Psychometric Evaluation of Iranian Version of the Evidence-Based Practice Questionnaire (EBPQ): A Methodological Study


Mohammad Reza Yeganeh 1 , Moluk Pouralizadeh 2 , * , Abbas Ebadi ORCID 3

1 Instructor, Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, IR Iran

2 Assistant Professor, Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, IR Iran

3 Associate Professor, Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR Iran

How to Cite: Yeganeh M R, Pouralizadeh M, Ebadi A. Psychometric Evaluation of Iranian Version of the Evidence-Based Practice Questionnaire (EBPQ): A Methodological Study, Iran Red Crescent Med J. 2017 ; 19(11):e13586. doi: 10.5812/ircmj.13586.


Iranian Red Crescent Medical Journal: 19 (11); e13586
Published Online: November 14, 2017
Article Type: Research Article
Received: May 16, 2017
Revised: July 7, 2017
Accepted: September 5, 2017




Background: There are different tools for assessing evidence-based practice in nursing in Iran, however, there are some limitations in each of them, and they do not examine EBP comprehensively.

Objectives: The purpose of this study was to evaluate the validity and reliability of the Persian version of EBPQ.

Methods: This study was a methodological research on 300 nurses working in Guilan province (Iran). A cluster sampling was done. After a forward-backward translation, the questionnaire was translated into Persian and its psychometric evaluation was done.

Results: CVIs for all items were ≥ 0.8 and CVRs were ≥ 0.63. All of the impact scores were > 1.5. Cronbach’s alpha of the scale was 0.92. The ICC test was 0.96 and significant (P < 0.001). In exploratory factor analysis, KMO was 0.84 and Bartlett’s test was significant (P < 0.001). Confirmatory factor analysis showed an acceptable fit model.

Conclusions: This study introduces the evidence-based practice questionnaire (EBPQ) as a valid and reliable tool to assess the status of evidence-based practice among nurses in Iran.


Barriers Nursing Clinical Nurses Evidence-Based Practice Questionnaire

Copyright © 2017, Iranian Red Crescent Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Background

During the past two decades, the term evidence-based practice (EBP) has been considered by health care systems, and nursing researchers (1, 2). The evidence is not limited to only knowledge, but also, it is a process, taking into account the conditions and available resources, nurses use of scientific studies combined with nurse’s personal experiences and opinions, values, and needs of patients for the best clinical decision making (3). According to studies, EBP helps improve the quality, effectiveness, and safety in Care (4), as well as reduces health care costs (5-7) and nurses who make use of EBP have better health care decisions. Since nowadays offering high quality service is an important challenge for healthcare systems, promoting EBP in nursing is one of the most important goals of such systems (8, 9). However there are many barriers to the implementation of EBP, for example, most nurses rely solely on their own experiences, and only 25% of nurses tend to prefer evidence-based practice (6, 10, 11). Therefore it is crucial that healthcare organizations recognize facilitators, barriers and nursing skills because its impact on promoting EBP.

Shin and Lee (2017) showed the social and organizational factors such as greater opportunities to exchange nurses’ ideas and the communication skills as facilitators of EBP in nursing (12). Yeganeh et al. (2016) resulted application of guidelines in nursing practice was a facilitator and lack of knowledge of nurses about it was a barrier in EBP (13). Black et al. (2015) confirmed studies about knowledge, skills, facilitators, and barriers bridged the gap between practice and knowledge (14). Tacia et al. (2015) believed the lack of comprehensive valid and reliable tools using study was a barrier in EBP (15).

In Iran, there are several tools to measure knowledge, attitude, and practice of evidence-based nursing, however, no standard tool exists that assesses barriers, facilitators, resources and self-reports on nursing skills in the use of evidence comprehensively. In this study, we evaluated the characteristics of psychometric of EBP in the context of Iran.

2. Objectives

The objective of this study was the psychometric evaluation of the evidence-based practice questionnaire (EBPQ) in an Iranian population.

3. Methods

3.1. Study Design

This research was a methodological study. According to the protocol of WHO, in the first part searches were done for selecting an appropriate questionnaire regarding EBP in Nursing. The second part was translation and evaluation of its psychometric properties.

3.2. The Process of Selection and Introducing EBPQ

After the literature search, EBPQ of Gerrish et al. (2007) was selected as a complete tool and permission was obtained from the initial designer of the questionnaire. The EBPQ is a self-report questionnaire consisting of five dimensions, and 49 items (5) included: ‘Bases of practice knowledge’ (22 items), ‘Barriers to finding and reviewing evidence’ (10 items), ‘Barriers to changing practice on the basis of evidence’ (5 items), ‘Facilitation and support in changing practice’ (4 items), and ‘Skills in finding and reviewing evidence’ (8 items).

