Objectives Evidence-based practice (EBP) has obtained a well-established position in healthcare. However, actual EBP-behaviour among all healthcare professionals in daily practice is still a challenge. In the quest to identify and subsequently address barriers for EBP-behaviour, EBP related self-efficacy (SE) of healthcare professionals appears to be underexposed. A better understanding of underlying problems to build SE and thus the influence on actual EBP-behaviour of healthcare professionals is needed. With this knowledge we can optimise education and enrich training for healthcare professionals. Therefore we undertook this systematic review of both quantitative and qualitative studies.
Method MEDLINE (through PubMed), EMBASE, Cochrane, CINAHL and PsycINFO were searched up to December 2017. Additional records were identified by snowballing. No date limitations nor language restrictions where applied. Study selection, quality assessment, data extraction and thematic synthesis were conducted by two authors independently. Original studies, either quantitative, qualitative or mixed methods designs were included. Therefore, quality was assessed in accordance to the Mixed Methods Appraisal Tool (MMAT), version 2011. Data was extracted systematically, crosschecked and discussed by two authors. Qualitative analysis was performed, following the Guidance on the conduct of Narrative Synthesis in Systematic Reviews to identify underlying themes and gain understanding of SE and EBP-behaviour.
Results We included 40 studies. Half of the studies included (student-)nurses, the other half healthcare- or social care professionals. The methodological quality was reasonable as the MMAT Scores were above 50% for half of the studies.
Thematic data analysis resulted in five themes ‘behaviour’, ‘competence’, ‘authority’, ‘autonomy’ and ‘support’. Positive attitudes were supportive as starting point for development of knowledge, skills, SE and subsequently EBP-behaviour. Perceived barriers for EBP-behaviour are especially lacking knowledge, skills and confidence to appraise research articles or interpret statistical matter. In case of educational strategies, knowledge improved, but confidence for EBP-behaviour and change patient procedures stayed behind. Especially nurses were hampered in their EBP-behaviour by low recognition of their profession as an autonomous, academic profession which is based on research, both within their own and other healthcare disciplines. Support and encouragement from managers and mentoring by peers and experienced colleagues is missed to build SE.
Conclusions SE has attention but its influence on actual EBP behaviour of healthcare professionals in daily practice seems to be underestimated. Studies on barriers for EBP implementation often do not mention SE. Future education, training and implementation projects should include specific components designed to develop SE in each of the EBP steps. In accordance with known learning strategies, positive experiences, exemplary behaviour from experienced colleagues and peers and encouragement from relevant parties such as the senior management, are indispensable. To evaluate the effect of interventions which improve SE, measurement instruments should be developed and evaluated on validity, reliability and responsiveness.
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