Evidence-based Practice Attitudes Research Articles

The dilemma of the split between theory and reality as experienced by primary healthcare professionals: a mixed methods study of evidence-based practice in a primary care context

BackgroundPrimary care depends upon a good information flow across professional and structural boundaries to provide the best care for patients. Previous research has mainly focused on Evidence-Based Practice (EBP) within specific professions. Mapping of pan-professional experiences of and attitudes to EBP in publicly funded clinical practice is necessary to deepen the understanding of EBP and its implementation. Thus, this study aimed to investigate healthcare professionals’ experiences of and attitudes towards working in accordance with EBP in primary care.MethodsThe study used a convergent mixed methods design divided into two strands: a quantitative enquiry tool (Evidence-Based Practice Attitude Scale, EBPAS) and a set of qualitative interviews analysed by means of qualitative content analysis. Both strands included all primary care employees with patient interaction in the studied county (n = 625), including doctors, nurses, physiotherapists, psychologists and assistant nurses. Out of the original 625 healthcare professionals, 191 finished the first strand and 8 volunteered for the second strand (2 nurses, 2 physiotherapists, 1 psychiatrist and 3 doctors).ResultsThe EBPAS value of 2.8 (max 4) indicated a generally positive attitude towards EBP amongst the population, which was also evident in the interviews. However, there were additional experiences of not having the ability or resources to engage in EBP. This was illustrated by the theme that emerged from the qualitative content analysis: “The dilemma of the split between theory and reality”. Due to the organisational and managerial focus on efficiency rather than quality of care, there were few or no incentives for promoting individual educational or research development.ConclusionsAlthough the general attitude towards EBP is positive, experiences of practising it differ. There is a need to increase knowledge of EBP concepts, requirements and implementation in the clinical setting. The absence of opportunities to do research and collegial debate about new ways of finding and implementing research-based evidence results might influence the quality of care.

A 10-month impact evaluation of a journal club among diagnostic radiographers in a single NHS Trust: A service evaluation study

IntroductionJournal clubs (JC) have emerged as a popular tool within medical and health professions to deliver outcomes such as promotion of evidence-based practice (EBP), improvement of critical appraisal skills, as well as stimulation of research interest among participating professionals. However, the delivery of these outcomes within the diagnostic radiography profession has not been evidenced and this is the aim of this service evaluation. MethodsThis evaluation adopted a pre- and post-evaluation survey design to explore the impact of a novel JC introduced among diagnostic radiographers in a UK NHS Trust. Impact was assessed based on four pre-determined outcomes such as Knowledge of EBP, Attitude to EBP, Critical Appraisal Skill and Research interest. Open ended questions in the post evaluation survey were also used to obtain participants feedback on JC activities attended. ResultsEvaluation of the four pre-determined outcomes indicated that JC activities participated by diagnostic radiographers resulted in positive changes across all evaluated categories. Attitude to EBP was the only outcome to show a statistically significant positive change across all participants, highlighting that the JC affected EBP attitudes positively for those that attended. Furthermore, thematic analysis of open-ended questions indicated that the collaboration experienced among JC members during critical appraisal of articles was a motivation for continued participation while factors such as high clinical workload and absence of management in meetings were identified as mitigating barriers. ConclusionParticipation in the JC showed positive improvements in all pre-determined categories. The collaborative nature of JC was motivating for staff, however barriers such as management absence in meetings, and high clinical workload did cause some challenges. Research is recommended to look at the longer-term impact of JC activities amongst diagnostic radiographers.

Teacher attitudes towards evidence-based practices for social, emotional and mental health difficulties in school and association with teacher academic research engagement

ABSTRACT The study examined the association between teacher engagement with academic research to inform practice for pupils with Social Emotional Mental Health Difficulties (SEMHD) and teacher attitudes towards the adoption of evidence-based practices (EBP) for pupils with SEMHD in a sample (n = 79) of undergraduate and postgraduate primary school trainee teachers in England, UK. A questionnaire was used to assess teachers’ academic research engagement operationalised as positive attitudes towards academic research, use of academic research, and knowledge about research. The Evidence-based Practice Attitude Scale (EBPAS) was used to examine attitudes towards EBP. The findings showed that while appreciation of academic research in the sample was high, the use of academic research to inform practice and knowledge about research was low. A positive attitude towards academic research, less scepticism towards the value of academic research to inform school practice, and high research knowledge was associated with a more positive attitude towards EBP. More scepticism towards academic research to inform school practice for SEMHD and weaker understanding of research methods was linked to more scepticism about the relevance of EBP for school practice. The findings have implications for pre-service and in-service teacher training on SEMHD and the implementation of EBP for SEMHD in schools.

