开发并验证循证医学问卷（EBMQ），以评估医生在初级保健中实施循证医学方面的知识、实践情况和障碍。
Development and validation of the Evidence Based Medicine Questionnaire (EBMQ) to assess doctors' knowledge, practice and barriers regarding the implementation of evidence-based medicine in primary care.
作者信息
Hisham Ranita, Ng Chirk Jenn, Liew Su May, Lai Pauline Siew Mei, Chia Yook Chin, Khoo Ee Ming, Hanafi Nik Sherina, Othman Sajaratulnisah, Lee Ping Yein, Abdullah Khatijah Lim, Chinna Karuthan
机构信息
Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Department of Medical Sciences School of Healthcare and Medical Sciences Sunway University, Selangor, Malaysia.
出版信息
BMC Fam Pract. 2018 Jun 23;19(1):98. doi: 10.1186/s12875-018-0779-5.
BACKGROUND
Evidence-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.
METHODS
The 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.
RESULTS
The 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.
CONCLUSIONS
The 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.
背景
循证医学（EBM）整合了文献中可得的最佳证据以及患者的价值观，以此为临床决策提供依据。然而，目前缺乏经过验证的工具来评估基层医疗医生在实施循证医学方面的知识、实践情况及障碍。本研究旨在开发并验证马来西亚的循证医学调查问卷（EBMQ）。
方法
循证医学调查问卷基于一项定性研究、文献综述及专家小组开发而成。由专家小组验证其表面效度和内容效度，并在10名参与者中进行预试验。于2015年12月至2016年1月招募了懂英语的、接受或未接受循证医学培训的基层医疗医生。在基线期及两周后发放循证医学调查问卷。得分越高表明循证医学知识掌握得越好、实践情况越好且实施循证医学的障碍越少。我们假设循证医学调查问卷将有三个领域：知识、实践和障碍。
结果
循证医学调查问卷的最终版本包含80个条目：62个条目采用名义量表测量，22个条目采用5点李克特量表测量。弗莱什易读度为61.2。共邀请了343名参与者；其中320人同意参与（应答率 = 93.2%）。因子分析显示，在删除13个条目后，循证医学调查问卷有八个领域：“循证医学网站”、“循证医学期刊”、“研究类型”、“与循证医学相关的术语”、“实践”、“获取途径”、“患者偏好”和“支持”。循证医学调查问卷总体的克朗巴哈α系数为0.909，而各个领域的克朗巴哈α系数范围为0.657 - 0.940。循证医学调查问卷能够在42个条目中的24个条目上区分接受和未接受循证医学培训的医生。在重测时，kappa值范围为0.155至0.620。
结论
循证医学调查问卷被发现是一种有效且可靠的工具，可用于评估马来西亚基层医疗医生在实施循证医学方面的知识、实践情况及障碍。
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