3.3. Validity Procedure

After translation, qualitative and quantitative face and content validity, and construct validity were used.

3.4. Translation

Forward-backward translation was performed with two dominant Persian translators that translated it from English to Persian, independently. Only one of the translators was familiar with the concept of EBP. Then a panel was formed (Included 2 professors in nursing and experienced in methodological studies, 3 instructors that were experienced in EBP studies and 2 translators) and the experts were in agreement regarding the choice of the most telling words for the items. In the next step ‘back translation’ was carried out by a person who had lived in America, without reading the original version of EBPQ. Next, it compared with the original version of the questionnaire and the Farsi version of EBPQ was obtained after reviewing the appropriateness of words with Iranian culture of nursing. Also, a pilot study was conducted with 30 nurses working in hospitals of the Guilan University of Medical Sciences in the north of Iran (GUMS). They introduced ambiguous points and after the change in the wording of 3 items, the final version of EBPQ in Farsi was prepared.

3.5. Validity Assessment

3.5.1. Face Validity

For face validity, 10 nurses were interviewed about their understanding of the items. In qualitative content validity, we requested 11 individuals specializing in nursing and the field of EBP to explain about writing, the grammatical problems, and the scoring. Item impact method was used for quantitative content validity (with 10 participants). Also, we used CVR method and point views of 11 experts in nursing (with acceptable value ≥ 0.63 (16), and CVI and panel of 15 researchers that were expert in nursing and EBP and acceptance rate ≥ 0.8 (17). Content Validity assessment was performed using exploratory and confirmatory factor analysis. In this study, Factor loadings ≥ 0.4 was used.

3.6. Reliability

To determine internal consistency, Cronbach’s alpha values of ≥ 0.7 were accepted (18). Also, Test-retest was performed with an interval of two weeks and 30 participants. For assessing stability, intraclass correlation coefficient (ICC) ≥ 0.8 was acceptable. Before the ICC, we checked normality of the distribution by Kolmogorov Smirnov test. It was normal in all of the dimensions and the total items (P > 0.05).

3.7. Participants and Data Collection

Nurses in hospitals of GUMS participated in the study. Primarily, we provided a list of the hospitals. By a cluster sampling, from 25 governmental hospitals, 10 ones from different Geographical areas of Guilan province were randomly selected. In factor analysis, 5 to 10 samples are sufficient for per item of questionnaire and minimum sample size 300 and KMO > 0.6 is acceptable (19, 20). Since a number of questionnaires may not be answered, to prevent sample deficiency, in a simple random sampling 320 nurses (32 nurses in each hospital) were chosen. 14 nurses did not respond to the questionnaires and six questionnaires were incomplete. Therefore, 300 questionnaires were analysed. Sampling phase was carried out from September to October 2016. Inclusion criteria were having a Bachelor’s degree in nursing and full-time work, and exclusion criterion was nurses who worked in those centers just part-time. We did not have any exclusion criteria.

3.8. Ethical Considerations

This study was approved by the ethics committee of GUMS (Number: IR.GUMS. REC. 1396. 95. We explained regarding the aims of the study and assured the participants that their personal information will remain confidential. Then the written informed consent was obtained from all of them. Also, they were assured that participation in the study is voluntary.

3.9. Statistical Analysis

Statistical analysis was performed using SPSS version 16 and the linear structural relations (LISREL). Descriptive statistics were employed for analyses of the items and dimensions of the questionnaire. For assessing the validity of EBPQ we calculated CVI, CVR, exploratory (KMO and Bartlett’s tests) and confirmatory factor analysis. Alpha coefficient and ICC values were used for reliability of the new instrument.

4. Results

The sample included 294 women (98%). The age range of the samples was 22 to 55 years old and the mean age was 34.32 ± 8.42 (Table 1).

