Whose evidence counts? An exploration of health professionals' perceptions of evidence-based practice, focusing on...

to gain an insight into how health professionals in the maternity services define evidence and how they perceive different types of evidence are valued in maternity care.

using a qualitative approach data were collected by semi-structured interviews: the content of each was analysed thematically.

England.

a purposeful sample of ten midwives, two obstetricians and one research nurse.

definitions of evidence vary widely among health practitioners. These definitions are affected by individuals' own beliefs and give rise to a hierarchy in which some types of evidence are valued above others. All the participants made direct or indirect reference to cultural beliefs inherent within the health service, and indicated that these beliefs determine the extent to which different types of evidence are seen as legitimate.

the concept of evidence-based practice is not value-free. Evidence that reinforces notions of authoritative knowledge may be transposed into clinical practice quickly and easily. Conversely, health practitioners may have difficulty putting evidence into practice that challenges the cultural norms of the profession. There is a need for further work to make explicit the values that underpin different sources of knowledge and expose the hierarchies of evidence that exist.