French adaptation of the Evidence Based Practice Attitude Scale 36 (EBPAS36-F) and attitudes of French health professionals in child and adolescent psychiatry towards evidence-based practices

French adaptation of the Evidence Based Practice Attitude Scale 36 (EBPAS36-F) and attitudes of French health professionals in child and adolescent psychiatry towards evidence-based practices | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article French adaptation of the Evidence Based Practice Attitude Scale 36 (EBPAS36-F) and attitudes of French health professionals in child and adolescent psychiatry towards evidence-based practices Paola Piccolo, Lucie Jurek, Romain Rey, Gaelle Bonnis, Gregory Aarons, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7427023/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background The enhancement of evidence-based practice (EBP) implementation is essential within healthcare systems. The attitudes of practitioners towards EBP can significantly influence the adoption of these practices. This study sought to validate the French version of the Evidence-Based Practice Attitudes Scale 36 (EBPAS-36F), assess the attitudes towards EBP among professionals in child and adolescent psychiatry in France, and examine the factors potentially associated with these attitudes in this context. Methods A cross-sectional observational study was conducted. Data were gathered through an online survey distributed to medical, paramedical, and educational professionals and students engaged in diagnostic or care activities in child and adolescent psychiatry in France. The study utilized a French-language version of the EBPAS-36 scale, which underwent translation and back-translation. Population and attitude characteristics were described, and validation tests of the EBPAS-36F were performed. A multiple linear regression model was employed to assess the association between attitudes and various individual and organizational factors. Results A total of 400 professionals responded to at least one question, with 211 respondents completing all items of the questionnaire and thus being included in the analysis. The face, content, and convergent validity, as well as the internal consistency of the EBPAS-36F, were found to be satisfactory. The mean attitude level in the study population was 2.63 (95% CI = 2.57–2.69). Two factors were significantly associated with attitude level: affiliation with a university center and employment in a tertiary care facility. Conclusions This study is the first to validate the French version of the Evidence-Based Practice Attitude Scale (EBPAS-36F). The attitude towards evidence-based practices in child and adolescent psychiatry in France was consistent with those in other European countries. These findings will enable the development of targeted strategies to improve EBP implementation in mental health services in France. Child and adolescent psychiatry Implementation Attitudes Evidence-based practices France BACKGROUND The implementation of evidence-based practices (EBP) in routine clinical settings is inadequate for ensuring the delivery of high-quality care. In this study, we define Evidence-Based Practice (EBP) as the conscientious, explicit, and judicious application of the current best evidence in the decision-making process for patient care. This perspective on EBP aims to integrate the best research evidence into a decision-making triangulation with the clinical expertise of the professional and the individual preferences of the patient ( 1 , 2 , 3 ). The most recent EBP models also consider the patient's environmental, cultural, and organizational contexts ( 4 ). Across medical specialties, it takes an average of 17 years to integrate only 14% of the knowledge generated by research into clinical practice ( 5 , 6 ). Despite a large and growing body of literature supporting a diverse set of evidence-based practices, their use remains low in child and adolescent psychiatry ( 7 , 8 ). This differential may constitute a loss of opportunity, resulting in less effective care in routine practice ( 9 ). In the field of mental health and child and adolescent psychiatry, implementing EBP is a key element in increasing the quality of early interventions, and thus improving the developmental trajectory of future adults ( 10 ). Therefore, improving the integration of EBP into routine practice is a major issue in child and adolescent psychiatry. Implementation research aims to assess facilitators and barriers to the practical use of research knowledge, and the means and strategies to encourage it ( 11 ). The implementation of EBP depends on many factors that can be divided into barriers and facilitators at different levels of the healthcare system: the individual (practitioner), team (group), organizational, and policy levels (national recommendations, funding). Frameworks such as the Consolidated Framework for Implementation Research (CFIR) and the Exploration, Preparation, Implementation, Sustainment (EPIS) framework consider implementation factors at the level of the characteristics of the intervention, the individual practitioner (for example, attitude towards evidence-based medicine), the internal setting or context (for example, characteristics of the structural and cultural contexts in which the implementation process will take place, the climate and culture of an organization), the external setting or context (the economic, political, and social context including the needs and resources of patients in which an organization is situated), and the implementation process (the process of active change to achieve the use of the intervention as designed at the individual and organizational levels), including movement through the four EPIS phases ( 12 , 13 ). The current challenge is to increase knowledge regarding the factors and test strategies to improve EBP implementation, as highlighted in a recent systematic review of child and adolescent psychiatry ( 14 ). Various implementation models have been used in recent years ( 15 , 16 ), enabling the identification of processes that facilitate or complicate the sustainable integration of new practices into the usual practice of health professionals. Among them, the EPIS framework developed by Aarons and colleagues ( 12 ) has recently been the subject of a systematic literature review, but remains without concrete application in France to date, despite a design that allows for a broad and context-sensitive application ( 13 ). The EPIS model integrates various quantitatively measurable concepts, corresponding to the dimensions influencing the implementation of practices, including the attitudes of those who may adopt and utilize EBP in the outer system or policy context or within healthcare organizations. Attitudes are positive or negative dispositions towards adopting and using EBP. They are regarded as individual dimensions involved in different stages of the implementation of a new practice. Attitude level is correlated with the implementation and use of typical EBP practices, sometimes with a higher correlation than organizational characteristics ( 17 ). To measure attitude, valid tools are needed, such as the EBPAS (Evidence-Based Practice Attitude Scale) 15 item version which was developed and validated by Aarons ( 18 ). The 36-item version is the most recent expansion and allows for the quantification of the overall level of attitudes as well as the exploration of its component subdimensions while maintaining brevity, ensuring ease of use for respondents ( 19 ). Moreover, it was initially designed for use in the public healthcare sector, including pediatric psychiatry, mental health, and child protection services. While its cross-cultural validity has been established in various countries, including Norway, the USA ( 19 ), and more recently, Germany ( 20 ), it has not yet been established in France. Factors associated with attitudes can be targeted in interventions aimed at improving them. Studies have previously identified factors associated with more positive attitudes, such as younger age ( 20 ), higher level of academic training ( 12 ), female gender ( 20 ), practising in a specialized setting ( 22 ), and being involved in research activity ( 23 ). However, these results may vary