Evaluation of the Evidence-Based practice Attitude and utilization SurvEy for complementary and alternative medicine practitioners

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1 Journal of Evaluation in Clinical Practice ISSN Evaluation of the Evidence-Based practice Attitude and utilization SurvEy for complementary and alternative medicine practitioners Matthew J. Leach RN Dip.App.Sc.(Nat.) BN(Hons) PhD 1 and David Gillham BSc BN RN MNS PhD 2 1 Lecturer in Health Sciences, School of Health Sciences, University of South Australia, Adelaide, SA, Australia 2 Senior Lecturer in Nursing, School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia Keywords complementary and alternative medicine, evaluation, evidence-based practice, reliability, survey, validity Correspondence Dr Matthew J. Leach School of Health Sciences University of South Australia Adelaide, SA 5000 Australia matthew.leach@unisa.edu.au Accepted for publication: 1 May 2008 doi: /j x Abstract Rationale This paper describes the development of the Evidence-Based practice Attitude and utilization SurvEy (EBASE), which was designed to measure complementary and alternative medicine (CAM) practitioner attitude to and utilization of evidence-based practice (EBP). Aim The aim of this study was to evaluate the validity and reliability of the EBASE as a measure of CAM practitioner skill, attitude and use of EBP in order to adequately inform clinicians and researchers about this comprehensive survey tool. Methods EBASE and the clinical effectiveness and EBP questionnaire (EBPQ) were distributed to nine experts in CAM education, research, questionnaire design and/or EBP. Responses to these questionnaires were used to evaluate the content validity, convergent validity, test-retest reliability and internal consistency of EBASE. Results EBASE has found to have good internal consistency (Cronbach s alpha = 0.84) and acceptable test-retest reliability (ICC = ). The instrument also demonstrated good content validity (CVI = 0.899), and adequately measured practitioner skill and utilization of EBP when compared to the EBPQ. Conclusion The current study supports the validity and reliability of EBASE as a measure of CAM practitioner skill, attitude, experience and training in, as well as barriers and facilitating factors of EBP. Introduction The term complementary and alternative medicine (CAM) encompasses a diverse range of theoretical and philosophical views of health and illness, as well as a wide variety of approaches to treatment. Attitudes to CAM among health professionals and consumers vary widely according to culture, beliefs, prior education and experience. While many mainstream health professionals may question the effectiveness of CAM, it is clear that a large percentage of the Australian population value CAM, with the Australian population spending AUD$494 million on CAM practitioner consultations every year [1]. Given the controversy surrounding the effectiveness of CAM and the importance the Australian public places on these therapies, it is critical to ascertain the extent and level of research evidence underpinning CAM. However, the task of determining the evidence base for such a large and diverse range of therapies is phenomenal. Furthermore, the existence of such evidence cannot guarantee that CAM practitioners will apply the best available research evidence. For this reason, it is important to ascertain CAM practitioner attitude and utilization of EBP. Greater understanding of the knowledge and attitudes towards EBP among CAM practitioners may, in the long term, facilitate EBP uptake by CAM therapists, and in effect, provide consumers with improved information on which to base health decisions related to CAM. The example of acupuncture can be used to illustrate this point. Acupuncture, while well accepted in China, remains the topic of research controversy among British medical practitioners. Melchart et al. s study, for instance, found both sham acupuncture and acupuncture effective in reducing the symptoms of headache [2]. While the Melchart study directly provides important information for health consumers, greater understanding of the knowledge and attitudes of CAM practitioners towards EBP will provide insight into whether CAM practitioners are aware of current research evidence and whether this influences their treatment decisions. The Evidence-Based practice Attitude and utilization SurvEy (EBASE) described in this paper investigates CAM practitioner attitude and utilization of EBP. By exploring attitudes to EBP and identifying precisely where and how CAM practitioners The Authors. Journal compilation 2008 Blackwell Publishing Ltd, Journal of Evaluation in Clinical Practice 14 (2008)

