Youssef Naglaa, Saleeb Marina, Gebreal Assem, Ghazy Ramy Mohamed
Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia.
Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool L2 2QP, UK.
Healthcare (Basel). 2023 Jul 31;11(15):2168. doi: 10.3390/healthcare11152168.
Fostering a culture of clinical effectiveness among healthcare professionals (HCPs) is crucial to achieving optimal patient health outcomes. To our knowledge, there is a lack of robust evidence-based practice (EBP) tools to assess the competence of HCPs in EBP in the Eastern Mediterranean Region (EMR).
This study aims to comprehensively investigate the construct validity and internal reliability of the evidence-based practice questionnaire (EBPQ) among HCPs in the EMR.
This multinational and multi-disciplinary cross-sectional study was conducted between 27 April and 11 May 2023. Convenience and snowball sampling methods were used to recruit a sample of HCPs (physicians, nurses, physiotherapists, dentists, and pharmacists) using an electronic survey questionnaire for data capture. To assess the reliability of the instrument, Cronbach's alpha, inter-item reliability, and split-half reliability analyses were conducted. Furthermore, the convergent and discriminant validity of the questionnaire was ensured by calculating the average variance extracted (AVE) and the correlation coefficient between the different constructs, respectively. Factor loadings and cross-loadings of different indicators within each construct were calculated by performing both exploratory and confirmatory factor analyses.
A total of 1536 HCPs from 18 countries in the EMR (response rate = 96.786%) with a median age of 28 years participated; 47% were female, and 55% had Arabic as their first language. English was the most common language for a bachelor's degree in science (54%). The construct validity of the EBPQ was investigated using exploratory factor analysis (EFA), which yielded four loaded factors. The confirmatory factor analysis (CFA) confirmed the four loaded factors. The CFA model showed that the root mean square error of approximation = 0.066, comparative fit index = 0.95, Tucker-Lewis's index = 0.94, standardized root mean square residual = 0.033, normal fit index = 0.94, goodness of fit = 0.91, and χ test statistic= 22,553, with < 0.001. The AVE values of the four factors were close to 1 (knowledge = 0.6, practice = 0.6, attitude = 0.5, and sharing = 0.7), thus supporting the convergent validity of the EBPQ. The four domains had Cronbach's alpha coefficients and Omega ≥ 0.7 (knowledge = 0.9, practice = 0.9, attitude = 0.7, and sharing = 0.8), suggesting that the items within each domain had good internal consistency. These results support the discriminant validity of the EBPQ.
The EBPQ is a robust questionnaire that can be completed in less than 10 min by EMR HCPs and can be used as a gold-standard questionnaire to collect valid data on the attitudes, knowledge, and proficiency of HCPs in making clinical decisions based on evidence. Future studies are recommended to investigate the retest reliability.
在医疗保健专业人员（HCPs）中培育临床有效性文化对于实现最佳患者健康结果至关重要。据我们所知，东地中海区域（EMR）缺乏强有力的基于证据的实践（EBP）工具来评估HCPs在EBP方面的能力。
本研究旨在全面调查EMR中HCPs的循证实践问卷（EBPQ）的结构效度和内部信度。
这项跨国多学科横断面研究于2023年4月27日至5月11日进行。采用便利抽样和滚雪球抽样方法，通过电子调查问卷招募HCPs（医生、护士、物理治疗师、牙医和药剂师）样本以收集数据。为评估该工具的信度，进行了Cronbach's alpha系数、项目间信度和分半信度分析。此外，分别通过计算平均提取方差（AVE）和不同结构之间的相关系数来确保问卷的收敛效度和区分效度。通过进行探索性和验证性因素分析，计算每个结构内不同指标的因素载荷和交叉载荷。
来自EMR 18个国家的1536名HCPs参与研究（回复率 = 96.786%），中位年龄为28岁；47%为女性，55%以阿拉伯语为第一语言。英语是科学学士学位最常用的语言（54%）。使用探索性因素分析（EFA）研究EBPQ的结构效度，得出四个载荷因素。验证性因素分析（CFA）证实了这四个载荷因素。CFA模型显示近似误差均方根 = 0.066，比较拟合指数 = 0.95，塔克 - 刘易斯指数 = 0.94，标准化均方根残差 = 0.033，正态拟合指数 = 0.94，拟合优度 = 0.91，χ检验统计量 = 22553，P < 0.001。四个因素的AVE值接近1（知识 = 0.6，实践 = 0.6，态度 = 0.5，分享 = 0.7），从而支持EBPQ的收敛效度。四个领域的Cronbach's alpha系数和Omega≥0.7（知识 = 0.9，实践 = 0.9，态度 = 0.7，分享 = 0.8），表明每个领域内的项目具有良好的内部一致性。这些结果支持EBPQ的区分效度。
EBPQ是一个强大的问卷，EMR的HCPs可以在不到10分钟内完成，可作为收集HCPs在基于证据做出临床决策方面的态度、知识和熟练程度的有效数据的金标准问卷。建议未来的研究调查重测信度。
