Creative Education
2012. Vol.3, Special Issue, 1094-1100
Published Online October 2012 in SciRes (http://www.SciRP.org/journal/ce) http://dx.doi.org/10.4236/ce.2012.326164
1094
Exploring the Impact of a Structured Model of Journal Club in
Allied Health—A Qualitative Study
Lucylynn M. Lizarondo, Saravana Kumar, Karen Grimmer-Somers
International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
Received August 17th, 2012; revised September 16th, 2012; accepted September 29th, 2012
Background: This paper presents the findings of a qualitative study associated with an experimental trial
which examined the impact over time, of a structured model of journal club (JC) on the knowledge, skills
and evidence uptake of allied health practitioners (AHPs). The primary aim of this qualitative study was
to explore the experiences of AHPs regarding the use of iCAHE (International Centre for Allied Health
Evidence) JC as a medium for evidence uptake. The secondary aim was to explain the quantitative find-
ings in the iCAHE JC trial based on the perspectives of the JC members. Methods: Semi-structured indi-
vidual interviews with purposively selected participants from the JCs were undertaken. The participants
were asked about their experiences with the iCAHE JC, and to comment on the results of the iCAHE JC
trial. Analysis of data was undertaken using the principles of the framework approach. Findings: A total
of 12 AHPs participated in the interview. Their experiences of the JC were classified into seven themes:
knowledge and confidence gain, convenience, empowerment, evidence utilisation, impediments, peculi-
arities, and refinements to iCAHE model. The participants found the current structure of JC suitable and
useful in generating creative thinking about how practices can be influenced by research evidence. They
identified ways of how they have used research evidence to inform their clinical decisions and described
circumstances when research findings are not applicable to practice. The participants thought that the
variability in EBP outcomes across disciplines found in the iCAHE JC trial was not surprising given that
allied health disciplines operate using different models of care, and vary in terms of culture, attitude, pro-
fessional orientation and the volume of evidence base available in their specific disciplines. There were a
few minor suggestions to modify the current iCAHE model of JC. Conclusion: When lack of EBP
knowledge and skills, and limited access to evidence sources are reported as barriers, they can be effec-
tively addressed by running a structured JC such as the iCAHE JC. In instances when barriers other than
lack of knowledge are present, more than one approach may be required. Future research should deter-
mine the impact of other approaches that may be integrated with the iCAHE JC to promote evidence up-
take and sustain practice behaviour change.
Keywords: Journal Club; Evidence-Based Practice; Continuing Education; Allied Health
Introduction
This paper presents the findings of a qualitative study associ-
ated with an experimental trial which examined the impact over
time, of a structured model of journal club on the knowledge,
skills and evidence uptake of allied health practitioners.
The Importance of Using Multiple, Integrated
Approaches in EBP Evaluation
Outcomes research in general has traditionally used quantita-
tive methods to measure the impact of interventions on health
care outcomes (Curry et al., 2009). In evidence-based practice
(EBP) studies specifically, there used to be a strong emphasis
on evidence associated with quantitative, experimental approaches,
with little regard for the value of other types of research such as
qualitative studies (Miles et al., 1997, 1998; Mitchell, 1999).
More recently there has been increasing recognition that quan-
titative methods have limitations in capturing more complex
aspects of healthcare delivery, such as organizational context
and perceptions of patients and practitioners (Petticrew & Rob-
erts, 2003). An approach that draws on diverse sources of evi-
dence can provide a more comprehensive understanding of
these complex issues.
Qualitative research has a role to play in addressing ques-
tions which cannot be investigated by experimental studies
(Goldsmith et al., 2007). Experimental studies can be used to
explore effects following deliberate interventions, but unlike
qualitative research, it cannot describe the complexity, breadth
and range of occurrences or phenomena (Curry et al., 2009).
Qualitative methods can contribute in several ways to the
evaluation of health-related interventions including EBP inter-
ventions. They are useful in gaining insight into the potential
reasons or mechanisms associated with an outcome and generate
hypotheses about such mechanisms (Lewin et al., 2009; Curry
et al., 2009). They can also explore individual perspectives and
responses to the intervention and examine variations in effec-
tiveness within a sample (Lewin et al., 2009; Curry et al.,
2009).
The use of both quantitative and qualitative approaches in the
evaluation of strategies to facilitate EBP uptake has become in-
creasingly common because they provide a broader under-
standing of research issues than ither method alone (Robins et e

L. M. LIZARONDO ET AL.
Table 1.
