Psychometric properties of the Dutch version of the Evidence-Based Practice Attitude Scale (EBPAS)

Attitudes Toward and Usage of Evidence-Based Mental Health Practices for Autistic Youth in Bangladesh and Germany: A Cross-Cultural Comparison

The implementation of evidence-based practices (EBPs) for autistic youth is a critical concern worldwide. Research examining factors facilitating the implementation of EBPs found that providers' attitudes are an important factor. In this study, we evaluated cross-cultural differences in attitudes toward and use of EBPs. We tested socio-demographic factors as predictors of attitudes, and attitudes as predictors of EBPs use among mental health professionals working with autistic youth in Bangladesh and Germany. We used purposeful sampling. Two-hundred-ninety-two professionals who worked in a clinical setting responded to the survey and fulfilled the inclusion criteria (101 in Bangladesh, 191 in Germany). Participants were asked to respond to nine subscales of the Evidence-Based Practice Attitude Scale-36 (EBPAS-36), to indicate which of nine types of treatments they used, and to provide sociodemographic data. Measurement invariance across countries could be established for four subscales of the EBPAS-36. Comparative analyses of attitudes showed that professionals in both countries were open to using EBPs, but German practitioners were more likely to use EBPs when they appealed to them. By contrast, Bangladeshi professionals claimed to be more likely to adopt an EBP when required and to be more willing to learn EBPs to enhance job security. The relationship between caseload and attitudes varied between countries. A broader variety of EBPs was used in Germany. The findings highlight the importance of considering country-specific factors when implementing EBPs. Directions for conducting comparative studies on mental health professionals' attitudes towards EBP including methodological considerations are discussed.

Impact of the person-centred intervention guided self-determination across healthcare settings-An integrated review

AIM

To review the evidence of the existing literature on the impact of guided self-determination across methodologies in different healthcare settings.

METHODS

An integrated five-stage review.

RESULTS

Forty-five eligible papers were included. Guided self-determination was applied in full- or small-scale, or combined with another intervention or approach in different healthcare settings handling, for example diabetes, stroke survivorship, schizophrenia, attention-deficit hyperactivity disorder and medical disorder, gynaecological and breast cancer, endometriosis, persons with chronic pain, persons in haemodialysis and intensive care survivors. The included studies covered 12 randomised trials, 26 qualitative and seven papers of different methodology. A statistically significant effect was found in three trials. Six main themes describe the qualitative findings across papers on patients: (1) Guided self-determination reduces disease-related loneliness, (2) Insight enables integration of life and disease, (3) Reflection sheets-appreciated but challenging tool to prompt insights and person-specific knowledge, (4) New person-specific knowledge enables person-centred support, (5) Feeling seen and believed in a new and trusted relationship and (6) Exchange of knowledge enables the development of life skills. Four themes describe the healthcare professionals' experience: (1) Change of usual practice-a decision from above, (2) A new role-unlearning previous behaviour and need for support, (3) Reflection sheets as facilitators and barriers and (4) Discovering the benefits of changing to a person-centred approach.

CONCLUSION

Overall, guided self-determination proved to have a great impact on patient important outcomes and was useful and well-accepted by the majority of patients and healthcare professionals. Albeit guided self-determination is not a 'one size fits all' method. Continuous training and supervision of professionals are a necessary mean when implementing guided self-determination to enhance adoption and sustainability in clinical practice.

Translation and validation of the evidence-based practice attitude scale (EBPAS-15) to Brazilian Portuguese: Examining providers' perspective about evidence-based parent intervention

Background

Few existing evidence-based parent interventions (EBPIs) for prevention and treatment of child and youth mental health disorders are implemented in low-middle-income countries. This study aimed to translate and confirm the factor structure of the Evidence-Based Practice Attitude Scale (EBPAS-15) survey in Brazilian Portuguese with the goal of examining providers' perspective about EBPIs.

Methods

We translated and back translated the EBPAS-15 from English to Brazilian Portuguese. Participants were recruited via snowball sampling and data were collected using an online survey from July of 2018 through January of 2020. A confirmatory factor analysis was conducted to determine if the scale retained its original structure. Open-ended questions about providers' perspectives of their own clinical practice were coded using the Theoretical Domains Framework (TDF). Analyses included data from 362 clinicians (318 women, 41 men) from 20 of the 27 states of Brazil. Participants on average were 26.7 years old, held specialist degrees in the field of psychology, actively worked as therapists, and practiced in private clinics.

