1 Private Bag X17, Department of Psychology, University of the Western Cape, Cape Town, South Africa
The current study examined the psychometric properties of the Evidence-Based Practice Attitudes Scale (EBPAS) among South African mental health care providers working with trauma. South Africa has one of the highest rates of exposure to trauma and a significant proportion of the population experience chronic psychological problems. In this context, evidence-based practice (EBP) offers a cost-effective avenue of enhancing standards of care and promoting the use of effective interventions. However, the adoption of EBP remains low and this is a significant public health concern. Existing research in the United States and Europe have identified the attitudes of service providers as a significant barrier to EBP use. Many of these studies used the EBPAS, which provides an assessment of service provider attitudes towards EBP. The instrument has been found to be psychometrically sound in developed countries. However, there remains limited research on the instrument in other contexts. The present study expanded existing research by investigating the replicability of the reliability and reported factor structure of the EBPAS in a developing country. More specifically, confirmatory factor analysis was used to test three different models of the hypothesized factor structure underlying the scale. The results support the second order and four-factor structure of the EBPAS. The reported norms provide a reference point for future research in the context of developing countries.
Keywords: evidence-based practice; EBPAS; mental health care; psychometric properties; provider attitudes; South Africa, trauma
Published online: 2018/03/01
Published print: 2018/03/01
Aarons, G.A, Green, A.E, & Miller, A.E. (2012). Researching readiness for implementation of evidence-based practice: A comprehensive review of the evidence-based practice attitude scale (EBPAS). In B. Kelly, & D. F. Perkins (Eds.), Handbook of implementation science for psychology in education (pp. 150-163). Cambridge, UK: Cambridge University Press
Aarons, G. A. (2004). Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-Based Practice Attitude Scale (EBPAS). Mental health services research, 6, 61-74. doi.org/10.1023
Aarons, G. A. (2005). Measuring provider attitudes toward evidence-based practice: Consideration of organizational context and individual differences. Child and adolescent psychiatric clinics of North America, 14, 255-271. doi.org/10.1016/j.chc.2004.04.008
Aarons, G. A., Fettes, D. L., Flores, L. E., & Sommerfeld, D. H. (2009). Evidence-based practice implementation and staff emotional exhaustion in children’s services. Behaviour research and therapy, 47, 954-960. doi.org/10.1016/j.brat.2009.07.006
Aarons, G. A., & Sawitzky, A. C. (2006). Organizational culture and climate and mental health provider attitudes toward evidence-based practice. Psychological services, 3, 61. doi.org/10.1037/1541-15184.108.40.206
Aarons, G. A., Glisson, C., Hoagwood, K., Kelleher, K., Landsverk, J., & Cafri, G. (2010). Psychometric properties and US National norms of the Evidence-Based Practice Attitude Scale (EBPAS). Psychological assessment, 22, 356. doi.org/10.1037/a0019188
Aarons, G. A., Cafri, G., Lugo, L., & Sawitzky, A. (2012). Expanding the domains of attitudes towards evidence-based practice: the evidence based practice attitude scale-50. Administration and policy in mental health and mental health services research, 39, 331-340. doi.org/10.1007/s10488-010-0302-3
Aarons, G. A., McDonald, E. J., Sheehan, A. K., & Walrath-Greene, C. M. (2007). Confirmatory factor analysis of the Evidence-Based Practice Attitude Scale (EBPAS) in a geographically diverse sample of community mental health providers. Administration and Policy in Mental Health and Mental Health Services Research, 34, 465. doi.org/10.1007/s10488-007-0127-x
Arbuckle, J.L. (2012). Users Guide. IBM® SPSS® Amos™ 21. Available at: ftp://public.dhe.ibm.com/software/analytics/spss/documentation/amos/21.0/en/Manuals/IBM_SPSS_Amos_Users_Guide.pdf.