Cultural Adaptation and Psychometric Properties of the Persian Version of the Evidence-Based Practice Attitudes Scale in Audiologists

Background and Aim: Evidence-based practice improves the quality of clinical performance. Attitude affects the implementation of research findings into practice. The Evidence-Based Practice Attitude Scale (EBPAS-36) evaluates the attitude of therapists toward evidence-based practice. The present study aimed to provide a validated Persian translation of the EBPAS-36 for audiologists. Methods: The original EBPAS-36 was translated by using the international quality of life assessment protocol. The validity of translated version was surveyed by an expert panel and the Persian version with 35 questions was yielded. A demographic questionnaire and EBPAS P-35 were given to 182 audiologists to evaluate the psychometric properties. The reliability was evaluated by completing the EBPAS P-35 after 2 weeks by 30 of the participants and Cronbach’s alpha and Intra-Class Correlation (ICC) were calculated. Confirmatory Factor Analyses (CFA) were also conducted. Results: The content validity ratio was above 0.33 for all except item 10 which was removed from the Persian version. The mean(SD) total score was 2.38(0.46). A significant relationship was observed between the total score and all subscales (p<0.05). The original factor structure showed an acceptable model fit (CMIN/DF=1.39, GFI=0.84, CFI=0.94, IFI=0.94, RMSEA=0.04) confirming the 12-factor structure of the EBPAS-36. The internal consistency was very good for the total score (α=0.88) and adequate to very good for the subscales (0.65–0.84), indicating high reliability. The ICC showed good agreement in the score of test-retest (total ICC=0.65). Conclusion: This study confirms good psychometric properties and validity of the EBPAS P-35 in a sample of audiologists. Keywords: Evidence-based practice; research-based intervention; clinical implementation; attitude; audiologist

Investigating Physiotherapists’ Knowledge, Attitude, and Practice of Evidence-Based Practice in Indonesia

Introduction: In order to deliver quality care to patients and clients, physiotherapists should implement Evidence Based Practice (EBP) in the area of clinical services. There has been little research into the adoption of EBP among physiotherapists in Indonesia.
 Aims: This study aims to investigate the attitudes, knowledge, and practice of physiotherapists in Indonesia regarding EBP.
 Methods: A descriptive, cross-sectional research approach was used to assess physiotherapists' attitudes, knowledge, and practice in Indonesia. An online self-administered questionnaire-based survey containing validated Indonesian versions of the Evidence Based Practice Questionnaire (EBPQ) and sociodemographic variables was distributed to physiotherapists via social media.
 Results: The questionnaire was completed by 156 physiotherapists, with 73 (46.8 %) men and 83 (53.35 %) women participating. The total EBP Questionnaire (EBPQ) average score was 127.67, with a mean of 5.31 out of 7 (SD = 0.96). The attitude (5.23, S D= 0.95) had the highest EBP score, followed by knowledge (5.25, SD=1.01) and practice (5.23, SD=1.30). Education level (p = 0.001), professional category (p = 0.002), and clinical instructor (p = 0.024) were the characteristics related with increased EBP performance.
 Conclusion: In summary, physiotherapists in Indonesia have positive attitudes, knowledge, and practices towards EBP. Higher education levels, working as a clinician and educator, and teaching clinical students may all help to enhance EBP implementation.

Evidence-based maintenance care among chiropractors in Norway: a cross-sectional survey in the Nordic maintenance care program

