Evidence-based practice profiles among bachelor students in four health disciplines: a cross-sectional study

Knowledge, attitudes, behavior, and self-efficacy related to evidence-based practice among healthcare professionals working in the municipal healthcare service in Norway: a cross-sectional survey

BACKGROUND

Practicing the process of evidence-based practice (EBP) may be challenging for healthcare professionals and may be affected by their EBP knowledge, attitudes, self-efficacy, and behavior. We have some insight into how Norwegian healthcare professionals and students perceive EBP. However, research on the perception of EBP among primary healthcare professionals working in the Norwegian municipal health service is lacking. This study aimed to map EBP knowledge, attitudes, behavior, and self-efficacy among healthcare professionals working with older people in the municipal health service in Norway and to examine associations between how they score and their background characteristics.

METHODS

A cross-sectional web-based survey was conducted among healthcare professionals in the Norwegian municipal healthcare service. We used the revised Norwegian version of the Evidence-based practice profile questionnaire (EBP2-N) to measure the healthcare professionals' EBP knowledge, attitudes, behavior, and self-efficacy, operationalized through the five domains of the EBP2-N. We calculated the mean scores for each EBP domain across the total sample and for each subgroup of healthcare professionals. We used a one-way between-groups analysis of variance (ANOVA) to analyze the differences in mean scores between the professions. We also calculated eta-squared values to determine effect size. We used linear regression analyses to examine associations with background variables.

RESULTS

A total of 313 healthcare professionals, including nurses, assistant nurses, physical therapists, occupational therapists, and medical doctors, responded to the survey. The total sample scored the highest on the relevance domain, with a mean domain score of 58.9 (95% CI = 58.1-59.7) on a scale ranging from 14 to 70. The practice domain had the lowest score, with a mean domain score of 22.2 (95% CI = 20.8-21.6) on a scale ranging from 9 to 45. Statistically significant differences in mean scores were found between professions in all domains except the confidence domain. The most considerable differences between professions' mean scores were found for the relevance and terminology domains, with eta-squared values of 0.13 and 0.19, respectively. The multivariate regression results showed that EBP training was significantly associated with the sum score of the relevance, terminology, and confidence domain. However, EBP training was not associated with the sum score of the practice and sympathy domains.

CONCLUSIONS

Primary healthcare professionals in the Norwegian municipal healthcare service hold positive attitudes toward EBP. However, they report a low understanding of research terms, low self-efficacy in performing EBP activities, a lack of perceived compatibility of EBP with professional work, and a low frequency of EBP behavior. Additionally, we observed differences among the included professions in four out of five domains, suggesting that various professions may be unequally prepared for EBP. Finally, our results indicate potential positive outcomes of EBP training. Those who received EBP training exhibited more positive attitudes, a better understanding of common research terms, and higher self-efficacy in performing EBP activities. However, EBP training was not associated with their self-reported EBP behavior.

TRIAL REGISTRATION

Retrospectively registered (prior to data analysis) in OSF Preregistration. Registration DOI: https://doi.org/10.17605/OSF.IO/428RP .

Evidence-based practice attitudes, knowledge and skills of nursing students and nurses, a systematic review and meta-analysis

AIM/OBJECTIVE

This study aims to carry out a meta-analysis of attitudes, knowledge, and skills level of nursing students and nurses in EBP, providing a reference for optimizing EBP education strategies.

BACKGROUND

At present, no meta-analysis has been performed to quantitatively synthesize the attitudes, knowledge and skill levels of nursing students and nurses toward EBP. This makes it difficult to precisely identify the true level of EBP among nurses, implying that there is no evidence to support the adoption of EBP teaching strategies approaches.

DESIGN

A total of 9 Chinese and English databases including CNKI, Wan fang, VIP, CBM, PubMed, Embase, Web of Science, Cochrane Library and CINAHL were used to search cross-sectional quantitative articles on EBP attitudes, knowledge and skills level of nurses and nursing students. The search time limit was from the inception of the database to September 2023.

METHODS

Two researchers independently screened the literature and extracted the data. The Agency for Healthcare Research and Quality (AHRQ) was used to assess the quality of the included studies. Stata15.0 software was used for statistical analysis to summarize the scores of EBP attitude, knowledge and skills level of nursing students and nurses included in the study.

