. It has to be in the health field. But it has to affect a lot of regular people who come to the place or service for help. It has to have more than specialized effects. *Note* I actually ended up changing this definition. My definition now is much more knowledge-based. I define public health as those who have to translate expert health knowledge into lay knowledge and everyday practice. 

What is your hierarchy of evidence? And how do I know you going about finding the most appropriate evidence/method for your research question?

Because my question is two-pronged (interrogating both the theory and the practice side of things), I imagine my 10 articles to be a little of this, a little of that. I want some practice literature, to show me what kinds of decisions practitioners are making on the basis of new theories, but then I might also need some theories that anticipate the limitations of evidence-based practice (EPB), or even the concept of "evidence" in public health.  

Practice
Policy
Theory
Studies about the effectiveness of EBP--is an RCT for an EPB possible?
Expert opinion
Anecdote 

How do I know that the remit of the method itself is selecting the research, rather than just you on a whim? + 1 thing you found interesting + how you imagine using the source

Article #1 (commentary; secondary source)= 

Kemm, J. (2006). The limitations of 'evidence-based' practice. Journal of Evaluation in Clinical Practice, 12(3). 319-324. 

This article is directly relevant to my topic (evidence-based practice in the 21st century) and to my research question (see above), and I know this because one of its key word is EBP, and it relates to the idea of the limits of EBP, which is what my topic is on. Further, it has a section about the concept of evidence in the context of public health, which I would discussion possibly in my introduction. I could see this paper working in my introduction. But I could also see using it in the results section of the paper, especially with the idea of how the decision making process for health professionals is already complex, which is a key word of mine. What I found particularly interesting was the idea of the context of public health, and that there is something unique to it that bends or refracts knowledge coming into it from the domain of research. Plus, there's this knowledge transfer from research to public health practice to health promotion that I don't know anything about but will be on the look out for. 

Article #2 (commentary; secondary-source; lit review; argument) = 

Rosenstock, L. & Lee, L. J. (2002). Attacks on Science: the risks to evidence-based policy. American Journal of Public Health, 92(1), 14-18. 

 

 

This source is directly relevant to my research question, which is to seek out the dissatisfactions with evidence-based practice in the field of public health, which I have defined very broadly as relating to the way in which specialized, health-related knowledge is translated and re-contextualized into knowledge accessible by a lay audience who is has a need for that knowledge. The reason this source is directly related to my project is it discusses a great counterpoint to the article I just leafed through the other day and that's represented just above this in this post. Whereas the previous source discussed how a sole emphasis on evidence-based practice is tyrannical and discredits knowledges and opinions that might complexify scientific findings (knowledges of the people who are the consumers of public health discourse, probably), this source, here, discusses how evidence-based practice is a necessary corrective to biases related not merely to funding, but also to emotion (14), which I found particularly interesting. In the results section of my literature review, I could imagine using this source in the same paragraph with the other source in a point, counterpoint type of way, so that I could give my reader the opportunity to decide for herself what conclusion to come to. I also found interesting the way in which the word complexity seems to be used. Previously, it was used to point to the decision-making process of the practitioner (Kemm, 2006); now, however, it's used to show how the strategies to discredit sound scientific judgement are becoming ever more sophisticated (Rosenstock & Lee, 2002). 

 

Article #3 (commentary; non-systematic lit review with recommendation)= 

 

Victora, C. G., Habicht, J., & Brice, J. (2004) Evidence-based public health: moving beyond randomized trials. American Journal of Public Health, 94(3), 400-405.
This article is directly related to my project, which is on what the limitations of evidence-based public health are, and what practitioners or policy officials are doing to move past these limits in practice. I'm particularly interested in how decisions are made in public health, and on the basis of what evidence, what counts as evidence in a given situation, and how different situations changes what counts as evidence. This article mentions how RTCs have limited generalizability due to context. Or they are really good in terms of scientific soundness, but they have limited applicability to large-scale public health campaigns, such as telling mothers how to ideally breast feed their children. The authors suggest that we should augment RCT-like studies with observational studies in order to provide richer data that from which decisions can be made in unexpected contexts. I imagine using this study probably in the middle of the literature review, and probably in passing. It's interesting here how "complexity" is figured in terms of causality. RCTs measure causality of a short pathway and simple impact, whereas decisions in public health must be made with an eye to the massive gap between intervention and effect (402). 

Article #4 (argument; narrative literature review; dissatisfaction with policy)= 

Martin, C. M. & Sturmberg J. P. (2009). Perturbing ongoing conversations about systems and complexity in health services and systems. Journal of Evaluation in Clinical Practice, 15(3), 549-552. 

This article is directly related to my topic, despite that evidence-based practice isn't really overtly discussed in it. However, what is discussed is a dissatisfaction with RCTs as the gold standard on which to base practice decisions. This article takes issue with RCTs as the gold standard because they limit certain individuals from care a priori because they do not fit into the narrowly defined and deductive criteria of the RCT. In a way, what one could take from this article is organizations, for economic reasons, base their practice decisions on models of evidence that stem from the business world, from what makes sense now. But "now"--i.e., what is visible and immediately analyzable right at this second--is a linear and simple narrative, and not infrequently what gets excluded from consideration because of the narrowness of a RCT's delimitation of "what counts" as meaningful comes back into the system as an "unintended consequence" (passim). Likewise, thinking not deductively and economically but rather complexly and in accordance with doctors' altruistic social contract (p. 550), we need theoretical models that can incorporate complexity and not have to deal with narrow inclusion criteria that just end up having to discuss unintended consequences anyways. What I found interesting about this article was the example wherein, if we totally scrutinize a doctor's time so as to make sure that we've eliminated unnecessary "opportunity costs," we hamper rather than increase productivity. I'm starting to get the idea that one of the big problems with RCTs (and with evidence-based practice in general) is its inability to think the future because of its being tied to a deductive model that only incorporates certainty. Thus, I plan to use this source as advocating not only narrative but only also participatory action research in the place of EBP (p. 551). 

Article #5 (research; interview-based, qualitative)= 

Lenne, B. S. & Waldby C. (2011). Sorting out autism spectrum disorders: evidence-based medicine and the complexities of the clinical encounter. Health Sociology Review, 20(1), 70-83. Print.   

This article is directly related to my topic because it is about the limits of evidence-base practice in practice, and this article suggests that autism spectrum disorder (ASD) is something that introduces complexity into the conversation on evidence-based practice (EBP) because EBD is something that is difficult to identify in practice and, as the article argues, diagnosing autism requires tacit, experiential knowledge (70), or there is no basis on which autism can be circumscribed in advance, as autism can only be diagnosed in the moment of the clinical encounter: that is, in context and in that moment. As the article says, diagnosis is always a negotiation between the evidence, the practitioner with tacit, experiential knowledge, and the family. So, whereas EBP would seek to eliminate the negotiation and therefore the complexity from the diagnostic situation, these authors would seek to preserve the complexity, which is figured here in terms of family involvement and depth of clinical experiences.I plan on using this article as a way to show another competing point about what complexity means in context. In other words, in the results section of my review, one of the things I will do is show how differently complexity gets used in different articles written in different contexts and for different purposes. What I found interesting about this article is where they implied that statistics and EBP ought to be used critically; that is to say, practitioners ought not  "submit to the[se] tools," but rather should use these tools in such a way as to "mutually transform" practice (73). Ideally, then, the evidence on which EBP is based ought to be used by the practitioner with the family to transform the situation, which may or may not result in a diagnosis. 

Anything else interesting happen?

I might have to slightly modify my research question as: What are the limits of evidence-base practice in practice, and what theories do practitioners turn to to think past these limits?