across populations and cultures and should be re-evaluated. The present study aimed to: i) carry out the psychometric validation of the EBPAS-36F scale in French, ii) measure the level of attitude among professionals in French child and adolescent psychiatry, and iii) study the factors associated with attitude level. METHODS Design, recruitment and Data Collection All data were collected using an online survey. The survey software used was SelectSurvey.NETv4.075.003. The survey and data were securely hosted on a University of Manchester server. Each child and adolescent psychiatry unit was contacted by telephone by one of the two researchers (PP and GB). The email contacts of a medical manager and paramedical manager (head nurse) or administrative manager (local secretary, general management) were systematically collected and included in a contact list. A link to the survey was then sent to the contact list for distribution to all departments. The email included an information letter outlining the purpose, context, and inclusion criteria of the study, enabling all participants to provide informed consent to participate to the study. All data were automatically anonymized using the software when the survey was launched. Data were collected between 03/01/2021 and 05/31/2021. This study was approved by the Ethics Committee of Claude Bernard Lyon 1 University (IRB 2020-11-17-02). Participants The inclusion criteria were as follows: i) being a healthcare professional, educator, or student of public or non-profit child and adolescent psychiatric services in metropolitan France and overseas territories (e.g., Guadeloupe); ii) having practiced or currently practising a diagnostic or care activity with minors; and iii) having answered the following demographic and professional questions: gender, age, place of practice, practice structure, number of years of study after high school graduation, affiliation with a university center, and types of disorders most often encountered in practice. No exclusion criteria were applied to the study. Measures The survey was designed by the principal associate investigator (PP) and principal investigator (MMG), and collected quantitative and qualitative data. This study only reported quantitative data. The survey comprised three distinct sections. The first section collected demographic and professional characteristics, the second one collected qualitative content (“What would you define as evidence-based practices?”) and perceived level of training in EBP, frequency of EBP use, and percentage of caseloads managed using EBP. The third section contained the EBPAS-36F. The software did not allow participants to go back and forth between each section to avoid influencing their responses. Indeed, some questions in section two were questioning the definition of EBP, and given the respondents' possible unfamiliarity with the concept of EBP, an accessible definition outlining the concept of EBP was provided before the EBPAS-36F, at the beginning of section three. Demographics, professional characteristics, and training information Data on demographic and professional characteristics were collected in the first two sections of the survey: age, gender, main department of practice, number of years of study after high school graduation, current profession, duration of professional practice, types of disorders most frequently encountered in their practice, type of service where they carry out their main activity, and whether the service is attached to a university center. Participants were also asked to estimate the total number of patients in their caseload, their perceived level of training in EBP, the frequency of EBP use, and the percentage of caseloads managed with EBP. Answers to questions regarding caseload were optional to avoid encouraging incorrect responses from participants because we anticipated that some professionals would not be able to estimate their caseloads exactly. The first two sections were designed to gradually lead the participant to answer the third section, the EBPAS-36F scale, which measures the respondents' level of attitude. EBPAS-36F The EBPAS-36 was translated and adapted to the French language and context. Translation and back-translation from English to French were performed according to the established practices ( 24 ). The translation from English to French was performed by the principal associate investigator (PP), and back-translation was performed by a bilingual English-French collaborator (Barbara Lamothe). The final translation was established by consensus between the two collaborators and the principal investigator (MMG). The translation was submitted to an independent panel of 15 respondents who met the study’s inclusion criteria. The French language version scale of the survey is available in the Supplementary Material (page 1) and the English language version scale is available in the Supplementary Material (page 14). Similar to the original version, participants were asked to rate a set of 36 items, each expressed on a 5-point Likert scale. Item scores ranged from 0 to 4, corresponding to different levels of likelihood or agreement, from 0: “not at all” (agreeing or being likely to) to 4: “strongly” (likely or agreeing to). The EBPAS-36F allows for the measurement of an overall attitude score, which is typically computed as the mean of all subscales. Noteworthily, some subscales (i.e., Divergence, Limitations, Monitoring, Balance, and Burden) had to be reverse-scored before computing the total mean score. The mean total score of the EBPAS ranged from 0 to 4. Higher scores indicated more favorable attitudes. The EBPAS-36F also allows for the study of 12 sub-scores measuring the sub-dimensions of attitude: Appeal (intuitive appeal of EBP); Requirements (the likelihood of adopting EBP if required to do so); Openness (openness to new practices); Divergence (the perceived gap between one’s practice and practices based on research results); Limitations of EBP as perceived by the respondent ; Fit between EBP and the professional’s values ; Monitoring (the negative perceptions of control on the work done by the professional) ; Balance of the importance of clinical skills and science ; Burden (the time and workload necessary to integrate EBPs); Job Security related to mastery and practice of EBP; Organizational Support (the perceived training and support for practising EBP in the organization); and Feedback (the likelihood of appreciating feedback on practices) ( 19 ). Analyses All quantitative analyses were performed using SPSS version 27 and 28 (SPSS Inc., Chicago, IL, USA). Confirmatory factor analysis was performed using the SPSS AMOS software. The significance level was set at p < 0.05 for the entire study. Observations that did not allow the calculation of the EBPAS-36F total score were removed from the final population. The assumption of normality was performed. The characteristics of the population and the overall score, as well as the sub-scores of the EBPAS-36F, were described by their mean and confidence interval or by their frequency and percentages. We examined and tested for scale validation ( 25 ): face validity; content validity; analysis of internal consistency with Cronbach's alpha of the entire EBPAS-36F scale and each of the EBPAS-36F subscales (alpha values above 0.7 are considered acceptable, above 0.8 good, and 0.9 excellent ( 26 )) ; convergent validity analysis by Pearson’s correlation with indicators known to be positively correlated with the level of Attitude; Structural validity by confirmatory factor analysis. The strategy of double presentation of fit indices was used ( 27 ). The condition of multivariate normality was not verified; therefore, higher chi-square values were expected ( 28 ). A multiple linear regression model was used to estimate the influence of the following demographic and professional factors on the global attitude score: sex, age, number of years of study, ambulatory practice, tertiary care activity, and affiliation with a university center. Collinearity diagnosis was performed on all independent variables. RESULTS Population A total of 400 participants completed the first question in our survey. A total of 211 observations were included in our analysis after verifying the