EVIDENCE-BASED PRACTICE IMPLEMENTATION SCALE: CULTURAL ADAPTATION AND PSYCHOMETRIC TESTING OF THE TURKISH VERSION

Öz

Objective: This study aimed to perform cultural adaptation and evaluate the psychometric properties of the Turkish version of the Evidence-Based Practice Implementation Scale developed by Melnyk et al. Method: This methodological study included 242 nurses from public, university, and private hospitals in a central metropolitan area of Türkiye. Scale adaptation was conducted according to Beaton et al.'s and International Test Commission's six-stage cross-cultural process. Sampling adequacy and the suitability of the data for factor analysis were evaluated using the Kaiser-Meyer-Olkin and Bartlett's tests of sphericity. Construct validity was examined through Exploratory and Confirmatory Factor Analysis. Reliability was determined using Cronbach's Alpha, McDonald's Omega, and item-total correlations. Results: Content validity index values ranged from 0.857 to 1.000 at the item level, and averaged 0.897 at the scale level. The Kaiser-Meyer-Olkin value was 0.950, and Bartlett's test of sphericity was significant (p<0.001). Exploratory factor analysis revealed two factors explaining 71.068% of total variance: "Evidence Integration and Clinical Implementation" (13 items, 45.064% variance) and "Evidence Search and Critical Appraisal" (5 items, 26.004% variance). Factor loadings ranged from 0.715 to 0.944. Confirmatory factor analysis demonstrated acceptable model fit (CMIN/df=3.158; GFI=0.805; CFI=0.870; RMSEA=0.095). Reliability analysis achieved excellent internal consistency; Cronbach's Alpha was 0.967, and McDonald's Omega was 0.983. Reliability coefficients for sub-dimensions were also adequate (α=0.883-0.964; ω=0.922-0.979). Conclusion: The Turkish version demonstrated strong psychometric properties, providing a valid and reliable tool for assessing evidence-based practice competencies among nurses. The two-factor structure identified in this study revealed that Turkish nurses perceive evidence-based practice skills differently from the original scale. This scale will contribute to evaluating competency development interventions for healthcare organizations and researchers.