BackgroundChiropractors use a treatment strategy called maintenance care with the intent of secondary and tertiary prevention. The Nordic Maintenance Care Program provides evidence of when and for whom maintenance care should be offered. Dissemination has occurred through articles, workshops, social media, conference in Europe and internationally. However, little is known about chiropractors’ awareness and use of this evidence. This study explores chiropractors’ attitudes, skills, and use of evidence on maintenance care, as well as study their association with general evidence-based practice and demographic characteristics. Moreover, barriers and facilitators of evidence access are also examined.MethodsQuestions pertaining our research aim were included in the anonymous and digital Evidence-Based practice Attitude and utilization SurvEy, which was distributed to all members (n = 770) of the Norwegian chiropractic association in the fall of 2021.ResultsThe response rate was 41% (n = 312). Regarding attitudes towards evidence-based maintenance care, 26% agreed they needed tools to recommend this care to patients. Approximately half (57%) believed they had skills to identify suitable patients, and 45% had used published information in the past month. Strong alignment was observed between Norwegian chiropractors’ attitudes, skills, and utilization of evidence-based maintenance care and general evidence-based practice. Maintenance care skills were significantly associated with age (those between 40 and 59 years being less likely to report having high skills), clinical setting (those working with conventional health care providers being less likely to report having high skills) and country of education (those educated in the US and Australia being more likely to report having high skills). Moreover, maintenance care use was significantly associated with country of education (those educated in Australia were less likely to have used published information regarding patient selection for maintenance care). Access to resources was a barrier, whereas knowledge of patient suitability facilitated evidence-based maintenance care.ConclusionsNorwegian chiropractors had neutral attitudes towards maintenance care, but generally reported moderate skills. Most had not used evidence about maintenance care in the previous month. Access to useful resources about the evidence regarding maintenance care was a barrier, and knowledge of who responds to maintenance care was a facilitator.

Development and validation of a questionnaire to assess evidence-based practice and evidence-informed practice knowledge, attitudes, understanding and behavior

Good-quality questionnaires are needed to assess the effectiveness of educational programs on undergraduate healthcare students’ knowledge, attitudes, understanding and behavior regarding evidence-based practice and evidence-informed practice. However, there is currently no available questionnaires designed to evaluate the outcomes of evidence-based practice and evidence-informed practice education. Based on the methods proposed by Streiner et al., this study developed and validated a questionnaire for assessing evidence-informed practice and evidence-based practice knowledge, attitudes, understanding, self-perceived application and use, and behavior among undergraduate preregistration students in the nursing and allied health disciplines. Seventy-three questionnaire items were developed and administered to varied groups of people, including students and academics. Principal component analysis was conducted to reduce dimensions and establish construct validity and internal consistency of the developed questionnaire. Following pilot-testing and expert review, the final validated questionnaire consists of 53 items (8 demographic items, 25 evidence-based practice items, and 20 evidence-informed practice items). The evidence-based practice and evidence-informed practice questionnaire is a valid and reliable tool to measure the outcomes of evidence-based practice and evidence-informed practice education.

Evidence implementation in naturopathy: A cross-sectional study of Australian naturopaths

Background and PurposeEvidence implementation refers to the application of appropriate enabling strategies to improve clinician engagement with the best available evidence. To date, little attention has been paid to evidence implementation in disciplines such as naturopathy. This study addresses this knowledge gap by examining the determinants of evidence implementation in Australian naturopathic practice. Materials and methodsThis cross-sectional study was open to all Australian naturopaths who had internet access and were fluent in the English language. Participants were invited to complete the 84-item Evidence-Based practice Attitude and utilization Survey (EBASE) online between March and July 2020. ResultsThe survey was completed in full by 174 naturopaths (87.4% female; 31.6% aged 40–59 years). While participant attitudes were predominantly favourable of evidence implementation, engagement in evidence implementation activities was reported at a low to moderate level. Factors impacting participant engagement in such activities included a lack of clinical evidence in naturopathy, lack of time, and a moderate to moderately-high level of self-reported skill in evidence implementation. Enablers of evidence implementation were access to the internet, free online databases, full-text journal articles, and online education materials. ConclusionThis study has provided valuable insights into the level of, and factors impacting evidence implementation among Australian naturopaths. Attitude did not pose a major barrier to evidence implementation; rather, the barriers were largely structural and cognitive. This suggests that the obstacles to evidence implementation in naturopathy are most likely surmountable with the right means and concerted effort.

Evidence implementation in Australian manual therapy practice: A cross-sectional study

BackgroundFew studies have explored the determinants of evidence implementation in complementary manual therapy professions. Exploring the factors that impede or enable evidence implementation in complementary manual therapy professions is critical to determining the most appropriate strategies to optimise this practice, and enhance the quality of care. MethodsThe study used a cross-sectional study design to examine Australian complementary medicine manual therapists’ attitudes, skills, training, use, barriers and enablers to evidence implementation. Eligible therapists were invited to self-administer the 84-item Evidence-Based practice Attitude and utilization Survey online. ResultsThe survey was completed by 294 manual therapists (77% female; 65% aged ≥50 years). Participants were mostly supportive of, and reported a moderate to moderate-high level of skill in evidence implementation. However, the level of engagement in evidence implementation was low. The leading barriers to evidence implementation were lack of time, and lack of clinical evidence. While few participants reported skill-level as a barrier, most indicated a desire to develop the skills necessary to improve their engagement in evidence implementation. Participants also supported a range of other enabling strategies to foster evidence implementation in their practice, with most of these strategies targeting access to evidence. ConclusionsAlthough participants reported few barriers to evidence implementation, there was a low level of engagement in this activity. The barriers to evidence implementation therefore warrant further exploration. This ongoing work will help better understand how to optimise evidence implementation in complementary manual therapy practice, and help drive improvements in patient care.

