The impact of small-group EBP education programme: barriers and facilitators for EBP allied health champions to share learning with peers

The impact of monthly small-group EBP education programme: early insights

Introduction All health professionals need to provide evidence-based, high quality clinical care EBP champions volunteered to encourage use of EBP in clinical allied health teams EBP champions requested further education within clinical routines knowledge confidence practical strategies

Scenario: Learning to share new EBP knowledge and skills with clinical peers IMPLEMENTATION: Small group learning with volunteer allied health clinicians Distributed time: 2 hours/month; 4 months Action tasks to share EBP skills and knowledge EVALUATION: Self–report questionnaires & focus group interviews Feasibility Effectiveness Impact to inform… EVIDENCE: Intensive EBP workshops promote short term knowledge acquisition Longer term small group work improves EBP self-efficacy & self reported EBP behaviours SUSTAINABILITY: PROBLEM: Clinicians do NOT have time for intensive EBP education REALITY: Volunteer champions keen to help clinical peers learn

Small group EBP education: what we did Expression of Interest to attend 2 hours/month over 4 months Didactic learning + small group work + local application Short action task with clinical teams each month Clinicians choose topic learnt to share with peers

Mixed Methods Evaluation plan Before and after: EBP Confidence Scale (EPIC): 9 items, 1-10 rating scale Salbach & Jaglal, 2011 Adapted Fresno Test: 7 item questionnaire of applied skills McCluskey & Bishop, 2009 EBP Implementation Scale: 13 items, frequency of use Melnyk, Fineout-Overholt & Mays, 2008 Immediately after: Satisfaction survey: rating scale + 4 open-ended questions 3 months later: Focus group (volunteer sample)

CREATE framework Tilson et al, 2011 Focus Group EBP Implementation Scale Adapted Fresno Test EBP Confidence Scale Satisfaction Survey Focus Group Tilson et al, 2011

Data analysis Quantitative data analyses: Qualitative data analyses: EPIC scale, Adapted Fresno and EBP implementation scale: Within group changes between pre-post measured using non-parametric Wilcoxon Matched pairs Descriptive summary for satisfaction survey Qualitative data analyses: Content analysis performed on open ended questions of the questionnaires. Transcripts independently thematically coded by two researchers into categories and sub-categories to provide a descriptive summary of the data.

Participant Summary Participant details (n= 16) % (n=16) Male: Female 25% (4) Research higher degree 43.8% (7) Years Clinical Experience <2 years 6.3% (1) 2 - <5 years 18.8% (3) 5 - 10 years 62.5% (10) 10 - 15 years >15 years Profession Dietitian 12.5% (2) Occupational Therapist Speech Pathologist Physiotherapist 18.8 (3) Pharmacist Medical Imaging Social Worker Music Therapist

Did the EBP workshops increase participants’ EBP skills, knowledge, self-efficacy? Significant improvements in self-efficacy (EBP Confidence) Non-significant change in knowledge & skills (Adapted Fresno) Domain Assessment Mean pre (total %) Mean post (total %) Mean difference CI 95% Difference between means (p= ) Self-Efficacy EBP Confidence TOTAL (maximum = 90) 64.50 (72%) 78.21 (87%) -13.71 (-17.53 to -9.90) 0.000** Knowledge & Skills Adapted Fresno TOTAL (maximum = 168) 106.63 (64%) 116.25 (69%) -9.62 (-25.5 to 6.29) 0.215

Did the EBP workshops increase participants’ EBP skills, knowledge, self-efficacy? EBP Confidence: [post –hoc analysis] Significant pre-post differences in formulating a question to guide literature search conducting an online literature search critically appraising the applicability of the research evidence to local context discriminating between statistical and clinical significance integrating research evidence, clinical judgement & clients’ preference Adapted Fresno: Significant difference in one item estimating magnitude of clinical and statistical significance

Does a small group education experience change clinicians’ behaviour? Significant improvement in total score of EBP implementation scale, indicating greater frequency of EBP use (p=0.02)

Does a small group education experience change clinicians’ behaviour?

Is a 4 month EBP programme feasible and acceptable for clinicians?

Is a 4 month EBP programme feasible and acceptable for clinicians? Attendance at EBP training

What are the barriers and facilitators to sharing learning with peers? *Preliminary findings from qualitative data Barriers: Other clinical and non-clinical demands Time to prepare teaching to others Facilitators: Having a workbook to refer to with practical examples Opportunities for incidental teaching Examples of how participants shared learning: prepared in-services for new graduates & new staff prepared summaries and handouts to team of key learnings provided support with critically appraising articles to others in journal club showed others how to search for articles giving incidental support as questions arise

Conclusion Small group training delivered over 2 hours across four months may lead to improved self-efficacy and changed behaviours in EBP in allied health clinicians Monthly EBP training format is a feasible and acceptable format for allied health clinicians Good attendance High satisfaction Need to explore further opportunities to promote shared learning in EBP training

Any Questions?

Does a small group education experience change clinicians’ behaviour? EBP Implementation Scale Question Mean pre Mean post Confidence interval 95% Sig. Used a clinical/EBP guideline or systematic review to change practice? 1.56 1.50  0.06 (-3.18 to 3.30) 0.763 Evaluated the outcomes of a practice change? 1.31 1.44  -0.13 (-0.53 to 0.27) 0.480 Shared research evidence with a multi-disciplinary team member? 1.68 2.69  -1.01 (-1.55 to-0.47) 0.004* Accessed the Cochrane database of systematic reviews? 2.06  -0.5 (-1.07 to 0.07) 0.021* Shared evidence from a study to more than 2 colleagues 1.37 2.31  -0.94 (11.52 to -0.36) 0.002* Generated a PICO question about my clinical practice? 1.25 2.15  -0.90 (-1.46 to -0.34) Accessed national guidelines? 1.81 2.19  -0.38 (-1.15 to 0.39) 0.058 TOTAL score (maximum 65) 23.50 30.06 -6.56 (-9.95 to -3.17) 0.002