2 M.J. Leach and D. Gillham Evaluation of the EBASE locate research evidence, the EBASE will provide important information for both health consumers and practitioners. This information may help to provide a small but important step towards improved consumer decision making while simultaneously contributing to improved evidence-based decision making among practitioners. Background Contemporary health care is increasingly based on research evidence. David Sackett, a leader in the field of evidence-based practice (EBP) in the last decade, defined EBP as the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients [3]. Since 1996, EBP has evolved rapidly in response to technological change as well as a trend towards increased accountability for health care provision. It is no longer considered acceptable for health care to be based upon tradition, outdated procedures or clinical experience alone. Consumers and health professionals alike expect and deserve health care based on the best available research evidence [4]. Advances in web technology and collaborative ventures such as the Cochrane Collaboration and the more recent, UK-based Map of Medicine have made evidence-based research accessible to practitioners using processes that are timeefficient for clinicians. The Map of Medicine, in particular, provides evidence-based client-centred care pathways that enable clinicians to access fundamental evidence-based content to support their clinical decisions. While the Map of Medicine is a valuable resource for orthodox medicine, its applicability to many other health-related disciplines is limited. Furthermore, clinicians need the time and skills to understand its content. The Map of Medicine is also currently not widely accessible in many countries, including Australia and the United States. The barriers to EBP, such as lack of time, resources, skill and access, are well documented and shared internationally [4]. In addition, there may be many areas of health care practice where limited research evidence is available. However, such barriers do not negate the need to provide clinical care based on the best available research evidence. In fact, in areas such as CAM, where some practitioners may work in relative isolation, the need for EBP may be even greater. Complementary and alternative medicine covers a wide range of disciplines, each with varied educational preparation, and diverse regulatory frameworks. While medical practitioners who have online access to the Cochrane Library and the Map of Medicine may be well supported with evidence-based content for independent practice, CAM practitioners may have limited web access, limited online resources and possibly even limited interest in EBP [5,6]. This may lead to the potential for some CAM practitioners to rely on outdated education with little scope for updating their knowledge base in the light of current evidence. For this reason, it is essential to determine CAM practitioner knowledge and attitude to EBP in order to better understand whether CAM practitioners are actively engaging in EBP, and what strategies may be useful in facilitating participation in EBP with the intention of enhancing the quality of patient care. While studies investigating EBP have explored a range of concepts, including attitude, skill, training, knowledge, utilization, solutions and barriers to use, relatively few have been identified that consider all of these constructs collectively. Of the 13 EBP surveys identified to date that have considered all these constructs, only three have published evidence of validity and reliability, as illustrated in Table 1. Given these concerns, and the fact that no studies to date have examined the abovementioned constructs among CAM practitioners specifically, there is a genuine need to develop a valid and reliable tool capable of accurately measuring CAM practitioner skill, attitude and use of EBP. Methods Research aim The aim of this study was to evaluate the validity and reliability of the EBASE as a measure of CAM practitioner skill, attitude and use of EBP. Description of questionnaire The EBASE was originally developed by the authors to evaluate the skill, attitude and use of EBP among system-based CAM practitioners, including naturopathy, homeopathy, western herbalism and traditional Chinese medicine (TCM). The six-page, 84-item, pencil and paper self-administered questionnaire was constructed according to methods described by Polit and Hungler [35], with most questions shaped by the literature, and a few items modified from other tools [20,34]. In order to improve readability and to simplify data analysis, the EBASE was divided into seven parts, with each section addressing a different construct. Part A of the survey explored practitioner opinion of EBP using a five-point Likert scale. Part B investigated practitioner skills in EBP using a five-point scale ranging from poor to advanced skills. Part C examined the level of practitioner training in five EBP-related areas, with the list of responses covering eight different levels of training. Part D examined CAM practitioner use of EBP using a five-point scale ranging from