Table 1. Demographical Characteristics of the Participants (N = 300)
VariablesNo. (%)
Age, y, (mean ± SD, 34.32 ± 8.42)
20 - 30126 (42)
31 - 4098 (32.7)
41 - 5067 (22.3)
> 509 (3)
Female294 (98)
Male6 (2)
Bachelor289 (96.3)
Masters degree11 (3.7)
Work experience, y
1 - 10169 (56.3)
10 - 2092 (30.7)
20 - 3039 (13.0)
Type of shift work
Shift rotation246 (82)
Head nurse18 (6)
In charge nurse (Day work only)24 (8)
Supervisor12 (4)
employment status
Fixed term141 (47)
Permanent46 (15.3)
Temporary71 (23.7)
New graduate nurses42 (14)

The CVI for all items of the questionnaire was 0.8 and above and total CVRs were ≥ 0.63. The values of impact scores on all items were > 1.5. In examining the reliability of the questionnaire Cronbach’s alpha of the questionnaire was 0.92. ICC was significant (P < 0.001) (Table 2). In examining the construct validity and exploratory factor analysis, KMO test was 0.84, indicating the sampling adequacy for the factor analysis (Table 3). Bartlett’s test (P < 0.001) suggested a significant relationship between items and adequacy of factor analysis test. Scree plot was used to determine the number of dimensions of EBPQ (Figure 1) and after orthogonal varimax rotation, 4 factors were determined. Confirmatory factor analysis was performed (Table 4). Path diagram in all of the indices showed an acceptable strong goodness of fit for each factor and total scale (Figure 2).

Scree Plot to Determine the Number of Constructing Factors of EBPQ
Figure 1. Scree Plot to Determine the Number of Constructing Factors of EBPQ
Path Diagram of Confirmatory Factor Analysis of EBPQ
Figure 2. Path Diagram of Confirmatory Factor Analysis of EBPQ
Table 2. Intraclass Correlation Coefficient, Cronbach’s Alpha Values, Means, and Standard Deviations of the Four Factors
DimensionsCronbach’s Alpha CoefficientICCMean ± SDNumber of Items
Barriers to change in evidence-based practiceα = 0.930.9935.14 ± 9.9915
knowledge sources used in nursing practiceα = 0.870.9831.80 ± 8.1612
Self assessment of nursing skills level in the evidence retrievalα = 0.870.8920.09 ± 5.758
facilitators evidence-based practiceα = 0.880.9736.29 ± 8.6314
Totalα = 0.920.962123.32 ± 23.0649
Table 3. KMO and Bartlett’s Test
Kaiser-Meyer-Olkin measure of sampling adequacy0.846
Bartlett’s test of sphericity
Approx. Chi-Square7.763E3
Sig.0. 001
Table 4. Results of Fit Index CFA of the Iranian Version of the Evidence-Based Practice Questionnaire (N = 300)
Statistical IndexX2dfX2/dfNNFIRMSEA (90% CI)CFINFIIFI

The extracted factors explained 51.6% of the total variance, and factor 1 to 4, respectively explained 16.42%, 11.87%, 11.75%, and 11.56% of the total variance. The minimum of the factor load was 0.3 (Table 5). The four factors in EBPQ were labeled as “barriers to change in evidence-based practice” (15 items), “knowledge sources used in nursing practice” (12 items), “self-assessment of nursing skills level in the evidence retrieval” (8 items) and “facilitators evidence-based practice” (14 items).