Anahtar Kelimeler

• Evidence-Based Practice
• Psychometrics
• Cross-Cultural Comparison
• Nurses

KANITA DAYALI UYGULAMA İMPLEMENTASYON ÖLÇEĞİ: TÜRKÇE VERSİYONUNUN KÜLTÜREL ADAPTASYONU VE PSİKOMETRİK DEĞERLENDİRMESİ

Öz

Amaç: Bu çalışma, Melnyk ve arkadaşları tarafından geliştirilen Kanıta Dayalı Uygulama İmplementasyon Ölçeği'nin Türkçe versiyonunun kültürel adaptasyonunu gerçekleştirerek psikometrik özelliklerini değerlendirmeyi amaçladı. Yöntem: Bu metodolojik araştırmaya Türkiye’nin merkezi bir büyükşehir bölgesindeki kamu, üniversite ve özel hastanelerden 242 hemşire dâhil edildi. Ölçek adaptasyonu Beaton ve arkadaşları ile Uluslararası Test Komisyonu'nun altı aşamalı kültürlerarası sürecine göre yürütüldü. Örneklem yeterliliği ve verinin faktör analizine uygunluğu Kaiser-Meyer-Olkin ve Bartlett Küresellik testleri ile değerlendirildi. Yapı geçerliliği Açımlayıcı ve Doğrulayıcı Faktör Analizi yoluyla incelendi. Güvenilirlik Cronbach's Alpha, McDonald's Omega ve madde-toplam korelasyonları ile belirlendi. Bulgular: Kapsam geçerlik indeksi değerleri madde düzeyinde 0.857-1.000 arasında, ölçek düzeyinde ortalama 0.897 olarak saptandı. Kaiser-Meyer-Olkin değeri 0.950 olarak hesaplandı ve Bartlett Küresellik testi anlamlı bulundu (p<0.001). Açımlayıcı faktör analizi toplam varyansın %71.068'ini açıklayan iki faktör ortaya koydu: "Kanıt Entegrasyonu ve Klinik Uygulama" (13 madde, %45.064 varyans) ve "Kanıt Arama ve Eleştirel Değerlendirme" (5 madde, %26.004 varyans). Faktör yükleri 0.715-0.944 arasında değişiklik gösterdi. Doğrulayıcı faktör analizi kabul edilebilir model uyumu sergiledi (CMIN/df=3.158; GFI=0.805; CFI=0.870; RMSEA=0.095). Güvenilirlik analizinde mükemmel düzeyde iç tutarlılık elde edildi; Cronbach's Alpha 0.967 ve McDonald's Omega 0.983 olarak hesaplandı. Alt boyutlar için güvenilirlik katsayıları da yeterli düzeyde saptandı (α=0.883-0.964; ω=0.922-0.979). Sonuç: Türkçe versiyonu güçlü psikometrik özellikler sergileyerek, hemşirelerin kanıta dayalı uygulama yeterliliklerini değerlendirmek için geçerli ve güvenilir bir araç sunmaktadır. Bu çalışmada belirlenen iki faktörlü yapı, Türk hemşirelerinin kanıta dayalı uygulama becerilerini orijinal ölçekten farklı şekilde algıladığını ortaya koymaktadır. Bu ölçek, sağlık kuruluşları ve araştırmacılar için yetkinlik geliştirme müdahalelerinin değerlendirilmesinde katkı sağlayacaktır.

Anahtar Kelimeler

• Kanıta Dayalı Uygulama
• Psikometri
• Kültürlerarası Karşılaştırma
• Hemşireler

Kaynakça

1. White J, Gunn M, Chiarella M, Catton H, Stewart D. Renewing the definitions of 'nursing' and 'a nurse': final project report. International Council of Nurses; June 2025. Available from: https://www.icn.ch/resources/publications-and-reports/renewing-definitions-nursing-and-nurse.
2. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence-based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71-72.
3. Brunt BA, Morris MM. Nursing professional development evidence-based practice. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
4. Ministry of Health, Turkey. Nursing regulation. Official Gazette of the Republic of Turkey. 2010 Mar 8; Issue 27515. Available from: https://www.resmigazete.gov.tr/eskiler/2010/03/20100308-4.htm
5. Melnyk BM, Gallagher-Ford L, Zellefrow C, et al. The first U.S. study on nurses' evidence-based practice competencies indicates major deficits that threaten healthcare quality, safety, and patient outcomes. Worldviews Evid Based Nurs. 2018;15(1):16-25.
6. Naghibi D, Mohammadzadeh S, Azami-Aghdash S. Barriers to evidence-based practice in health system: a systematic review. Evid Based Care. 2021;11(2):74-82.
7. Shayan SJ, Kiwanuka F, Nakaye Z. Barriers associated with evidence-based practice among nurses in low- and middle-income countries: a systematic review. Worldviews Evid Based Nurs. 2019;16(1):12-20.
8. Yılmaz E, Özkan SA, Özer N. Attitudes towards evidence-based nursing and perceptions of obstacles in using research of nurses working in surgical clinics. J Educ Res Nurs. 2018;15(4):235-241.