Summary of the iCAHE journal club trial.
Design A pre-post study design without a control group
Inte rv en t i on The intervention consisted of six monthly JC sessions using the iCAHE model.
Data Collection
Measurements were collected prior to the implementation of the iCAHE JC with follow-up six months later.
The Adapted Fresno Test (AFT) assessed knowledge and skills in the major domains of EBP, such as formulating
clinical questions, searching for and critically appraising research evidence. The Evidence-based Practice Ques-
tionnaire measured EBP uptake, attitude to and perceived knowledge (self-reported knowledge) about EBP.
AFT Score 134.3 (54.8 - 213.8)
Self-Reported Knowledge 12.9 (2.0 - 23.8)
Attitude 2.6 (−4.16 - 9.4)
Speech Pathology
n = 10
EBP Uptake 42.3 (−4.76 - 89.4)
AFT Score 245.9 (110.6 - 381.2)
Self-Reported Knowledge 27.4 (13.2 - 41.6)
Attitude 15.9 (6.5 - 25.3)
Physiotherapy
n = 19
EBP Uptake 71.1 (12.3 - 129.9)
AFT Score 141.2 (24.1 - 258.3)
Self-Reported Knowledge 11.3 (4.0 - 18.6)
Attitude 8.0 (−0.3 - 16.3)
Social Work
n = 16
EBP Uptake 28.3 (4.8 - 51.8)
AFT Score 198.5 (135.7 - 261.3)
Self-Reported Knowledge 14.3 (6.8 - 21.8)
Attitude 2.7 (−2.0 - 7.4)
Occupational Therapy
n = 36
EBP Uptake 16.5 (−5.9 - 38.9)
AFT Score 87.8 (50.7 - 124.9)
Self-Reported Knowledge 13.7 (3.4 - 24.0)
Attitude 0.2 (−8.4 - 8.8)
Results
Mean percentage change from
baseline (95% confidence
interval)
Dietetics/Nutrition
n = 12
EBP Uptake 39.2 (8.6 - 69.8)
al., 2008). The two approaches complement one another, such
that the qualitative method will “explore and obtain depth of
understanding as to the reasons for success or failure to imple-
ment EBP or to identify strategies for facilitating implementa-
tion while quantitative methods are used to test and confirm
hypotheses based on an existing conceptual model and obtain
breadth of understanding of predictors of successful implemen-
tation” (Palinkas et al., 2011).
The iCAHE (International Centre for Allied Health
Evidence) Journal Club Trial
Lizarondo et al. (2012) examined the impact of a structured
journal club (JC), known as iCAHE JC, on the knowledge,
skills and behaviour of allied health practitioners relevant to
EBP using two established instruments, the Adapted Fresno
Test (McCluskey & Bishop, 2009) and Clinical Effectiveness
and Evidence-based Practice Questionnaire (Upton & Upton,
2006). A summary description of this trial is provided in Table
1; a complete description of the implementation of this inter-
vention is reported elsewhere (Lizarondo et al., 2012).
The primary aim of the research reported in this paper was to
explore the experiences of allied health practitioners regarding
the use of iCAHE JC as a medium for evidence uptake. The
secondary aim was to explain the quantitative findings in the
iCAHE JC trial based on the perspectives of the JC members.
Methods
Ethics
This study was approved by the University of South Austra-
lia Human Research Ethics Committee and the Human Re-
search Ethics Committee (Tasmania) Network.
Participants
The participants for the semi-structured interviews were re-
cruited by email invitation through the facilitator of the JC who
was in monthly contact with the primary author. The facilitators
were asked to assist with identifying key informants for the
interview from the pool of AH providers who participated in
iCAHE JC. The authors aimed to involve practitioners from

L. M. LIZARONDO ET AL.
every iCAHE JC, from different allied health disciplines.
Data Collection
Semi-structured individual interviews were undertaken with
participants, by the primary author in a private and quiet room.
Individual interviews, in particular, are useful when detailed
information to explore issues is required (Liamputtong & Ezzy,
2005; Sandelowski, 2002). They provide more in-depth infor-
mation than is available in other data collection method such as
focus group interviews. The participants were asked about their
experiences with the iCAHE JC and differences it might have
made, if any, to their clinical practice. The results of the iCAHE
JC trial were then presented and the participants were asked for
their reactions and the reasons they attributed to the apparent
success of the JC to some allied health practitioners and reasons
for the absence of positive change in the other practitioners.
The following broad questions were asked:
1) What are your views/perspectives of the iCAHE JC that
was organized in your department? How well did the staff em-
brace the JC project?