Knowledge, attitude, understanding and implementation of evidence-based practice among Jordanian radiographers

IntroductionEvidence-based practice (EBP) has gained attention globally from healthcare professionals and researchers. The aim of this study was to assess Jordanian diagnostic radiographers’ knowledge, attitude, education/knowledge, and skills related to EBP; and identify specific terms related to EBP. MethodsA paper-based, self-administered questionnaire with two sections was used. The first section included 11 socio-demographic questions and the second section contained 56 questions regarding EBP categorized under seven distinct subscales. The data were imported into SPSS for analysis. ResultsResponses were received from 203 radiographers, most of them 135 (66.5%) aged 21–30 years. The majority of radiographers agreed or strongly agreed that the application of EBP is necessary for radiography practice, and 129 (63.6%) of radiographers learned the foundations of EBP as part of their academic preparation. Less than half of the participants stated that they completely understood the research terminology listed in the survey. Most participants had access to the internet and research databases, 79.3% (n = 161). The majority of participants, 63.1% (n = 128) stated that they always used their personal experience, as a source to make a clinical decision in radiography practice. The most common barrier to the implementation of EBP was insufficient time (63.5%, n = 129). ConclusionThis study showed that despite the positive attitude, and beliefs of radiographers toward EBP, and access to information resources, radiographers still need a higher level of confidence in their ability to engage in and implement EBP; including increased education to support the research skills needs to search and interpret publications. Implications for practiceThe findings of this study may help inform restructure of the undergraduate radiography curriculum, training programs or other interventions required to promote or facilitate the adoption of EBP in Jordan.

Investigating attitudes, skills, and use of evidence-based practice among Norwegian chiropractors; a national cross-sectional study

BackgroundEvidence-based practice (EBP) is essential in improving the quality of healthcare and of importance for all health care personnel. No study in Norway has investigated attitudes, skills and use related to EBP among chiropractors. The aim of this study was to describe Norwegian chiropractors’ attitudes, skills, and use of EBP, as well as the barriers and facilitators to their use of EBP.MethodsA national cross-sectional survey, the online version of the Evidence Based practice Attitudes & Utilisation SurvEy (EBASE), was sent by email to 770 Norwegian practicing chiropractors, all members of the Norwegian Chiropractic Association. Three EBASE sub-scores were generated (Attitudes, Skills and Use), and the demographic characteristics of the sample were reported. Linear regression analyses were conducted to examine the association between responses of the three sub-scores and demographic characteristics. Information on main barriers and facilitators of EBP was collected and described.ResultsA total of 312 (41%) chiropractors responded to the survey, and 95% agreed that EBP is necessary for chiropractic practice. While overall use of EBP activities was low participants were interested in learning and improving their skills to incorporate EBP into practice. Chiropractors’ attitudes, skills, and use of EBP were positively associated with being female and having spent more than one hour per week on research, but negatively associated with having practiced more than 10 years. Main barriers of EBP were lack of skills to critically evaluate, interpret, and apply research findings to practice. Main facilitators of EBP included access to the internet and free online databases in the workplace.ConclusionAlthough chiropractors in Norway reported positive attitudes and moderate skills in EBP, their use of EBP activities was limited. The main barriers and facilitators to EBP were primarily related to perceived skills deficits, whilst enablers of EBP were mostly related to infrastructure requirements.

