Sultan Qaboos University Med J, February 2017, Vol. 17, Iss. 1, pp. e66–73, Epub. 30 Mar 17 Submitted 24 Jul 16 Revision Req. 1 Sep 16; Revision Recd. 24 Sep 16 Accepted 23 Oct 16 doi: 10.18295/squmj.2016.17.01.012 clinical & b asic research
Knowledge, Practice and Self-Efficacy in Evidence-Based Practice among Midwives in East Iran *Elham Azmoude,1 Fereshteh Farkhondeh,2 Maryam Ahour,2 Maryam Kabirian1
املعرفة وفاعلية العناية والتفعيل الذايت املعتمدة علی الدليل لدی القابالت القانونيات يف شرقي إيران مرمي كابرييان، مرمي �آهور، فر�شته فرخنده،الهام �آزموده abstract: Objectives: The successful implementation of evidence-based practice (EBP) can lead to appropriate and effective midwifery care during pregnancy, childbirth and in the postnatal period. However, levels of knowledge and confidence in one’s ability to apply EBP are related to its effective implementation. This study aimed to investigate levels of knowledge, practice of and self-efficacy towards the use of EBP among midwives in East Iran. Methods: This cross-sectional study took place between January and February 2016 and involved 98 midwives employed at two hospitals and all four urban health care centres in Torbat-e Heydariyeh, Iran. Two subscales of the Evidence-Based Practice Questionnaire were used to assess participants’ knowledge and practice of EBP, respectively, while a modified version of a previously described scale was used to determine self-efficacy. Results: A total of 76 midwives participated in the study (response rate: 77.6%). Mean knowledge, practice and self-efficacy scores were 4.48 ± 0.94, 3.53 ± 0.68 and 2.80 ± 0.81, respectively. Significant relationships were found between mean selfefficacy, practice and knowledge scores and proficiency in English language (P = 0.001 each) and statistical methods (P 0.050( الفاعلية بالن�سبة لتنفيذ عمليات العناية املعتمدة علی الدليل واتقان ا�ستخدام قواعد البيانات تدلّ هذه النتائج علی �رضورة حت�سني: اخلال�صة.)P = 0.001( ذو داللة �أح�صائية بني املعرفة والتفعيل الذاتي بالن�سبة لفاعلية ال�شخ�ص آليات التي واملعرفة بالن�سبة للعناية القائمة علی �أ�سا�س الدليل لدی القابالت القانونيات، والفاعلية،التفعيل الذاتي ّ �ستلعب ال.�رشقي �إيران ّ .تت�سبب يف حت�سني هذه امل�ستويات دوراً ملحوظ ًا يف ارتفاع م�ستوی توظيف العناية القائمة علی الدليل . العناية املعتمدة علی الدليل؛ املعرفة؛ التفعيل الذاتي؛ القابالت القانونيات؛ �إيران:الكلمات املفتاحية
Advances in Knowledge - The findings of this study indicate that midwives in East Iran have poor levels of practice and moderate levels of knowledge and selfefficacy regarding evidence-based practice (EBP). - Significant relationships were observed between EBP knowledge, practice and self-efficacy and proficiency in English, statistical methods and using databases. Knowledge and self-efficacy were also significantly correlated with practice.
Department of Nursing & Midwifery and 2Student Research Committee, Torbat Heydariyeh University of Medical Sciences, Torbat-e Heydariyeh, Iran
1
*Corresponding Author e-mail: [email protected]
Elham Azmoude, Fereshteh Farkhondeh, Maryam Ahour and Maryam Kabirian
Application to Patient Care - The implementation of EBP is a vital competency for midwives. The moderate levels of EBP knowledge and self-efficacy and poor levels of practice reported among the Iranian midwives in the current study have alarming implications for future patient care. As such, interventions to promote EBP implementation are recommended in this population.