RESULTS

A total of 25 cross-sectional studies from 13 countries were included, involving 11363 nursing students and nurses. The meta-analysis results revealed that nursing students and nurses lacked evidence-based practical knowledge and skills, with pooled mean scores of 3.06 (95 % CI: 2.72, 3.39), 2.91 (95 % CI: 2.60, 3.22), 4.31 (95 % CI: 4.08, 4.54) and 4.45 (95 % CI: 4.20, 4.70). In contrast, nursing students and nurses revealed a positive attitude towards EBP, with pooled mean scores of 3.57 (95 % CI: 3.28, 3.86) and 5.11 (95 % CI: 4.80, 5.42). Subgroup analysis revealed that senior nursing students and nurses with master's degree or above had higher attitudes, knowledge and skills.

CONCLUSIONS

In summary, nursing students and nurses have a positive attitude towards EBP. However, they seem to lack the necessary knowledge and skills. Therefore, nursing educators should consider this as an opportunity to strengthen the teaching of their evidence-based practical knowledge and skills. This will lay a reference for developing nursing discipline.

Scientific approach, attitudes, and perspectives on research among Swedish physiotherapy students-a cross-sectional study

BACKGROUND

Scientific evidence is important to evidence-based practice. Hence, the application of evidence-based practice requires relevant skills and an understanding of science, which therefore need to be learned and trained during the undergraduate program in physiotherapy. The aim of this study was to investigate attitudes, perceived competence, and conditions for a scientific approach among physiotherapy students in Sweden, and to compare attitudes and perceived competence between students in different program years.

METHODS

Physiotherapy students from six universities (n = 1499) were invited to respond to a digital survey. The survey contained questions regarding attitudes toward science, perceived competence in research interpretations and open comments regarding requirements for a strengthened scientific approach during education. Comparisons between education years were performed with ANOVA/Kruskal‒Wallis test (scale outcomes) and logistic regression (binary outcomes).

RESULTS

A total of 466 students responded to the survey. In total, 57% (n = 266) of the students had a high interest in science. No significant difference in interest in science was found between students in the three program years, but 75% (n = 347) reported increased interest during the program. A perceived high ability to understand the structure and performance of scientific studies was reported by 31% (n = 144), to evaluate the methodology by 16% (n = 72) and to interpret statistical results from scientific studies by 12% (n = 55). The lowest perceived competence was reported among students in their second year (p < 0.05). A majority of the students (88%; n = 410) reported a perceived personal need for strengthened conditions for a scientific approach, with suggested prerequisites during education via increased theoretical and applied understanding of the research.

CONCLUSION

Even though this study does not fully cover physiotherapy students at all undergraduate programmes in Sweden, the results support that a scientific approach and training should be strengthened during education to enable physiotherapists to understand and interpret science and to fully apply an evidence-based approach in upcoming clinical practice. Both theoretical and applied knowledge and understanding are needed.

Refining and adapting the measurement properties of evidence-based practice measures for physiotherapy students

OBJECTIVE

There is a lack of reliable and valid evidence-based practice (EBP) measures for physiotherapy students. This study validated EBP-student (EBP-S) measures for physiotherapy students.

METHODS

EBP measures developed from previous research were cross-culturally validated for use by physiotherapy students. The adapted EBP-S consisted of six measures: use of EBP, EBP activities, EBP knowledge, self-efficacy for EBP, attitudes towards EBP, and perceptions of the teaching and assessment of EBP in the curriculum. The final version was completed by physiotherapy students (n = 335). The psychometric properties for each EBP-S measure were estimated, including construct validity using Rasch model, internal consistency reliability using person separation index (PSI), test-retest reliability using intraclass correlation coefficient (ICC), and differential item functioning (DIF).

