Creed Torrey A, Crane Margaret E, Calloway Amber, Olino Thomas M, Kendall Philip C, Stirman Shannon Wiltsey
Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Suite 3046, Philadelphia, PA, USA.
Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, USA.
Implement Res Pract. 2021 Jan 1;2. doi: 10.1177/26334895211030220. Epub 2021 Jul 15.
Although the literature suggest that attitudes toward evidence-based practices (EBPs) are associated with provider use of EBPs, less is known about the association between attitudes and how competently EBPs are delivered. This study examined how initial attitudes and competence relate to improvements in attitudes and competence following EBP training.
Program evaluation data was collected during implementation of an EBP in a large community mental health network. Clinicians (N=891) received intensive training in cognitive behavioral therapy followed by six months of consultation. Attitudes were assessed using the Evidence-Based Practice Attitude Scale, and competence was assessed using the Cognitive Therapy Rating Scale. Data were analyzed by fitting three latent change score models to examine the relationship between changes in attitudes and competence across the training and within its two phases (workshop phase, consultation phase).
Latent change models identified significant improvement in attitudes ( ≥1.03, s≤ 0.18, ≥6.55, s< .001) and competence ( ≥14.16s3.10s2.82, s<.001) across the full training and in each phase. Higher pre-workshop attitudes predicted significantly greater change in competence in the workshop and across training (bs≥1.62, s≤0.90, ≥1.09, <.04, β≥0.10); however, contrary to our hypothesis, post-workshop attitudes did not significantly predict change in competence in consultation (b=1.62, =0.86, =1.87, =.06, β=0.09). Change in attitudes and change in competence in the training period and within the two phases were not significantly correlated.
Results indicate that pre-training attitudes about EBPs present a target for implementation interventions, given their relation to changes in both attitudes and competence throughout training. Following participation in in itial training workshops, other factors such as subjective norms, implementation culture, or system-level policy shifts may be more predictive of change in competence through consultation.
尽管文献表明对循证实践（EBPs）的态度与提供者对EBPs的使用有关，但对于态度与EBPs实施能力之间的关联了解较少。本研究考察了初始态度和能力与循证实践培训后态度和能力的改善之间的关系。
在一个大型社区心理健康网络实施循证实践期间收集项目评估数据。临床医生（N = 891）接受了认知行为疗法的强化培训，随后进行了六个月的咨询。使用循证实践态度量表评估态度，使用认知疗法评定量表评估能力。通过拟合三个潜在变化分数模型来分析数据，以检验培训期间及其两个阶段（工作坊阶段、咨询阶段）态度和能力变化之间的关系。
潜在变化模型表明，在整个培训过程以及每个阶段，态度（≥1.03，s≤0.18，≥6.55，s<.001）和能力（≥14.16，s3.10，s2.82，s<.001）都有显著改善。工作坊前较高的态度显著预测了工作坊期间及整个培训过程中能力的更大变化（bs≥1.62，s≤0.90，≥1.09，<.04，β≥0.10）；然而，与我们的假设相反，工作坊后的态度并未显著预测咨询期间能力的变化（b = 1.62，= 0.86，= 1.87，=.06，β = 0.09）。培训期间以及两个阶段内态度变化和能力变化之间没有显著相关性。
结果表明，鉴于培训前对循证实践的态度与整个培训过程中态度和能力的变化有关，它是实施干预的一个目标。参与初始培训工作坊后，其他因素，如主观规范、实施文化或系统层面的政策变化，可能更能预测通过咨询实现的能力变化。
