Theory-based strategies for teaching evidence-based practice to undergraduate health students: a systematic review

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Abstract

Background

Undergraduate students across health professions are required to be capable users of evidence in their clinical practice after graduation. Gaining the essential knowledge and clinical behaviors for evidence-based practice can be enhanced by theory-based strategies. Limited evidence exists on the effect of underpinning undergraduate EBP curricula with a theoretical framework to support EBP competence. A systematic review was conducted to determine the effectiveness of EBP teaching strategies for undergraduate students, with specific focus on efficacy of theory-based strategies.

Methods

This review critically appraised and synthesized evidence on the effectiveness of EBP theory-based teaching strategies specifically for undergraduate health students on long or short-term change in multiple outcomes, including but not limited to, EBP knowledge and attitudes. PubMed, CINAHL, Scopus, ProQuest Health, ERIC, The Campbell Collaboration, PsycINFO were searched for published studies and The New York Academy of Medicine, ProQuest Dissertations and Mednar were searched for unpublished studies. Two independent reviewers assessed studies using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument.

Results

Twenty-eight studies reporting EBP teaching strategies were initially selected for review with methodological quality ranging from low to high. Studies varied in course duration, timing of delivery, population and course content. Only five included papers reported alignment with, and detail of, one or more theoretical frameworks. Theories reported included Social Cognitive Theory (one study), Roger’s Diffusion of Innovation Theory (two studies) and Cognitive Apprenticeship Theory (one study). Cognitive Flexibility Theory and Cognitive Load Theory were discussed in two separate papers by the same authors. All but one study measured EBP knowledge. Mixed results were reported on EBP knowledge, attitudes and skills across the five studies.

Conclusions

EBP programs for undergraduate health students require consideration of multiple domains, including clinical behaviors, attitudes and cognitive learning processes; Interventions grounded in theory were found to have a small but positive effect on EBP attitudes. The most effective theory for developing and supporting EBP capability is not able to be determined by this review therefore additional rigorous research is required.

Electronic supplementary material

The online version of this article (10.1186/s12909-019-1698-4) contains supplementary material, which is available to authorized users.

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Most cited references 48

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Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges

Alison Kitson, Jo Rycroft Malone, Gill Harvey … (2008)

Background The PARiHS framework (Promoting Action on Research Implementation in Health Services) has proved to be a useful practical and conceptual heuristic for many researchers and practitioners in framing their research or knowledge translation endeavours. However, as a conceptual framework it still remains untested and therefore its contribution to the overall development and testing of theory in the field of implementation science is largely unquantified. Discussion This being the case, the paper provides an integrated summary of our conceptual and theoretical thinking so far and introduces a typology (derived from social policy analysis) used to distinguish between the terms conceptual framework, theory and model – important definitional and conceptual issues in trying to refine theoretical and methodological approaches to knowledge translation. Secondly, the paper describes the next phase of our work, in particular concentrating on the conceptual thinking and mapping that has led to the generation of the hypothesis that the PARiHS framework is best utilised as a two-stage process: as a preliminary (diagnostic and evaluative) measure of the elements and sub-elements of evidence (E) and context (C), and then using the aggregated data from these measures to determine the most appropriate facilitation method. The exact nature of the intervention is thus determined by the specific actors in the specific context at a specific time and place. In the process of refining this next phase of our work, we have had to consider the wider issues around the use of theories to inform and shape our research activity; the ongoing challenges of developing robust and sensitive measures; facilitation as an intervention for getting research into practice; and finally to note how the current debates around evidence into practice are adopting wider notions that fit innovations more generally. Summary The paper concludes by suggesting that the future direction of the work on the PARiHS framework is to develop a two-stage diagnostic and evaluative approach, where the intervention is shaped and moulded by the information gathered about the specific situation and from participating stakeholders. In order to expedite the generation of new evidence and testing of emerging theories, we suggest the formation of an international research implementation science collaborative that can systematically collect and analyse experiences of using and testing the PARiHS framework and similar conceptual and theoretical approaches. We also recommend further refinement of the definitions around conceptual framework, theory, and model, suggesting a wider discussion that embraces multiple epistemological and ontological perspectives.

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Empirical validation of affect, behavior, and cognition as distinct components of attitude.

Steven J. Breckler (1984)

A prevalent model of attitude structure specifies three components: affect, behavior, and cognition. The validity of this tripartite model was evaluated. Five conditions needed for properly testing the three-component distinction were identified. Two new studies were then designed to validate the tripartite model. A consideration of the tripartite model's theoretical basis indicated that the most important validating conditions are (a) the use of nonverbal, in addition to verbal, measures of affect and behavior, and (b) the physical presence of the attitude object. Study 1, in which subjects' attitudes toward snakes were examined, indicated very strong support for this tripartite model: The model was statistically acceptable, its relative fit was very good, and the intercomponent correlations were moderate (.38 less than r less than .71). Study 2 was a verbal report analogue of Study 1. Results from Study 2 indicated that higher intercomponent correlations occurred when attitude measures derived solely from verbal reports and when the attitude object was not physically present.

