Validation of the Brazilian Portuguese version of Evidence-based Practice Knowledge Assessment in Nursing (EKAN)

Nick, Jan M.; Durkin, Adelaide Caroci; Caroci-Becker, Adriana; Cruz, Diná de Almeida Lopes Monteiro da; Zorzim, Vivian Inacio; Wonder, Amy H.

doi:10.1590/S1980-220X2020012003768

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2020012003768 copy

Validation of the Brazilian Portuguese version of Evidence-based Practice Knowledge Assessment in Nursing (EKAN)

Validação da versão Brasileira da Evidence-based Practice Knowledge Assessment in Nursing (EKAN)

Validación de versión brasileña de la Evidence-based Practice Knowledge Assessment in Nursing (EKAN)

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

The Evidence-based Practice Knowledge Assessment in Nursing (EKAN) is an objective measure of evidence-based practice (EBP) knowledge. The aims of the project were to translate the EKAN instrument into Brazilian Portuguese, test its psychometric properties, and document a baseline assessment of students’ EBP knowledge.

Method

This study used methodological design. The EKAN-Brazilian Portuguese was administered to nursing students from two baccalaureate programs. Data were analyzed using Rasch procedures.

Results

123 students participated (87% ranged 19-25 years old; 60% were juniors; 38% perceived having no exposure to EBP). Validity indices showed the mean difficulty index = -2.48 to 2.07, the Infit (WMS) mean was.985 (SD = 2.13), and the Outfit (UMS) mean was.975 (SD = 0.17). Reliability indices showed sufficient item separation index (4.47); moderate person separation index (.47); high item reliability (.95); and low person reliability (.18). The mean EKAN sum score (max = 20) was 7.6 (SD = 2.13).

Conclusion

This study on the EKAN-Brazilian Portuguese version provided sufficient evidence for validity and reliability; the person reliabilities showed the need for improvement in incorporating EBP concepts and content in nursing programs.

Evidence-Based Practice; Health-Knowledge, Attitudes, Practice; Validation Study; Psychometrics

Characteristics	Institution A (n = 77)	Institution B (n = 46)	Total (N = 123)
Age
19-25 26-30 31-35 36-40	63 (82.0%) 6 (8.0%) 6 (8.0%) 2 (2.0%)	44 (96.0%) 2 (4.0%) - -	107 (87.0%) 8 (6.0%) 7 (6.0%) 2 (1.0%)
Gender
Female Male	66 (86.0%) 11 (14.0%)	39 (85.0%) 7 (15.0%)	105 (85.0%) 18 (15.0% )
Progression in nursing program
5^th semester 7^th semester 9^th semester	37 (48.0%) 17 (22.0%) 23 (30.0%)	37 (80.0%) 9 (20.0%) -	74 (60.0%) 26 (21.0%) 23 (19.0%)
Country of origin
Brazil Angola South Korea	74 (96.1%) 2 (2.6%) 1 (1.3%)	46 (100.0%) - -	120 (97.6%) 2 (1.6%) 1 (0.8%)
Exposure to statistics course
Completed Enrolled Have not taken	25 (32.0%) 16 (21.0%) 36 (47.0%)	46 (100.0%) - -	71 (58.0%) 16 (13.0%) 36 (29.0%)
Perceived exposure to EBP content (number of days for EBP content exposition)*
Not taken any content < one 1-2 > 2 Took a whole course	15 (19.5%) 3 (4.0%) 5 (6.5%) 8 (10.0%) 46 (60.0%)	32 (69.5%) 5 (11.0%) - - 9 (19.5%)	47 (38.0%) 8 (6.5%) 5 (4.0%) 8 (6.5%) 55 (45.0%)
Self-rated confidence in providing EBP care
Strongly agree Agree Neither agree or disagree Disagree Strongly disagree	29 (38.0%) 41 (53.0%) 6 (8.0%) - 1 (1.0%)	4 (9.0%) 1 8 (39.0%) 20 (43.0%) 4 (9.0%) -	33 (27.0%) 59 (48.0%) 26 (21.0%) 4 (3.0%) 1 (< 1.0%)

