title: Barriers and facilitators to the implementation of evidence-based practice by pediatric surgeons.
abstract: OBJECTIVE
  Evidence-based practice (EBP) has been identified as a foundation of mainstream medical practice, yet pediatric surgery has been slow in the acceptance and implementation of EBP.
  
  
  METHODS
  Semi-structured interviews of 14 pediatric surgeons were conducted to determine barriers and facilitators to EBP. Resulting data were analyzed using a systematic 3-step approached of coding, generation of specific beliefs, and identification of domains relevant to practice change.
  
  
  RESULTS
  Six domains were identified as relevant to changing pediatric surgeons' use of evidence in practice: environmental context and resources, goals, knowledge, skills, social influence, and social/professional role and identity. Important barriers to EBP implementation included time constrains and resource limitations, the general poor quality of evidence in pediatric surgery, a lack of required skills, and a culture that continues to rely on an apprenticeship style of teaching. Facilitators include working in a research hospital, and having a local champion/ peers that support EBP implementation. There were conflicting thoughts as to whether working as a group facilitated or impeded EBP.
  
  
  CONCLUSIONS
  Pediatric surgeons' use of research evidence in practice is influenced by a number of domains. These results may be used to inform the design of behavior change interventions intended to encourage EBP implementation.
  
  
  METHODS
  Level V.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada, K1H 8L1. Electronic address: ksullivan@cheo.on.ca.
authors.forename: Katrina J
authors.initials: KJ
authors.lastname: Sullivan
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada, K1H 8L1. Electronic address: cwayne@cheo.on.ca.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Wayne
authors.affiliation: City, University of London, Northampton Square, London, United Kingdom, EC1V 0HB; The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada, K1H 8L6. Electronic address: apatey@ohri.ca.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Patey
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada, K1H 8L1; Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada, K1H 8M5. Electronic address: anasr@cheo.on.ca.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nasr
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002983:Clinical Competence; D055317:Evidence-Based Practice / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006776:Hospitals, Pediatric; D006801:Humans; D020377:Self Efficacy; D066231:Surgeons / Q000592:standards*; D011795:Surveys and Questionnaires
keywords: Barrier; Behavior change intervention; Evidence-based practice; Facilitator