Climate for evidence-based mental health care implementation in Germany: psychometric investigation of the Implementation Climate Scale (ICS)

Organizational implementation climate is an important construct in implementation research to describe to what extent implementation is expected, supported, and rewarded. Efforts in bridging the research-practice gap by implementing evidence-based practice (EBP) can benefit from consideration of implementation climate. The Implementation Climate Scale (ICS) is a psychometrically strong measure assessing employees’ perceptions of the implementation climate. The present cross-sectional study aimed at providing a German translation and investigating its psychometric properties. The translation followed standard procedures for adapting psychometric instruments. German psychotherapists (N = 425) recruited online completed the ICS, the Evidence Based Practice Attitudes Scale (EBPAS-36D) and the Intention Scale for Providers (ISP). We conducted standard item and reliability analyses. Factorial validity was assessed by comparing an independent cluster model of Confirmatory Factorial Analysis (ICM-CFA), a Bifactor CFA, a Second-order CFA and an (Bifactor) Exploratory Structural Equation Model (ESEM). Measurement invariance was tested using multiple-group CFA and ESEM, convergent validity with correlation analysis between the ICS and the ISP subjective norms subscale (ISP-D-SN). The mean item difficulty was pi = .47, mean inter-item correlation r = .34, and mean item-total correlation ritc = .55. The total scale (ω = 0.91) and the subscales (ω = .79–.92) showed acceptable to high internal consistencies. The model fit indices were comparable and acceptable (Second-order CFA: RMSEA [90% CI] = .077 [.069; .085], SRMR = .078, CFI = .93). Multiple-group CFA and ESEM indicated scalar measurement invariance across gender and presence of a psychotherapy license. Psychotherapists in training reported higher educational support for EBP than licensed psychotherapists (T = 2.09, p = .037, d = 0.25). The expected high correlation between the ICS and the ISP-D-SN was found (r = .59, p < .001). Results for the German ICS confirm good psychometric properties including validity.

Promoting Evidence-Based Practice: The Influence of Novel Structural Change to Accelerate Translational Rehabilitation

ObjectiveTo evaluate changes in clinicians’ use of evidence-based practice (EBP), openness toward EBP, and their acceptance of organizational changes after a rehabilitation hospital transitioned to a new facility designed to accelerate clinician-researcher collaborations. DesignThree repeated surveys of clinicians before, 7-9 months, and 2.5 years after transition to the new facility. SettingInpatient rehabilitation hospital. ParticipantsPhysicians, nurses, therapists, and other health care professionals (n=410, 442, and 448 respondents at Times 1, 2, and 3, respectively). InterventionsImplementation of physical (architecture, design) and team-focused (champions, leaders, incentives) changes in a new model of care to promote clinician-researcher collaborations. Main Outcome MeasuresAdapted versions of the Evidence-Based Practice Questionnaire (EBPQ), the Evidence-Based Practice Attitudes Scale (EBPAS), and the Organizational Change Recipients’ Beliefs Scale (OCRBS) were used. Open-ended survey questions were analyzed through exploratory content analysis. ResultsResponse rates at Times 1, 2, and 3 were 67% (n=410), 69% (n=422), and 71% (n=448), respectively. After accounting for familiarity with the model of care, there was greater reported use of EBP at Time 3 compared with Time 2 (adjusted meant2=3.51, standard error (SE)=0.05; adj. meant3=3.64, SE=0.05; P=.043). Attitudes toward EBPs were similar over time. Acceptance of the new model of care was lower at Time 2 compared with Time 1, but rebounded at Time 3 (adjusted meant1=3.44, SE=0.04; adj. meant2=3.19, SE=0.04; P<.0001; adj. meant3=3.51, SE=0.04; P<.0001). Analysis of open-ended responses suggested that clinicians’ optimism for the model of care was greater over time, but continued quality improvement should focus on cultivating communication between clinicians and researchers. ConclusionsAccelerating clinician-researcher collaborations in a rehabilitation setting requires sustained effort for successful implementation beyond novel physical changes. Organizations must be responsive to clinicians’ changing concerns to adapt and sustain a collaborative translational medicine model and allow sufficient time, probably years, for such transitions to occur.

Utilizing a webinar to introduce an evidence-based trauma treatment in Chile: Results from a pilot study investigating clinician attitudes and needs

Objective: Scalable clinician training in evidence-based trauma treatments is important to increase the use and impact of these treatments in different countries. The aim of the current pilot investigation was to understand the attitudes of mental health care providers in Chile toward narrative exposure therapy (NET), an evidence-based treatment (EBT) for traumatic distress. Method: This study used a mixed-methods design and gathered demographic and questionnaire data as well as data from semi-structured qualitative interviews. A total of 31 clinicians completed the Evidence-Based Practice Attitude Scale (EBPAS) following a webinar on NET, and among those participants 10 completed semi-structured interviews. Results: Findings from this study suggest mental healthcare workers reported overall satisfaction from the NET training and knowledge gained from the training. Both qualitative and quantitative findings indicated broadening understanding of trauma treatments as well as additional training and supervision are necessary in the process of learning to implement an EBT such as NET. Conclusions: A web-based training in NET may be a feasible method for introducing a trauma-focused EBT; however, additional training and supervision are necessary in follow-up trainings.

