Evidence implementation represents a “purposeful and enabling set of activities designed to engage key stakeholders with research evidence to inform decision-making and generate sustained improvement in the quality of healthcare delivery” [1]. Whilst this definition refers specifically to research evidence, evidence implementation acknowledges all types of evidence, whether that be research, text or opinion [1]. Unlike evidence-based practice - where the onus is on individual clinicians to deliver care based on the best available evidence - evidence implementation embraces a broader, systems-based approach. Specifically, evidence implementation acknowledges the diverse range of stakeholders, and factors implicated in, the delivery of best practice care.

There are several reasons why health professions and associated stakeholders (e.g. patients, regulators, educators, governments) are encouraged to embrace an evidence-based approach to health care. Primarily, the provision of best practice care is associated with improvements in health outcomes and patient satisfaction [2,3]. Best practice care also can contribute to reductions in health care expenditure by achieving desired outcomes at a lower cost (e.g. reducing length of stay, decreasing the need for hospital admission) [4,5]. But despite the many benefits of delivering evidence-based health care, implementing evidence into practice can be fraught with challenges.

Barriers to evidence implementation are varied, but can be broadly sorted into four main categories: structural (e.g. access to resources, time), cultural (e.g. norms, philosophical orientation), cognitive (e.g. self-efficacy, training) and attitudinal (e.g. preconceptions) [6]. While many health professions share similar barriers to evidence implementation, these barriers are not the same across all professions. For instance, complementary medicine (CM) practitioners (e.g. naturopaths, chiropractors, osteopaths, yoga therapists, Western herbal medicine and traditional Chinese medicine practitioners) report a number of obstacles to evidence implementation not expressed by other health professions, such as the perceived misalignment between evidence-based practice (EBP) and the culture of the profession, and the perceived adverse impact of EBP on the practice or philosophy of the profession [7]. Even within the field of CM, barriers to evidence implementation are shown to vary between disciplines, and across jurisdictions [[7], [8], [9], [10], [11]]. But, despite increasing awareness of these barriers, there has been little discourse or enquiry into the evidence implementation environment for CM professions.

The interprofessional and interjurisdictional variations in reported barriers to evidence implementation indicate that a one-size-fits-all approach to managing these barriers would be inappropriate. Strategies aimed at improving evidence implementation should instead take into account the nuances of each profession, including the regulatory, educational, clinical and geographical contexts that each profession operates within. Establishing these nuances maybe somewhat problematic however, as it would require researchers to survey the various stakeholders of each discipline, in every jurisdiction. Such an approach is not feasible, and furthermore, is unlikely to clearly capture the complexity of the evidence implementation environment. Additionally, as professional contexts change (e.g. through policy reform), the findings of these surveys can rapidly become obsolete.

The abovementioned challenges highlight the need for an efficient, systematic, comprehensive and innovative approach to assessing the capacity and capability of a profession to engage in EBP at an optimal level. Such an approach would not only help ascertain the preparedness/readiness of a profession for evidence implementation, but also identify where resources should be directed in order to augment the uptake of evidence-based practices within that profession. Thus, the aim of this research was to develop, refine and validate a tool to assess the evidence implementation environment for complementary medicine (CM) professions. CM professions were targeted for this research as the barriers and enablers to evidence implementation in this population have been extensively investigated [[7], [8], [9], [10], [11]].