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What Are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of Systematic Reviews

Taryn Young, Anke Rohwer, Jimmy Volmink … (2014)

Background An evidence-based approach to health care is recognized internationally as a key competency for healthcare practitioners. This overview systematically evaluated and organized evidence from systematic reviews on teaching evidence-based health care (EBHC). Methods/Findings We searched for systematic reviews evaluating interventions for teaching EBHC to health professionals compared to no intervention or different strategies. Outcomes covered EBHC knowledge, skills, attitudes, practices and health outcomes. Comprehensive searches were conducted in April 2013. Two reviewers independently selected eligible reviews, extracted data and evaluated methodological quality. We included 16 systematic reviews, published between 1993 and 2013. There was considerable overlap across reviews. We found that 171 source studies included in the reviews related to 81 separate studies, of which 37 are in more than one review. Studies used various methodologies to evaluate educational interventions of varying content, format and duration in undergraduates, interns, residents and practicing health professionals. The evidence in the reviews showed that multifaceted, clinically integrated interventions, with assessment, led to improvements in knowledge, skills and attitudes. Interventions improved critical appraisal skills and integration of results into decisions, and improved knowledge, skills, attitudes and behaviour amongst practicing health professionals. Considering single interventions, EBHC knowledge and attitude were similar for lecture-based versus online teaching. Journal clubs appeared to increase clinical epidemiology and biostatistics knowledge and reading behavior, but not appraisal skills. EBHC courses improved appraisal skills and knowledge. Amongst practicing health professionals, interactive online courses with guided critical appraisal showed significant increase in knowledge and appraisal skills. A short workshop using problem-based approaches, compared to no intervention, increased knowledge but not appraisal skills. Conclusions EBHC teaching and learning strategies should focus on implementing multifaceted, clinically integrated approaches with assessment. Future rigorous research should evaluate minimum components for multifaceted interventions, assessment of medium to long-term outcomes, and implementation of these interventions.

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Author and article information

Contributors

Mary-Anne Ramis:

ORCID: http://orcid.org/0000-0001-9453-9565

m.ramis@qut.edu.au , Mary-anne.Ramis5@mater.org.au

Anne Chang: am.chang@qut.edu.au

Aaron Conway: aaron.conway@utoronto.ca

David Lim: d.lim3@westernsydney.edu.au

Judy Munday: judy.munday@qut.edu.au

Lisa Nissen: l.nissen@qut.edu.au

Journal

Journal ID (nlm-ta): BMC Med Educ

Journal ID (iso-abbrev): BMC Med Educ

Title: BMC Medical Education

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6920

Publication date (Electronic): 18 July 2019

Publication date PMC-release: 18 July 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 267

Affiliations

[1 ]Mater Health, Evidence in Practice Unit & Queensland Centre for Evidence Based Nursing and Midwifery, A Joanna Briggs Institute Centre of Excellence, South Brisbane, QLD 4101 Australia

[2 ]Queensland University of Technology, School of Nursing, Kelvin Grove Campus, Victoria Park Road, Brisbane, 4059 Australia

[3 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Peter Munk Cardiac Centre, Toronto General Hospital, , University Health Network, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, ; Toronto, ON M5G 2N2 Canada

[4 ]ISNI 0000 0000 9939 5719, GRID grid.1029.a, School of Science and Health, , Western Sydney University, ; Sydney, 2751 Australia

[5 ]Queensland University of Technology, School of Clinical Sciences, Gardens Point Campus, QLD, Brisbane, 4000 Australia

[6 ]ISNI 0000000089150953, GRID grid.1024.7, Queensland University of Technology, School of Nursing, ; Victoria Park Road, Kelvin Grove, Brisbane, Queensland 4059 Australia

[7 ]ISNI 0000 0004 0417 6230, GRID grid.23048.3d, Faculty of Health and Sports Sciences, , University of Agder, ; Grimstad, Norway

Author information

Mary-Anne Ramis http://orcid.org/0000-0001-9453-9565

Article

Publisher ID: 1698

DOI: 10.1186/s12909-019-1698-4

PMC ID: 6637485

PubMed ID: 31319892

SO-VID: 846051b6-fda0-43f1-bbe3-a3b2df4b608f

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 2 May 2018

Date accepted : 8 July 2019

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ScienceOpen disciplines: Education

Keywords: evidence-based practice,ebp,undergraduate,health professions,education,social cognitive theory,theory-based intervention

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ScienceOpen disciplines: Education

Keywords: evidence-based practice, ebp, undergraduate, health professions, education, social cognitive theory, theory-based intervention

Theory-based strategies for teaching evidence-based practice to undergraduate health students: a systematic review

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Special issue: IOE@120: Critical Engagement with Educational and Social Thought, Practice and Development

Most cited references 48

Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges

Empirical validation of affect, behavior, and cognition as distinct components of attitude.

What Are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of Systematic Reviews

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