Attitudes, skills and implementation of evidence-based practice: a national cross-sectional survey of licensed naprapaths in Sweden

BackgroundEvidence-based practice (EBP) is fundamental to the delivery of high-quality, safe and effective health care. Naprapaths, manual therapy providers that specialize in the treatment of musculoskeletal pain and dysfunction, became a Swedish licensed health profession in 1994. This study investigated the attitudes, skills and implementation of EBP among licensed naprapaths in Sweden.MethodsLicensed naprapaths (n = 950) of Svenska Naprapatförbundet (the Swedish Naprapathy Association) were invited by email to take part in this cross-sectional anonymous online study using the Evidence-Based Practice Attitude and Utilisation Survey in February 2019.ResultsFourteen percent (137/950) of invited naprapaths completed the survey. There was an approximately equal gender divide among responders; most were in the mid-career age range, practiced in city areas, and had a university or college certificate/diploma as their highest qualification. The majority of naprapaths agreed or strongly agreed that EBP was necessary in the practice of naprapathy, assisted them in making care decisions, and improved the quality of patient care. Naprapaths’ self-reported skills in EBP were mostly in the moderate to moderate-high range. The majority of participating naprapaths reported infrequent implementation of EBP. Perceived minor or moderate barriers to EBP uptake included a lack of colleague support for EBP and a lack of relevant resources. Access to the internet and free online databases were reported as very useful enablers to improving EBP uptake.ConclusionsThe licensed naprapaths participating in this survey reported positive attitudes toward EBP, moderate levels of EBP skills, and infrequent implementation of EBP.

Teacher attitudes toward evidence-based practices: Exploratory and confirmatory analyses of the school-adapted evidence-based practice attitude scale.

The Evidence-Based Practice Attitudes Scale (EBPAS) is widely used in implementation research, but it has not been adapted and validated for use among general education teachers, who are most likely to deliver evidence-based prevention programs in schools, the most common setting where youth access social, emotional, and behavioral health services. School-based stakeholders and a research team comprised of experts in the implementation of evidence-based practices in schools adapted the EBPAS for teachers (the S-EBPAS). The adapted instrument was administered to a representative sample (n = 441) of general education teachers (grades K-5) to assess the reliability and internal consistency via factor analyses. The S-EBPAS included two forms (i.e., EBP-agnostic and EBP-specific item referents), therefore, a multiple-group confirmatory factor analysis (CFA) was also performed to establish measurement invariance between the two forms. After adaptation and refinement, a 9-item, 3-factor structure was confirmed, with the final model supporting three first-order factors that load onto a second-order factor capturing attitudes toward adopting evidence-based practices. Multiple-group CFA analyses of measurement invariance indicated there were no significant differences between the two forms. Overall, this study provides a brief, flexible instrument capturing attitudes toward adopting EBPs that has high reliability and internal consistency, which support its use among general education teachers in school settings implementing evidence-based practices. The Evidence-Based Practice Attitudes Scale (EBPAS) is a popular instrument for measuring attitudes toward evidence-based practices (EBPs). This instrument provides valuable information during implementation initiatives, such as whether providers or front-line implementers have favorable attitudes toward a given practice. The EBPAS has been used in many different settings, such as in community-based mental health clinics, medical hospitals, and in child welfare. However, it's use in schools has been limited, and it has not yet been tested with general education teachers, who are key implementers of evidence-based practices in schools. In order to trust that the scores from an instrument are accurate, it needs to be evaluated when scaling it out to new populations and settings. One popular method to determine this is to use factor analysis, which was employed in this study. This study fills the identified gap by assessing the reliability (i.e., accuracy) and internal consistency of the EBPAS among a representative sample of general education teachers. Findings from this study indicate that the school-adapted EBPAS (S-EBPAS) is a brief, nine-item instrument that provides a reliable estimate of teachers' attitudes toward evidence-based practices. Our results also provide evidence that the S-EBPAS can be used to capture attitudes toward specific EBPs as well as attitudes toward EBP-agnostic. This study provides a flexible instrument that can be used by school-based implementation researchers, practitioners, and intermediaries at multiple phases of implementation projects, such as when exploring a new EBP to adopt.

Individual and organizational factors as predictors of early evidence-based practice adoption in Michigan high schools: Baseline data from an implementation trial.