2) What did you like most/least about the iCAHE JC?
3) How can we improve the JC process?
4) What is the impact of the JC to your practice?
5) Do you use the evidence obtained from JC meetings to
inform your practice? Why/Why not?
6) What are your thoughts regarding the results of the
iCAHE JC trial?
7) Are the results something you would have expected?
Why/Why not?
Data Analysis
All interviews were audio-taped, and transcribed by an inde-
pendent transcription service. Analysis of data was undertaken
using the principles of the framework approach (Pope et al.,
2000), which includes the following stages:
1) Familiarization—immersion in the raw data by reading the
transcripts more than once;
2) Determining a thematic framework—identifying themes
by which the data can be examined and referenced;
3) Indexing—applying all the themes to all the data in textual
form by labeling the transcripts with codes;
4) Charting—rearranging the data according to the appropri-
ate part of the thematic framework to which they relate, and
forming charts;
5) Mapping and interpretation—using the charts to inform
the key objectives of the research.
Two authors jointly coded the data and identified themes (LL,
SK) and another author (KGS) reviewed the analysis to ensure
accuracy of the interpretations.
Investigator Perspective
The primary author (LL) has been the project officer of all
the iCAHE JCs for several years. The other authors (KGS, SK)
were responsible for the conceptualisation and development of
the iCAHE model of JC.
Findings
A total of 12 allied health practitioners participated in the in-
terview, and comprised two physiotherapists, two dieticians/
nutritionists, three speech pathologists, two social workers and
three occupational therapists. More than half of the participants
were facilitators of an iCAHE JC. The majority had completed
bachelor’s degree and most held senior positions.
The experiences of the JC members were classified into
seven themes: knowledge and confidence gain, convenience,
empowerment, evidence utilisation, impediments, peculiarities,
and refinements to iCAHE model.
Knowledge and Confidence Gain
There was consensus among participants concerning the im-
pact of JC on their level of knowledge and skills relevant to
EBP. They agreed the JC sessions improved their ability to
formulate a clinical question and helped them critically examine
the quality of research evidence. The participants felt more con-
fident in appraising research articles which allowed them to
obtain relevant information that can be integrated with clinical
decisions.
“I think people got a bit more savvy with their knowledge…
they were sharper at picking things which are not right or
picking gaps. People start talking about power calculations and
things like that which we never talked a lot before.”
Another participant said:
“People have become more confident and now they are able
to identify study design and they also know how to look a little
bit more at the details of the study. I really think people did
improve.”
The allied health practitioners described JC discussions to be
very informative and facilitated broad learning which made
them think more deeply about what EBP really meant. Many
participants felt that JC discussions fostered a critical and re-
flective way of thinking that went beyond the EBP skills (i.e.
formulating a question, critical appraisal) that were being pur-
posefully taught.
“So I think the benefit—the increased understanding of levels
of evidence happened and we did discuss that but the real
power comes through the discussion that came after that. It’s
the reflection of what should be done with patient care and how
best to achieve that.”
Convenience
Concerns about the lack of time to search for research arti-
cles and limited information technology skills have been identi-
fied as major barriers to EBP (Bennett 2003, Jette et al., 2003).
According to JC members, the searching for relevant articles
undertaken by iCAHE researchers served to address these bar-
riers, which made the JC process a lot more convenient for busy
practitioners. The participants reported that JC members were
motivated to participate because the iCAHE JC model takes the
load off them in terms of searching for literature.
“Having a pool of articles to pick from was fantastic! With-
out having to do that research side of it ourselves was very
helpful. Also, having someone else gone through the searching
whom you know is an expert in the field is just handy.”
The participants valued the structured format of the critical
appraisal and felt that the appraisal summaries provided to the
facilitators was helpful. The facilitators expressed that leading
the discussion was challenging, especially during the first few
JC sessions, but having the appraisal summaries made them
feel more certain and confident of their skills.
“I think it was really helpful having a structured format, and
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L. M. LIZARONDO ET AL.
the same format that we all use to critique a journal, it just
means we could be more consistent in our discussions, that we
weren’t missing sort of key parts.”
One of the facilitators explained:
“I think probably one of the things that were a bit challeng-
ing is being able to look at the data and interpret that, and
know whether that was statistically significant and if there were
enough participants and things like that. So I found it useful
that we got some information about that in the summaries that
we receive from you before the JC meeting.”
