Approaches to teach evidence-based practice among health professionals: an overview of the existing evidence

Figures & data

Figure 1 Flowchart for selection of systematic reviews of teaching strategies for evidence-based practice among health professionals.

Table 1 Summary of studies conducted among health professionals

Study	Main study characteristics	Intervention and instrument	Main findings
Schneider et al^Citation21	USA, cross-sectional national survey, January 2013–September 2014	MI: online seminar and lessons on EBP during a 7-month period	Pre-intervention vs 9 and 16 months post-intervention mean scores
	293 chiropractors – IG: 147 CG: 146	EBASE Questionnaire	Attitude 70.0 vs 69.1, 69.4 vs 65.3, 69.7 vs 73.1, P<0.01  Skills 49.2 vs 53.6, 56.4 vs 49.0, 53.2 vs 55.4, P<0.001  Use 41.4 vs 45.7, 40.5 vs 43.3, 42.0 vs 46.3, P<0.001
Allen et al^Citation11	USA, Oncology Nursing Society in Pittsburgh, December 2009–November 2013	SI: “Developing Skills for Evidence-Based Practice” web course	Pre- vs post-intervention mean scores
	225 nurses	Study questionnaire, EBPQ Test	EBP knowledge – 52.6±5.6 vs 87.6±3.8, P=0.00  EBPQ test – practice of EBP: 4.46±2.4; attitude towards EBP: 5.69±1.46;  knowledge/skills associated with EBP: 5.46±0.61
Ramos- Morcillo et al^Citation10	Spain, Nursing Council of Jaen, 2013	MI: comprehensive course on EBP competencies with both online and face-to-face sections	Pre-intervention vs 21 and 60 days post-intervention mean scores
	109 nurses – IG: 54; CG: 55	Study questionnaire	Knowledge and skills: 3.65 vs 3.61, 4.89 vs 4.07, 4.92 vs 4.3, P<0.05 only for 21 and 60 days post-intervention  Attitude: 5.88 vs 5.97, 6.05 vs 5.85, 5.85 vs 5.99, P>0.05  Practice: 3.56 vs 3.77, 4.14 vs 4.31, 4.72 vs 4.47, P>0.05
Wilson et al^Citation23	USA, Magnet^®-recognized hospital	MI: journal club (8-week duration) attended either face to face, or through online site, or with a combination of methods	Pre-intervention vs post-intervention mean scores
	36 health care professionals (72% nurses)	Study questionnaire	EBP use: 1.2±0.7 vs 1.7±0.7  EBP behaviors: 3.0±0.4 vs 3.2±0.4  EBP ability: 4.0±0.8 vs 4.2±0.7, P>0.05
Weng et al^Citation24	Taiwan, 39 medical centers, 2009 and 2011	SI: EBM competition using PICO queries	Pre- vs post-competition mean scores
	358 health care professionals (physicians, nurses, pharmacists, and other)	Study questionnaire	Knowledge about EBM principles is adequate: 3.42±0.71 vs 3.77±0.72, P<0.001  Skills concerning literature searching are adequate: 3.70±0.64 vs 3.87±0.68, P<0.001  Skill concerning critical appraisal is adequate: 3.48±0.71 vs 3.80±0.72, P<0.001  Skills concerning EBM principles are adequate: 3.40±0.74 vs 3.76±0.71, P<0.001
Sprague et al^Citation25	Canada, Department of Surgery and Department of Clinical Epidemiology and Biostatistics (McMaster University), 2009	SI: 2.5-day seminar including interactive lectures and small group sessions	Pre- vs post-intervention mean scores
	Participants: 62 health professionals	Fresno Test, CAMS Test, Questions by course chairs	38.2% (SD 21.3) vs 51.7% (SD 19.1)  Absolute increase: 13.5%  Relative increase: 35.3%, P<0.001
Escoffery et al^Citation15	USA, Rollins School of Public Health (Emory University), Spring 2009	SI: 3 trainings with 7 different sections (presentations, small group workshops, etc)	Pre- vs post-intervention mean scores