Adolescents increasingly access mental health services in schools. School mental health professionals (SPs; school counselors, social workers, etc.) can offer evidence-based mental health practices (EBPs) in schools, which may address access gaps and improve clinical outcomes. Although some studies have assessed factors associated with EBP adoption in schools, additional research focusing on SP- and school-level factors is warranted to support EBP implementation as SPs' mental health delivery grows. Baseline data were collected from SPs at Michigan high schools participating in a statewide trial to implement SP-delivered cognitive behavioral therapy (CBT) to students. Models examined factors associated with attitudes about EBPs, implementation climate, and implementation leadership, and their associations with CBT knowledge, training attendance, and pre-training CBT delivery. One hundred ninety-eight SPs at 107 schools (87%) completed a baseline survey. The mean Evidence-Based Practice Attitude Scale (EBPAS) total score was 2.9, and school-aggregated mean scores of the Implementation Climate Scale (ICS) and Implementation Leadership Scale (ILS) were 1.83 and 1.77, respectively, all on a scale ranging from 0 (low) to 4 (high). ICS and ILS scores were lower than typically reported in clinical settings, while EBPAS scores were higher. School characteristics were not significantly associated with EBPAS, ICS, or ILS scores, but scores did differ by SP role. Higher EBPAS scores were associated with more CBT knowledge (average marginal effect for 1 SD change [AME] = 0.15 points) and a higher probability of training completion (AME = 8 percentage points). Higher ICS scores were associated with a higher probability of pre-training CBT delivery (AME = 6 percentage points), and higher ILS scores were associated with higher probability of training completion (AME = 10 percentage points). Our findings suggest that SPs' attitudes toward EBPs and organizational support were positively associated with early signs of implementation success. As schools increasingly fill the adolescent mental healthcare access gap, efforts to strengthen both provider attitudes toward EBP and strategic organizational factors supporting EBP delivery will be key to encouraging EBP uptake in schools. Schools are an important setting in which adolescents receive mental healthcare. We need to better understand how to implement evidence-based practices (EBPs) in this setting to improve student mental health. This study examined the attitudes and perceptions of school professionals (SPs) as key contributors to the implementation of a particular EBP, the delivery of cognitive behavioral therapy (CBT) in schools. The study found that implementation climate and leadership scores in participating schools were lower than scores typically reported in clinical settings, while scores for SP attitudes about EBP adoption were higher than typical scores in clinical settings. Results further suggest that SPs with more positive attitudes toward EBPs are more knowledgeable of CBT and more likely to complete a 1-day CBT training. We also found that higher implementation climate scores were associated with SPs reporting pre-training CBT delivery (although this association was not statistically significant), and more implementation leadership was associated with SPs completing the CBT training. These findings suggest that SP attitudes toward EBPs and organizational support in schools are positively associated with early signs of implementation success. Early, low-intensity efforts to (1) improve SP attitudes about mental health EBPs, and (2) increase schools' support for implementation may scaffold more intensive implementation efforts in schools down the road.

Influence of provider openness and leadership behaviors on adherence to motivational interviewing training implementation strategies: Considerations for evidence-based practice delivery.

Adherence to intervention training implementation strategies is at the foundation of fidelity; however, few studies have linked training adherence to trainee attitudes and leadership behaviors to identify what practically matters for the adoption and dissemination of evidence-based practices. Through the conduct of this hybrid type 3 effectiveness-implementation cluster randomized controlled trial, we collected Exploration, Preparation, Implementation, and Sustainment (EPIS) data and merged it with tailored motivational interviewing training adherence data, to elucidate the relationship between provider attitudes toward evidence-based practices, leadership behaviors, and training implementation strategy (e.g., workshop attendance and participation in one-on-one coaching) adherence. Our sample included data from providers who completed baseline (pre-intervention) surveys that captured inner and outer contexts affecting implementation and participated in tailored motivational interviewing training, producing a dataset that included training implementation strategies adherence and barriers and facilitators to implementation (N = 77). Leadership was assessed by two scales: the director leadership scale and implementation leadership scale. Attitudes were measured with the evidence-based practice attitude scale (EBPAS-50). Adherence to training implementation strategies was modeled as a continuous outcome with a Gaussian distribution. Analyses were conducted in SPSS. Of the nine general attitudes toward evidence-based practice, openness was associated with training adherence (estimate [EST] = 0.096, p < .001; 95% CI = [0.040, 0.151]). Provider general (EST = 0.054, 95% CI = [0.007, 0.102]) and motivational interviewing-specific (EST = 0.044, 95% CI = [0.002, 0.086]) leadership behaviors were positively associated with training adherence (p < .05). Of the four motivational interviewing-specific leadership domains, knowledge and perseverant were associated with training adherence (p < .05). As these leadership behaviors increased, knowledge (EST = 0.042, 95% CI = [0.001, 0.083]) and perseverant (EST = 0.039, 95% CI = [0.004, 0.075]), so did provider adherence to training implementation strategies. As implementation science places more emphasis on assessing readiness prior to delivering evidence-based practices by evaluating organizational climate, funding streams, and change culture, consideration should also be given to metrics of leadership. A potential mechanism to overcome resistance is via the implementation of training strategies focused on addressing leadership prior to conducting training for the evidence-based practice of interest.