Empowerment
The participants described how they felt empowered to take
responsibility for improving their practice through the integra-
tion of research evidence with their clinical decisions, although
they may have been initially sceptical to the principles of EBP.
They felt a sense of ownership of the journal club despite ob-
taining strong support from iCAHE. The participants thought
the regular meetings where they discuss clinical questions/cases
relevant to their practice and the sharing of clinical experience
was very informative.
“What I like most is the joint ownership of doing it. I think it
raises the bar in terms of collective responsibility for looking at
evidence and presenting it. I think team meetings such as this
are really empowering… it raised the participation rate of all
the members in presenting and thinking through so I think the
incorporation of everyone’s involvement was one of the best
things about it.”
One of the participants added:
“It’s always good to have discussion with co-clinicians and
then as a group pool our expertise and made a conclusion our-
selves really.”
Evidence Utilization
When asked about the usefulness of research findings dis-
cussed during JC meetings, the participants reported they were
valuable, and often they use them to validate their clinical deci-
sions and actions. Many of the JC members felt there wasn’t
always a need to change clinical practice because their current
practice is often supported by evidence.
“Okay so there is good evidence out there, but what we are
doing is what’s according to the evidence. It was more of rein-
forcing the things we do, although we were mindful that if there
is something that needs to be changed, we will have to.”
The practitioners additionally reported they use research
evidence to educate patients who felt more confident that the
treatments they are receiving are no less than the best possible
care.
“The most common place I use evidence is in patient educa-
tion, so to be able to say—look the best evidence out there says
that this is what we should be doing. So if I know that what I’ve
found out there shows that this is effective, and it’s been shown
that recently, then I guess that changes clients’ perspectives
and perception of what’s important.”
Some participants suggested that research findings from JC
sessions facilitated discussion of current practice which in turn
shaped future strategies or approaches to treatment. One of the
practitioners commented:
“What we read from the article helps us to frame or start
thinking about a service that we can potentially provide clients;
it might help us shape our intervention. The research evidence
provides us opportunities to decide where we’re going.”
The participants believed in the value of continuing educa-
tion and felt that it was part of their professional responsibility.
They recognised that allied health practice is continually evolv-
ing and therefore it is important that their professional knowl-
edge is constantly updated. The JC members also understood
the need to be constantly updated of the changes and develop-
ments in their practice which they can learn by reading or dis-
cussing current literature.
“I think the most important thing is when there is good evi-
dence out there; we should know what it is.”
Impediments
The evidence from research was seen as fundamental to clini-
cal decision-making, but practitioners felt there were instances
when they were not feasible. For example, one of the JCs dis-
cussed in their meeting the most effective intervention for a
particular condition and found that the highest and best avail-
able evidence required very intensive form of therapy. One of
the participants said:
“I think a lot of it came down to resources that are available
to us, so a lot of the therapeutic interventions that had the
highest level of evidence were very intensive, and I suppose
within our service, it is difficult because we work in a commu-
nity so we’re servicing people who live hours away, and to sort
of give them twice-weekly therapeutic interventions is a bit of a
challenge.”
Another participant commented:
“For example, an hour of therapy thrice a week is sure to be
effective but it’s not applicable if there’s only point five staffing
in that post.”
Lack of skills to implement the recommendations from re-
search was also described as a major barrier to EBP uptake.
“I can read about and discuss research and go yes that’s
great, but my actual skills and ability to use that technique from
that study without having some extra training or working with
somebody who has got experience in using it successfully, I
don’t know that I am necessarily able to implement that on my
own.”
There were participants who felt disappointed because of the
limited research available to address the clinical queries they
have on certain clients.
“I suppose one of the problems is sometimes there’s very lit-
tle information on the things that we’re asking, and that’s
really frustrating.”
In some instances, however, while there were high levels of
evidence about the JCs’ topics of interest, the findings are not
relevant to their practice.
“Some of the RCTs, even though they sort of address our
queries, are not of intrinsic value to everyday practice because
they were far too removed. We were hoping to find something a
bit more relevant to us. It just wasn’t something we could act
on.”
Peculiarities
Towards the end of the interview, the participants were pre-
sented with the results of the quantitative study into JC effec-
tiveness. The quantitative findings showed variability in EBP
learning and behaviour outcomes across disciplines following

L. M. LIZARONDO ET AL.
participation in the iCAHE JC. The participants were shown
that only the physiotherapists demonstrated improvements in all
outcomes (i.e. knowledge, attitude and behaviour); speech pa-
thologists and occupational therapists demonstrated an increase
in both objective and perceived knowledge but not for attitude
and EBP uptake; social workers and dieticians/nutritionists
showed positive changes in their objective and perceived knowl-
edge, and EBP uptake but not for attitude.
