Barriers to EBP with strategies

Barriers to EBP in Optometry and Eye Health Care

Evidence-based practice involves the practitioner being able to access and identify best evidence on all areas relevant to clinical decision-making. This is more time consuming than basing clinical decisions on undergraduate knowledge, and it requires that the practitioner is able to find evidence and to discriminate high from low quality evidence. It depends not only on the practitioner having the necessary time, knowledge, skills and access to evidence, but also on the patient being prepared to accept and comply with evidence-based advice. These factors can be barriers to the implementation of EBP, and have been studied extensively in a range of health areas (Hutchinson and Johnston, 2004; McKenna et al, 2004; Sekimoto et al, 2006; Haron et al, 2012). Ultimately, providing evidence-based advice requires these potential barriers are identified and managed.

The table below shows some of the barriers to EBP that might be encountered in practice. This list is based in part on suggestions from optometrists who participated in a University of New South Wales postgraduate course on evidence-based optometry, indicating that they have encountered these issues. This list may give insight into what barriers you may experience and provides suggestions of strategies to address these.



Strategies to overcome


The practitioner may not have time to search and appraise the evidence relevant to each clinical question.

  • Journal clubs at the practice, or among a group of practices.
  • Anticipation of “FAQ” clinical questions that can go through the first three EBP steps so that when the patient presents recent best evidence is available.
  • Use of online open access systems to obtain level 1 evidence quickly.
  • Use of online systems to access databases with ready-appraised evidence.

Access to evidence

The practitioner is unlikely to have access to all peer-reviewed publications in which external research reports can be found.

  • Practitioner awareness of all available open-access sources of relevant evidence.
  • Potentially, professional body providing an optometry-specific database with ready-appraised evidence (e.g. “SightBite”).


The practitioner might not explain their advice clearly, or the patient may not understand it. This may be due to a language barrier or simply poor explanation of the need for an evidence-based strategy.

  • Language barriers overcome by translator as needed.
  • Practitioner training for good communication of evidence-based strategies and the importance of these.

Skills and knowledge

The practitioner may not have the skills required for EBP. He/she may not know what EBP means, or may be unable to ask a focused clinical question, search for and appraise evidence, and apply the answer to that question.

  • Optometrist training in EBP skills and knowledge at undergraduate level.
  • Professional requirement for maintenance via continuing education.
  • Professional requirement for continuing education to teach and assess these skills and knowledge.

Practice environment

The practice may facilitate or inhibit the application of EBP, in any one of several ways. For example, the practice may or may not provide computers with Internet access. The culture of the practice may or may not encourage EBP. In a teaching practice, the teachers may or may not encourage questions and challenges from students.

  • In educational practice environments, professional body requirement for trainees to challenge their teachers and to support their own arguments with appropriate evidence.
  • Professional body requirement for EBP encourages EBP centrally, with an influence on individual practices.


Patient’s attitude

The patient may not follow the optometrist’s evidence-based advice if it conflicts with advice received elsewhere (e.g. from another eye-care practitioner). This may be exacerbated if there are cultural or other differences that deter the patient from heeding the optometrist’s advice.

  • Explain the basis for the advice as clearly as possible.


Patient’s preferences

The patient may not want what the practitioner is advising. The practitioner may not have taken the patient’s preferences into account before applying EBP, or it may be that the advice needs to be given (e.g. adherence to glaucoma treatment) despite the patient’s preference.

  • Take into account patient’s preferences when applying EBP.
  • If important advice conflicts with patient’s preference (e.g. a child with amblyopia does not wish to be occluded) discuss a compromise intervention that will be effective (based on best evidence) and will not discourage compliance.


  • Haron IM, Sabti MY and Omar R (2012) Awareness, knowledge and practice of evidence-based dentistry amongst dentists in Kuwait. European Journal of Dental Education 16: e47-e52.
  • Hutchinson AM and Johnston L (2004) Bridging the divide: a survey of nurses’ opinions regarding barriers to, and facilitators of, research utilization in the practice setting. Journal of Clinical Nursing 13: 304-315.
  • McKenna HP, Ashton S and Keeney S (2004) Barriers to evidence-based practice in primary care. Journal of Advanced Nursing 45(2): 178-189.
  • Sekimoto M, Imanaka Y, Kitano N, Ishizaki T and Takahashi O. (2006) Why are physicians not persuaded by scientific evidence? A grounded theory interview study. BMC Health Services Research 6: 92.
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