	47 practitioners from community-based organizations	Study questionnaire	Ability to locate evidence-based resources: 3 vs 4.7, P<0.001  Filter search results to be more precise: 3 vs 4.6, P<0.001  Define methods for the collection strategy of primary data: 3.17 vs 4.63, P<0.001
Mollon et al^Citation18	USA, Sharp Grossmont Hospital	SI: online learning module (via organization’s intranet system, accessibility for 2 months)	Pre- vs post-intervention mean scores
	609 participants among clinical staff	Clinical Effectiveness and EBPQ	Practice of EBP: 4.51 vs 4.46, P=0.692  Attitude towards EBP: 5.22 vs 5.16, P=0.585  Knowledge/skills associated with EBP: 4.55 vs 4.58, P=0.741
Rutledge and Skelton^Citation20	USA, St. Joseph Hospital, 2008	SI: 4 6-hour sessions during summer with classroom or PC courses	Pre-intervention, immediate post-intervention, and 1 year after intervention mean scores
	11 nurses	Study questionnaire	Comfort to find the best evidence: 4.45, 5.00, 6.00  Overall comfort: 4.11, 4.89, 5.56  Skill to find research evidence: 2.72, 3.27, 2.25  Overall skills: 2.93, 3.41, 2.02
Sciarra^Citation22	USA, Hospital in Northeastern United States, 2010	SI: 5 2-hour sessions	Pre- vs post-intervention mean scores
	33 ICU nurses	Clinical Effectiveness and EBPQ	EBP application: 3.77 (SD 1.44) vs 5.43 (SD 1.29), P<0.01  EBP attitudes: 4.77 (SD 1.36) vs 5.70 (SD 1.14), P<0.01  EBP skill level: 4.89 (SD 1.02) vs 5.21 (SD 0.98), P<0.01  Total scores of EBPQ: 12.40 (SD 3.18) vs 16.35 (SD 2.87), P<0.01
Tomatis et al^Citation26	Lima (Peru), 2005–2009	SI: annual 3-day course (interactive lectures/case-based workshops), each day: 2–3 interactive lectures (45 min each), after lecture an interactive workshop (45 min)	Pre- vs post-intervention mean scores
	220 clinicians	Study questionnaire	Self-reported competence: 2 vs 3, P<0.001  Self-reported importance of EBP for basic practice: remained the same before and after intervention (5)
Allen et al^Citation14	USA, National College of Natural Medicine, 2007	SI: 20-hour intensive week-long course “Principles of EBM for Complementary and Alternative Medicine (CAM) Professionals”	Pre- vs post-intervention mean scores
	11 faculty members	Study questionnaire	Research attitudes: 4.4 vs 4.9, P<0.02  Critical appraisal attitudes: 3.4 vs 4, P<0.04  EBM attitudes: 3.7 vs 3.9, P<0.07  Skills self-appraisal: 3.6 vs 4.3, P<0.01  Knowledge test: 11 vs 14.2, P<0.02
Hatmi et al^Citation27	Iran, Tehran University of Medical Sciences	SI: 12 2-day programs (6 hours per day)	Differences between IG and CG
	170 members of the medical faculty divided into two groups – IG: 86; CG: 84	Conferences followed by small group discussions and group activities	Increase in knowledge score: IG 17.84, CG 10.35, P=0.001
		Study questionnaire	Improvement in attitude score: IG 18.62, CG 6.10, P=0.001  Improvement in EBM-related skills: IG 40.29, CG 12.50, P=0.001
Zaidi et al^Citation28	Pakistan, Shifa College of Medicine and Nursing, before 2009	SI: 14-hour workshop composed of 7 sessions, covering basic EBM concepts: development of question on clinical practice, search of the available literature, and critical appraisal of evidence	Pre- vs post-intervention mean scores
	14 health care professionals of several faculties	Berlin Questionnaire	Berlin Questionnaire score: 4.7 (SD=2.3) vs 7.6 (SD=1.0), P<0.001