The participants commented the results were consistent with
their expectations. They were not surprised to find that other
disciplines scored better in some outcomes whereas others did
not improve. There were participants who reported differences
in the model of care by which their discipline operates. For
example, one participant said:
“The model of care in allied health would differ; it can be a
medical model for the physios whereas with OTs we go by an
occupational model. For physios for example, they give exer-
cises pre and post whereas with OTs it’s comprehensive—you
consider their occupation , family situation and things like that.”
There were some who described differences in terms of pro-
fessional attitude and culture. As one participant commented:
“I guess physios are quite known for being very scheduled,
and when things are mandatory, they really are mandatory
whereas some other disciplines are more flexible in their ap-
proach. As social workers, we tend to focus more on process
and systems and outcomes whereas others can be a bit more
clinical and a bit more focused.”
The participants thought allied health disciplines could be
grouped into at least two distinct communities—clinical or
biomedical scientists and social scientists. They speculated that
physiotherapists, speech pathologists, dieticians/nutritionists lean
towards clinical or biomedical science while occupational thera-
pists and social workers consider themselves under the field of
social science. The participants perceived that these two groups
tend to cluster around quite specialised bodies of knowledge
and preferred research methodologies.
“Right from the beginning there’s a difference. The first thi ng
probably is I think we, in social work, see ourselves more as a
social science than a biomedical science, so already we’re kind
of different to other disciplines like physios and speeches and
so on. Second, we are more interested in context and individual
experiences—you know, in what way did this happen, or which
type of event was it—more about the richness of data which is
more leaning towards qualitative research.”
There were some participants who recognised that the evi-
dence base is often different for every discipline. They sug-
gested that some disciplines have a lot more research to inform
their practice than other disciplines. One participant com-
mented:
“I think physio has been a sort of longer standing allied
health profession in some aspects, and a real branch directly
from the medical field. So I think there is a lot more research,
this is just from my understanding, a lot more research that
advises physiotherapy practice.”
Refinements to iCAHE Model
Overall, the participants were positive about the iCAHE JC
model and felt that it was a worthwhile experience. However,
they believed that there were still some opportunities for im-
provements which could increase its effectiveness. The most
telling comments came from the facilitators who felt that being
responsible for leading the JC discussions every meeting was
challenging and difficult at times. They thought that the role of
the facilitator should rotate every meeting so that every member
will have a sense of responsibility and ownership of the club.
“I was probably the main person responsible for it, and that
was a little bit hard to sustain, just because of time. It would
have been better if they all did it, so the facilitating and the
discussion, everything like that, so it wasn’t just all on one
person to arrange.”
There were participants who noted that the training provided
to facilitators at the start of the iCAHE JC focused on interven-
tion types of clinical questions which highlighted the superior-
ity of randomised controlled trials and other experimental de-
signs over observational studies and case studies. They also felt
that quantitative studies were favoured more than qualitative
studies as sources of evidence. The participants suggested that
EBP training should not only focus on the hierarchy of evi-
dence that includes quantitative studies but should include both
quantitative and qualitative studies as important in informing
clinical decisions.
“I think there was angst about the privileging of the hierar-
chy—you know that medical kind of quantitative hierarchy. We
actually got some literatures that were more specific with so-
cial work and evidence-based practice but the facilitators
talked about us not fitting that model and that we should find
higher forms of evidence.”
Discussion
The current study explored how the participants in the iCAHE
trial experienced the intervention (i.e. iCAHE JC), and the rea-
sons for the findings in the trial. The themes that emerged from
this study confirmed that a JC is an effective strategy in im-
proving EBP knowledge, skills and confidence of allied health
practitioners. The participants found the current structure of JC
suitable and useful in generating creative thinking about how
practices can be influenced by research evidence. They identi-
fied ways of how they have used research evidence to inform
their clinical decisions and described circumstances when re-
search findings are not applicable to practice. The participants
thought that the variability in EBP outcomes across disciplines
found in the iCAHE JC trial was not surprising given that allied
health disciplines operate using different models of care, and
vary in terms of culture, attitude, professional orientation and
the volume of evidence base available in their specific disci-
plines. There were a few minor suggestions to modify the cur-
rent iCAHE model of JC.