Item and Content Description	Difficulty (SE)	Infit		Outfit
Item and Content Description	Difficulty (SE)	WMS	SWMS	UMS	SUMS
1. Purpose of regression versus other tests	1.57 (0.29)	0.92^a	-0.31^b	0.79	-0.79^b
2. Sampling and study design	0.37 (0.21)	0.97^a	-0.30^b	0.98^a	-0.14^b
3. Purpose of Institutional Review Board	0.01 (0.19)	0.97^a	-0.47^b	0.96^a	-0.46^b
4. Distinguishing measures of central tendency	0.01 (0.19)	0.97^a	-0.50^b	0.96^a	-0.45^b
5. Distinguishing validity, reliability, and generalizability	0.64 (0.22)	0.96^a	-0.30 ^b	0.91^a	-0.61^b
6. Proper use of pre-appraised evidence	0.25 (0.20)	0.99^a	-0.07^b	0.99^a	-0.04^b
7. Role of judgement in EBP decision making	-0.27 (0.19)	1.01^a	0.17^b	1.02^a	0.41 ^b
8. Steps of the EBP process	-2.48 (0.26)	0.99^a	0.02^b	1.05^a	0.31^b
9. Facilitating EBP in practice settings	1.67 (0.30)	0.97^a	-0.08^b	1.02^a	0.18^b
10. Interpreting odds ratio	-0.05 (0.19)	1.01^a	0.10^b	1.00^a	0.08^b
11. Understanding credibility and bias	-0.74 (0.19)	0.94^a	-1.23^b	0.95^a	-0.89^b
12. Identifying steps in plan-do-study-act cycle for quality improvement	0.11 (0.20)	1.10^a	1.48^b	1.10^a	1.06^b
13. Priority of evidence, patient values, and clinical judgement in EBP decision making	0.01 (0.19)	1.01^a	0.16^b	1.05^a	0.67^b
14. Distinguishing causation from correlation in regression	0.10 (0.20)	0.97^a	-0.49^b	0.97^a	-0.36^b
15. Ranking of evidence quality (hierarchy)	-1.11 (0.19)	1.07^a	1.08^b	1.06^a	0.78^b
16. Strength of measurement approaches	-0.76 (0.19)	0.96^a	-0.84^b	0.94^a	-0.98^b
17. Role of PICOT question in evidence searching	0.15 (0.20)	0.96^a	-0.58^b	0.93^a	-0.76^b
18. Nurse-sensitive quality indicators	2.07 (0.35)	0.92^a	-0.19^b	0.87^a	-0.27^b
19. Understanding effect sizes	-0.23 (0.19)	1.05^a	0.90^b	1.03^a	0.48^b
20. Statistical v. clinical significance	-1.33 (0.20)	0.92^a	-1.02^b	0.93^a	-0.80^b

Rasch Validity Indices	EKAN-Brazilian Portuguese	*EKAN-English	Benchmark
Difficulty index range θ (in logits)	-2.48 to 2.07	-2.00 to 2.8	-3.0 to 3.0
Infit Weighted MS Mean (SD)	.985 (2.13)	1.01
Infit Weighted MS Range	0.69 - 1.43	-0.7 – 1.6	0.7 to 1.3**
Infit Weighted MS Interquartile Range	0.23
Outfit Unweighted MS Mean (SD)	.975 (0.17)	1.02
Outfit Unweighted MS range	0.57 - 2.11	0.93 – 1.14	0.7 to 1.3**
Outfit Unweighted MS Interquartile Range	0.34
Rasch Reliability Indices	EKAN-Brazilian Portuguese	*EKAN-English	Benchmark
Item Separation Index (ISI)	4.47	7.05	> 2***
Person Separation Index (PSI)	.47	1.66	> 2
Item Reliability (IR)	.95	.98	>.80
Person Reliability (PR)	.18	.66	>.80

Statistics	Site A (n = 77)	Site B (n = 46)	Combined Sites (N = 123)	*EKAN-English
Mean (SD)	6.8 (2.09)	8.6 (1.92)	7.6 (2.13)	10.4 (2.13)
Median	6	9	8	*
Min - Max	3–13	5 - 13	3 - 13	5
Inter-quartile range	3.0	3.0	3.0	*

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Diná de Almeida Lopes Monteiro da Cruz Alameda Franca, 732 ap. 111 CEP 01422-002 – São Paulo, SP, Brazil dinamcruz@usp.br