zero to 16-plus episodes, for a total of seven items. This section also examined the percentage of practice that was based on clinical research, using six categorical response options ranging from zero to 100%. This was followed by a question asking participants to rank 11 sources of information according to how much these sources influence their clinical decision making. Part E explored practitioner barriers to EBP, using a four-point scale ranging from not a barrier to major barrier. Part F investigated practitioner preference about a proposed EBP intervention, using a four-point scale ranging from not useful to very useful. The final section, Part G, solicited the demographic details of the respondent. Participants Practitioners, academics and researchers in CAM, who were considered leaders in their field, were invited to participate in the questionnaire evaluation. Leaders were defined as executive members of professional CAM associations, directors/senior lecturers in CAM education, researchers in CAM and/or experts in questionnaire design and EBP. Two academics with expertise in survey design and EBP, and nine CAM practitioners/academics/ researchers in naturopathy, western herbalism, homeopathy and 2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd 793

3 Evaluation of the EBASE M.J. Leach and D. Gillham Table 1 Details of surveys examining health practitioner use, attitude and knowledge of EBP Author Year Location Sample Outcomes Tool Studies that have used the tool Validity and reliability Bostrom & Suter [7] Funk et al. [11] McColl et al. [18] McKenna et al. [23] Nagy et al. [24] Olatunbosun et al. [25] Oliveri et al. [26] Pain et al. [27] 1993 California, USA 1588 nurses: cluster sample across 12 health care agencies 1991 USA 1989 registered nurses: stratified, random sample of American Nurses Association members across 22 US states 1998 Wessex, England, UK 302 GPs: random, regional sample 2004 Northern Ireland 462 community nurses and GPs: random, stratified nationwide sample 2001 Sydney, Australia 816 nurses: cluster sample across three teaching hospitals 1998 Saskatchewan, Canada 2003 Copenhagen, Denmark 120 family physicians and 36 obstetricians: random regional sample 225 hospital doctors: convenience sample of single institution 1996 Edmonton, Canada 172 rehabilitation hospital staff: convenience sample of single institution Stuttard [29] 2002 Lancashire, UK 103 masseurs: random sample of professional association members Taylor [30] 1998 Britain, UK 183 dieticians: convenience sample of conference delegates Thomas et al. [31] Upton et al. [32] Upton & Upton [34] 2003 Australia 59 paediatric dieticians: purposive, nationwide sample 1998 Wales, UK 295 allied health workers: cluster sample of a randomly selected hospital 2006 Wales, UK 751 nurses: multi-stage, cluster sample attitude; use Survey of nurses research attitudes and activities attitude; barriers; skill Barriers to research utilization scale access to evidence; attitude; barriers; knowledge barriers; use Evidence-Based Practice in Primary Care questionnaire Brener et al. [8]; Smirnoff et al. [9]; Vallino-Napoli & Reilly [10] Kajermo et al. [12]; McCleary & Brown [13]; Parahoo [14]; Oranta et al. [15]; Retsas [16]; Veeramah et al. [17] New survey Bennett et al. [19]; Jette et al. [20]; O Donnell [21]; Young et al. [22] For the two subscales, Cronbach s alpha ranged between Cronbach s alpha ranged between ; test retest reliability (r = ) Not stated NR Not stated attitude; barriers; skill New survey NR For the six subscales, Cronbach s alpha ranged between access to evidence; attitude; skill; use New survey NR Not stated knowledge; use; skills New survey NR Not stated attitude; use Edmonton Research Orientation Survey McCleary & Brown [13]; McCleary & Brown [28] attitude; knowledge; use New survey NR Not stated attitude; barriers; skill New survey NR Not stated barriers; critical appraisal knowledge; information needs; skill; sources of information attitude; barriers; knowledge; solutions; use attitude; skill; use Evidence-based practice questionnaire New survey NR Not stated Cronbach s alpha = 0.93 New survey McCluskey [33] Cronbach s alpha ranged between ; test retest reliability (r = ) NR Cronbach s alpha = 0.87; construct validity (r = , P < 0.001) EBP, evidence-based practice; GP, general practitioner; NR, not reported The Authors. Journal compilation 2008 Blackwell Publishing Ltd