inclusion criteria, answering the mandatory questions (all details in the flow chart in the Supplementary Material, p.9), and selecting data for the analysis of the overall attitude score. The characteristics of the study population are presented in Table 1 . The analyzed population of respondents was not significantly different from the non-analyzed population regarding demographic and professional characteristics, except for “affiliation with an academic center” which was significantly more prevalent in the non-analyzed population (Supplementary Material p. 10). Table 1 Characteristics of the Population (N = 211) Age (years)- Mean (95% CI) 39.6 (38.2–41.0) Gender - N (%) Female 166 (78.7%) Male 45 (21.3%) Number of years in initial training - Mean (95% CI) 6.9 (6.4–7.3) Profession - N (%) Medical doctor 73 (34.6%) Nurse 57 (27.0%) Psychologist 35 (16.6%) Occupational therapist, speech therapist and psycho-motor therapist 21 (10%) Medical resident 12 (5.7%) Educator 8 (3.8%) Head nurse 5 (2.4%) Nursing auxiliary et educationnal auxiliary 0 (0%) Non medical residents students 0 (0%) Total duration of work experience - N (%) Has not yet begun 1 (0.5%) Less than 2 years 20 (9.0%) From 2 to 5 years 41 (19.4%) From 5 to 10 years 43 (20.3%) From 10 to 20 years 56 (26.5%) From 20 to 30 years 36 (17.1%) 30 years and more 14 (6.6%) Type of disorders most frequently encountered in practice - N (%) Mood and anxiety disorders 123 (58.3%) Eating disorders 28 (13.3%) Psychotic disorders 74 (35.1%) Neurodevelopmental disorders 144 (68.2%) Practice characteristics - N (%) Ambulatory 169 (80.1%) Terciary care 39 (18.5%) Affilitation with a university center - N (%) 60 (28.4%) N = number; CI confidence interval Validation of the EBPAS36F The face and content validity of the EBPAS-36F were examined and judged satisfactory by both the two principal authors and an independent panel of respondents (15 residents in psychiatry with experience in child and adolescent psychiatry) when the scale translation was tested. Regarding the sample, 39.0% of the 346 eligible respondents did not complete the EBPAS-36F. The overall internal consistency of the French version of the EBPAS-36 was 0.752 (Cronbach's alpha score). Most of the subscales had an alpha coefficient greater than or equal to 0.7, except for the subscales "divergence,” "balance,” "monitoring,” and "appeal, " for which the alpha coefficient was between 0.6 and 0.7. The internal consistency of all subscales is reported in Supplementary Material p.11. For the convergent validity analysis, the mean attitude level was positively and significantly correlated with the estimated frequency of use of EBP-type practices (r = 0.352, p < 0.001), reported level of EBP training (r = 0.121, p = 0.039), and rate of EBP management of the active caseload (r = 0.268, p < 0.001). As part of the structural validity assessment through confirmatory factor analysis, the fit indices of the structural equation model were as follows: significant Chi-square test (χ2 = 964.599, p < 0.001), RMSEA = 0.56, and RMR = 0.105. All standardized factor loadings for the EBPAS-36F between the 36 items and sub-dimensions were between 0.35 and 0.97. The figure in the Supplementary Material (p. 12) represents the confirmatory factor analysis model. Attitude measured with the EBPAS-36F The mean level of attitude in our population was 2.63 (95% CI = 2.57–2.69). The mean scores for each EBPAS-36F subdimension are presented in Table 2 . Table 2 EBPAS36-F Sub-Scales Scores EBPAS36-F dimensions - Mean Score (95% CI) Requirements 1,92 (1.75–2.08) Appeal 3.22 (3.13–3.32) Openneness 2.78 (2.65–2.90) Divergence 1.27 (1.17–1.38) Limitations 1.57 (1.43–1.71) Fit 3.39 (3.31–3.48) Monitoring 0.72 (0.61–0.84) Balance 2.00 (1.88–2.12) Burden 1.03 (0.89–1.16) Job Security 1.36 (1.21–1.51) Organizational Support 2.40 (2.55–2.56) Feedback 3.09 (2.98–3.19) CI: confidence interval Factors Predicting Attitude Level The results of the multiple linear regression analyses are presented in the Supplementary Material (p. 13). Affiliation with a university center (B = 0.152, p = 0.033) and employment in a tertiary care facility (B = 0.145, p = 0.038) were significantly associated with better attitude scores. In contrast, no significant association was observed between attitude scores and age, years of initial training, outpatient practice, and duration of work experience. This model explained 12.9% of the total variance in attitude scores (R²=0.129). DISCUSSION To our knowledge, this study is the first to validate a tool measuring attitudes towards EBP in a French sample of child and adolescent psychiatric professionals. Using the EBPAS-36F scale, we observed a moderate attitude towards evidence-based practice. The study also suggests that practice in a tertiary care facility or in a service affiliated with a university center promotes a more positive attitude. The French version of the EBPAS-36 scale showed good internal consistency, as well as good convergent validity, and as such is a robust measure of attitude in a child and adolescent psychiatric population. The overall internal consistency of the scale was acceptable (α > 0.70). The internal consistency of most of the sub-scales was acceptable (α > 0.70) except for "divergence,” "balance,” "monitoring,” and "appeal, " which nonetheless showed alphas greater than 0.6. Similarly, Norwegian and German studies ( 20 , 21 ) reported weaker alpha coefficient values for these dimensions (except for monitoring) than the current study. Since EBPAS-36 is a short scale, these latter authors emphasized that alpha coefficients between 0.6 and 0.7 did not exclude the use of the subscales ( 20 , 27 ). However, future studies should consider how and why subscale scores and reliability may vary depending on the context. Structural validation of our model by reproducing the original 12-factor model showed borderline fit indices. This may be due to the limited sample size for analyses with so many items ( 24 ). The standardized factor loadings between the EBPAS-36F items and the sub-dimensions of the 12-factor structure were all correct (> 0.5) ( 29 ), except for five of the 36 items (items 4, 7, 19, 23, 36).This may be due to the limited sample size for such analyses ( 24 ) or the non-normality of our data, a common problem in psychometric data ( 30 ). Our sample was characterized by a mean attitude of 2.63, which is similar to (even if slightly inferior) that of another European population evaluated with the same tool (in Norway). Indeed, a mean attitude between 2.67 and 2.78 was found in a population of Norwegian mental health professionals (N = 792, including 671 psychologists and 121 nurses) ( 23 ). Although the EBPAS-36F scale was derived from a 50 items version of the EBPAS ( 19 ) to be user-friendly and shorter to complete, 39% of the 346 eligible respondents did not complete it. This may be due to the design of our study, which used a three-part questionnaire that might have been too long for some respondents to complete. This may also reflect a lack of interest or knowledge of the target population regarding the EBP. Indeed, preliminary results from the qualitative portion of the survey showed that more than a quarter of this population (57 of 211 (27,0%)) could not provide any definition of EBP, illustrating the lack of understanding of the concept that may be a barrier to the adoption of such practices. Respondents may also have responded in a socially desirable manner ( 31 ), avoiding appearing unsupportive of EBP in their daily practice. Among the studied factors, gender was not a determinant of attitude level in our sample. Although most of the available literature shows higher levels of attitude in women ( 20 , 22 ), another study observed no gender differences in attitudes towards EBP ( 32 ). We did not find any significant association between attitude and age, level of initial training, or duration of work experience. Regarding age and level of training, these results contrast with previous studies that linked lower age and higher level of training with higher attitudes ( 20 , 22 ). No previous study has directly evaluated the association between the duration of professional experience and attitudes towards EPB. However, in a sample of German psychotherapists ( 