RESULTS

Two formative measures (use of EBP and EBP activities) were only linguistically modified for use with students. A Rasch model was applied to the other four reflective measures. For knowledge, 55% (6/11) items fit the Rasch model with chi-square fit statistic (χ2) = 34.46, p = 0.08; PSI = 0.85. For self-efficacy, 89% (8/9) items fit the Rasch model with χ2 = 25.11, p = 0.80; PSI = 0.89. For attitudes, 62% (8/13) items fit the Rasch model with χ2 = 61.49, p = 0.00; PSI = 0.71. For perception of the teaching and assessment of EBP in the curriculum, 62% (8/13) items fit the Rasch model with χ2 = 80.99, p = 0.45; PSI = 0.92. perception of the teaching and assessment of EBP in the curriculum showed DIF in three items. The ICCs ranged between 0.80 and 0.98.

CONCLUSIONS

The EBP-S measures were validated for physiotherapy students, including the testing of psychometric properties, which were not tested in the original studies. Further refinements should be considered for the use of the EBP-S with other groups of students or if changes are applied to the current curriculum.

Teaching evidence-based practice to physiotherapy students in Italy: a cross sectional study

BACKGROUND

Evidence-based practice (EBP) is being rapidly adopted by the Italian physiotherapy community, although a knowledge gap persists at clinical level with consequent lack of integration of EBP into ground roots practice. Teaching of EBP during the Bachelor of Science (BSc) undergraduate course in physiotherapy likely has a vital role to play in the spread of knowledge, providing a grounding in the fundamental concepts of EBP. The aim of the present study was to investigate the prevalence of EBP educational content in Italian BSc courses in physiotherapy.

METHODS

This is a cross-sectional study during which characteristics of EBP teaching in BSc degree courses of physiotherapy in Italy were collected from institutional websites during the period May to September 2021 with an update in August 2022. We used the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines for our manuscript.

RESULTS

Forty-two physiotherapy BSc degree programs were retrieved, accounting for all the BSc delivered in the 2021-2022 academic year. Fourteen of these (33.3%) did not report EBP content. Northern universities provided EBP content in 16 out of 18 (88%) degree courses. Central Italian universities provided EBP content in 6 out of 9 (66.6%) degree courses. Southern universities delivered EBP content in 3 out of 9 (33.3%) degree courses. The universities of Sicily and Sardinia provided EBP content in 2 out of 5 (40%) degree courses. The degree courses taught in public universities were more likely to contain EBP material (25 out of 37, 67.4%), compared to those taught within the private system (3 out of 5, 60%).

CONCLUSIONS

The prevalence of EBP content within physiotherapy BSc degree programs in Italy can be considered suboptimal, with both regional differences and according to the system (public vs private). The results of this study could be used as a stimulus for increasing investment in the teaching of EBP in Italian physiotherapy degree courses, thereby improving educational standards.

Research-based education in undergraduate occupational therapy and physiotherapy education programmes: a scoping review

BACKGROUND

In a research-based learning environment, students learn how to become critical thinkers and lifelong learners, and to generate discipline-enriching knowledge. Research training is important for all healthcare professionals and the integration of research in education can be one approach to improve evidence-based practice among future professionals. The purpose of this scoping review was to identify studies reporting on research-based education in undergraduate occupational therapy and physiotherapy curricula to document the current state of knowledge and to map factors that reflect and support the implementation of research-based education in undergraduate occupational therapy and physiotherapy programmes.

METHODS

A scoping review was used to systematically select and summarize existing literature. The search was conducted using a combination of keywords and MeSH terms in the following databases: EBSCO (Academic Search Elite, CINAHL, ERIC), MEDLINE, Embase, Education Source and grey literature. A thematic analysis identified strategies used to implement and promote research-based education in occupational therapy and physiotherapy bachelor programmes.

RESULTS

The database search identified 3068 records. 75 were eligible for full-text assessment and 27 studies were included. The studies were published between 1999 and 2021 and were conducted in Norway, Canada, South Africa, Australia, the United Kingdom, the United States, New Zealand, Ireland, Taiwan, Italy, and Iran. The study designs were mainly quantitative and qualitative, and studies included primarily occupational therapy and physiotherapy students. We identified the following four strategies: 'student engagement in research', 'curriculum improvement regarding EBP', 'EBP teaching' and 'journal club', where 'EBP teaching' was most frequently identified.

