Relevance for Public Health

The evidence-based practice attitude scale was developed to address a phenomenon seen in mental health -- health care providers used treatments and interventions in practice, but lacked awareness or concern about the evidence-base or efficacy of these interventions. In order to determine how to disseminate the most efficacious interventions to those professionals working in community-based settings, the authors recognized a need to first understand attitudes toward evidence-based practice. This tool asks questions related to attitudes and decisions about the use of evidence for clinical decision-making, and push and pull factors such as organizational mandates. The questions are sufficiently general to be useful in any type of public health practice setting.

Description

This tool examines attitudes toward evidence-based practice among social service providers who specialize in child and adolescent mental health (Aarons, 2004). The initial study to create this evidence-based practice attitude scale was based on participation by over 322 clinical and case management service providers and 51 program managers from public sector programs. The tool includes 15 questions regarding clinician and case manager willingness to adopt evidence-based practices give the appeal of evidence-based practice, system, organization, or supervisor requirements for evidence-based practices, the clinician or case manager’s degree of openness to innovation, and the perceived importance of using research-based interventions as part of practice. While this tool was not created for public health, it can be used without adaptation in any public health setting or discipline. For example, a public health program manager could use the evidence-based practice attitude scale to assess staff perceptions of using evidence for public health interventions and decision-making. The methodological rating for this tool is “strong”.

This instrument has received initial testing of its psychometric properties to produce a 15-item tool. Further evaluation of the tool is required to test its psychometric properties among public health providers and across varied organizational settings.

Face and content validity were described and involved researchers, mental health clinicians and other mental health service providers (Aarons, 2004). Factor analysis was completed and provides some initial evidence for convergence and consistency (Aarons). Results of a study testing the association between organizational culture and climate with mental health provider attitudes toward adoption of evidence-based practice provided additional support for tool validation (Aarons & Sawitzky, 2006).This tool would benefit from continued examination of criterion and construct validity. The article, "Transformational and Transactional Leadership: Association with Attitudes Toward Evidence-Based Practice", further provides evidence for validity of the EBPAS (Aarons, 2006).

Both exploratory and confirmatory factor analysis was conducted in the original scale development study (Aarons, 2004) and a further study provided item factor loadings and item-total correlations to evaluate and test domain structure for the tool in a more geographically diverse sample (Aarons, McDonald, Sheehan, & Walrath-Greene, 2007). Chronbach’s alpha was used to assess internal consistency reliability which ranged from high to moderate with requirements (3 items; α=0.93), appeal (4 items; α = 0.74), openness (4 items; α=0.81), divergence (4 items; α=0.66), and EBPAS Total (15-items; α=0.79. Test-retest reliability was not assessed and inter-rater reliability does not pertain to this type of measure.

Participants were part of a study on organizational factors in child and adolescent mental health services in California (Aarons, 2004). A program manager and service providers who worked with youth and families were among the participants who consented to be interviewed and surveyed in groups. A project coordinator administered surveys and answered questions about the overall process. Those participants who could not attend the group survey session were given the option to mail back surveys (Aarons, 2004).

Two to five minutes are required to complete the tool.

Administration and scoring instructions are available from the author.

The EBPAS is copyrighted. The EBPAS is available from the author at no charge.

Gregory A. Aarons, PhD (author correspondence) University of California, San Diego Department of Psychology (0812) La Jolla, CA 92093-0812 Email: gaarons@ucsd.edu

An initial pool of items, based on literature, and on consultations with clinicians and with experts and researchers experienced in the implementation of evidence-based protocols, was used to create an original 18-item tool (Aarons, 2004). Provider surveys were used to develop individual scale items. Program manager interviews assessed organizational level elements. Factor analysis resulted in a 15-item tool with four domains: requirements, appeal, openness and divergence.

Gregory A. Aarons, PhD (author correspondence) University of California, San Diego Department of Psychology (0812) La Jolla, CA 92093-0812 Email: gaarons@ucsd.edu

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Aarons, G. A. (2004). Mental health provider attitudes toward adoption of evidence-based practice: The evidence-based practice attitude scale. Mental Health Services Research, 6(2), 61-74.

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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, 34, 465-469.

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Aarons, G. A. (2006). Transformational and transactional leadership: Association with attitudes toward evidence-based practice. Psychiatric Services, 57(8), 1162-9.

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