4 M.J. Leach and D. Gillham Evaluation of the EBASE Table 2 Panel of reviewers of the EBASE Position Experience Qualifications Expertise 1 Head of Naturopathy Australian Traditional Medicine Society (ATMS) 2 Head of Naturopathy Programme, School of Biomedical and Health Sciences, University of Western Sydney 3 President of the National Herbalist Association of Australia (NHAA) 4 Adjunct Associate Professor (herbal medicine), School of Health, University of New England 5 Homeopath; Course Assessor for the Australian Register of Homeopaths 6 Acupuncturist; PhD Candidate, University of South Australia 7 Postdoctoral Fellow and Deputy Director of the Centre for Allied Health Evidence (CAHE), University of South Australia 8 Project Officer for the Centre for Allied Health Evidence, University of South Australia 9 Postdoctoral Research Assistant, University of South Australia 21 years in naturopathy practice; 5 years as Head of Naturopathy (ATMS) 16 years in naturopathy practice; 28 years in nursing practice; 6 years as Head of Naturopathy Programme 11 years in naturopathy and western herbalism practice; 2.5 years as President of the NHAA 24 years in western herbalism practice; 9 years as Director of Research and Development, Mediherb; 11 years as Principal of the Australian College of Phytotherapy Dip. Naturopathy Cert. Midwifery; Cert. Acupuncture; Bach. Health Science (Complementary Medicine); Registered Nurse Dip. Botanical Medicine; Dip Naturopathy; Dip. Nutrition; Dip. Homeopathy; Dip. Remedial Therapies; Dip. Remedial Massage; Bach. Health Science (Complementary Medicine) Bach. Science (Hons); Dip. Phytotherapy 28 years in homeopathy practice Cert. IV Workplace Training and Assessment; Cert. Submodalities (Neurolinguistic programming); Adv. Dip Health Science (Homeopathy); Bach. Teaching; Mast. Learning Management; Registered Nurse; Midwife 6.5 years in acupuncture practice; 1 year in research 7 years in physiotherapy practice; 5 years in research; 2 years as deputy director (CAHE) 13 years in physiotherapy practice; 2 years as Project Officer (CAHE) 10 years in Naturopathy; 1 year in research Bach. Health Science (Acupuncture) (Hons); PhD candidate Bach. Applied Science (Physiotherapy); Mast. Physiotherapy; PhD Bach. Physiotherapy; Mast. Physiotherapy; Grad. Cert. Biostatistics Dip. Naturopathy; Bach. Health Science; PhD Naturopath Naturopath; Academic Western Herbalist; Naturopath Western Herbalist Homeopath Acupuncturist; Academic; Academic; Naturopath; Bach., Bachelor; Cert., Certificate; Dip., Diploma; EBASE, Evidence-Based practice Attitude and utilization SurvEy; Mast., Master. TCM/acupuncture were contacted, and all agreed to participate. However, two reviewers withdrew from the study within the first week for unspecified reasons. Details of the nine remaining panel members are listed in Table 2. Data collection Once participating reviewers agreed to evaluate the survey, the study cover letter, the EBASE, the evidence-based practice questionnaire (EBPQ) [34] and the content-validity record were dispatched by . Participants were prompted to complete the following tasks: 1 content-validity assessment of the EBASE; 2 convergent validity assessment of the EBASE by completing the EBASE and the comparable EBPQ survey tool [34]; and 3 test retest reliability of the EBASE by completing the EBASE a second time after a 2-week period. Participants who had not returned the completed tools within 14 days were ed a reminder letter. Two weeks after receipt of the completed documents, participants were ed another copy of the EBASE. Data collection was completed in January Content validity To ensure the EBASE adequately captured participant opinion, skill and use of EBP, the validity and reliability of the tool was established. The face validity of the instrument was confirmed by the authors in collaboration with a statistical consultant. The content validity of the tool was also measured to determine if all content areas of importance were sufficiently represented [36]. To ascertain the content validity of the EBASE, the panel of reviewers rated the relevance of each instrument item from 1 = not relevant to 4 = very relevant. The mean percentage of items with a score 2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd 795

5 Evaluation of the EBASE M.J. Leach and D. Gillham of 3 or 4 was calculated, with good content validity defined as an index of 0.8 or above [35]. Convergent validity The convergent validity of EBASE was assessed against another convergent measure of EBP, the clinical effectiveness and EBPQ in order to determine whether the EBASE adequately measured practitioner use, skills and opinion of EBP. As a measure of EBP, EBPQ has demonstrated good internal reliability (Cronbach s alpha = 0.87) and moderate construct validity (r = , P < 0.001) in a recent survey of 751 randomly selected Welsh nurses [34]. Reliability A particularly useful method for evaluating the reliability of questionnaires is Cronbach s alpha [37]. This reliability index was selected to test the internal consistency of each section of EBASE [37]. Good internal reliability was determined if the Cronbach s alpha was above the 0.70 needed for group-level comparisons [35]. To establish test retest reliability, or the stability of the instrument over time [37], reviewer responses to the first completed EBASE were compared with survey responses completed 2 weeks later. Statistical analysis Data were analysed