Evidence-based practice related self-efficacy among healthcare and social care professionals: a narrative review.
Quality improvement through EBP has obtained a well-established position in healthcare. A lot of the professionals who are trained today become acquainted with the EBP steps. However, in practice, they often do not show EBP-behaviour. This suggests that gaining knowledge and training skills is not enough to ‘empower’ healthcare professionals to take action.
There are quite a lot of studies and reviews after barriers and facilitators and studies on implementation methods. We undertook this review to find out what is known about EBP related self-efficacy among healthcare and social care professionals.
Besides knowledge, skills and the opportunities to, professionals need to feel confident about their ability to successfully organise and execute tasks such as searching or appraising literature, this is self-efficacy. Also, there is an outcome-expectancy, or the expectation that the efforts of your actions will have positive results on your professional practice and patient outcomes.
We have included 48 studies with eight different study designs, so we have compiled a narrative synthesis. Qualitative analysis of the data resulted in the three themes; competence, authority and autonomy, and support. The experienced, self-perceived and actual competence are very important to gain confidence as meant by self-efficacy. Professionals need to feel supported to perform EBP-behaviour. This support can come from their leaders as well as their peers. Their leaders should not only facilitate these professionals, but also challenge and reward them. These leaders need to have Bachelor or Masters degrees in order to have positive attitudes towards EBP themselves. Peers and role-models are essential towards EBP-behaviour, not only to reflect but also to see where we can head to with EBP. EBP-workgroups do answer to this need.
Besides self-efficacy, outcome-expectancy appears to be an important factor. It appears that professionals who report that they do not have the ability to change their practice, experience that their knowledge and expertise is less appreciated. When the efforts likely are not worth the outcome, people put their energy in something else. Not having the say and ability to make changes within practice can be a reason to make changes in the organisational structure. Also, cultural change herein is needed. Again, peers, role-models and supportive leaders can add value here.
To enhance EBP-behaviour, we need to have attention for the position of the healthcare and social care professionals. Caregivers, respected for their expertise as autonomous professionals who feel supported by their supervisors and peers seem to be highly motivated to improve their practice though EBP.
So, it is likely that efforts into the development of self-efficacy and outcome-expectancy related to EBP do pay-off. Implementation strategies should contain interventions dedicated to do so.
Within further research we will determine the best instrument to measure self-efficacy and outcome-expectancy. Thereafter we will be able to evaluate interventions that may be helpful to develop self-efficacy and outcome-expectancy.