Results

The translation of the EBPAS to Brazilian Portuguese retained the same four-factor structure as the English version except for dropping one item from the Divergence domain. When asked about the challenges in their practices, providers generally referred to parents as clients with little skills to discipline their children and lacking knowledge about child development.

Discussion

The Brazilian version of the EBPAS-15 is promising, but future research should consider using quantitative data alongside qualitative information to better understand providers' attitudes about evidence-based interventions to inform implementation efforts.

Trial registration

N/A.

Developing an Evidence-Based Nursing Culture in Nursing Homes: An Action Research Study

Background: Nursing homes face challenges caused by increasing numbers of older adults with multimorbidity and the demand for quality of care. Developing an evidence-based nursing (EBN) culture is a promising strategy to face these challenges. Therefore, the aim of this study was to develop an EBN culture in nursing homes and gain insight into the influencing factors. Methods: An action research study was conducted with 12 nursing teams in 4 Dutch nursing homes, using the Practice Development approach to develop an EBN culture. The teams (mostly certified nurse assistants) were coached by internal facilitators (bachelor’s or master’s degree nurses) and external facilitators (nursing teachers). Data were gathered at baseline and after 15 months using questionnaires and individual and focus group interviews. Results: With varying degrees, most nursing teams implemented elements (related to values, attitudes, and behaviors) of an EBN culture with appropriate leadership, advocacy, and training. The team members became open to new insights and asked critical questions. During the project, participants learned how EBN could be incorporated into daily practice, for example, by keeping it small, discussing information from professional journals, and using creative methods such as quizzes. Influencing factors of an EBN culture were: (a) support of managers, (b) inspiring facilitators close to the team, and (c) stable teams with driving forces and student nurses. Conclusions: Integrating EBN into daily practice in creative and motivating ways contributes to the development of an EBN culture in nursing homes. To facilitate this, managers should support teams in the process and content of EBN, and internal facilitators should collaborate with driving forces on the teams.

Adaptation of the evidence-based practices attitude scale-15 in Turkish family medicine residents

AIMS

Aim of this study is to translate and apply a cross-cultural adaptation of the Evidence-Based Practice Attitude Scale (EBPAS) in Turkish and investigate its validity and reliability.

METHODS

The original EBPAS-15 (a questionnaire assessing health professionals' attitudes to implementation of evidence-based practice) was translated into Turkish. To assess its validity and reliability, 151 family medicine residents answered the EBPAS-15 by web-based survey. In addition, relationships of family medicine residents' characteristics with EBPAS-15 total scores are examined.

RESULTS

The results showed that the EBPAS-15 has good internal consistency and reliability. The Cronbach's alpha value for EBPAS-15 was 0.828. The scores of the two scales were highly correlated (ρ = 0.72). In the scale, there was no item with a total correlation value of less than 0.40. For this reason, no item was removed due to the high reliability value of all 15 items.

CONCLUSION

The Turkish version of the EBPAS-15 shows mainly good validity and reliability.

Cross-cultural adaption and psychometric investigation of the German version of the Evidence Based Practice Attitude Scale (EBPAS-36D)

BACKGROUND

The implementation of evidence-based practice (EBP) in mental health care confers many benefits to patients, and research into factors facilitating the implementation of EBP is needed. As an important factor affecting the implementation of EBP, service providers' attitudes toward EBP emerged. The Evidence-Based Practice Attitude Scale (EBPAS-36) is an instrument with good psychometric characteristics that measures positive and ambivalent attitudes toward EBP. However, a German version is missing. The present study therefore aims to provide a validated German translation of the EBPAS-36.

METHODS

The scale was translated and back-translated as recommended by standard procedures. German psychotherapists were recruited to participate in an online survey. They provided demographic and professional information, completed the EBPAS-36, the Implementation Climate Scale (ICS) and the Intention Scale for Providers (ISP). Standard item and reliability analyses were conducted. Construct validity was evaluated with exploratory (EFA) and confirmatory factor analyses (CFA) in two subsamples (random split). Convergent validity was tested by predicting a high positive correlation of the EBPAS-36D with two scores of attitudes of the ISP and an interest in EBP score. It was tested whether the EBPAS-36D predicts the intention to use EBP.

