Barriers and facilitators for using research-based knowledge - A qualitative study on first-line managers'...

Research-based knowledge (RBK), together with the users' values and preferences and employees' experiences and skills, forms the essential foundation for evidence-based practice in health services. In Norway, as well as in many other countries, local municipalities are comprehensive deliverers of health and care services. Nevertheless, they face major challenges related to accessing and integrating new research into their services. First-line managers in municipal health care are crucial in creating an organisational culture to facilitate the application of RBK. This study aims to explore barriers and facilitators for using RBK in municipal health and care based on first-line managers' experiences.

We conducted individual semi-structured qualitative interviews with twelve first-line managers in municipal health care services. We did a framework analysis to explore their experiences and perspectives.

Four core themes were identified from the analysis: 1) organising for RBK, with the subthemes; current barriers for employing RBK and visioning the ideal promotion of RBK, 2) culture for RBK, with the subthemes; the inner culture and culture shaped by external conditions and expectations, 3) motivation for RBK, with the subthemes; first-line managers perspectives on their own motivation for RBK and on their employees´ motivation for RBK , and 4) barriers and facilitators related to competence on RBK, which we created as an overarching theme, with competence on the individual level and the system level as subthemes.

The managers experienced a gap between what is expected and what they can do. On a national or regional level, gathering research-based information and having supporting networks could facilitate the application of RBK. Locally, ensuring RBK in strategic documents, planning competence for RBK, emphasising RBK activities and having professional development roles supporting the managers were found to be important.

First-line managers experience several barriers and facilitators in applying RBK in clinical practice related to organisational, cultural, motivational and competence elements in municipal health care. Both on the local and national level efforts are needed to support the integration of RBK into clinical expertise and the users' experiences, thereby strengthen municipal health and care services.