Barriers and Facilitators of Evidence-Based Practice in Pediatric Behavioral Sleep Care: Qualitative Analysis of the Perspectives of Health Professionals

Abstract

Behavioral sleep problems are highly prevalent among young and school-aged children. Despite strong evidence for effective interventions, few children receive evidence-based care. In this study, 124 Canadian health professionals answered open-ended questions regarding barriers and facilitators of their provision of evidence-based behavioral sleep-related care, and responses were analyzed for content. Responses represented issues at an individual practice level, as well as broader systemic issues. The most frequently reported barrier and facilitator related to knowledge, training, and education. Other barriers included lack of time and institutional support, and facilitators included supportive sleep attitudes and beliefs. This study may inform the design of education programs for health professionals, and provides support for broader systems-level initiatives targeted at increasing evidence-based practice.

Core Competencies for Health Professionals' Training in Pediatric Behavioral Sleep Care: A Delphi Study

“…This is a unique contribution to the field. Such a resource for structuring education for health professionals is clearly needed, as a lack of education and training in pediatric behavioral sleep problems has been identified as a primary barrier by health professionals to their ability to provide evidence-based care (Boerner et al, 2014). Of note, training based on the present core competency list should involve a variety of learning opportunities beyond didactic training and self-study, including practical experience, skills-based training, and supervised clinical practice.…”

“…Additionally, this high level of consensus ensured that only the most essential items were included in the final list to create a manageable list. As time has also been identified as a barrier to the provision of evidence-based pediatric behavioral sleep care (Boerner et al, 2014), we believe it was essential that the list only include the most critically important items, to reduce the burden on health professionals receiving training. The final core competency list, which was substantially revised throughout the study process, reflects the consensus of a large group of experts in the area of behavioral sleep problems in children and/or health professional sleep training from multiple disciplines, demonstrating the strength of using the Delphi method for core competency list development.…”

“…Recent work suggests that, among health professionals, it is often up to the individual provider to seek out sleep-related knowledge and training (e.g., via continuing education; Boerner et al, 2014); however, this provides little guarantee of the quality and content of education obtained. This identified need for evidence-based educational resources highlights the need for a core competency list, such as that described in the present article, to assist in the standardization of pediatric behavioral sleep education provided to health professionals.…”

“…Recent research has identified knowledge, training, and education to be the most frequently reported barrier to, and facilitator of, the provision of evidence-based sleep care among non-sleepspecialist health professionals (Boerner, Coulombe, & Corkum, 2014). If these health professionals were to represent the first line of care in a stepped-care model for pediatric sleep services, they would require the necessary knowledge and skills to deliver basic interventions and to screen for issues requiring more specialized services.…”

Beyond synthesis: augmenting systematic review procedures with practical principles to optimise impact and uptake in educational policy and practice

“…Such strategies include organising practitioner workshops, producing a lay summary of the review and, if possible, actionable implementation guidance to be distributed to key stakeholders, open-access publication, and exploration of the infrastructural conditions necessary to implement recommendations. Analysing infrastructural conditions and contexts can help reviewers appreciate the complexity of practice, identify the characteristics, priorities and beliefs of users and institutions and monitor the barriers and enablers to evidence use (Boerner et al 2015). In health professions education the barriers and enablers to uptake for various potential users (including, curriculum designers, managers, clinical teachers, policy-makers, commissioners, regulatory and professional bodies, educational researchers, students, service users and the wider public) could be mapped by review teams and accounted for when planning dissemination activities.…”