RESULTS

N = 599 psychotherapists participated in the study. The item analyses showed a mean item difficulty of p_i = 0.64, a mean inter-item correlation of r = 0.18, and a mean item-total correlation of r_itc = 0.40. The internal consistency was very good for the total scale (α = 0.89) and ranged from adequate to very good for the subscales (0.65-0.89), indicating high reliability. The original factor structure showed an acceptable model fit (RMSEA = 0.064 (90% CI = 0.059-0.068); SRMR = 0.0922; AIC = 1400.77), confirming the 12-factor structure of the EBPAS-36. However, a second-order factor structure derived by the EFA had an even better model fit (RMSEA = 0.057 (90% CI = 0.052-0.062); SRMR = 0.0822; AIC = 1274.56). When the EBPAS-36D was entered in a hierarchical regression model with the criterion Intention to use EBP, the EBPAS-36D contributed significantly to the prediction (Change in R² = 0.28, p < 0.001) over and above gender, age and participants' report of ever having worked in a university context.

CONCLUSIONS

The present study confirms good psychometric properties and validity of a German version of the EBPAS-36 in a sample of psychotherapists.

Confirmatory factor analysis of the Evidence-Based Practice Attitude Scale (EBPAS) in a large and representative Swedish sample: is the use of the total scale and subscale scores justified?

Background

There is a call for valid and reliable instruments to evaluate implementation of evidence-based practices (EBP). The 15-item Evidence-Based Practice Attitude Scale (EBPAS) measures attitude toward EBP, incorporating four lower-order factor subscales (Appeal, Requirements, Openness, and Divergence) and a Total scale (General Attitudes). It is one of a few measures of EBP attitudes evaluated for its psychometric properties. The reliability of the Total scale has been repeatedly supported, but also the multidimensionality of the inventory. However, whether all of the items contribute to the EBPAS Total beyond their subscales has yet to be demonstrated. In addition, the Divergence subscale has been questioned because of its low correlation with the other subscales and low inter-item correlations. The EBPAS is widely used to tailor and evaluate implementation efforts, but a Swedish version has not yet been validated. This study aimed to contribute to the development and cross-validation of the EBPAS by examining the factor structure of t a Swedish-language version in a large sample of mental health professionals.

Methods

The EBPAS was translated into Swedish and completed by 570 mental health professionals working in child and adolescent psychiatry settings spread across Sweden. The factor structure was examined using first-order, second-order and bifactor confirmatory factor analytic (CFA) models.

Results

Results suggested adequate fit for all CFA models. The EBPAS Total was strongly supported in the Swedish version. Support for the hierarchical second-order model was also strong, while the bifactor model gave mixed support for the subscales. The Openness and Requirements subscales came out best, while there were problems with both the Appeal (e.g. not different from the General Attitudes factor) and the Divergence subscales (e.g. low reliability).

Conclusions

Overall, the psychometric properties were on par with the English version and the total score appears to be a valid measure of general attitudes towards EBP. This is the first study supporting this General Attitudes factor based on a bifactor model. Although comparatively better supported in this Swedish sample, we conclude that the use of the EBPAS subscale scores may result in misleading conclusions. Practical implications and future directions are discussed.

A psychometric evaluation of the Vietnamese version of the Evidence-Based Practice Attitudes and Beliefs Scales

AIM

The aim of this study is to develop and to test the construct validity and reliability of the Vietnamese versions of the Evidence-Based Practice Attitude and Evidence-Based Practice Beliefs scales.

METHODS

This is a psychometric evaluation study. Three hundred and fifty-three nurses and midwives were recruited from a national hospital in Vietnam from September to December 2018. Data were obtained from two scales. Content validity, face validity and construct validity measures were all conducted, whereas exploratory and confirmatory factor analyses were performed from data collected from two cohorts of participants. Cronbach's alpha coefficient represented reliability, and data were analysed in SPSS 20 and AMOS 24.

RESULTS

The four-factor model developed with openness, requirements, appeal and divergence factors accounted for 55% of total variance in the Attitude scale. A three-factor model labelled as value beliefs, knowledge beliefs and resource beliefs with 59% of total variance was explained in the Beliefs scale. Cronbach's α coefficients were .72 for the Attitude scale and .81 for the Beliefs scale.