P
regnancy-related complications are the second global leading cause of death among women of reproductive age.1 In 2015, approximately 303,000 maternal deaths occurred worldwide, most of which could have been prevented; in the same year, 340 women in Iran died from pregnancyrelated complications, resulting in a maternal mortality ratio of 25 deaths per 100,000 live births.2 Evidence-based practice (EBP) plays an integral role in high-quality healthcare by promoting a problemsolving approach that emphasises implementation of the current best available research within a clinical context, helping healthcare professionals to remain up-to-date and make better healthcare decisions.3–7 The National Academy of Medicine in the USA recognises EBP as an essential skill for healthcare providers in the 21st century.8 Several studies have also indicated that EBP improves the quality and safety of patient care.6,7,9 Nevertheless, many healthcare decisions are still based on traditional practices, assumptions, personal experiences and individual opinions and skills.10,11 The possession of adequate knowledge and skills is essential for gathering and appraising evidence and implementing best practices in a clinical setting.4 However, numerous studies have revealed that most healthcare professionals do not have sufficient knowledge and skills for the effective implementation of EBP.4,11–14 In a study analysing perceptions of EBP among nurses, Melnyk et al. found that fewer than half of the participants believed that their colleagues consistently used EBP in patient care.5 Similarly, Zhou et al. indicated that most Chinese nurses lacked practice in many EBP-related skills.15 Another important variable affecting the implementation of EBP is self-efficacy, which is defined as an individual’s belief in their own ability to execute skills at a designated level of performance.11,16–18 Several studies have indicated that the majority of healthcare professionals do not have the desired level of selfefficacy in the implementation of EBP.11,19 To the best of the authors’ knowledge, few studies have focused on the knowledge, practice and selfefficacy of EBP among Iranian midwives. As health policies in Iran are based on population growth, the role of midwives is becoming more prominent, due to their importance in the pregnancy and childbirth process. This study therefore aimed to determine
levels of knowledge, practice and self-efficacy towards EBP in clinical decision-making among midwives working in hospitals and healthcare centres in Torbat-e Heydariyeh, Iran.
Methods This descriptive cross-sectional study took place from January to February 2016 and included 98 midwives employed at two public hospitals and all four urban health centres in Torbat-e Heydariyeh. Only those midwives with at least six months of work experience at the time of the study were included. Midwives who were sick or on maternity leave during this period were excluded from the study. A convenience sampling method was used to recruit the midwives. All midwives in the hospitals and health centres were informed of the study goals and were invited to participate at the beginning of each work shift. A questionnaire was designed to collect information regarding the participants’ sociodemographic and professional characteristics, including age, education level, number of years of work experience, previous participation in EBP courses, proficiency in English, statistical methods and use of databases, participation in conferences or congresses and number of previously published articles in national and international journals. The frequency of use of various print (five items), electronic (eight items) or human (six items) health information sources was scored on a 5-point Likert scale, with a score of 1 indicating never and 5 indicating always.11 In order to assess EBP knowledge and practice, the 14-item and 6-item subscales of the Evidence-Based Practice Questionnaire were used; items were scored on 7-point Likert scales ranging from 1 to 7, indicating poor and best knowledge for knowledge items and never and frequently for practice items, respectively.20 A modified version of a previously described EBP self-efficacy scale was used to determine the participants’ self-efficacy towards implementing EBP.11 These eight items were scored on a 5-point Likert scale, with scores of 1 and 5 indicating poor and best efficacy, respectively.11 All of the questionnaire items were translated from the original English into Persian, after which two linguists made revisions to ensure the validity of the translations. Subsequently, the content and face validity of all questionnaire items was confirmed by
Clinical and Basic Research
| e67
Knowledge, Practice and Self-Efficacy in Evidence-Based Practice among Midwives in East Iran
Table 1: Sociodemographic and professional characteristics of midwives in Torbat-e Heydariyeh, Iran (N = 76) Characteristic
n (%)
Experience in years* 10
9 (11.8)
Previous participation in EBP courses Yes
34 (44.7)
No
42 (55.3)
Proficiency in English Low
25 (32.9)
Moderate
48 (63.2)
High
3 (3.9)
Proficiency with statistical methods* None
14 (18.4)
Low
37 (48.7)
Moderate
22 (28.9)
High
2 (2.6)
Proficiency in database use† None
3 (3.9)
Low
22 (28.9)
Moderate
41 (53.9)
High
6 (7.9)
Previous participation in conferences or congresses Yes
58 (76.3)
No
18 (23.7)
Number of previously published articles in national journals* 0
66 (86.8)
1–2
3 (3.9)
≥3
6 (7.9)
Number of previously published articles in international journals 0
73 (96.1)
1
1 (1.3)
≥2
2 (2.6)
*Due to missing data in the completed questionnaire of one participant, the total cohort for this variable was 75. †Due to missing data in the completed questionnaires of four participants, the total cohort for this variable was 72.