using spss, version 11.0 (SPSS Inc., Chicago, IL, USA). Demographic data and content-validity data were descriptively analysed using frequency distributions and percentages. Convergent validity was examined using Spearman rank correlation coefficient (r), and test retest reliability using a twoway mixed model, absolute agreement type and intraclass correlation coefficient (ICC). Internal consistency was analysed using Cronbach s alpha. Ethics This study was reviewed and approved by the Human Research Ethics Committee of the University of South Australia. The study was also conducted in accordance with the National Health and Medical Research Council national statement on ethical conduct in research [38] and the approved study plan. Results Validity Content validity The content-validity index (CVI) of the EBASE, as determined by all nine experts, was (range = ). The index varied according to practitioner group, with the CVI for naturopaths (n = 4), western herbalists (n = 2), homeopaths (n = 1), TCM/acupuncturists (n = 1) and academics (n = 3) determined to be (range = ), (range = ), (range = not applicable), (range = not applicable) and (range = ), respectively. Table 3 Intraclass correlation coefficients (ICC) for each section of the EBASE Section ICC 95% CI P-value Part A <0.001 Part B <0.001 Part C Part D Part E <0.001 Part F CI, confidence interval; EBASE, Evidence-Based practice Attitude and utilization SurvEy. Convergent validity All three domains of the EBPQ were found to be positively correlated with corresponding sections of the EBASE. For the experience domain, there was a strong, positive correlation between the two instruments (r=0.752), which was statistically significant (P = 0.024). A small positive correlation was also evident between the two instruments for the opinion domain (r=0.306), although this was not statistically significant (P = 0.423). For the skill domain, there was a very strong and statistically significant correlation (r=0.950, P = ) between the EBASE and the EBPQ. Reliability Internal consistency Testing the first 70 items of EBASE yielded a Cronbach s alpha of The remaining 14 items in Part G were excluded from the analysis as the demographic data were not directly related to the concept of EBP. The internal consistency of each subscale was also measured. A Cronbach s alpha of 0.87 was determined for the attitude subscale (Part A), 0.77 for the skill subscale (Part B), 0.86 for the training subscale (Part C), 0.66 for the utilization subscale (Part D), 0.95 for the barrier subscale (Part E) and 0.87 for the facilitation subscale (Part F). Test retest reliability The EBASE was administered twice, 2 weeks apart, and was completed by all nine panel members on both occasions. There was a strong and statistically significant agreement between the scores in both administered tests for five out of six parts of the EBASE (ICC = , P < 0.01), and moderate agreement between scores for Part C (ICC = 0.578, P = 0.043). The ICCs for each section of EBASE are presented in Table 3. General feedback The panel of experts was invited to comment on each item in the survey during the content-validity evaluation. For most questions, no comments were provided. Comments leading to changes in the EBASE related particularly to the provision of terms of reference, including EBP, clinical research and professional literature. Apart from a few minor changes to the phrasing of questions in Parts B The Authors. Journal compilation 2008 Blackwell Publishing Ltd

6 M.J. Leach and D. Gillham Evaluation of the EBASE and D, the only major amendment to the instrument was to question 9 in Part D ( percentage of practice based on clinical research evidence ), where the number of responses was increased from four to six. The mean time to complete the survey was 11.1 minutes (range: minutes). Discussion Over the past decade, there has been increased discussion both within the literature and among health care professionals, about utilizing the best available evidence to support clinical practice. While there are many convincing arguments to support the adoption of EBP, including financial, ethical and legal reasons, it remains unclear whether clinicians, particularly CAM practitioners, have accepted these arguments and embraced EBP, or whether they continue to practice according to tradition. This is because few studies have explored the extent to which practitioners have integrated EBP into clinical practice, or examined the range of factors that may contribute to EBP acceptance or rejection. The EBASE evaluated in this study was an 84-item selfadministered questionnaire, designed to measure health practitioner skill, attitude and use of EBP, particularly among system-based CAM practitioners. This well-structured, easy to navigate and quick to complete tool can be easily modified so that it can be administered to any clinician, including nurses, doctors and the wide spectrum of allied