CONCLUSIONS

The two scales could be used to assess Vietnamese nurses' attitudes and beliefs to adopt evidence-based practice enabling hospitals to align individual and organizational goals for developing evidence-based practice and enable comparison of the results with international samples.

Evaluation of an Adaptive Implementation Program for Cognitive Adaptation Training for People With Severe Mental Illness: Protocol for a Randomized Controlled Trial

BACKGROUND

Cognitive Adaptation Training is a psychosocial intervention that focuses on reducing the negative effects of cognitive disorders, especially executive functions such as planning and targeted action. International research has shown that Cognitive Adaptation Training enhances multiple aspects of daily functioning in people with severe mental illnesses. Despite this evidence, implementation of the intervention into routine care remains a challenge.

OBJECTIVE

In this implementation research, a newly developed implementation program based on previous experience and scientific literature, is tested. The primary aim of this research is to assess the effectiveness of the implementation program. The secondary aim of this study is to evaluate the factors that impede or facilitate the implementation of Cognitive Adaptation Training.

METHODS

To test the effectiveness of the implementation program, a multicenter cluster randomized controlled trial was conducted comparing the implementation program to a single training program in four mental health institutions in The Netherlands. Focus groups, semistructured interviews, and questionnaires were used at multiple levels of service delivery (service user, professional, team, organization) to identify factors that may hamper or facilitate implementation. The RE-AIM framework was applied to measure the implementation effectiveness. Following this framework, the primary outcomes were Reach, Intervention Effectiveness, Adoption, Implementation, and Maintenance. These are assessed before, during, and after implementation. The research had a total duration of 14 months, with a follow-up measurement at 14 months. Data will be analyzed using multilevel modeling.

RESULTS

The study was funded in April 2018. Data collection occurred between November 2018 and January 2020. In total, 21 teams of 4 mental health institutions agreed to participate. Data analysis is ongoing and results are expected to be published in December 2020.

CONCLUSIONS

This implementation research may provide important information about the implementation of psychosocial interventions in practice and may result in a program that is useful for Cognitive Adaptation Training, and possibly for psychosocial interventions in general.

TRIAL REGISTRATION

The Netherlands Trial Register (NL7989); https://www.trialregister.nl/trial/7989.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/17412.

Individual and organizational characteristics predicting intervention use for children with autism in schools

LAY ABSTRACT

Several interventions or treatment programs have been shown through research to improve social outcomes for children with autism, but they often are not used in schools. This study examined individual (school personnel) and organizational (school level) factors associated with the use of a research-informed social engagement intervention, Remaking Recess, for children with autism in elementary schools. A total of 28 school personnel from 12 schools in 5 districts in the northeastern United States participated. Schools were randomly assigned to (1) training in Remaking Recess only or (2) training in Remaking Recess with implementation support (tailored strategies to remove barriers to increase use of Remaking Recess). School personnel rated their attitudes about research-informed interventions, organizational readiness (school's readiness to use a research-informed intervention), and fidelity or the degree to which an intervention is used as it was originally designed. Observers rated school personnel's fidelity at baseline (pre-intervention training) and exit (post-intervention training). The results suggest that self-rated fidelity was lower when staff perceived the use of Remaking Recess was required; however, observer-rated fidelity was lower when staff rated Remaking Recess as appealing. In addition, self-rated fidelity was higher when there was a sufficient number of staff, positive individual growth, and organizational adaptability. The results also indicated higher observer-rated fidelity when staff perceived positive influence over their coworkers. The results suggest that both individual (attitudes) and organizational (influence, staffing, growth, adaptability) characteristics may affect implementation success in schools. A collaborative decision-making approach for evidence-based practice use is recommended.

Reliability of the Swedish version of the Evidence-Based Practice Attitude Scale assessing physiotherapist's attitudes to implementation of evidence-based practice

Purpose

To translate and apply a cross-cultural adaptation of the Evidence-Based Practice Attitude Scale (EBPAS) in Swedish and investigate its absolute and relative reliability.

Methods

The original EBPAS (a questionnaire assessing health professionals’ attitudes to implementation of evidence-based practice) was translated into Swedish using a forward and backward procedure, including a group discussion and expert committee. To assess reliability, 55 physiotherapists (48 women) aged 23–64 years from different clinical settings in the Stockholm region answered the EBPAS by postal survey twice within an interval of 2 weeks.