20 ), psychotherapists in training had a higher level of attitude than licensed psychotherapists, suggesting that a shorter duration of professional experience may be associated with a higher level of attitude. Practising in a service affiliated with a university center or practising at least part-time in a tertiary care service was associated with a higher level of attitude. Consistently, among Norwegian psychologists and nurses, non-research clinicians had a lower level of attitude than research clinicians ( 23 ). Tertiary care positioning of providers should, in theory, require greater expertise in a targeted area, often fuelled by training and a service culture supportive of EBP. In addition, professionals dealing with complex situations may be more likely to rely on the literature. Furthermore, a higher attitude in academic or tertiary care services could be explained by a better climate (how the organizational atmosphere and working conditions impact the psychological state of the professionals involved) and organizational culture (set of values and knowledge held by an organization) within these services. Indeed, a positive organizational climate and culture is associated with a favourable attitude at the individual level ( 33 , 34 , 35 ). Interestingly, some interventions can help foster a more positive organizational culture towards EBP, even in services that are not tertiary care- or university-affiliated. In a literature review concerning nurses, a service culture that values EBP (conferences, scientific events) was found to be a facilitator of EBP implementation ( 36 ). Moreover, a pilot study demonstrated that providing EBP training to nursing teams improved the integration of EBP into routine care ( 37 ). Encouraging the training of paramedical health professionals in the research and concept of EBP could improve their attitudes and implementation of such practices. Promoting collaborations between primary and tertiary care services, as well as between university and non-university services, may also lead to a more positive organizational culture of a service or team towards the use of EBP. Such networking could also be improved by the development of mixed positions, including partial activities in tertiary care units. In our study, some of the professionals included in the analysis for this factor worked only part-time in tertiary care. Organizational climate may be regarded as another potential target. A degraded organizational climate may lead to a defensive climate within the unit, characterized by greater rigidity and mistrust, in which the priority of professionals is to protect themselves ( 38 ). Such a climate can hinder the innovation necessary for integrating new practices. The interaction between EBP implementation and a supportive climate may be bidirectional. In a study comparing groups of child welfare professionals (one delivering usual care and the other receiving training to implement EBP), both incentives and training in EBP were found to significantly reduce emotional exhaustion ( 39 ). Eventually, the fit between innovation and professional values is a critical parameter for the effectiveness and sustainability of practice integration ( 40 ). While some of these values can be inferred from organizational culture (depending on the characteristics of the service), it is also possible that the staff's values influence this adjustment at the local and individual levels. Asking professionals about the values central to their care practices may be an important complementary variable in this regard. The interpretation of these results is subject to certain limitations, as follows. Unlike other studies, we aimed to include all types of service professionals (e.g., speech therapists, educators, and nurses). However, most of our respondents were medical doctors, even though nurses outnumbered them in the target population ( 41 ). This may be due to a greater interest in the topic among French medical doctors, whose initial university training tends to be more oriented towards evidence-based practice (EBP). Second, the small sample size (n = 211) of the present study, as well as some of its characteristics that are not representative of the actual distribution in the target population (high average level of education in our sample and distribution of occupations), may explain some of the discrepancies observed in previous studies. Third, our analysis focused on public and non-profit service sectors. Further studies should include professionals in the private for-profit sector, which could yield different results ( 34 , 42 ). Fourth, the cross-sectional design of our study only allowed for the establishment of associations, and not causal relationships, between attitude levels and the factors studied in the linear regression analysis. Future studies are needed to test the impact of specific implementation strategies at the individual level, as well as strategies that include the different factors involved in the implementation. CONCLUSION This is the first study to validate the French version of the EBPAS-36, a tool for measuring attitudes towards EBP in a French sample of child and adolescent psychiatric professionals. Using the EBPAS-36F scale, we reported a moderate attitude in this population. The study also suggests that practice in a tertiary care facility or in a service affiliated with a university center promoted a more positive attitude towards EBP. Our findings suggest that health professionals' awareness of research and the concept of EBP is a strong lever for increasing their individual propensity to adopt evidence-based practices. Specific implementation strategies at the individual level can be supported by developing relevant tools. Strategies considering the professionals’ own values as well as strategies including the systemic factors involved in the implementation might be relevant. One perspective is more frequent networking between university and non-university structures and between specialized and more generalist structures, particularly in training logic. Declarations Ethics approval and consent to participate : This cross-sectional observational online survey study was approved by the Ethics Committee of Claude Bernard Lyon 1 University (IRB 2020-11-17-02) in accordance with the Declaration of Helsinki. All the participants provided informed consent. Consent for publication: Not applicable Availability of data and materials: Data can be shared upon request by contacting the corresponding author. Declaration of competing interest: The authors declare no conflicts of interest related to the subject of this study. Author Contributions: PP and MMG contributed to the conception and design of the study. GB, PP and LJ were responsible for data acquisition and analysis. RR, LJ, and GA contributed to the interpretation of the data. All authors participated in drafting the manuscript. All authors approved the final version of the manuscript and agree to be accountable for their own contributions as well as to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Acknowledgements : The authors would like to thank B. Lamothe for her kind help with the translation and back-translation of the EBPAS-36F. We would also like to thank Dr. M. 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Mental health provider attitudes towards the adoption of evidence-based practice: the Evidence-Based Practice Attitude Scale (EBPAS). Ment Health Serv Res. 2004;6(2):61‑74. Rye M, Torres EM, Friborg O, Skre I, Aarons GA. The Evidence-based Practice Attitude Scale-36 (EBPAS-36): a brief and pragmatic measure of attitudes towards evidence-based practice validated in US and Norwegian samples. Implement Sci. 2017;12(1):44. Szota K, Thielemann JFB, Christiansen H, Rye M, Aarons GA, Barke A. Cross-cultural adaption and psychometric investigation of the German version of the Evidence Based Practice Attitude Scale (EBPAS-36D). Health Res Policy Syst. 2021;19(1):90. Finne J, Malmberg-Heimonen I. Norwegian Social Work and Child Welfare Students’ Attitudes Towards Research-Supported Treatments. J Evid Based Soc Work 2021;18(3):340‑52. Egeland KM, Ruud T, Ogden T, Lindstrøm JC, Heiervang KS. Psychometric properties of the Norwegian version of the Evidence-Based Practice Attitude Scale (EBPAS): Measuring implementation readiness. Health Res Policy Syst. 2016;14(1):47. Rye M, Friborg O, Skre I. Attitudes of mental health providers towards adoption of evidence-based interventions: relationship to workplace, staff roles and social and psychological factors at work. BMC Health Serv Res. 2019;19(1):110. Sousa VD, Rojjanasrirat W. Translation, adaptation, and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline: Validation of instruments or scales. Journal of Evaluation in Clinical Practice. avr 2011;17(2):268‑74. De Vet H, et coll. Measurement in Medicine. Cambridge University Press. 