Academic journal article Journal of Nursing Measurement

Psychometric Testing of the Health Care Evidence-Based Practice Assessment Tool

Academic journal article Journal of Nursing Measurement

Psychometric Testing of the Health Care Evidence-Based Practice Assessment Tool

Article excerpt

Background and Purpose: Evidence-based practice (EBP) is essential to optimal health care outcomes. Interventions to improve use of evidence depend on accurate assessments from reliable, valid, and user-friendly tools. This study reports psychometric analyses from a modified version of a widely used EBP questionnaire, the information literacy for nursing practice (ILNP). Methods: After content validity assessments by nurse researchers, a convenience sample of 2,439 nurses completed the revised 23-item questionnaire. We examined internal consistency and used factor analyses to assess the factor structure. Results: A modified 4-factor model demonstrated adequate fit to the data. Cronbach's alpha was .80-.92 for the subscales. Conclusions: The shortened ILNP (renamed Healthcare EBP Assessment Tool or HEAT) demonstrated adequate content validity, construct validity, and reliability.

Keywords: evidence-based practice; questionnaire; psychometric; measurement; nursing practice

Evidenced-based practice (EBP) is well-known to improve quality, lower costs, and optimize outcomes in health care (Institute of Medicine, 2010). As a result, leaders and policy makers expect care providers to use standards of care and evidence of effectiveness in delivering care. Because organizations strive to increase use of evidence in practice, they need valid and reliable tools to measure successes, gaps, and barriers. In the past decade, many instruments have been developed to assess EBP. One of the earliest questionnaires on EBP is the Information Literacy for Nursing Practice (ILNP; Pravikoff, Tanner, & Pierce, 2005). In this article, we describe in detail our INLP modifications and psychometric analyses into a shorted and revised ILNP (renamed Healthcare EBP Assessment Tool or HEAT).

BACKGROUND AND CONCEPTUAL FRAMEWORK

EBP is generally considered to include the five A's: Ask (a clinical question), Access (do literature searches for evidence), Appraise (evaluate research articles), Apply (integrate evidence into practice), and Assess (evaluate the results; Oude Rengerink et al., 2013). EBP models often include both disseminating findings and also contributing to research evidence by conducting research where evidence is lacking (Stetler, 2001; Titler et al., 2001). In addition to items reflecting these components, EBP questionnaires often include subscales related to perceptions of (a) frequency of EBP usage, (b) ability, knowledge or understanding, (c) values, intention, or desire, and (d) barriers. A large body of evidence on planned behavior (Fishbein & Ajzen, 2010) and self-efficacy (Bandura, 1997) theorizes that individual behavior is influenced by beliefs and attitudes (reflected in ability, self-efficacy, and desire subscales), and by perceptions of control (reflected in the barriers subscale). Subscales of frequency of EBP usage reflect respondents' perceptions of their actual EBP activities and actions. Although there are numerous EBP questionnaires, few had psychometric analyses and fewer still had been analyzed with both exploratory and confirmatory factor analyses. Such analyses are warranted to strengthen the theoretical underpinnings of EBP instruments.

The original information literacy for nursing practice (ILNP) is a 93-item questionnaire with items in varying formats (yes/no, rank-order, and Likert-type responses in four and five categories) to examine nurses' perceptions of their EBP skills, ability, desire, and access to resources. Twenty-one items pertained to availability and quality of library resources and databases, whereas 34 items explored respondents' demographics, employment information, or computer skills. Pravikoff et al. (2005) reported a content validity process where experts in nursing, library science, and nursing informatics ranked the content validity of items related to information science, informatics, or nursing, depending on their unique skills and experience. It was originally used for dissertation research by Tanner and Pierce, revised and piloted with nurses in two states (Louisiana and New York), then mailed to a geographically stratified sample of 3,000 nurses representing all 50 states to comprise a national sample of 1,097 (37% response rate). …

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