Study on the factors facilitating the application of evidence-based healthcare among physicians and nurses: based on the Decomposed Theory of Planned Behavior

• Main Authors: Jung-Mei Tsai, 蔡榮美
• Other Authors: Shu Yu
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/97824799155926238827

博士 === 國立陽明大學 === 護理學系 === 105 === Physicians and nurses performing clinical application based on the evidence-based healthcare (EBHC) to improve quality of patient care is an important issue. In particular, the physicians and nurses of EBHC competitions are already competent with specific EBHC practices and aware of EBHC clinical application. Whether the clinical application of these EBHC practices reaches the ‘adhered to’ stage is a critical issue requires further investigation. This study was first to understand the distribution of the EBHC clinical application in seven action stages, then to explore factors influencing the behavior of EBHC clinical application by adopting the Decomposed Theory of Planned Behavior (DTPB), and finally to identify factors predicting the ‘adhered to’ stage of EBHC clinical application. Methods: The study employed a cross-sectional study design. The total population of physicians and nurses of EBHC competitions was 631. A survey was conducted using a structural questionnaire. Data was collected from 312 of the population; the returning rate 49.45%. The overall model of the study was analyzed using the structural equation modeling. Results: In the distribution of seven action stages (7As), 33.3% of the survey reported the ‘adhered to’ stage. In DTPB model testing revealed that all hypotheses, except for the association between ease of use and attitude and the association between technology facilitating condition and perceived behavioral control, were supported by the data with good overall model fit. The influences of behavioral intention and perceived behavioral control on the behavior of EBHC clinical application was positive with 37% variance of the behavior explained. As for predicting the ‘adhered to’ stage of EBHC clinical application, the odds for supervisory vs. nonsupervisory was 2.03 (OR=2.03, CI=1.10-3.77) resource facilitating condition, perceived behavioral control, and behavioral intention each incremental point the odds increased by 1.06 (OR=1.06, CI=1.01-1.11), 2.21 (OR=2.21, CI=1.47-3.32) and 1.96 (OR=1.96, CI=1.40-2.73) times respectively. Conclusion and recommendation: The study found that: perceived usefulness, compatibility, peer and superior influences, self-effcacy, resource facilitating condition, attitude, subjective norm, perceived behavioral control, and behavioral intention influencing EBHC clinical application; supervisory duties, resource facilitating condition, perceived behavioral control, and behavioral intention predicting the ‘adhered to’ stage of EBHC clinical application. Therefore, we recommend as follows: promoting continuing education for nonsupervisory physicians and nurses to improve knowledge and skill related to EBHC clinical application; installing databases and equipments necessary for EBHC clinical application as well as encouraging involvement of EBHC competitions. The study model based on the DTPB model revealed a good fit and the questionnaire was valid and reliable hence suitable for measuring the behavior of EBHC clinical application and exploring other relevant factors facilitating the behavior of EBHC clinical application in future studies.