CONCLUSIONS

Findings from this scoping review suggest that ensuring students' competence in research methods is necessary for students to be able to read and understand research articles, which are important as foundational skills in undergraduate research training. Journal clubs can be a foundation for student engagement with research literature, and students' basic research skills may be facilitated through their involvement in research projects and by conducting systematic reviews. Further, cooperation with clinical practice is important, and the awareness of research-based education should be increased among both faculty members and students.

Student perspectives on factors that influence the implementation of evidence-based practice in occupational therapy

AIM

Evidence-based practice (EBP) is perceived as an integral component of contemporary allied health practice. While allied health clinicians (such as occupational therapists) have generally positive attitudes towards EBP, research suggests that they find its implementation consistently challenging. The professional literature increasingly suggests that more effective EBP learning takes place when social constructivist approaches to learning are adopted. The authors of this study sought to use the pre-existing knowledge and perceptions of occupational therapy students to inform a curriculum review of an EBP unit. Therefore, the aim of this content analysis study was to investigate how occupational therapy students perceive and critically analyse factors that influence the implementation of EBP, specifically strengths, weaknesses, opportunities and threats (SWOT).

METHODS

The study sampled students in the third year of a 4-year, Bachelor level Australian Occupational Therapy Program. The students were undertaking the first of two EBP units, and data were collected from the first assignment they submitted for these units. The assignment required the students to complete a SWOT analysis of EBP in occupational therapy, and response to a statement around whether it should be mandatory. Data were collected over 2 consecutive years from a total of 64 occupational therapy students. All data collected were subjected to content analysis, with themes identified by at least 25% of students in each cohort retained for analysis and formation into overall themes.

RESULTS

Participating occupational therapy students identified five strengths, four weaknesses, six threats but only one opportunity for EBP. Three key themes were identified within the data: first, the role and purpose of EBP; second, the resources it requires and third, factors that influence its success. The students perceived the main purpose of EBP as supporting positive practice change, and highlighted its roles in building clinician capacity and professional credibility. They also characterized EBP as a separate and specialist practice that requires specific training and resourcing to achieve, and questioned its feasibility as an integrated part of daily practice. Along with previously identified challenges around time and resourcing, the students also highlighted negative attitudes and beliefs from senior colleagues as an important negative influence on the success of EBP.

CONCLUSION

The current study consolidates a growing body of international literature about the value of social constructive approaches to EBP in undergraduate education. Vertical constructive alignment that embeds EBP through undergraduate education, rather than the provision of 'EBP'-specific units, should now be considered best practice. However, this embedded approach requires the explicit and repeated communication of the presence of EBP in all learning opportunities, to enable students to recognize opportunities to deploy their existing knowledge and skills.

Physical therapists' evidence-based practice profile and perspectives of entry-level EBP education: a mixed methods study in the Philippines

Background and Purpose. Inclusion of evidence-based practice (EBP) in entry-level physical therapy (PT) curricula is meant to develop the necessary competencies for better EBP uptake in clinical practice. This study aimed to: 1) determine the practice, knowledge, and values for EBP of the graduates of an entry-level PT curriculum with EBP education; 2) compare graduates' EBP practice profile to their EBP knowledge and values; and 3) explore their views on their EBP education and how EBP education influenced their practice. Methods.A convergent parallel design was used to gather quantitative and qualitative data. The Evidence-based Practice Profile - 2 (EBP²) questionnaire was used for quantitative data. Focus group discussions and open-ended questions in the EBP² were sources for qualitative data. Results.Seventy-seven completed the questionnaire and eight participated in focus group discussions. Participants scored highest for Relevance domain (standardized mean = 75.3) and lowest for Practice (standardized mean = 45.5). Three themes, 'Positive impact of EBP education,' 'Realities of PT clinical practice, and 'Strategies to improve EBP education' were derived. Data integration confirmed findings that graduates have good knowledge, value for, and confidence in doing EBP. Discussion and Conclusion.Findings suggest that early EBP education led to adequate knowledge, confidence, and positive attitudes, but practice barriers hinder EBP uptake. The medical model of service delivery was identified as a factor that influences EBP use. There is a need to revisit the EBP education program to complement real-world demands.