title: Competency, confidence and conflicting evidence: key issues affecting health visitors' use of research evidence in practice.
abstract: BACKGROUND
  Health visitors play a pivotal position in providing parents with up-to-date evidence-based care on child health. The recent controversy over the safety of the MMR vaccine has drawn attention to the difficulties they face when new research which raises doubts about current guidelines and practices is published. In the aftermath of the MMR controversy, this paper investigates the sources health visitors use to find out about new research evidence on immunisation and examines barriers and facilitators to using evidence in practice. It also assesses health visitors' confidence in using research evidence.
  
  
  METHODS
  Health visitors were recruited from the 2007 UK Community Practitioners' and Health Visitors' Association conference. All delegates were eligible to complete the questionnaire if in their current professional role they advise parents about childhood immunisation or administer vaccines to children. Of 228 who were eligible, 185 completed the survey (81.1%).
  
  
  RESULTS
  These health visitors used a wide range of resources to find out about new research evidence on childhood immunisation. Popular sources included information leaflets and publications, training days, nursing journals and networking with colleagues. A lack of time was cited as the main barrier to searching for new evidence. The most common reason given for not using research in practice was a perception of conflicting research evidence. Understanding the evidence was a key facilitator. Health visitors expressed less confidence about searching and explaining research on childhood immunisation than evidence on weaning and a baby's sleep position.
  
  
  CONCLUSIONS
  Even motivated health visitors feel they lack the time and, in some cases, the skills to locate and appraise research evidence. This research suggests that of the provision of already-appraised research would help to keep busy health professionals informed, up-to-date and confident in responding to public concerns, particularly when there is apparently conflicting evidence. Health visitors' relative lack of confidence about research on immunisation suggests there is still a job to be done in rebuilding confidence in evidence on childhood immunisation. Further research on what makes evidence more comprehensible, convincing and useable would contribute to understanding how to bridge the gulf between evidence and practice.
authors.affiliation: MRC Social and Public Health Sciences Unit, Glasgow, Scotland, UK.
authors.forename: Shona
authors.initials: S
authors.lastname: Hilton
authors.affiliation: Centre for Epidemiology and Biostatistics, Institute of Child Health, London, England, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Bedford
authors.affiliation: School of Social Policy, Sociology and Social Research, University of Kent, Kent, England, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Calnan
authors.affiliation: MRC Social and Public Health Sciences Unit, Glasgow, Scotland, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Hunt