iCAHE as an Educational Tool
Journal clubs have long been considered in the medical pro-
fession as a tool for improving reading habits (Linzer et al.,
1987; Linzer et al., 1988; Khan et al., 1999), critical appraisal
skills and research knowledge of practitioners (Seelig, 1991;
Burstein et al., 1996; Spillane & Crow, 1998; Khan et al., 1999;
Macrae et al., 2004; Mukherjee et al., 2006). Similar outcomes
were reported in the nursing profession (Thompson, 2006;
Steenbeek et al., 2009). In allied health, while there were a
number of articles which described the potential benefits of a
JC, there was no study which explored the learning experiences
of JC members. The findings from the current study make a
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L. M. LIZARONDO ET AL.
significant contribution to the existing evidence about the ef-
fectiveness of JCs in educating practitioners about the processes
involved in EBP. Overall, the JC participants were satisfied
with the model and found the JC discussions very useful in
understanding EBP concepts such as critical appraisal, which
are congruent with the results of the iCAHE JC trial. The con-
venience experienced by the practitioners because of the sup-
port from iCAHE researchers tends to fit well with the clinical
demands of allied health practice. Such experience increased
their motivation to engage in the learning activity (iCAHE JC),
which could explain the positive impact of the JC on learning
outcomes. Moreover, participants felt empowered following
participation in the JC, despite the strong support offered by
iCAHE. “Individual empowerment means people feeling and
actually having a sense of control over their lives” (Woodall et
al., 2010). To empower individuals, it means building their
confidence or enhancing their personal skills in order for them
to make choices (Woodall et al., 2010). The participants of the
JC assumed a degree of control by having input on the learning
targets every JC session. Establishing an empowering learning
environment appeared to have positively affected the practitio-
ners’ motivation to learn which potentially led to improved
knowledge and skills.
iCAHE as a Medium for Facilitating Change in
Practice
Becoming an evidence-based practitioner requires skills and
knowledge in terms of formulating a question, searching for
relevant evidence, critically appraising and using research evi-
dence. However, while knowledge is necessary, it is not suffi-
cient in itself for practice behaviour change. In allied health,
lack of knowledge and skills to undertake the EBP processes
and the lack of access to research evidence are commonly re-
ported barriers to EBP (Bennett, 2001; Jette et al., 2003; Heiwe
et al., 2011). The findings of the experimental study and this
qualitative study showed that a JC approach, particularly a struc-
tured model such as iCAHE JC, can address these barriers. This
study also found that the iCAHE JC was instrumental in pro-
viding the evidence base which allied health practitioners used
to educate their clients, discuss and reflect about future strate-
gies, and validate their current practice. However, there were
other barriers to evidence uptake in allied health which cannot
be addressed by participation in a JC alone. There were practi-
tioners who expressed that lack of requisite skills to implement
the recommendations based on research was a significant bar-
rier. There were others who described that their setting did not
have the resources or staff time to deliver the recommended
interventions. Other challenges include factors such as limited
evidence base or recommendations not being relevant to the local
patient population or practice. The participants also highlighted
differences across allied health disciplines, in terms of models
of care, attitude, culture, evidence base and professional orien-
tation (i.e. biomedical versus social science). These observa-
tions demonstrate how the characteristics of the practitioners,
aspects of the practice setting, and organisational context can
influence the use of research-based recommendations. Experts
in the field of evidence implementation suggest that a compre-
hensive approach at various levels is needed to address the indi-
vidual professional, teams, organisations and wider systems (Grol
& Grimshaw, 2003; Estabrooks et al., 2007). The EBP inter-
vention/s should therefore be linked to the barriers identified at
each level.
While the evidence highlights the effectiveness of iCAHE JC
in addressing one particular barrier (i.e. knowledge barrier), it
appears that a JC approach is an important medium that nur-
tures a different kind of thinking (i.e. reflective and critical
reasoning); a level of thinking which is crucial in changing
one’s behaviour. This was highlighted by the participants who
felt that the learning experience went beyond just acquiring the
knowledge about EBP processes. As Buswell (1998) reported,
there are two compelling reasons why a JC can serve to bridge
the gap between evidence and practice. First, it can develop ana-
lytical, reflective and evaluative skills and second, it enables
individuals to disseminate the results of research. Therefore, a
JC, while it cannot address all the other barriers, plays a sig-
nificant role in creating a higher level of thinking required in
individual practitioners in order to change their practice behav-
iour.