health professionals. The current study has demonstrated that the EBASE has good internal consistency (Cronbach s alpha = 0.84) and acceptable test retest reliability (ICC = ), exceeding the coefficient of 0.70 needed for group-level comparisons in most cases [33]. While internal consistency was comparable to that calculated for the EBPQ [34], the range of ICC values reported for the EBASE was higher than the coefficients reported for the Jette et al. survey [20]. Even so, the lower values reported by Jette et al. [20] could be explained by the comparatively longer retest duration (i.e. between 2 and 8 weeks) as retests over 4 8 weeks can yield comparatively lower reliability coefficients than short-term retests [35]. The EBASE has also demonstrated good validity across a range of measures. Even though three experts in survey design and/or EBP confirmed the face validity of the EBASE, it needs to be acknowledged that face validity fails to provide sufficient evidence of an instrument s ability to adequately measure the construct under investigation [39]. Despite this, it is almost certainly the case that evaluations of most measures of EBP utility are limited to face validity, as evidenced by the paucity of validity and reliability data in studies to date (Table 1). Because of the limitations of face validity, the current study also assessed the instrument for content validity. The EBASE was found to have good content validity (CVI = 0.899), exceeding the acceptable index of 0.8 [33]. As such, the EBASE is the only known measure of EBP utility where content validity has been quantifiably evaluated (Table 1). The only other study known to have evaluated content validity of an EBP instrument was Jette et al. [20], although this was assessed in a somewhat subjective and ambiguous manner. Convergent validity testing further supported the validity of the EBASE, which demonstrated that the EBASE adequately measured practitioner skill and utilization of EBP when compared with a different measure of the same constructs, that is, the EBPQ. Future evaluation of the EBASE now needs to consider sensitivity testing, including the capacity to detect differences in participant skill base, attitude and knowledge base following exposure to EBP education programmes or evidence-retrieval initiatives. Testing the validity and reliability of the instrument in other populations, including nurses, doctors and allied health professionals, is also recommended in order to provide some assurance that these measures of accuracy and reproducibility are not amenable to group bias or confounding. Conclusion The current study supports the validity and reliability of the EBASE as a measure of CAM practitioner skill, attitude, experience and training in, as well as barriers and facilitating factors of EBP. With minor modification, the tool may also accurately evaluate these aforementioned constructs among other groups of clinicians, including nurses, doctors and allied health practitioners, although further sensitivity, validity and reliability testing in these populations are needed. Further support for the accuracy and reproducibility of the EBASE now needs to be demonstrated using data from larger studies. Acknowledgement The authors wish to acknowledge the assistance of Professor Adrian Esterman (accredited biostatistician) in reviewing this paper, and to each of the panel members for their contribution towards the evaluation of the EBASE. References 1. MacLennan, A., Myers, S. & Taylor, A. (2006) The continuing use of complementary and alternative medicine in South Australia: costs and beliefs in Medical Journal of Australia, 184 (1), Melchart, D., Streng, A., Hoppe, A., et al. (2005) Acupuncture in patients with tension-type headache: randomised controlled trial. British Medical Journal, 331 (7513), Sackett, D., Rosenberg, W., Muir Gray, J., Haynes, R. & Richardson, W. (1996) Evidence based medicine: what it is and what it isn t. British Medical Journal, 312 (7023), Leach, M. (2006) Evidence-based practice: a framework for clinical practice and research design. International Journal of Nursing Practice, 12, Barry, C. (2006) The role of evidence in alternative medicine: contrasting biomedical and anthropological approaches. Social Science and Medicine, 62, Lambert, H., Gordon, E. & Bogdan-Lovis, E. (2006) Introduction: gift horse or Trojan horse? Social science perspectives on evidence-based health care. Social Science & Medicine, 62, Bostrom, J. & Suter, W. (1993) Research utilisation: making the link to practice. Journal of Nursing Staff Development, 9 (1), Brener, L., Vallino-Napoli, L., Reid, J. & Reilly, S. (2003) Accessing the evidence to treat the dysphasic patient: can we get it? Is there time? Asia Pacific Journal of Speech, Language and Hearing, 8 (1), Smirnoff, M., Ramirez, M., Kooplimae, L. & Gibney, M. (2007) Nurses attitudes toward nursing research at a metropolitan medical center. Applied Nursing Research, 20, Vallino-Napoli, L. & Reilly, S. (2004) Evidence-based health care: a survey of speech pathology practice. Advances in Speech Language Pathology, 6 (2), The Authors. Journal compilation 2008 Blackwell Publishing Ltd 797