Table 5. Results of Exploratory Factor Analysis Using Rotated Component Matrix
Factors and Items (% of Cumulative Variance = 51.6)Rotated Component Matrix
(Factor1): “barriers to change in evidence-based practice” “barriers to change in evidence-based practice”, (% of Variance = 16.42)
Identifying implications of organizational information in my own practice is difficult for me0.83
Identifying the application of research findings in my own practice is difficult for me0.82
Understanding the results of the research report is difficult for me0.80
Finding organizational information (including the Guidelines, protocols, etc.) is not easy for me0.77
I can not confidently judge about the quality of research reports0.75
I do not know how to find appropriate research reports0.74
Organizational information (including protocols, guidelines, etc.) are found with difficulty0.74
Research reports are not found easily0.72
I do not feel confident about starting to change my practice0.70
There are insufficient resources (such as equipment) to make changes in practice0.69
I do not have enough time to find organizational information (including guidelines and protocols)0.68
I do not have enough time to find research reports0.66
My team culture is not receptive to change in practice0.65
I do not have authority in the work place to make changes in practice0.59
I do not have enough time to search research reports0.42
(Factor2): “knowledge sources used in nursing practice” (% of Variance = 11.87)
I get my scientific information from articles published in research journals0.84
I get my scientific information from articles published in medical journals0.83
I get my scientific information about treatments and medication from representatives of the equipment and pharmaceutical companies0.69
I get my scientific information from articles published in nursing journals0.68
I get my scientific information from local audit reports0.63
I get scientific information from my intuition about what seems to be right for the patient0.62
I get my scientific information from the media (magazines, TV, etc.)0.56
I get my scientific information from national policy guidelines0.53
I get my scientific information from the Internet0.44
I get the scientific information the way that I have always done it0.43
I get my scientific information from textbooks0.42
I get my scientific information from literature0.42
(Factor3): “self assessment of nursing skills level in the evidence retrieval” (% of Variance = 11.75)
Level of your skill to find research evidence0.89
Level of your skill to find organizational information0.86
Level of your skill to review the research evidence0.86
Level of your skill to review organizational information0.84
Level of your skills using the library to locate information0.82
Level of your skills using research evidence to change practice0.77
Level of your skill in the use of organizational information (e g, guidelines and policies), to changes in practice0.70
Level of your skills when you use the Internet to search for information0.46
(Factor4): “facilitators evidence-based practice: (% of Variance = 11.56)
Nursing managers support changes in my practice0.73
Nurse colleagues support changes in my practice0.69
I get my scientific information from what my colleagues have shared with me0.69
Head nurses support the change in my practice0.67
I get the information of researches through attending in-service training conferences0.62
I get the scientific information the ways that I have always done it0.58
I get my scientific information from the personal experience of caring for patients over time0.57
The doctors with whom I work are supportive of my changing practice0.57
I get my scientific information from what the doctors discuss with me0.54
I get new information from treatments and medications that the doctors have prescribed for patients0.52
I get my scientific information from the local policies and protocols0.52
I get my scientific information from senior clinical nurses share such as clinical nurse specialist and nurses practitioners0.46
I get the scientific information using my personal training0.42
I get the scientific information from what has worked for me for years0.40

The means of dimensions of the questionnaire were respectively for “barriers to change in evidence-based practice” 37.95± 10.75, “knowledge sources used in nursing practice” 31.8 ± 8.16, “self-assessment of nursing skills level in the evidence retrieval” 20.09 ± 5.75, “facilitators evidence-based practice” 36.29 ± 8.63 and total score 126.13 ± 23.55.

After obtaining the Iranian version of the questionnaire of EBP, Ceiling and floors effects on the scores obtained were analyzed using statistical methods. In this context, none of the participants had scored Ceiling and floors.

5. Discussion

The results of this study confirmed the validity and reliability of the Persian version of EBPQ, and therefore, it can be used for evaluation of evidence-based practice in nursing.

In this study qualitative content and face validity were used, in addition to the CVR and CVI for determining the questionnaire validity. Also, the average of scale content validity index (SCVI/Ave) was calculated as 0.9, that is acceptable (21). In examining the reliability of the questionnaire, internal consistency, Cronbach’s alpha was 0.92 of the entire questionnaire and within acceptable limits that were satisfactory (22). Internal consistency of the instrument indicated a degree of homogeneity in components of the tool (23).

In assessing external consistency, ICC showed a good stability over time (24). However, in the original study of the design of the questionnaire, no report was submitted regarding the conduct Test-retest and stability of this questionnaire (25). In examining the construct validity and exploratory and confirmatory factor analysis, the high KMO and goodness of the model were the strengths of this study and revealed the high quality of factor analysis to determine the factors (21). Most of the nurses expressed difficulty understanding study results in the research journals, as the biggest barrier, and personalized search, as the least skill. They also introduced medical support as the most common facilitator in this field.

Khammarnia et al. (2014) introduced personal aspects such as lack of special English proficiency, and weaknesses in working with the computer as the major barriers, and medical support as facilitating factor in EBP (8). Sanjari et al. (2015) demonstrated a lack of physician support in the implementation of evidence-based practice as one of the barriers to implementation of EBP (26).

5.1. Conclusion

This study presented EBPQ as a valid and reliable tool to evaluate the status of evidence-based practice in Iranian nursing. This questionnaire is a simple tool in EBP in nursing. It can be applied by nursing Policymakers to assess barriers, and adopt solutions to problems.

5.2. Strengths and Limitations

In this study quantitative and qualitative content validity, construct validity and test-retest were strong point compared to the original. Most of the standard questionnaires in Iran investigate the knowledge, attitude and practice regarding EBP but the questionnaire is new because it assesses facilitators, barriers, knowledge sources and nurses’ skill in EBP. The self- report questionnaire was the limitation of this study.




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