Relationship Between Evidence-based Practice Knowledge,Belief,Implementation And The Perceived Barriers On Community Nurses :A Structural Equation Model

Aims:This study aims to build a structural equation model(SEM)among Chinese community nurses(CNs)' knowledge,belief and implementation of evidence-based practice(EBP),and clarify the relationship and effect size between these factors as well as to analyze the barriers of EBP in order to improve CNs' EBP.Methods:Evidence-based Practice Questionnaire was adopted in this cross-sectional study to assess CNs' knowledge,beliefs and implementation of EBP.The Barriers to Research Utilization Scale was used to identify the barriers to EBP.A total of 53 community health service centers in 5 cities in the eastern,central and western regions of mainland China were selected by using convenience sampling method,and a total of 769 valid questionnaires were saved.Data was analyzed by SPSS20.0.Model construction and verification were performed by Amos22.0.A total of 15 community nurses with primary,intermediate and senior professional titles were selected to participate in the thematic interview about CNs' EBP barriers.Nvivo 11.0 was used to extract information from the interview.Results:The scores of implementation,belief and knowledge of EBP on CNs were3.76±0.29,3.98±0.19,3.48±0.25,which were generally low.Barriers in the process of evidence-based practice include insufficient evidence resources,insufficient evidence-based practice time,and insufficient guidance.The results of SEM supportthat EBP belief had a positive influence on knowledge and implementation(P<0.05),and knowledge had a direct positive impact on implementation(P<0.05).EBP barrier had negative impacts on CNs' EBP knowledge,belief and implementation(P<0.01).The total effect size from barrier to knowledge,belief and implementation was-0.931,-0.847,-0.880.The results of interviews showed that the main EBP barriers were EBP abilities lacking,working pressure,policies and supports lacking.CNs need supports included literature resource search channels,superior policies,institutional optimization to overcome the barriers.Conclusions:CNs' EBP knowledge,belief and implementation interact with each other,and all of them were affected by barriers.It is important to overcome the barriers of EBP acquisition,beliefs maintaining,and EBP implementation in the process of EBP of CNs.CNs should be supported in policies,working environment,resources,and education to reduce EBP barriers and improve the quality of EBP.