7 Evaluation of the EBASE M.J. Leach and D. Gillham 11. Funk, S., Champagne, M., Wiese, R. & Tornquist, E. (1991) Barriers: barriers to research utilization scale. Applied Nursing Research, 4 (1), Kajermo, K., Nordstrom, G., Krusebrant, A. & Bjorvell, H. (1998) Barriers to and facilitators of research utilization, as perceived by a group of registered nurses in Sweden. Journal of Advanced Nursing, 27, McCleary, L. & Brown, G. (2003) Barriers to paediatric nurses research utilization. Journal of Advanced Nursing, 42 (4), Parahoo, K. (2000) Barriers to, and facilitators of, research utilization among nurses in Northern Ireland. Journal of Advanced Nursing, 31, Oranta, O., Routasalo, P. & Hupli, M. (2002) Barriers to and facilitators of research utilization among Finnish Registered Nurses. Journal of Clinical Nursing, 11 (2), Retsas, A. (2000) Barriers to using research evidence in nursing practice. Journal of Advanced Nursing, 31 (3), Veeramah, V. (2004) Utilization of research findings by graduate nurses and midwives. Journal of Advanced Nursing, 47 (2), McColl, A., Smith, H., White, P. & Field, J. (1998) General practitioners perceptions of the route to evidence based medicine: a questionnaire survey. British Medical Journal, 316, Bennett, S., Tooth, L., McKenna, K., Rodger, S., Strong, J., Ziviani, J., Mickan, S. & Gibson, L. (2003) Perceptions of evidence-base practice: a survey of Australian occupational therapists. Australian Occupational Therapy Journal, 50, Jette, D., Bacon, K., Batty, C., Carlson, M., Ferland, A., Hemingway, R., Hill, J., Ogilvie, L. & Volk, D. (2003) Evidence-based practice: beliefs, attitudes, knowledge, and behaviours of physical therapists. Physical Therapy, 83 (9), O Donnell, C. (2004) Attitudes and knowledge of primary care professionals towards evidence-based practice: a postal survey. Journal of Evaluation in Clinical Practice, 10 (2), Young, J. & Ward, J. (2001) Evidence-based medicine in general practice: beliefs and barriers among Australian GPs. Journal of Evaluation in Clinical Practice, 7 (2), McKenna, H., Ashton, S. & Keeney, S. (2004) Barriers to evidencebased practice in primary care. Journal of Advanced Nursing, 45 (2), Nagy, S., Lumby, J., McKinley, S. & Macfarlane, C. (2001) Nurses beliefs about the conditions that hinder or support evidence-based nursing. International Journal of Nursing Practice, 7, Olatunbosun, O., Edouard, L. & Person, R. (1998) Physicians attitudes toward evidence based obstetric practice: a questionnaire survey. British Medical Journal, 316, Oliveri, R., Gluud, C. & Wille-Jorgensen, P. (2004) Hospital doctors self-rated skills in and use of evidence-based medicine a questionnaire survey. Journal of Evaluation in Clinical Practice, 10 (2), Pain, K., Hagler, P. & Warren, S. (1996) Development of an instrument to evaluate research orientation of clinical professionals. Canadian Journal of Rehabilitation, 9, McCleary, L. & Brown, G. (2002) Research utilization among pediatric health professionals. Nursing and Health Sciences, 4 (4), Stuttard, P. (2002) Working in partnership to develop evidence-based practice within the massage profession. Complementary Therapies in Nursing and Midwifery, 8, Taylor, M. (1998) Evidence-based practice: are dieticians willing and able? Journal of Human Nutrition and Dietetics, 11, Thomas, D., Kukuruzovic, R., Martino, B., Chauhan, S. & Elliot, E. (2003) Knowledge and use of evidence-based nutrition: a survey of paediatric dietitians. Journal of Human Nutrition and Dietetics, 16, Upton, D. & Lewis, B. (1998) Clinical effectiveness and EBP: design of a questionnaire. British Journal of Therapy and Rehabilitation, 5, McCluskey, A. (2003) Occupational therapists report a low level of knowledge, skill and involvement in evidence-based practice. Australian Occupational Therapy Journal, 50, Upton, D. & Upton, P. (2006) Development of an evidence-based practice questionnaire for nurses. Journal of Advanced Nursing, 54 (4), Polit, D. & Hungler, B. (2004) Nursing Research: Principles and Methods. Philadelphia, PA: Lippincott. 36. Greenwood, K. (1999) The logic and need for statistics. In Handbook for Research Methods in Health Sciences (eds V. Minichiello, G. Sullivan, K. Greenwood & K. R. Axford), pp Sydney: Addison-Wesley. 37. Thomas, B. (1990) Nursing Research: An Experiential Approach. St Louis, CV: Mosby. 38. National Health and Medical Research Council (NHMRC) (2007) National Statement on Ethical Conduct in Human Research. Canberra: Australian Government. 39. Burns, N. & Grove, S. (2005) The Practice of Nursing Research: Conduct, Critique and Utilization. Philadelphia, PA: WB Saunders The Authors. Journal compilation 2008 Blackwell Publishing Ltd