a group of experts. Additionally, Cronbach’s alpha values indicated good internal consistency reliability of the knowledge (0.81), self-efficacy (0.88), practice (0.70), print information sources (0.72) electronic information sources (0.88) and human information sources (0.72) questionnaire items. The various questionnaire subscales were compiled into one survey which was distributed individually to each midwife. The researchers then collected the completed surveys from midwives at each hospital and healthcare centre. The entire survey took approximately 15 minutes to complete. Data were analysed using the Statistical Package for the Social Sciences (SPSS), Version 19.0 (IBM Corp., Chicago, Illinois, USA). Means, standard deviations and frequencies were calculated for the descriptive data. To determine relationships between variables, Pearson and Spearman’s correlation tests were performed. A P value of
Knowledge, Practice and Self-Efficacy in Evidence-Based Practice among Midwives in East Iran *Elham Azmoude,1 Fereshteh Farkhondeh,2 Maryam Ahour,2 Maryam Kabirian1
املعرفة وفاعلية العناية والتفعيل الذايت املعتمدة علی الدليل لدی القابالت القانونيات يف شرقي إيران مرمي كابرييان، مرمي �آهور، فر�شته فرخنده،الهام �آزموده abstract: Objectives: The successful implementation of evidence-based practice (EBP) can lead to appropriate and effective midwifery care during pregnancy, childbirth and in the postnatal period. However, levels of knowledge and confidence in one’s ability to apply EBP are related to its effective implementation. This study aimed to investigate levels of knowledge, practice of and self-efficacy towards the use of EBP among midwives in East Iran. Methods: This cross-sectional study took place between January and February 2016 and involved 98 midwives employed at two hospitals and all four urban health care centres in Torbat-e Heydariyeh, Iran. Two subscales of the Evidence-Based Practice Questionnaire were used to assess participants’ knowledge and practice of EBP, respectively, while a modified version of a previously described scale was used to determine self-efficacy. Results: A total of 76 midwives participated in the study (response rate: 77.6%). Mean knowledge, practice and self-efficacy scores were 4.48 ± 0.94, 3.53 ± 0.68 and 2.80 ± 0.81, respectively. Significant relationships were found between mean selfefficacy, practice and knowledge scores and proficiency in English language (P = 0.001 each) and statistical methods (P 0.050( الفاعلية بالن�سبة لتنفيذ عمليات العناية املعتمدة علی الدليل واتقان ا�ستخدام قواعد البيانات تدلّ هذه النتائج علی �رضورة حت�سني: اخلال�صة.)P = 0.001( ذو داللة �أح�صائية بني املعرفة والتفعيل الذاتي بالن�سبة لفاعلية ال�شخ�ص آليات التي واملعرفة بالن�سبة للعناية القائمة علی �أ�سا�س الدليل لدی القابالت القانونيات، والفاعلية،التفعيل الذاتي ّ �ستلعب ال.�رشقي �إيران ّ .تت�سبب يف حت�سني هذه امل�ستويات دوراً ملحوظ ًا يف ارتفاع م�ستوی توظيف العناية القائمة علی الدليل . العناية املعتمدة علی الدليل؛ املعرفة؛ التفعيل الذاتي؛ القابالت القانونيات؛ �إيران:الكلمات املفتاحية
Advances in Knowledge - The findings of this study indicate that midwives in East Iran have poor levels of practice and moderate levels of knowledge and selfefficacy regarding evidence-based practice (EBP). - Significant relationships were observed between EBP knowledge, practice and self-efficacy and proficiency in English, statistical methods and using databases. Knowledge and self-efficacy were also significantly correlated with practice.
Department of Nursing & Midwifery and 2Student Research Committee, Torbat Heydariyeh University of Medical Sciences, Torbat-e Heydariyeh, Iran
1
*Corresponding Author e-mail: [email protected]
Elham Azmoude, Fereshteh Farkhondeh, Maryam Ahour and Maryam Kabirian
Application to Patient Care - The implementation of EBP is a vital competency for midwives. The moderate levels of EBP knowledge and self-efficacy and poor levels of practice reported among the Iranian midwives in the current study have alarming implications for future patient care. As such, interventions to promote EBP implementation are recommended in this population.