Results

The Cronbach’s alpha values for EBPAS were >0.721. The intraclass correlation (ICC) between test and retest (relative reliability) was moderate to good for the four subscales, with ICC(A.1) and ICC(C.1) values approximately equal and in the range 0.56–0.89. Values for the absolute reliability of the mean score were a standard error of measurement of about 7% and a smallest real difference of about 19%.

Conclusion

The Swedish version of the EBPAS shows mainly good reliability.

Reducing inappropriate psychotropic drug use in nursing home residents with dementia: protocol for participatory action research in a stepped-wedge cluster randomized trial

BACKGROUND

Psychotropic drugs are often prescribed to treat neuropsychiatric symptoms in nursing home residents with dementia, despite having limited efficacy and considerable side effects. To reduce the inappropriate prescribing of these psychotropic drugs, various non-pharmacological, psychosocial, person-centered, or multidisciplinary interventions are advocated. However, existing multidisciplinary interventions have shown variable effects, with limited effectiveness often resulting from suboptimal implementation. We hypothesize that an effective intervention needs to fit the local situation of a nursing home and that support should be offered during implementation.

METHODS

We will embed participatory action research within a stepped-wedge cluster randomized controlled trial to study the effects of a tailored intervention and implementation plan to reduce inappropriate psychotropic drug prescribing. Nursing homes will be provided with tailored information about the perceived problems of managing neuropsychiatric symptoms and we will offer coaching support throughout. Alongside the participatory action research, we will perform a process evaluation to examine the quality of the study, the intervention, and the implementation. Our aim is to recruit 600 residents from 16 nursing homes throughout the Netherlands, with measurements taken at baseline, 8 months, and 16 months. Nursing homes will be randomly allocated to an intervention or a deferred intervention group. During each intervention stage, we will provide information about inappropriate psychotropic drug prescribing, neuropsychiatric symptoms, and difficulties in managing neuropsychiatric symptoms through collaboration with each nursing home. After this, a tailored intervention and implementation plan will be written and implemented, guided by a coach. The primary outcome will be the reduction of inappropriate prescribing, as measured by the Appropriate Psychotropic drug use In Dementia index. Secondary outcomes will be the frequency of psychotropic drug use and neuropsychiatric symptoms, plus quality of life. A mixed methods design will be used for the process evaluation. Effects will be assessed using multilevel analyses. The project leader of the nursing home and the coach will complete questionnaires and in-depth interviews.

DISCUSSION

We anticipate that the proposed tailored intervention with coaching will reduce inappropriate psychotropic drug prescribing for nursing home residents with neuropsychiatric symptoms. This study should also provide insights into the barriers to, and facilitators of, implementation.

TRIAL REGISTRATION

NTR5872 , registered on July 2, 2016.

Pivotal response treatment: A study into the relationship between therapist characteristics and fidelity of implementation

In this study, we investigated the relationship between fidelity of pivotal response treatment implementation and therapist characteristics, such as therapist personality, therapist–child relationship, therapist attitude toward evidence-based practices, and therapist experience. We also explored whether child age and autism symptom severity were related to pivotal response treatment fidelity. Participants were 41 level III certified pivotal response treatment therapists who recorded three 10-min pivotal response treatment sessions and completed four questionnaires to measure therapist characteristics. Results indicated that therapists’ attitude toward evidence-based practices, specifically openness to innovation, and therapists’ experience with pivotal response treatment significantly predicted fidelity of pivotal response treatment implementation. Cross-validation methods largely confirmed these findings. Therapist personality, therapist–child relationship, and child characteristics were not significantly related to pivotal response treatment fidelity. Implications for clinical practice and directions for future research are discussed.

[Psychometric Evaluation of the Brazilian Version of the "Sexually Transmitted Disease Knowledge Questionnaire"]

This study evaluated the psychometric properties of the Brazilian version of the Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ). A convenience sample of 429 students of a Brazilian public university participated in the study. Exploratory Factor Analysis suggested one factor solution (variance explained = 61.1%, eigenvalue = 7.2), confirmed by the confirmatory analysis (Root Mean Square Error of Approximation = 0.04; Comparative Fit Index = 0.91; Tucker-Lewis Index = 0.90; Standardized Root Mean Square Residual = 0.05). Five items feature charges less than 0.30 and wer eliminated. The instrument demonstrated internal consistency (Composite reliability = 0.97; Cronbach's alpha = 0.83) and temporal stability (Pearson correlation = 0.86; kappa = 0.16) over a brief period. The knowledge significantly varies by age, sex and course of study. In conclusion, this study highlights the satisfactory psychometric proprieties of the Brazilian version of STD-KQ in university students.

