Innovation(s) to promote Evidence-based Practice

Project summary

Science has resulted in major progress within treatment, prevention and diagnosis of diseases, but a persistent gap still exists between existing knowledge and clinical practice. Evidence-based practice (EBP) is an approach to help health care professionals use the best available evidence from systematic research, integrating it with clinical expertise and patient and family values and circumstances, to make clinical decisions for individual patients. There is an international consensus that health care professionals should integrate the knowledge, skills and attitudes of EBP into their undergraduate education and life-long learning and patient care (Dawes et al. 2015). However, health and social care personnel lack the necessary competence in EBP, and students struggle to apply EBP in real patient situations. It is therefore essential to find ways to translate EBP to clinical education, as EBP teaching is most effective when integrated into clinical practice (Young et al. 2014).

The Health & Care 21 strategy emphasize that EBP should be mandatory for programs educating health and social care professional. The higher education (HE) institutions in Norway are encouraged to initiate projects that aim to improve the quality of HEs, taking into consideration EBP, innovation and digital learning (including mobile learning). The InSTEP project is in line with these national calls, and strategies at HVL related to EBP and digital technology. EBP and digital competence are relevant learning outcomes in HEs, and as such, the InSTEP project focusing on using an app (digital tool) for learning EBP is relevant for our programmes. EBP is a requirement for clinical education at all health and social care programs. However, we lack tools to enhance EBP. Therefore, with this project, we will investigate the use of a mobile application as a tool for learning and assessing EBP in health and social care education.

The overall aim of the InSTEP project is to strengthen the quality and relevance of higher education by improving competence among students and clinical instructors in EBP. To achieve this aim, we will investigate how to implement and best utilize a new and innovative mobile application supporting EBP in clinical education.

 

Method

We will combine qualitative and quantitative methods to increase our understanding of how to increase EBP competence by exploring use of the EBPSteps app as a complex phenomenon and intervention. We have designed the project in line with the framework for complex interventions (Craig et al. 2008), with work packages (WPs) related to the early phases of complex interventions.

WPI

Objective #1: Through focus group interviews we will explore user experience and user performance of the EBPsteps app among students from health and social care programs, and potentially also among clinical instructors. We aim to achieve an increased understanding of the user experience and usefulness of the EBPSteps app in different settings (e.g. classroom, clinical education and in simulation training), including element such as, values, usability, adoptability and desirability. We will also investigate EBP competence among users of the app (user performance), and conduct iterative improvements of the EBPsteps app based on the qualitative and quantitative evaluations about experiencing values. To assess EBP competence, we will analyse data stored in the users’ app (e.g. type of clinical questions asked or sources used); data will be stored at HVL server. In addition to anticipated results listed above, the results will expand knowledge about: 1) adoption of new technology in a generally non-technology learning environment, and 2) how health and social care profession can contribute to the development, improvement of technology for their own educational settings.

 

Objective #2: Through focus group interviews we will also aim to optimise trial procedures, including evaluating the uptake of the EBPsteps app among students, clinical instructors, and faculty. To optimise trial procedures we aim to achieve knowledge on: 1) challenges related to implementing the app in real settings (usability, demand, implementation, delivery, practicality, adaption, integration), 2) the acceptability (acceptance/uptake), and the feasibility of implementing the EBPsteps app into clinical education, and 3) the proposed trial design and interventions and ways in which to maximise recruitment to a trial (WPs 2).

 

To explore usability (part of objective #1), experts in EBP will be asked to perform a series of tasks using a smartphone and/or a computer in a closed office with a test leader, who will follow a semi-structured test guide. We will record all movement on the computer desktop through use of usability test software (e.g. Morae), and observe and film the participants, who will be prompted to think aloud during this session. The filming of the desktop and the participant as well as the sound track, will be projected to another room where two observers will transcribe, discuss, and take notes. We will emphasise the collection and analysis of qualitative data, and interpretive description strategy in line with Thorne (2008) will guide this process.

 

WPII

Objective #3: We will perform a pilot randomised controlled trial (RCT) to address whether a full RCT of EBP teaching is an appropriate trial design, and if feasible with regard to: 1) recruitment and retention 2) acceptability, and 3) adherence to protocol. In addition, we wish to investigate the EBP competence in the population.

Objective #4: We will use both qualitative and quantitative methods to conduct process evaluation alongside the pilot RCT to examine the feasibility of the innovation, mechanism of impact and the context including barriers and facilitators. We will adhere to the CONSORT statement for pilot and feasibility studies (Eldrige et al. 20016).