2019. Taber KS. The Use of Cronbach’s Alpha When Developing and Reporting Research Instruments in Science Education. Res Sci Educ. 2018;48(6):1273‑96. Hu L, Bentler PM. Cutoff criteria for fit indices in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal. 1999;6(1):1‑55. Benson J, Fleishman JA. The robustness of maximum likelihood and distribution-free estimators to non-normality in confirmatory factor analysis. Qual Quant. 1994;28(2):117‑36. Hair JF. Multivariate data analysis: a global perspective. 7. ed., global ed. Upper Saddle River, NJ: Pearson; 2010. 800 p. Blanca MJ, Arnau J, López-Montiel D, Bono R, Bendayan R. Skewness and Kurtosis in Real Data Samples. Methodology. 2013;9(2):78‑84. Gnambs T, Kaspar K. Socially Desirable Responding in Web-Based Questionnaires: A Meta-Analytic Review of the Candor Hypothesis. Assessment. 2017;24(6):746‑62. Melas CD, Zampetakis LA, Dimopoulou A, Moustakis V. Evaluating the properties of the Evidence-Based Practice Attitude Scale (EBPAS) in health care. Psychol Assess. 2012;24(4):867‑76. Aarons GA, Sawitzky AC. Organizational Culture and Climate and Mental Health Provider Attitudes Towards Evidence-Based Practice. Psychol Serv. 2006;3(1):61‑72. Aarons GA, Sommerfeld DH, Walrath-Greene CM. Evidence-based practice implementation: the impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice. Implement Sci. 2009;4:83. Powell BJ, Mandell DS, Hadley TR, Rubin RM, Evans AC, Hurford MO, et al. Are general and strategic measures of organizational context and leadership associated with knowledge and attitudes towards evidence-based practices in public behavioral health settings? This was a cross-sectional observational study. Implement Sci. 2017;12(1):64. Li S, Cao M, Zhu X. Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses-systematic review. Medicine (Baltimore). 2019;98(39):e17209. Friesen MA, Brady JM, Milligan R, Christensen P. Findings From a Pilot Study: Bringing Evidence-Based Practice to the Bedside: Bringing EBP to the Bedside. Worldviews on Evidence-Based Nursing. 2017;14(1):22‑34. Glisson C, Dukes D, Green P. The effects of the ARC organizational intervention on caseworker turnover, climate, and culture in children’s service systems. Child Abuse & Neglect. 2006;30(8):855‑80. Aarons GA, Fettes DL, Flores LE, Sommerfeld DH. Evidence-based practice implementation and staff emotional exhaustion in children’s services. Behaviour Research and Therapy. 2009;47(11):954‑60. Klein KJ, Sorra JS. The Challenge of Innovation Implementation. The Academy of Management Review.1996;21(4):1055. Direction de la recherche, des études, de l’évaluation et des statistiques. Démographie des professionnels de santé. France. Mise à jour 2022. https://drees.shinyapps.io/demographie-ps/ De Paúl J, Indias S, Arruabarrena I. Adaptation of the Evidence-Based Practices Attitude Scale in Spanish child welfare professionals. Psicothema. 2015;(27.4):341‑6. Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterialBMC21.08.2025revised04.09.2025.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 28 Nov, 2025 Reviewers agreed at journal 21 Nov, 2025 Reviewers invited by journal 05 Sep, 2025 Editor assigned by journal 05 Sep, 2025 Editor invited by journal 05 Sep, 2025 Submission checks completed at journal 05 Sep, 2025 First submitted to journal 05 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7427023","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":514019746,"identity":"6c6ee4e5-66e8-46b3-8abb-9e466768c922","order_by":0,"name":"Paola Piccolo","email":"","orcid":"","institution":"Centre Hospitalier Le Vinatier","correspondingAuthor":false,"prefix":"","firstName":"Paola","middleName":"","lastName":"Piccolo","suffix":""},{"id":514019747,"identity":"cd331c0e-7899-4c2e-8130-f54d5c7e633f","order_by":1,"name":"Lucie Jurek","email":"","orcid":"","institution":"Centre Hospitalier Le Vinatier","correspondingAuthor":false,"prefix":"","firstName":"Lucie","middleName":"","lastName":"Jurek","suffix":""},{"id":514019748,"identity":"d8a7cdc0-26f9-4c7e-aad0-3423cfcc8de9","order_by":2,"name":"Romain Rey","email":"","orcid":"","institution":"CH le Vinatier","correspondingAuthor":false,"prefix":"","firstName":"Romain","middleName":"","lastName":"Rey","suffix":""},{"id":514019750,"identity":"97ff31a7-d8a9-486c-a0e7-9ae30329849a","order_by":3,"name":"Gaelle Bonnis","email":"","orcid":"","institution":"Centre Hospitalier Le Vinatier","correspondingAuthor":false,"prefix":"","firstName":"Gaelle","middleName":"","lastName":"Bonnis","suffix":""},{"id":514019752,"identity":"db36f147-d9a7-404d-938b-6f9382746993","order_by":4,"name":"Gregory Aarons","email":"","orcid":"","institution":"University of California San Diego","correspondingAuthor":false,"prefix":"","firstName":"Gregory","middleName":"","lastName":"Aarons","suffix":""},{"id":514019753,"identity":"0ef16091-ca90-48d7-8e85-8535beb680bc","order_by":5,"name":"Marie-Maude Geoffray","email":"data:image/png;base64,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","orcid":"","institution":"Centre Hospitalier Le Vinatier","correspondingAuthor":true,"prefix":"","firstName":"Marie-Maude","middleName":"","lastName":"Geoffray","suffix":""}],"badges":[],"createdAt":"2025-08-21 14:08:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7427023/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7427023/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91315756,"identity":"5c4cd80d-16a9-4a15-bccc-cf59278b7466","added_by":"auto","created_at":"2025-09-15 08:15:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":804169,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7427023/v1/b5602f0d-9dc7-4224-ace1-1dec51db4d73.pdf"},{"id":91314255,"identity":"b2a74f4c-098e-4846-b56d-410789edfc17","added_by":"auto","created_at":"2025-09-15 07:59:43","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":325877,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterialBMC21.08.2025revised04.09.2025.docx","url":"https://assets-eu.researchsquare.com/files/rs-7427023/v1/48c2a43c752776f9215c6709.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"French adaptation of the Evidence Based Practice Attitude Scale 36 (EBPAS36-F) and attitudes of French health professionals in child and adolescent psychiatry towards evidence-based practices","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eThe implementation of evidence-based practices (EBP) in routine clinical settings is inadequate for ensuring the delivery of high-quality care. In this study, we define Evidence-Based Practice (EBP) as the conscientious, explicit, and judicious application of the current best evidence in the decision-making process for patient care. This perspective on EBP aims to integrate the best research evidence into a decision-making triangulation with the clinical expertise of the professional and the individual preferences of the patient (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The most recent EBP models also consider the patient's environmental, cultural, and organizational contexts (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Across medical specialties, it takes an average of 17 years to integrate only 14% of the knowledge generated by research into clinical practice (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Despite a large and growing body of literature supporting a diverse set of evidence-based practices, their use remains low in child and adolescent psychiatry (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). This differential may constitute a loss of opportunity, resulting in less effective care in routine practice (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In the field of mental health and child and adolescent psychiatry, implementing EBP is a key element in increasing the quality of early interventions, and thus improving the developmental trajectory of future adults (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Therefore, improving the integration of EBP into routine practice is a major issue in child and adolescent psychiatry.