Development and Validation of the Dutch EBPAS-ve and EBPQ-ve for Nursing Assistants and Nurses with a Vocational Education

BACKGROUND

In recent years, there has been an increasing focus on the role of evidence-based practice (EBP) to increase the quality and safety of care. However, EBP implementation research has predominantly taken place in hospitals and hardly in nursing homes or home care. In these care settings, patients are attended by nursing assistants and registered vocationally trained nurses. A good EBP starting point is to assess their current attitude toward and use of EBP. However, current questionnaires are not valid for assistants and nurses with vocational education.

AIMS

To adapt the Evidence-Based Practice Attitude Scale (EBPAS) and the Evidence-Based Practice Questionnaire (EBPQ) to a Dutch questionnaire for nursing assistants and registered vocationally trained nurses European Qualification Framework level 3-4 employed in home care or nursing homes.

METHODS

Translation, adaptation through cross-cultural validation, pretesting, exploratory factor analysis, and evaluation of psychometric properties among a group of nursing assistants and registered vocationally trained nurses.

RESULTS

Cross-cultural validation led to modified items of EBPQ and EBPAS. The sample comprised 273 nurses. Analysis of both instruments showed a robust factor structure. EBPAS-ve: internal consistency: α = 0.76; intra-rater reliability: ICC = 0.52. EBPQ-ve: α = 0.75; ICC = 0.60. Convergent validity (correlation EBPAS-ve and EBPQ-ve's subscale Attitude): r = .300 (p < .01). Construct validity: significantly higher scores (p < .01) in the group with higher education.

LINKING EVIDENCE TO ACTION

Psychometric qualities of both instruments were satisfactory, although we recommend refinement of EBPAS-ve's subscale Divergence and extra instructions for the EBPQ's subscale Attitude. To our knowledge, this is the first adaptation of an EBP measurement instrument for nursing assistants and registered vocationally trained nurses. The questionnaires appeared to be feasible and showed multiple valid and reliable properties, including a satisfactory intra-rater reliability. Both questionnaires may facilitate the implementation of EBP as they contribute to a richer understanding of the attitude toward and use of EBP in nursing homes and home care.

Measuring Youth Residential Care Provider Attitudes

Abstract. In this study the 15-item Evidence-Based Practices Attitude Scale (EBPAS), a measure designed to assess attitudes toward the adoption of EBPs, was collected from administrators of residential care facilities for youth in the United States. As the EBPAS was administered to a different sample for which it was originally developed (i.e., community mental health), we conducted a Confirmatory Factor Analysis (CFA) to investigate if its factor structure was maintained. Results confirm the factor structure of the EBPAS as a valid measure of attitude toward evidence-based practice among youth residential care providers. Limitations and areas of future research are discussed.

The deadlock of saying "That is what we already do!" A thematic analysis of mental healthcare professionals' reactions to using an evidence-based intervention

WHAT IS KNOWN ON THIS SUBJECT?: There is a need to shed light on healthcare professionals' reactions to the use of the Guided Self-Determination method in a mental health hospital to better understand and adjust the implementation process of evidence-based practice. Healthcare professionals´ values and beliefs play an important role when implementing evidence-based practice in real-world healthcare settings. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The study identifies opposite positions in mental healthcare professionals: being ready or resistant to change when implementing an evidence-based intervention. The positions are elaborated in four thematic dynamic continuums describing reactions to using the intervention. In addition, this is the first study to explore mental healthcare professionals´ reactions to using the Guided Self-Determination method in a mental health context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When preparing implementation of an evidence-based intervention, it is important to consider adaptation of the intervention, the mental healthcare professionals' acceptability, support from management and participation in supervision. In future research, it is important to consider collecting data from mental healthcare professionals trained in using an evidence-based intervention, however not using it in clinical practice, to understand barriers towards evidence-based practice. ABSTRACT: Introduction Evidence-based interventions are required in mental health nursing to improve quality and outcome for patients. However, there is a need to shed light on professionals' reactions to the use of evidence-based interventions to better understand and adjust the implementation process. Aim To explore mental healthcare professionals´ reactions to using the evidence-based intervention Guided Self-Determination method in the care of inpatients with severe mental illness. Method A qualitative study conducted in relation to an 8 months implementation program. Data collection: 9 qualitative interviews and field notes generated from supervision of the intervention. Results Four themes emerged from a thematic analysis: "The expert becomes novice," "Theory used as a looking glass," "Guided Self-Determination perceived as an interruption" and "Becoming an informer of the impact of GSD." Discussion Using the themes may help leaders or researchers predict or discover the support needed by individual professionals. Implications for practice When preparing implementation of an evidence-based intervention, it is important to consider adaptation and acceptability, as well as support from management and participation in supervision. Finally, it is worth to consider collecting data from trained professionals, who did not use the intervention in practice to understand barriers towards evidence-based practise.