Implications for Practice
To develop a successful intervention that will facilitate evi-
dence uptake, there needs to be a careful understanding and
consideration of the barriers faced in healthcare. The choice of
EBP intervention should then be linked to the identified barriers,
and guided by the local circumstances or context. When lack of
EBP knowledge and skills, and limited access to evidence
sources are reported as barriers, they can be effectively ad-
dressed by running a structured JC such as the iCAHE JC. In
instances when barriers other than lack of knowledge are pre-
sent, more than one approach may be required. Managers and
policy makers who implement interventions should understand
that different approaches will be effective for different practi-
tioners and different settings.
Implications for Research
Further research should determine the impact of other ap-
proaches that may be integrated with the iCAHE JC to promote
evidence uptake and practice behaviour change that is ecu-
menical and sustainable. Exploring which types of approaches
work for whom and in what circumstances and context, requires
considerable careful future investigation. It may also be worth-
while to identify a specific area of practice (e.g. role of alterna-
tive therapies in cognitive function) and carefully analyse the
current practice before strategies are designed.
Limitations
As in any other research, there are limitations in this research
which need to be considered when interpreting the results. First,
the facilitator of the interview is the project officer of iCAHE
JC which may have limited the participants from being critical
of the iCAHE model. Second, because the participants volun-
teered in the study, they are likely to represent only the practi-
tioners who may have been more motivated to change their prac-
tice than the average allied health practitioner.
Conclusion
The findings suggest that allied health practitioners found the
iCAHE JC an effective tool in improving their knowledge and

L. M. LIZARONDO ET AL.
1100
confidence about EBP, and that the current structure is conven-
ient to busy practitioners. The participants considered the re-
search evidence obtained from JC meetings useful in validating
their current practice, educating clients and determining future
strategies. However, there were other factors which influenced
their uptake of research evidence, including lack of skills and
resources to implement evidence-based recommendations, lim-
ited evidence base in some areas of practice and research find-
ings not being applicable to local practice. These findings, along
with observations that allied health disciplines vary in their atti-
tude, culture, models of care, evidence base and professional
orientation, underscore the need to design and implement tar-
geted EBP interventions to facilitate evidence uptake and be-
haviour change. Future research should explore the impact of
these approaches when integrated with a JC approach as an
educational tool.
REFERENCES
Bennett, S., Tooth, L., McKenna, K., Rodger, S., Strong, J., Ziviani, J.,
Mickan, S., et al. (2003). Perceptions of evidence-based practice: A
survey of Australian occupational therapists. Australian Occupa-
tional Therapy Journal, 50, 13-22.
Burstein, J., Hollander, J., & Barlas, D. (1996). Enhancing the value of
journal club: Use of a structured review instrument. American Jour-
nal of Emergency Medicine, 14, 561-563.
Buswell, C. (1998). Journal clubs—A rationale for implementation.
Journal of Community Nursing, 13, 52-53.
Curry, L. A., Nembhard, I. M., & Bradley, E. H. (2009). Qualitative
and mixed methods provide unique contributions to outcomes re-
search. Circulation, 1191, 1442-1452.
Estabrooks, C., Midodzi, W., Cummings, G., & Wallin, L. (2007).
Predicting research use in nursing organizations: A multi-level
analysis. Nursing Research, 56, S7-S23.
Grol, R., & Grimshaw, J. (2003). From best evidence to best practice:
Effective implementation of change in patients’ care. Lancet, 362,
1225-1230.
Goldsmith, M. R., Bankhead, C. R., & Austoker, J. (2007). Synthesis-
ing quantitative and qualitative research in evidence-based patient
information. Journal of Epidemiology & Community Health, 61, 262-
270.
Heiwe, S., Kajermo, N., Tyni-Lenne, R., Guidetti, S., Samuelsson, M.,
Andersson, I., & Wengstrom, Y. (2011). Evidence-based practice:
Attitudes, knowledge and behavior among allied health care profes-
sionals. International Journal for Quality in Health Care, 23, 198-
209.
Jette, D. U., Bacon, K., Batty, C., Carlson, M., Ferland, A., Hemingway,
R. D., Hill, J. C., et al. (2003). Evidence-based practice: Beliefs, at-
titudes, knowledge, and behaviors of physical therapists. Physical
Therapy, 83, 786-805.
Khan, K., Dwarakanath, L., Pakkal, M., Brace, V., & Awonuga, A.
(1999). Postgraduate journal club as a means of promoting evi-
dence-based obstetrics and gynaecology. Journal of Obstetrics &
Gynaecology, 19, 231-234.