\u003c/p\u003e\u003cp\u003eImplementation research aims to assess facilitators and barriers to the practical use of research knowledge, and the means and strategies to encourage it (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The implementation of EBP depends on many factors that can be divided into barriers and facilitators at different levels of the healthcare system: the individual (practitioner), team (group), organizational, and policy levels (national recommendations, funding). Frameworks such as the Consolidated Framework for Implementation Research (CFIR) and the Exploration, Preparation, Implementation, Sustainment (EPIS) framework consider implementation factors at the level of the characteristics of the intervention, the individual practitioner (for example, attitude towards evidence-based medicine), the internal setting or context (for example, characteristics of the structural and cultural contexts in which the implementation process will take place, the climate and culture of an organization), the external setting or context (the economic, political, and social context including the needs and resources of patients in which an organization is situated), and the implementation process (the process of active change to achieve the use of the intervention as designed at the individual and organizational levels), including movement through the four EPIS phases (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The current challenge is to increase knowledge regarding the factors and test strategies to improve EBP implementation, as highlighted in a recent systematic review of child and adolescent psychiatry (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eVarious implementation models have been used in recent years (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), enabling the identification of processes that facilitate or complicate the sustainable integration of new practices into the usual practice of health professionals. Among them, the EPIS framework developed by Aarons and colleagues (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) has recently been the subject of a systematic literature review, but remains without concrete application in France to date, despite a design that allows for a broad and context-sensitive application (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The EPIS model integrates various quantitatively measurable concepts, corresponding to the dimensions influencing the implementation of practices, including the attitudes of those who may adopt and utilize EBP in the outer system or policy context or within healthcare organizations.\u003c/p\u003e\u003cp\u003eAttitudes are positive or negative dispositions towards adopting and using EBP. They are regarded as individual dimensions involved in different stages of the implementation of a new practice. Attitude level is correlated with the implementation and use of typical EBP practices, sometimes with a higher correlation than organizational characteristics (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). To measure attitude, valid tools are needed, such as the EBPAS (Evidence-Based Practice Attitude Scale) 15 item version which was developed and validated by Aarons (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The 36-item version is the most recent expansion and allows for the quantification of the overall level of attitudes as well as the exploration of its component subdimensions while maintaining brevity, ensuring ease of use for respondents (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Moreover, it was initially designed for use in the public healthcare sector, including pediatric psychiatry, mental health, and child protection services. While its cross-cultural validity has been established in various countries, including Norway, the USA (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), and more recently, Germany (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), it has not yet been established in France.\u003c/p\u003e\u003cp\u003eFactors associated with attitudes can be targeted in interventions aimed at improving them. Studies have previously identified factors associated with more positive attitudes, such as younger age (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), higher level of academic training (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), female gender (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), practising in a specialized setting (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), and being involved in research activity (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, these results may vary across populations and cultures and should be re-evaluated.\u003c/p\u003e\u003cp\u003eThe present study aimed to: i) carry out the psychometric validation of the EBPAS-36F scale in French, ii) measure the level of attitude among professionals in French child and adolescent psychiatry, and iii) study the factors associated with attitude level.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDesign, recruitment and Data Collection\u003c/h2\u003e\u003cp\u003eAll data were collected using an online survey. The survey software used was SelectSurvey.NETv4.075.003. The survey and data were securely hosted on a University of Manchester server. Each child and adolescent psychiatry unit was contacted by telephone by one of the two researchers (PP and GB). The email contacts of a medical manager and paramedical manager (head nurse) or administrative manager (local secretary, general management) were systematically collected and included in a contact list. A link to the survey was then sent to the contact list for distribution to all departments. The email included an information letter outlining the purpose, context, and inclusion criteria of the study, enabling all participants to provide informed consent to participate to the study. All data were automatically anonymized using the software when the survey was launched. Data were collected between 03/01/2021 and 05/31/2021. This study was approved by the Ethics Committee of Claude Bernard Lyon 1 University (IRB 2020-11-17-02).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThe inclusion criteria were as follows: i) being a healthcare professional, educator, or student of public or non-profit child and adolescent psychiatric services in metropolitan France and overseas territories (e.g., Guadeloupe); ii) having practiced or currently practising a diagnostic or care activity with minors; and iii) having answered the following demographic and professional questions: gender, age, place of practice, practice structure, number of years of study after high school graduation, affiliation with a university center, and types of disorders most often encountered in practice.\u003c/p\u003e\u003cp\u003eNo exclusion criteria were applied to the study.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eThe survey was designed by the principal associate investigator (PP) and principal investigator (MMG), and collected quantitative and qualitative data. This study only reported quantitative data.\u003c/p\u003e\u003cp\u003eThe survey comprised three distinct sections. The first section collected demographic and professional characteristics, the second one collected qualitative content (\u0026ldquo;What would you define as evidence-based practices?\u0026rdquo;) and perceived level of training in EBP, frequency of EBP use, and percentage of caseloads managed using EBP. The third section contained the EBPAS-36F. The software did not allow participants to go back and forth between each section to avoid influencing their responses. Indeed, some questions in section two were questioning the definition of EBP, and given the respondents' possible unfamiliarity with the concept of EBP, an accessible definition outlining the concept of EBP was provided before the EBPAS-36F, at the beginning of section three.