title: Development of evidence-based practice in occupational health services in Sweden: a 3-year follow-up of attitudes, barriers and facilitators.
abstract: OBJECTIVE
  The Swedish government initiated an investigation of how to secure and develop the competence of the occupational health services. The primary aim of the present study was to investigate whether the development of evidence-based practice (EBP) in the Swedish occupational health services in relation to attitudes, knowledge and use improved during the first 3 years of the government's initiative.
  
  
  METHODS
  The study has a mixed methods design combining questionnaires and interviews with data collection at baseline and at 3-year follow-up.
  
  
  RESULTS
  The response rate was 66% at baseline and 63% at follow-up. The results show that practitioners' knowledge of EBP was moderate at baseline and improved at follow-up (p = 0.002; 95% CI 0.01; 0.21). Practitioners experienced lower levels of organizational and managerial support for EBP at follow-up (p < 0.001; 95% CI 0.18; 0.38). The results revealed that managers viewed responsibility for implementing EBP as a matter for individual practitioners rather than as an organizational issue.
  
  
  CONCLUSIONS
  Occupational health service managers and practitioners are generally positive to EBP. However, the findings emphasize the need to educate managers in how to support EBP at the organizational level by creating an infrastructure for EBP in the OHS.
authors.affiliation: Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 77, Stockholm, Sweden. Elisabeth.bjork.bramberg@ki.se.
authors.forename: Elisabeth Björk
authors.initials: EB
authors.lastname: Brämberg
authors.affiliation: Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 77, Stockholm, Sweden.|Unit of Ergonomics, School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden.|Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
authors.forename: Teresia
authors.initials: T
authors.lastname: Nyman
authors.affiliation: Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 77, Stockholm, Sweden.
authors.forename: Lydia
authors.initials: L
authors.lastname: Kwak
authors.affiliation: Storvretens Primary Health Clinic, Stockholm, Sweden.
authors.forename: Akbar
authors.initials: A
authors.lastname: Alipour
authors.affiliation: Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 77, Stockholm, Sweden.|Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Bergström
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Liselotte Schäfer
authors.initials: LS
authors.lastname: Elinder
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ulric
authors.initials: U
authors.lastname: Hermansson
authors.affiliation: Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 77, Stockholm, Sweden.
authors.forename: Irene
authors.initials: I
authors.lastname: Jensen
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000706:statistics & numerical data; D055317:Evidence-Based Practice / Q000379:methods / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009786:Occupational Health Services / Q000379:methods / Q000458:organization & administration*; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D013548:Sweden
keywords: Clinical expertise; Evidence-based practice; Interviews; Quality of occupational health services; Questionnaire; Scientific knowledge