Protocol for development and validation of a context-appropriate tool for assessing organisational readiness for change in primary health clinics in South Africa

INTRODUCTION

A large treatment gap for common mental disorders (such as depression) exists in South Africa. Comorbidity with other chronic diseases, including HIV and diseases of lifestyle, is an increasing public health concern globally. Currently, primary health facilities as points of care for those with chronic disease provide limited services for common mental disorders. Assessing organisational readiness for change (ORC) towards adopting health innovations (such as mental health services) using contextually appropriate measures is needed to facilitate implementation of these services. This study aims to investigate the validity of the Texas Christian University Organisational Readiness for Change (TCU-ORC) scale in the South African context. Subsequently, we will develop a shortened version of this scale. This study is nested within Project MIND, a multiyear randomised controlled trial that is testing two different approaches for integrating counselling for common mental disorders into chronic disease care. Although the modified, contextually appropriate ORC measure resulting from the proposed study will be developed in the context of integrating mental health into primary healthcare services, the potential for the tool to be generalised to further understanding barriers to any change being implemented in primary care settings is high.

METHODS AND ANALYSIS

We will establish internal consistency (Cronbach's alpha coefficients), test-retest reliability (intraclass correlation coefficient) and construct validity of the long-form TCU-ORC questionnaire. Survey data will be collected from 288 clinical, management and operational staff from 24 primary health facilities where the Project MIND trial is implemented. A modified Delphi approach will assess the content validity of the TCU-ORC items and identify areas for potential adaptation and item reduction.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the South African Medical Research Council (Protocol ID EC004-2-2015, amendment of 20 August 2017). Results will be submitted to peer-reviewed journals relevant to implementation and health systems strengthening.

Openness to adopting evidence-based practice in public substance use treatment in South Africa using task shifting: Caseload size matters

BACKGROUND

In response to the lack of coverage for substance use treatment in the Western Cape province of South Africa, the local government expanded funding for evidence-based practices (EBPs) for treating substance use. Yet, little is known about provider and staff attitudes towards adopting EBPs in this setting, which is particularly relevant in this context where task shifting clinical care increases demands on paraprofessional providers. This study aimed to (1) assess attitudes towards adopting EBPs among a range of staff working in substance use treatment in Cape Town using a task shifting model; and (2) evaluate factors associated with openness towards adopting EBPs in this setting.

METHODS

Staff (n = 87) were recruited from 11 substance use treatment clinics. Demographics and job-related characteristics were assessed. Staff perceptions of organizational factors were assessed using the TCU Organizational Readiness for Change (ORC) scale. The dependent variable, attitudes towards adopting EBPs, was assessed using the Evidence-Based Practice Attitude Scale (EBPAS).

RESULTS

This study is one of the first to administer the EBPAS in South Africa and found good internal consistency (total score: α = .82). In a multivariable model adjusting for site and factors associated with EBPAS total score at the bivariate level, only smaller caseload size was associated with greater openness to adopting EBPs (B = 1.61, SE = .73; t = 2.21; p<.05).

CONCLUSIONS

As pressure to scale up implementation of EBPs in South African substance use treatment services intensifies, additional efforts are needed to understand barriers to adopt EBPs in this setting. Supporting staff adoption of EBPs in resource-limited settings may require additional resources to limit staff caseloads in the context of task shifting.

The Evidence-based Practice Attitude Scale-36 (EBPAS-36): a brief and pragmatic measure of attitudes to evidence-based practice validated in US and Norwegian samples

Background

Short and valid instruments for measuring factors facilitating or hindering implementation efforts are called for. This article describes (1) the adaptation of a shorter version of the Evidence-based Practice Attitude Scale (EBPAS-50 items), and (2) the psychometric properties of the shortened version in both US and Norwegian data.