\u003c/p\u003e\n\u003ch3\u003eDemographics, professional characteristics, and training information\u003c/h3\u003e\n\u003cp\u003eData on demographic and professional characteristics were collected in the first two sections of the survey: age, gender, main department of practice, number of years of study after high school graduation, current profession, duration of professional practice, types of disorders most frequently encountered in their practice, type of service where they carry out their main activity, and whether the service is attached to a university center. Participants were also asked to estimate the total number of patients in their caseload, their perceived level of training in EBP, the frequency of EBP use, and the percentage of caseloads managed with EBP. Answers to questions regarding caseload were optional to avoid encouraging incorrect responses from participants because we anticipated that some professionals would not be able to estimate their caseloads exactly. The first two sections were designed to gradually lead the participant to answer the third section, the EBPAS-36F scale, which measures the respondents' level of attitude.\u003c/p\u003e\n\u003ch3\u003eEBPAS-36F\u003c/h3\u003e\n\u003cp\u003eThe EBPAS-36 was translated and adapted to the French language and context. Translation and back-translation from English to French were performed according to the established practices (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The translation from English to French was performed by the principal associate investigator (PP), and back-translation was performed by a bilingual English-French collaborator (Barbara Lamothe). The final translation was established by consensus between the two collaborators and the principal investigator (MMG). The translation was submitted to an independent panel of 15 respondents who met the study\u0026rsquo;s inclusion criteria. The French language version scale of the survey is available in the Supplementary Material (page 1) and the English language version scale is available in the Supplementary Material (page 14). Similar to the original version, participants were asked to rate a set of 36 items, each expressed on a 5-point Likert scale. Item scores ranged from 0 to 4, corresponding to different levels of likelihood or agreement, from 0: \u0026ldquo;not at all\u0026rdquo; (agreeing or being likely to) to 4: \u0026ldquo;strongly\u0026rdquo; (likely or agreeing to).\u003c/p\u003e\u003cp\u003eThe EBPAS-36F allows for the measurement of an overall attitude score, which is typically computed as the mean of all subscales. Noteworthily, some subscales (i.e., Divergence, Limitations, Monitoring, Balance, and Burden) had to be reverse-scored before computing the total mean score. The mean total score of the EBPAS ranged from 0 to 4. Higher scores indicated more favorable attitudes. The EBPAS-36F also allows for the study of 12 sub-scores measuring the sub-dimensions of attitude: Appeal (intuitive appeal of EBP); Requirements (the likelihood of adopting EBP if required to do so); Openness (openness to new practices); Divergence (the perceived gap between one\u0026rsquo;s practice and practices based on research results); Limitations of EBP as perceived by the respondent ; Fit between EBP and the professional\u0026rsquo;s values ; Monitoring (the negative perceptions of control on the work done by the professional) ; Balance of the importance of clinical skills and science ; Burden (the time and workload necessary to integrate EBPs); Job Security related to mastery and practice of EBP; Organizational Support (the perceived training and support for practising EBP in the organization); and Feedback (the likelihood of appreciating feedback on practices) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eAnalyses\u003c/h2\u003e\u003cp\u003eAll quantitative analyses were performed using SPSS version 27 and 28 (SPSS Inc., Chicago, IL, USA). Confirmatory factor analysis was performed using the SPSS AMOS software. The significance level was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for the entire study. Observations that did not allow the calculation of the EBPAS-36F total score were removed from the final population. The assumption of normality was performed.\u003c/p\u003e\u003cp\u003eThe characteristics of the population and the overall score, as well as the sub-scores of the EBPAS-36F, were described by their mean and confidence interval or by their frequency and percentages.\u003c/p\u003e\u003cp\u003eWe examined and tested for scale validation (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e): face validity; content validity; analysis of internal consistency with Cronbach's alpha of the entire EBPAS-36F scale and each of the EBPAS-36F subscales (alpha values above 0.7 are considered acceptable, above 0.8 good, and 0.9 excellent (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)) ; convergent validity analysis by Pearson\u0026rsquo;s correlation with indicators known to be positively correlated with the level of Attitude; Structural validity by confirmatory factor analysis. The strategy of double presentation of fit indices was used (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The condition of multivariate normality was not verified; therefore, higher chi-square values were expected (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e A multiple linear regression model was used to estimate the influence of the following demographic and professional factors on the global attitude score: sex, age, number of years of study, ambulatory practice, tertiary care activity, and affiliation with a university center. Collinearity diagnosis was performed on all independent variables.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003ePopulation\u003c/h2\u003e\u003cp\u003eA total of 400 participants completed the first question in our survey. A total of 211 observations were included in our analysis after verifying the inclusion criteria, answering the mandatory questions (all details in the flow chart in the Supplementary Material, p.9), and selecting data for the analysis of the overall attitude score. The characteristics of the study population are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The analyzed population of respondents was not significantly different from the non-analyzed population regarding demographic and professional characteristics, except for \u0026ldquo;affiliation with an academic center\u0026rdquo; which was significantly more prevalent in the non-analyzed population (Supplementary Material p. 10).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of the Population\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;211)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)- Mean (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.6 (38.2\u0026ndash;41.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender - N (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e166 (78.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45 (21.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of years in initial training - Mean (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.9 (6.4\u0026ndash;7.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProfession - N (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedical doctor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (34.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57 (27.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychologist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (16.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupational therapist, speech therapist and psycho-motor therapist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (10%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedical resident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (5.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducator\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (3.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHead nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (2.