Arnadottir, S. A., & Gudjonsdottir, B. (2016). Icelandic Physical Therapists’ Attitudes Toward Adoption of New Knowledge and Evidence-Based Practice: Cross-Sectional Web-Based Survey. Physical therapy, 96, 1724-1733. doi.org/10.2522/ptj.20150428
Arnadottir, S. A., Gudjonsdottir, B., Gudmundsson, H. S., Arnadottir, H. A., & Juliusdottir, S. (2015). Evidence based practice and teamwork: comparison of physical therapists’ and social workers’ attitudes towards adoption of new knowledge. Physiotherapy, 101, 85. doi.org/10.1016/j.physio.2015.03.215
Atwoli, L., Stein, D. J., Koenen, K. C., & McLaughlin, K. A. (2015). Epidemiology of posttraumatic stress disorder: prevalence, correlates and consequences. Current opinion in psychiatry, 28, 307. doi: 10.1097/YCO.0000000000000167
Bentler, P.M. (1995). EQS: Structural equations program manual. Encino, CA: Multivariate Software.
Bantjes, J., Kagee, A., & Young, C. (2016). Counselling psychology in South Africa. Counselling Psychology Quarterly, 29, 171-183. doi.org/10.1080/09515070.2015.1128401
Brown, C. E., Wickline, M. A., Ecoff, L., & Glaser, D. (2009). Nursing practice, knowledge, attitudes and perceived barriers to evidence‐based practice at an academic medical center. Journal of Advanced Nursing, 65, 371-381. doi: 10.1111/j.1365-2648.2008.04878.x
Byrne, B. M. (1994). Structural equation modeling with EQS and EQS/Windows. Thousand Oaks, CA: Sage Publications.
Davidov, E., Meuleman, B., Cieciuch, J., Schmidt, P., & Billiet, J. (2014). Measurement equivalence in cross-national research. Annual Review of Sociology, 40. doi.org/10.1146/annurev-soc-071913-043137
Edwards, D. (2013). Responsive integrative treatment of clients with PTSD and trauma-related disorders: An expanded evidence-based model. Journal of Psychology in Africa, 23, 7-19. doi.org/10.1080/14330237.2013.10820589
Egeland, K. M., Ruud, T., Ogden, T., Lindstrøm, J. C., & Heiervang, K. S. (2016). Psychometric properties of the Norwegian version of the Evidence-Based Practice Attitude Scale (EBPAS): to measure implementation readiness. Health Research Policy and Systems,14, 47. doi.org/10.1186/s12961-016-0114-3
Gray, M. J., Elhai, J. D., & Schmidt, L. O. (2007). Trauma professionals’ attitudes toward and utilization of evidence-based practices. Behavior modification, 31, 732-748. doi.org/10.1177/0145445507302877
Government Gazette. Regulations defining the scope of the profession of psychology (No 34581) 2011 Retrieved from http://www.hpcsa.co.za/Uploads/editor/UserFiles/ downloads/psych/sept_promulgated_scope_of_practice.pdf.
Gregorich, S. E. (2006). Do self-report instruments allow meaningful comparisons across diverse population groups? Testing measurement invariance using the confirmatory factor analysis framework. Medical care, 44. doi: 10.1097/01.mlr.0000245454.12228.8f
Harachi, T. W., Choi, Y., Abbott, R. D., Catalano, R. F., & Bliesner, S. L. (2006). Examining equivalence of concepts and measures in diverse samples. Prevention Science, 7, 359-368. doi.org/10.1007/s11121-006-0039-0
Hu, L., & Bentler, P.M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Mo-deling: A Multidisciplinary Journal, 6, 1-55. doi.org/10.1080/10705519909540118
Jette, D. U., Bacon, K., Batty, C., Carlson, M., Ferland, A., Hemingway, R. D., … & Volk, D. (2003). Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Physical therapy, 83, 786-805. doi.org/10.1093/ptj/83.9.786
Jöreskog, K.G. (1969). A general approach to confirmatory factor analysis. Psychometrika, 34, 183-202. doi.org/10.1007/BF02289343
Kagee, A. (2006). Where is the evidence in South African clinical psychology? South African Journal of Psychology, 36, 233-248. Retrieved from: http://hdl.handle.net/10520/ EJC98381
Kagee, A., & Lund, C. (2012). Psychology training directors’ reflections on evidence-based practice in South Africa. South African Journal of Psychology, 42, 103-113. Retrieved from: http://hdl.handle.net/10520/EJC98673
Kagee, A. (2014). South African psychology after 20 years of democracy: Criticality, social development, and relevance. South African Journal of Psychology, 44, 350-363.