Self-reported attitudes, skills and use of evidence-based practice among Swiss chiropractors: a national survey

Study ObjectivesThe high burden of disease associated with musculoskeletal disorders severely impacts patients’ well-being. As primary care providers, Swiss chiropractors ought to contribute towards identifying and using effective treatment strategies. An established approach is the full integration of evidence-based practice (EBP). This study aimed to investigate the attitudes, skills and use of EBP among Swiss chiropractors, as well as investigating potential facilitators and barriers for its adoption.Methods and materialAll 329 members of the Swiss Association of Chiropractic (ChiroSuisse) were invited in March 2021 to participate in this cross-sectional survey. Data were acquired anonymously online, using the Evidence-Based practice Attitude and utilization SurvEy (EBASE). The survey encompassed 55 questions measuring attitudes (n = 8, response range 1–5; total score range of 8–40), skills (n = 13, response range 1–5; total score range of range of 13–65) and use of EBP (n = 6, response range 0–4; total score range of 0–24).Results228 (69.3%) chiropractors returned complete EBASE questionnaires. This sample was representative of all ChiroSuisse members with respect to gender, age groups and proportion of chiropractic residents. Respondents generally held positive attitudes towards EBP, as indicated by the high mean (31.2) and median (31) attitude sub-score (range 11–40). Self-reported skills had a mean sub-score of 40.2 and median of 40 (range 13–65). Knowledge about EBP-based clinical practice had been primarily obtained in chiropractic under- or postgraduate education (33.8% and 26.3%, respectively). Use of EBP achieved a lower sub-score, with mean and median values of 7.4 and 6, respectively (range 0–24). The most commonly identified barriers preventing EBP uptake were lack of time (67.9%) and lack of clinical evidence in chiropractic/manual therapy-related health fields (45.1%).ConclusionSwiss chiropractors held favourable attitudes and reported moderate to moderate-high skill levels in EBP. Nevertheless, similar to chiropractors in other countries, the self-reported use of EBP was relatively low, with lack of time and lack of clinical evidence being the most named barriers.

Knowledge, Attitudes, Practice and Related Factors among Nurses Regarding Evidence-Based Practices in Bahrain

Objective: The study aimed to determine the factors related to knowledge, attitudes, and practice of nurses regarding evidence-based practice (EBP) in Bahrain. Methods: A descriptive, cross-sectional study was conducted in Salmaniya Medical Complex hospital in Bahrain from 2017 to 2018. Nurses from all shifts, both genders, and age range between 30–65 years old work in different inpatient departments were included in the study. Research instruments were distributed and completed during the nurses' shift duty which comprised of nurses' demographic characteristics questionnaire and the validated English version of Upton &amp; Upton's self-reported Evidence-Based Practice Questionnaire (EBPQ)Results: Of 404 nurses' the majority of nurses were females 369 (91.6%), with a mean age was 37.7 + 7.7 years. most of the nurses 313 (77.5%) had moderate score of knowledge, and 312 (77.2%) were moderate implementers for EBP, and 179 (44.3%) had a positive attitude. Nurses who were working in the gynecology units reported significantly higher knowledge about EBP with mean scores 68.6 ± 7.06 as compared to pediatrics 67.0 ± 4.78, critical care 65.9 ± 4.67, surgical 65.8 ± 4.94 and medical 66.4 ± 4.20 (p-value 0.004) respectively. An insignificant association between attitude (p-value 0.123) and practice (p-value 0.123) of EBP was found in a work setting. Conclusion: The EBP is a vital and effective instrument for raising the quality of health care. Healthcare organizations should focus more on developing training programs for nurses to improve their clinical skills, knowledge, and attitude on the use of EBP to elevate the quality of care.