Lewin, S., Glenton, C., & Oxman, A. D. (2009). Use of qualitative
methods alongside randomised controlled trials of complex health-
care interventions: Methodological study. British Medical Journal,
339, 1-7.
Liamputtong, P., & Ezzy, D. (2005). Qualitative research methods (2nd
ed.). South Melbourne, VIC: Oxford University Press.
Linzer, M., Brown, J. T., Frazier, L. M., DeLong, E. R., & Siegel, W. C.
(1988). Impact of medical journal club on house-staff reading habits,
knowledge and critical appraisal skills. A randomised controlled trial.
Journal of the American Medical Association , 4, 2537-2541.
Linzer, M., DeLong, E. R., & Hupart, K. H. (1987). A comparison of
two formats for teaching critical reading skills in a medical journal
club. Journal of Medical Education, 62, 690-692.
Lizarondo, L., Grimmer-Somers, K., Kumar, S., & Crockett, A. (2012).
Does journal club membership improve research evidence uptake in
different allied health disciplines: A pre-post study. BMC Research
Notes.
Macrae, H., Regehr, G., McKenzie, M., Henteleff, H., Taylor, M.,
Barkun, J., Fitzgerald, G., et al. (2004). Teaching practicing surgeons
critical appraisal skills with an internet-based journal club: A ran-
domised controlled trial. Surgery, 136, 641-646.
McCluskey, A., & Bishop, B. (2009). The adapted fresno test of com-
petence in evidence-based practice. Journal of Continuing Education
in the Health Professions, 29, 119-126.
Miles, A., Bentley, P., & Grey, J. (1997). Evidence-based medicine:
Why all the fuss? This is why. Journal of Evaluation in Clinical
Practice, 3, 83-86.
Miles, A., Bentley, P., Grey, J., & Price, N. (1998). Recent progress in
health services research: On the need for evidence-based debate.
Journal of Evaluation in Clinical Practice , 4, 257-265.
Mitchell, G. J. (1999). Evidence-based practice: Critique and alterna-
tive view. Nursing Science Quarterly, 12, 30-35.
Mukherjee, R., Owen, K., & Hollins, S. (2006). Evaluating qualitative
papers in a multidisciplinary evidence-based journal club: A pilot
study. The Psychi atris t, 30, 31-34.
Palinkas, L. A., Aarons, G. A., Horwitz, H., Chamberlain, P., Hurlburt,
M., & Landsverk, J. (2011). Mixed methods design in implementa-
tion research. Administration and Policy in Mental Health, 38, 44-53.
Petticrew, M., & Roberts, H. (2003). Evidence, hierarchies, and typolo-
gies: Horses for courses. Journal of Epidemiology & Community
Health, 57, 527-529.
Pope, C., Ziebland, S., & Mays, N. (2000). Analysing qualitative data.
British Medical Journal, 320, 114-116.
Sandelowski, M. (2002). Re-embodying qualitative inquiry. Qualitative
Health Research, 12, 104-115.
Seelig, C. (1991). Affecting residents’ literature reading attitudes, be-
haviors, and knowledge through a journal club intervention. Journal
of General Internal Medicine, 6, 330-334.
Steenbeek, A., Edgecombe, N., Durling, J., LeBalnc, A., Anderson, R.,
& Bainbridge, R. (2009). Using an interactive journal club to en-
hance nursing research knowledge acquisition, appraisal and applica-
tion. International Journal of Nursing Education Scholarship, 6, 1-8.
Spillane, A., & Crowe, P. (1998). The role of journal club in surgical
training. The Australian and New Zealand Journal of Surgery, 68,
288-291.
Thompson, C. (2006). Fostering skills for evidence-based practice: The
student journal club. Nurse Education in Practice, 6, 69-77.
Upton, D., & Upton, P. (2006). Knowledge and use of evidence-based
practice by allied health and health science professionals in the
United Kingdom. Journal of Allied Health, 35, 127-133.
Woodall, J., Raine, G., South, J., & Warwick-Booth, L. (2010). Em-
powerment and health & well-being. URL (last checked 12 June
2012).
http://www.google.com.au/url?sa=t&rct=j&q=Empowerment+and+h
ealth+%26+well-being.+&source=web&cd=1&ved=0CEkQFjAA&u
rl=http%3A%2F%2Fwww.yhpho.org.uk%2Fresource%2Fview.aspx
%3FRID%3D87504&ei=pOotUPSuBM2jiAet_oDYAw&usg=AFQj
CNFx-Wl8Q29sN1cwdcpYBKzEoRJzlQ