Development and validation of the Evidence Based Medicine Questionnaire (EBMQ) to assess doctors\u2019 knowledge, practice and barriers regarding the implementation of evidence-based medicine in primary care

Ranita Hisham,Yook Chin Chia,Karuthan Chinna,Chirk Jenn Ng,Su May Liew,Pauline Siew Mei Lai,Ee Ming Khoo,Nik Sherina Hanafi,Ping Yein Lee,Sajaratulnisah Othman,Khatijah Lim Abdullah

doi:10.1186/s12875-018-0779-5

Abstract

BackgroundEvidence-Based Medicine (EBM) integrates best available evidence from literature and patients’ values, which then informs clinical decision making. However, there is a lack of validated instruments to assess the knowledge, practice and barriers of primary care physicians in the implementation of EBM. This study aimed to develop and validate an Evidence-Based Medicine Questionnaire (EBMQ) in Malaysia.MethodsThe EBMQ was developed based on a qualitative study, literature review and an expert panel. Face and content validity was verified by the expert panel and piloted among 10 participants. Primary care physicians with or without EBM training who could understand English were recruited from December 2015 to January 2016. The EBMQ was administered at baseline and two weeks later. A higher score indicates better knowledge, better practice of EBM and less barriers towards the implementation of EBM. We hypothesized that the EBMQ would have three domains: knowledge, practice and barriers.ResultsThe final version of the EBMQ consists of 80 items: 62 items were measured on a nominal scale, 22 items were measured on a 5 point Likert-scale. Flesch reading ease was 61.2. A total of 343 participants were approached; of whom 320 agreed to participate (response rate = 93.2%). Factor analysis revealed that the EBMQ had eight domains after 13 items were removed: “EBM websites”, “evidence-based journals”, “types of studies”, “terms related to EBM”, “practice”, “access”, “patient preferences” and “support”. Cronbach alpha for the overall EBMQ was 0.909, whilst the Cronbach alpha for the individual domain ranged from 0.657–0.940. The EBMQ was able to discriminate between doctors with and without EBM training for 24 out of 42 items. At test-retest, kappa values ranged from 0.155 to 0.620.ConclusionsThe EBMQ was found to be a valid and reliable instrument to assess the knowledge, practice and barriers towards the implementation of EBM among primary care physicians in Malaysia.

Highlights

Evidence-Based Medicine (EBM) integrates best available evidence from literature and patients’ values, which informs clinical decision making
Face and content validity of the Evidence-Based Medicine Questionnaire (EBMQ) was verified by an expert panel which consisted of nine academicians
Exploratory factor analysis (EFA) found that the “knowledge” domain had four factors: (“evidence-based medicine websites”, “evidence-based journals”, “type of studies” and “terms related to Evidence-based medicine (EBM)”) after 9 items were removed

Summary

Introduction

Evidence-Based Medicine (EBM) integrates best available evidence from literature and patients’ values, which informs clinical decision making. Evidence-based medicine (EBM) is defined as the integration of best available evidence in a conscientious, explicit and judicious manner from literature and patients’ values which informs clinical decision making [1]. Evidence-based medicine has an increasing impact in primary care over recent years [4]. It involves patients in decision making and influences the development of guidelines and quality standards for clinical practice [4]. Primary care physicians are the first person of contact for patients [5] They have high workload and at the same time they need to uphold the quality of healthcare [6]. Integrating EBM into clinical practice in primary care is challenging as there are variations in team composition, organisational structures, culture and working practices [8]

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