9. Chien LY. Evidence-based practice and nursing research. J Nurs Res. 2019;27(4):e29.
10. Khan S, Chambers D, Neta G. Revisiting time to translation: implementation of evidence-based practices (EBPs) in cancer control. Cancer Causes Control. 2021;32(3):221-230.
11. Mathieson A, Grande G, Luker K. Strategies, facilitators and barriers to implementing evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Prim Health Care Res Dev. 2019;20:e6.
12. Cruz JP, Colet PC, Alquwez N, et al. Evidence-based practice beliefs and implementation among the nursing bridge program students of a Saudi university. Int J Health Sci (Qassim). 2016;10(3):405-414.
13. Menekli T, Korkmaz M. Attitudes of internal medicine nurses towards evidence-based nursing. DEUHFED. 2021;14(1):38-47.
14. Zeleníková R, Gurková E, Žiaková K, Tomagová M, Jarošová D, Fineout-Overholt E. Psychometric properties of the Slovak and Czech versions of the evidence-based practice beliefs and implementation scales. Worldviews Evid Based Nurs. 2016;13(2):139-152.
15. Ayhan Y, Kocaman G, Bektaş M. Turkish adaptation of the attitude scale towards evidence-based nursing: validity and reliability study. J Res Dev Nurs. 2015;17(2/3):21-35.
16. Türe A, Demirsoy N, Yıldırım A. Validity and reliability of evidence-based practice leadership scale and evidence-based work environment scale in Turkish. Perspect Psychiatr Care. 2020;56(4):968-978.
17. Yıldız E, Güngörmüş Z. The validity and reliability study of the Turkish version of the evidence-based practice evaluation competence questionnaire. Nurse Educ Today. 2016;45:91-95.
18. Melnyk BM, Fineout-Overholt E, Mays MZ. The evidence-based practice beliefs and implementation scales: psychometric properties of two new instruments. Worldviews Evid Based Nurs. 2008;5(4):208-216.
19. Verloo H, Desmedt M, Morin D. Adaptation and validation of the evidence-based practice belief and implementation scales for French-speaking Swiss nurses and allied healthcare providers. J Clin Nurs. 2017;26(17-18):2735-2743.
20. Kerwien-Jacquier E, Verloo H, Pereira F, Peter KA. Adaptation and validation of the evidence-based practice beliefs and implementation scales into German. Nurs Open. 2020;7(6):1997-2008.
21. Zare O, Ebadi A, Ozgoli G, Kariman N. Psychometric properties of the Persian version of the evidence-based practice implementation questionnaire in nurses. J Holist Nurs Midwifery. 2024;34(2):125-132.
22. Comrey AL, Lee HB. A first course in factor analysis. 2nd ed. Psychology Press; 1992.
23. Hoerger M. Participant dropout as a function of survey length in internet-mediated university studies: implications for study design and voluntary participation in psychological research. Cyberpsychol Behav Soc Netw. 2010;13(6):697-700.
24. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186-3191.
25. Hernández A, Hidalgo MD, Hambleton RK, Gómez-Benito J. International Test Commission guidelines for test adaptation: a criterion checklist. Psicothema. 2020;32(3):390-398.
26. Davis LL. Instrument review: getting the most from a panel of experts. Appl Nurs Res. 1992;5(4):194-197.
27. Polit DF, Beck CT. The content validity index: are you sure you know what's being reported? Critique and recommendations. Res Nurs Health. 2006;29(5):489-497.
28. Melnyk BM, Hsieh AP, Gallagher-Ford L, et al. Psychometric properties of the short versions of the EBP beliefs scale, the EBP implementation scale, and the EBP organizational culture and readiness scale. Worldviews Evid Based Nurs. 2021;18(4):243-250.
29. Şimşek P, Özmen GÇ, Yavuz ME, Koçan S, Çilingir D. Exploration of nursing students' views on the theory-practice gap in surgical nursing education and its relationship with attitudes towards the profession and evidence-based practice. Nurse Educ Pract. 2023;69:103624.
30. Ovayolu Ö, Ovayolu N. The gap between theory and practice in nursing: according to perspective the academician nurse. Int Soc Sci Stud J. 2020;6(62):2013-2020.
31. Yılmaz G, Düzgün F, Durmaz A. Examining the competence status of nurses in evidence-based practices and the influencing factors: a multicenter study in Turkey. BMC Nurs. 2025;24:152.