Munroe et al^Citation19	USA (Illinois), rural hospital in a community with a state university, before 2008	Organizational supports to affect nursing personnel regarding EBP (consultative relationship with a nurse researcher, 3 workshops over 10 weeks and other interventions)	Pre- vs post-intervention mean scores
	200 registered nurses	Study questionnaire	Knowledge: 1.31 vs 1.85, P=0.005  Skill: 1.44 vs 1.73 P>0.05  Attitude: 1.64 vs 1.82, P>0.05
Dearholt et al^Citation13	USA, Johns Hopkins Hospital and The Johns Hopkins University School of Nursing, March/April 2008	SI: 2-day workshop (Day 1: introduction to EBP+2-hour computer laboratory; Day 2: mock evidence appraisal group meeting)		Post-intervention mean scores
	Members of the central hospital nursing quality committees – Day 1: n=45; Day 2: n=31	Study questionnaires		Describe the steps used in the process of EBP: 4.5, SD=0.6  Describe how to do a literature/evidence search: 4.4, SD=0.7  Identify how to find the best sources of evidence online: 4.4, SD=0.63
Shuval et al^Citation29	Israel, north and center district of a large health maintenance organization	MI: EBM educational 5-hour intervention with workshop		Pre- vs post-intervention mean scores
	175 primary care doctors – IG: 101; CG: 74	Study questionnaire		Impact of the MI on utilizing EBP resources: 1.1/4 vs 1.4/4, P=0.001  Impact of the MI on EBP knowledge: 22.4% vs 40.8%, P=0.000
Nicholson et al^Citation17	USA, University of California San Diego School of Medicine	SI: a CME course: 9 90-min workshops, every 4–6 weeks, for 1 year		Pre- vs post-intervention mean scores
	26 clinician educators from 2 university hospitals	Fresno Test		Self-reported EBM knowledge: 2.6 vs 3.3, P<0.0005  Skill for evaluating the validity of a scientific article: 31.4% vs 71.6%, P<0.0005  Overall literature appraisal skill score: 57.9% vs 78.4%, P<0.0005
Green^Citation16	USA, six of the seven accredited colleges of podiatric medicine in the USA, one podiatric medical residency program, and the Veterans Affairs podiatry service, 2001	SI: 2-day workshop divided into 8 sessions		Pre- vs post-intervention mean scores
	10 academic podiatric physicians representing	Study questionnaire		Efficiently search for the best evidence answering my questions: 3.1 vs 4.1, P=0.005  Critically appraise the report of a clinical study: 2.8 vs 3.8, P=0.004  “Commitment-to-change” evaluation – 3 months survey: 25% fully implemented, 48% partially implemented, 26% failed to implement; 12 months survey: 32% fully implemented, 48% partially implemented, 20% failed to implement
Cullen and Titler^Citation12	USA, University of Iowa Hospitals and Clinics	MI – 18–24 months project: (1) 12 meeting days (12 months): 3 classroom days (interactive lesson), 1 conference day, and 8 facilitated workdays; (2) meetings aiming project evaluation and integration into education		Post-intervention mean scores
	6 nurses	Study questionnaire		The EBP Staff Nurse Internship program helped me to grow professionally: 4.8  The internship program has given me the knowledge I need to use EBP to answer clinical questions: 4.5  As a result of the EBP internship, I plan to use EBP in the future: 4.5

Abbreviations: MI, multiple intervention; EBP, evidence-based practice; IG, intervention group; CG, control group; SI, single intervention; EBPQ, EBP Questionnaire; EBM, evidence-based medicine; CME, continuing medical education; PICO, problem/population, intervention, comparison and outcome.

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