Attitudes and Behaviour Related to Evidence-Based Practice a longitudinal study. Snibsøer AK. Espehaug B, Nortvedt MW

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1 Attitudes and Behaviour Related to Evidence-Based Practice a longitudinal study Snibsøer AK Espehaug B, Nortvedt MW Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Bergen University College, Norway Background National policies in Norway require clinical employees in health and social services to work evidence-based A 15 ECTS credits postgraduate education in evidence-based practice (EBP) was established at Bergen University College in

2 Aim To examine change in attitudes and behaviour related to EBP one year after participation in a 15 ECTS credits postgraduate education in EBP Postgraduate education in EBP - Content Session Day Topic 1 Introduction to EBP Asking an answerable clinical question 2 Critical appraisal: Survey How do we understand statistics? 3 Critical appraisal: RCT Critical appraisal: Systematic reviews 4 Critical appraisal: Evidence-based guideline Critical appraisal: Qualitative study 5 Finding the evidence (hands-on search with librarian) 6 Shared decision making Implementing EBP 7 Oral presentation in small groups: 1. Explain a term within EBP 2. Explain how you will use EBP at your workplace 2

3 Postgraduate education in EBP - Exam Choose between: 1. Describe the steps and process of EBP. 2. Choose a clinical question, search for evidence, critically appraise evidence and address the findings to your practice. 3. Describe a strategy for implementing EBP at your workplace. Individually written home-based exam, 10 pages Oral presentation at participants workplace Methods Sample Participants from six classes who passed the 15 ECTS credits examination in the period 2009 to 2011 (n=158) Pre and post-test survey Questionnaires answered before the teaching started, and one year after the examination Instruments N- EBP Beliefs Scale (16 items) N- EBP Implementation Scale (18 items) (Originals by: Melnyk BM, Fineout-Overholt E & Mays MZ., 2008) 3

4 Results Of 158 eligible participants, 120 respondents answered (76%) Nurses (77 %) Mean age 42.8 years Postgraduate degree (64 %) University Hospital (70 %) Results - Attitudes N-EBP Beliefs Scale* N Mean (SD) Mean diff. CI (95 %) p** Pre (5.5) Post (6.8) <0.001 *EBP Beliefs Scale has a total score that ranges between **Paired t-test 4

5 N-EBP Beliefs Scale* Clear about the steps of EBP Confident about my ability to implement EBP Know how to implement EBP to make practice changes Can implement EBP Sure about how to measure the outcomes of clinical care EBP is difficult Can search for best evidence in a time efficient way The care that I deliver is evidence-based Can access the best resources to implement EBP Evidence-based guidelines can improve clinical care Critically appraising evidence is an important step Can implement EBP in a time efficient way EBP takes too much time EBP results in the best clinical care Implementing EBP will improve the care I deliver Can overcome barriers in implementing EBP Higher score Equivalent score Lower score *Statements are shortened Results - Behaviour N-EBP Implementation Scale* N Mean (SD) Mean diff. CI (95 %) p** Pre (10) Post (9.7) *EBP Implementation Scale has a total score that ranges from 0 72 **Paired t-test 5

6 N-EBP Implementation Scale* Promoted the use of EBP to my colleagues Accessed the Cochrane database of systematic reviews Shared an EBP guideline with a colleague Read and critically appraised a clinical research study Critically appraised evidence from a research study Used evidence to change my clinical practice Generated a PICO question about my clinical practice Informally discussed evidence from a research study Used an EBP guideline or systematic review to change practice Shared evidence from a study to more than 2 colleagues Collected data on a patient problem Shared evidence from a research study with a patient/family Accessed the National Guidelines Clearinghouse Shared evidenced with a multi-disciplinary team member Shared the outcome data collected with colleagues Evaluated the outcomes of a practice change Changed practice based on patient outcome data Evaluated a care initiative by collecting patient outcome data Higher score Equivalent score Lower score *Statements are shortened Comparisons with other studies Attitudes: The observed pre-post difference and mean beliefs score after one year were comparable to other studies Behaviour: The observed pre-and post difference and the mean implementation score after one year was low compared to other studies (Varnell et al. 2008, Melnyk et al. 2010, Wallen et al. 2010, Levin et al. 2011) 6

7 Conclusion Attitudes towards EBP were improved after participation in the 15 ECTS credits postgraduate education in EBP There was a minor improvement in behaviour related to EBP Welcome to our network conferance: Innovative tiltak for implementering - den nasjonale nettverkskonferansen i kunnskapsbasert praksis 7

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