Methods

The US participants were mental health service providers (N = 418) recruited from clinics providing mental health services in San Diego County, California. The Norwegian participants were psychologists, psychiatric nurses, and psychology students (N = 838) recruited from the Norwegian Psychological Association and the Norwegian Nurses Organization. A confirmatory factor analysis (CFA) approach was used.

Results

The reduction resulted in 36 items named EBPAS-36, and the original 12 factor model was maintained. The EBPAS-36 had acceptable model fit, as indicated by a low degree of misspecification errors in both the US (RMSEA = .045 (CI_90% .040–.049); SRMR = .05) and the Norwegian data (RMSEA = .052 (CI_90% .047–.056, SRMR = .07). Incremental model fit was fair in the US (CFI = .93, TLI = .91) and in the Norwegian samples (CFI = .91, TLI = .89). The internal consistency (Cronbach’s α) in the US and the Norwegian samples were good for the total EBPAS-36 score (.79 and .86, respectively) and were ranged from adequate to excellent for the subscales (US .60–.91 and Norway .61–.92).

Conclusions

The EBPAS-36 has adequate psychometric properties both in US and Norwegian samples, hence indicating cross-cultural validity. It is a brief, pragmatic, and more user-friendly instrument than the EBPAS-50, yet maintains a broad scope by retaining the original 12 measurement domains.

Electronic supplementary material

The online version of this article (doi:10.1186/s13012-017-0573-0) contains supplementary material, which is available to authorized users.

Mental healthcare providers’ attitudes towards the adoption of evidence-based practice in the treatment of post-traumatic stress disorder in South Africa

South African society is characterised by a high prevalence of exposure to traumatic events that can lead to post-traumatic stress disorder. In treating post-traumatic stress disorder, mental healthcare providers are tasked with ensuring that their practice is evidence based. However, existing evidence indicates that the rates of adoption of evidence-based practice are generally poor. The promotion and implementation of evidence-based practice into routine clinical settings requires an understanding of the attitudes of mental healthcare providers towards these practices. This study investigated attitudes towards evidence-based practice in the treatment of post-traumatic stress disorder. Participants were 60 mental healthcare providers (clinical/counselling psychologists, social workers, and registered counsellors) in the Western Cape Province working predominantly with trauma survivors. Participants completed a demographic survey and the Attitude Towards Evidence-Based Practice Scale, adapted to assess for attitudes towards the adoption of evidence-based practice in relation to the treatment of post-traumatic stress disorder. Overall, participants reported favourable attitudes towards evidence-based practice in the treatment of post-traumatic stress disorder. Statistical analysis revealed that occupation, age, and gender significantly correlated with attitudes. Social workers and registered counsellors were more likely to report adopting evidence-based practice for post-traumatic stress disorder compared to clinical and counselling psychologists. Older participants and women also reported more favourable attitudes towards evidence-based practice. The implications of these findings are discussed.

Psychometric properties of the Norwegian version of the Evidence-Based Practice Attitude Scale (EBPAS): to measure implementation readiness

BACKGROUND

Attitudes can be a precursor to the decision of whether or not to try a new practice. In order to tailor the implementation of evidence-based practices (EBPs) in mental health settings, we must first consider practitioner attitudes towards EBP adoption. To assess these attitudes, the Evidence-Based Practice Attitude Scale (EBPAS) was developed. The purpose of this study was to investigate the psychometric properties of the Norwegian version of the EBPAS, and to examine differences in attitudes towards implementing EBPs among mental health practitioners.

METHODS

The EBPAS was translated into Norwegian and administered to 294 practitioners from seven primary and 22 specialized mental care units within a defined geographical area of Norway.

RESULTS

The EBPAS showed good psychometric properties. The less clinical experience the practitioner had, the more positive their attitude toward EBPs. Primary care practitioners reported more positive attitudes towards implementing EBPs that were required of them than specialized care practitioners.

CONCLUSIONS

The Norwegian version of the EBPAS is a promising tool for measuring implementation readiness in mental health services, and can be used in clinical practice to tailor implementation efforts.

TRIAL REGISTRATION

The study was approved by the regional committees for medical and health research ethics [ REK 2013/2035 ] on 25(th) of May, 2014.