P
regnancy-related complications are the second global leading cause of death among women of reproductive age.1 In 2015, approximately 303,000 maternal deaths occurred worldwide, most of which could have been prevented; in the same year, 340 women in Iran died from pregnancyrelated complications, resulting in a maternal mortality ratio of 25 deaths per 100,000 live births.2 Evidence-based practice (EBP) plays an integral role in high-quality healthcare by promoting a problemsolving approach that emphasises implementation of the current best available research within a clinical context, helping healthcare professionals to remain up-to-date and make better healthcare decisions.3–7 The National Academy of Medicine in the USA recognises EBP as an essential skill for healthcare providers in the 21st century.8 Several studies have also indicated that EBP improves the quality and safety of patient care.6,7,9 Nevertheless, many healthcare decisions are still based on traditional practices, assumptions, personal experiences and individual opinions and skills.10,11 The possession of adequate knowledge and skills is essential for gathering and appraising evidence and implementing best practices in a clinical setting.4 However, numerous studies have revealed that most healthcare professionals do not have sufficient knowledge and skills for the effective implementation of EBP.4,11–14 In a study analysing perceptions of EBP among nurses, Melnyk et al. found that fewer than half of the participants believed that their colleagues consistently used EBP in patient care.5 Similarly, Zhou et al. indicated that most Chinese nurses lacked practice in many EBP-related skills.15 Another important variable affecting the implementation of EBP is self-efficacy, which is defined as an individual’s belief in their own ability to execute skills at a designated level of performance.11,16–18 Several studies have indicated that the majority of healthcare professionals do not have the desired level of selfefficacy in the implementation of EBP.11,19 To the best of the authors’ knowledge, few studies have focused on the knowledge, practice and selfefficacy of EBP among Iranian midwives. As health policies in Iran are based on population growth, the role of midwives is becoming more prominent, due to their importance in the pregnancy and childbirth process. This study therefore aimed to determine
levels of knowledge, practice and self-efficacy towards EBP in clinical decision-making among midwives working in hospitals and healthcare centres in Torbat-e Heydariyeh, Iran.
Methods This descriptive cross-sectional study took place from January to February 2016 and included 98 midwives employed at two public hospitals and all four urban health centres in Torbat-e Heydariyeh. Only those midwives with at least six months of work experience at the time of the study were included. Midwives who were sick or on maternity leave during this period were excluded from the study. A convenience sampling method was used to recruit the midwives. All midwives in the hospitals and health centres were informed of the study goals and were invited to participate at the beginning of each work shift. A questionnaire was designed to collect information regarding the participants’ sociodemographic and professional characteristics, including age, education level, number of years of work experience, previous participation in EBP courses, proficiency in English, statistical methods and use of databases, participation in conferences or congresses and number of previously published articles in national and international journals. The frequency of use of various print (five items), electronic (eight items) or human (six items) health information sources was scored on a 5-point Likert scale, with a score of 1 indicating never and 5 indicating always.11 In order to assess EBP knowledge and practice, the 14-item and 6-item subscales of the Evidence-Based Practice Questionnaire were used; items were scored on 7-point Likert scales ranging from 1 to 7, indicating poor and best knowledge for knowledge items and never and frequently for practice items, respectively.20 A modified version of a previously described EBP self-efficacy scale was used to determine the participants’ self-efficacy towards implementing EBP.11 These eight items were scored on a 5-point Likert scale, with scores of 1 and 5 indicating poor and best efficacy, respectively.11 All of the questionnaire items were translated from the original English into Persian, after which two linguists made revisions to ensure the validity of the translations. Subsequently, the content and face validity of all questionnaire items was confirmed by
Clinical and Basic Research
| e67
Knowledge, Practice and Self-Efficacy in Evidence-Based Practice among Midwives in East Iran
Table 1: Sociodemographic and professional characteristics of midwives in Torbat-e Heydariyeh, Iran (N = 76) Characteristic
n (%)
Experience in years* 10
9 (11.8)
Previous participation in EBP courses Yes
34 (44.7)
No
42 (55.3)
Proficiency in English Low
25 (32.9)
Moderate
48 (63.2)
High
3 (3.9)
Proficiency with statistical methods* None
14 (18.4)
Low
37 (48.7)
Moderate
22 (28.9)
High
2 (2.6)
Proficiency in database use† None
3 (3.9)
Low
22 (28.9)
Moderate
41 (53.9)
High
6 (7.9)
Previous participation in conferences or congresses Yes
58 (76.3)
No
18 (23.7)
Number of previously published articles in national journals* 0
66 (86.8)
1–2
3 (3.9)
≥3
6 (7.9)
Number of previously published articles in international journals 0
73 (96.1)
1
1 (1.3)
≥2
2 (2.6)
*Due to missing data in the completed questionnaire of one participant, the total cohort for this variable was 75. †Due to missing data in the completed questionnaires of four participants, the total cohort for this variable was 72.
a group of experts. Additionally, Cronbach’s alpha values indicated good internal consistency reliability of the knowledge (0.81), self-efficacy (0.88), practice (0.70), print information sources (0.72) electronic information sources (0.88) and human information sources (0.72) questionnaire items. The various questionnaire subscales were compiled into one survey which was distributed individually to each midwife. The researchers then collected the completed surveys from midwives at each hospital and healthcare centre. The entire survey took approximately 15 minutes to complete. Data were analysed using the Statistical Package for the Social Sciences (SPSS), Version 19.0 (IBM Corp., Chicago, Illinois, USA). Means, standard deviations and frequencies were calculated for the descriptive data. To determine relationships between variables, Pearson and Spearman’s correlation tests were performed. A P value of