Kaminer, D., du Plessis, B., Hardy, A., & Benjamin, A. (2013). Exposure to violence across multiple sites among young South African adolescents. Peace and Conflict: Journal of Peace Psychology, 19, 112. doi.org/10.1037/a0032487
Kankaraš, M., & Moors, G. (2010). Researching measurement equivalence in cross-cultural studies. Psihologija, 43, 121-136. doi:10.2298/PSI1002121K
Kessler, R. C., Angermeyer, M., Anthony, J. C., De Graaf, R. O. N., Demyttenaere, K., Gasquet, I., … & Kawakami, N. (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry, 6, 168. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174588/
Keyser, D., Harrington, D., & Ahn, H. (2016). A confirmatory factor analysis of the evidence-based practice attitudes scale in child welfare. Children and Youth Services Review, 69, 158-165. doi.org/10.1016/j.childyouth.2016.08.005
Lilienfeld, S. O., Ritschel, L. A., Lynn, S. J., Cautin, R. L., & Latzman, R. D. (2013). Why many clinical psychologists are resistant to evidence-based practice: Root causes and constructive remedies. Clinical Psychology Review, 33, 883-900. doi.org/10.1016/j.cpr.2012.09.008
McHugh, R. K. & Barlow, D. H. (2010). The dissemination and implementation of evidence-based psychological treatments: A review of current efforts. American Psychologist, 65, 73-84. doi.org/10.1037/a0018121
Melas, C. D., Zampetakis, L. A., Dimopoulou, A., & Moustakis, V. (2012). Evaluating the properties of the Evidence-Based Practice Attitude Scale (EBPAS) in health care. Psychological Assessment, 24, 867. doi.org/10.1037/a0027445
Melnyk, B. M., Fineout-Overholt, E., Giggleman, M., & Cruz, R. (2010). Correlates among cognitive beliefs, EBP implementation, organizational culture, cohesion and job satisfaction in evidence-based practice mentors from a community hospital system. Nursing Outlook, 58, 301-308. doi.org/10.1016/j.outlook.2010.06.002
Padmanabhanunni, A. (2017). A review of the transportability of cognitive therapy for the treatment of PTSD among South African rape survivors. Health SA Gesondheid (Online), 22, 268-274.
Padmanabhanunni, A., & Sui, X. C. (2017). Mental healthcare providers’ attitudes towards the adoption of evidence-based practice in the treatment of post-traumatic stress disorder in South Africa. South African Journal of Psychology, 47, 198-208.
Sackett, D., & Rosenberg, W. (1995). On the need for evidence based medicine. Health Economics, 4, 249-254. doi: 10.1002/hec.4730040401
Schumaker, R. E. & Lomax, R. G. (2004). A beginner’s guide to structural equation modelling (2nd Ed). London, UK: Lawrence Erlbaum Associates Inc.
Smith, B. D., & Manfredo I. T. (2011): Frontline counselors in organizational contexts: A study of treatment practices in community settings. Journal of Substance Abuse Treatment, 41, 124-136. doi 10.1016/j.jsat.2011.03.002.
Stevenson, K., Lewis, M., & Hay, E. (2004). Do physiotherapists’ attitudes towards evidence‐based practice change as a result of an evidence‐based educational programme?. Journal of Evaluation in Clinical Practice, 10, 207-217. doi: 10.1111/j.1365-2753.2003.00479.x
van Sonsbeek, M. A., Hutschemaekers, G. J., Veerman, J. W., Kleinjan, M., Aarons, G. A., & Tiemens, B. G. (2015). Psychometric properties of the Dutch version of the Evidence-Based Practice Attitude Scale (EBPAS). Health research policy and systems, 13, 69. doi.org/10.1186/s12961-015-0058-z
Vassos, M. V., & Carroll, M. F. (2016). Assessing Attitudes Toward Evidence-Based Practices of Workers Supporting People With Disabilities: A Validation of the Evidence-Based Practice Attitudes Scale. American Journal on Intellectual and Developmental Disabilities, 121, 364-378. doi.org/10.1352/1944-7558-121.4.364
Wolf, D. A. P. S., Dulmus, C. N., Maguin, E., & Fava, N. (2014). Refining the evidence-based practice attitude scale: an alternative confirmatory factor analysis. Social Work Research, 38, 47-58. doi.org/10.1093/swr/svu0