Table 6 The finalized steps and sub-steps of the EBDM framework resulted from evidence synthesis and the research team analysis

Situation analysis and priority setting

(7)^a

Identifying and prioritizing the problem (4)

Surveying the results of previous interventions (4)

Acquisition of experts’ opinions (RTS)^b

Determining information gaps (2)

Quantifying the issue and developing a statement

(2)

Developing the conceptual model for the issue (3) and defining the main statement of issues (RTS)

Determining data resources like:

surveillance data or clinical problems data (RTS), process improvement or risk-management data (RTS), internal/external benchmarking data (RTS), financial data (RTS), national agencies or organizational standards and guidelines (RTS), new researches and other literature (RTS), and experts’ opinions/experiments (1)

Capacity building (2) and setting objectives (RTS)

Understanding the context (2) and building an evidence-based culture (1)

Forming a team (RTS)

Gaining leadership support & commitment (3)

Setting objectives (RTS)

Identifying the capabilities required by employees and their skills weaknesses (3)

Training (1)

Developing the necessary infrastructures and structures (1) like improving health information systems (RTS)

Assigning mandates (20) and determining incentives (2)

Evidence acquisition and integration

(10)

Developing an efficient search strategy (2)

Finding the sources for seeking the evidence (6) according to 6S Pyramid (1) including: Scientific literature (2), Meta-analysis or meta-synthesis (RTS), Rapid Reviews (1), Other types of evidence (case-report, expert opinion, scientific principles, theory (RTS), Expert panels (1), Patient’s experience (1), Professional expertise (1), Consultation (1), Risk assessments (RTS), Economic data (RTS), case studies (1)

Keeping track of search results (1)

(If necessary) designing to^a conduct research (RTS)

Evidence appraising

(7)

Sourcing the evidence (1) using library services and reference managers (1) and Removing duplicates (RTS)

Appraising and selecting the evidence according to appropriate appraisal tools/methods^a such as: AGREE II instrument, AMSTAR Tool, Critical Appraisal Skills Program (CASP) Tools, Scottish Intercollegiate Guidelines Network, Quality Assessment Tool for Quantitative Studies (1), Benefits & risks, feasibility, applicability, and transferability data (5)

Analysis, synthesis and interpretation of data

(7)

Data extraction (1) and discarding mismatched alternatives (RTS)

Data analysis and synthesis (3) according to: evidence format, style of presentation, accessibility, validity, context sensitivity, applicability, timeliness

Determining potential features (scope, components, knowledge brokers, target audience, methods) (1)

Translation of data into user-friendly formats (1) using knowledge translation planning tools (1)

Developing evidence- based alternatives

(8)

Engaging community and stakeholders (3) and participatory decision making (3)

Developing program logic (1) and defining proposed change alternatives (1)

Identifying needed resources (1)

Planning implementation and evaluation process and strategies (1) /design EBP guideline(s) (RTS)

Defining outcomes to be achieved (2) and develop indicators (1)

Pilot implementation of selected alternatives

(10)

Document and investigate the change process in an action research approach (RTS)

Training the trainers and target audience (RTS) and empowerment staff according to the specific needs assessments (RTS)

Resources allocation (1)

Pre-implementation (RTS) and pilot change in practice (1)

Assessing barriers and enablers for implementation (1)

Developing recommendations and reporting template (RTS)

Modifying the practice guidance (RTS)

Evaluate alternative

(8)

Collecting baseline data (1) and Measuring at baseline mid-project and one-year post-project (RTS)

Evaluating processes and outcomes (2) and revise (1)

Deciding to adapt, adopt, or reject practice change (1)

Assessing factors for success and sustainability (1)

Checking the program checklist (1) [and if necessary] modifying the assessment criteria (RTS)

Feedback/correction (RTS)

Integrate and maintain change in practice

(1)

Making decisions based on the best available scientific and rigorous program evaluation evidence (RTS)

Disseminating evidence results to decision makers (2)/ [making sure that] Essential information conveyed effectively to target audiences/stakeholders (2)

Integrating change into standards of practice (1) or discontinue program or policy (1)

Presenting staff in-service education on change in practice (RTS)

Thoughts for future and adaptions (1)/ Feedback and feedforward to evidence-based decision-making model (RTS)