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNursing auxiliary et educationnal auxiliary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon medical residents students\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal duration of work experience\u003c/b\u003e - \u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHas not yet begun\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLess than 2 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (9.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrom 2 to 5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (19.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrom 5 to 10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (20.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrom 10 to 20 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56 (26.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrom 20 to 30 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (17.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30 years and more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (6.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eType of disorders most frequently encountered in practice - N (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMood and anxiety disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e123 (58.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEating disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (13.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychotic disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74 (35.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeurodevelopmental disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e144 (68.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePractice characteristics - N (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmbulatory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e169 (80.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTerciary care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (18.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAffilitation with a university center - N (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60 (28.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eN\u0026thinsp;=\u0026thinsp;number; CI confidence interval\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eValidation of the EBPAS36F\u003c/h2\u003e\u003cp\u003eThe face and content validity of the EBPAS-36F were examined and judged satisfactory by both the two principal authors and an independent panel of respondents (15 residents in psychiatry with experience in child and adolescent psychiatry) when the scale translation was tested. Regarding the sample, 39.0% of the 346 eligible respondents did not complete the EBPAS-36F.\u003c/p\u003e\u003cp\u003eThe overall internal consistency of the French version of the EBPAS-36 was 0.752 (Cronbach's alpha score). Most of the subscales had an alpha coefficient greater than or equal to 0.7, except for the subscales \"divergence,\u0026rdquo; \"balance,\u0026rdquo; \"monitoring,\u0026rdquo; and \"appeal, \" for which the alpha coefficient was between 0.6 and 0.7. The internal consistency of all subscales is reported in Supplementary Material p.11.\u003c/p\u003e\u003cp\u003eFor the convergent validity analysis, the mean attitude level was positively and significantly correlated with the estimated frequency of use of EBP-type practices (r\u0026thinsp;=\u0026thinsp;0.352, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), reported level of EBP training (r\u0026thinsp;=\u0026thinsp;0.121, p\u0026thinsp;=\u0026thinsp;0.039), and rate of EBP management of the active caseload (r\u0026thinsp;=\u0026thinsp;0.268, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eAs part of the structural validity assessment through confirmatory factor analysis, the fit indices of the structural equation model were as follows: significant Chi-square test (χ2\u0026thinsp;=\u0026thinsp;964.599, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), RMSEA\u0026thinsp;=\u0026thinsp;0.56, and RMR\u0026thinsp;=\u0026thinsp;0.105. All standardized factor loadings for the EBPAS-36F between the 36 items and sub-dimensions were between 0.35 and 0.97. The figure in the Supplementary Material (p. 12) represents the confirmatory factor analysis model.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eAttitude measured with the EBPAS-36F\u003c/h2\u003e\u003cp\u003eThe mean level of attitude in our population was 2.63 (95% CI\u0026thinsp;=\u0026thinsp;2.57\u0026ndash;2.69). The mean scores for each EBPAS-36F subdimension are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEBPAS36-F Sub-Scales Scores\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEBPAS36-F dimensions - Mean Score (95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRequirements\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1,92 (1.75\u0026ndash;2.08)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAppeal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.22 (3.13\u0026ndash;3.32)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOpenneness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.78 (2.65\u0026ndash;2.90)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivergence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.27 (1.17\u0026ndash;1.38)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.57 (1.43\u0026ndash;1.71)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.39 (3.31\u0026ndash;3.48)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonitoring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.72 (0.61\u0026ndash;0.84)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBalance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.00 (1.88\u0026ndash;2.12)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBurden\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.03 (0.89\u0026ndash;1.16)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJob Security\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.36 (1.21\u0026ndash;1.51)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOrganizational Support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.40 (2.55\u0026ndash;2.56)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFeedback\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.09 (2.98\u0026ndash;3.19)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCI: confidence interval\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eFactors Predicting Attitude Level\u003c/h2\u003e\u003cp\u003eThe results of the multiple linear regression analyses are presented in the Supplementary Material (p. 13). Affiliation with a university center (B\u0026thinsp;=\u0026thinsp;0.152, p\u0026thinsp;=\u0026thinsp;0.033) and employment in a tertiary care facility (B\u0026thinsp;=\u0026thinsp;0.145, p\u0026thinsp;=\u0026thinsp;0.038) were significantly associated with better attitude scores. In contrast, no significant association was observed between attitude scores and age, years of initial training, outpatient practice, and duration of work experience. This model explained 12.9% of the total variance in attitude scores (R\u0026sup2;=0.129).\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eTo our knowledge, this study is the first to validate a tool measuring attitudes towards EBP in a French sample of child and adolescent psychiatric professionals. Using the EBPAS-36F scale, we observed a moderate attitude towards evidence-based practice. The study also suggests that practice in a tertiary care facility or in a service affiliated with a university center promotes a more positive attitude.\u003c/p\u003e\u003cp\u003eThe French version of the EBPAS-36 scale showed good internal consistency, as well as good convergent validity, and as such is a robust measure of attitude in a child and adolescent psychiatric population. The overall internal consistency of the scale was acceptable (α\u0026thinsp;\u0026gt;\u0026thinsp;0.70). The internal consistency of most of the sub-scales was acceptable (α\u0026thinsp;\u0026gt;\u0026thinsp;0.70) except for \"divergence,\u0026rdquo; \"balance,\u0026rdquo; \"monitoring,\u0026rdquo; and \"appeal, \" which nonetheless showed alphas greater than 0.6. Similarly, Norwegian and German studies (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) reported weaker alpha coefficient values for these dimensions (except for monitoring) than the current study. Since EBPAS-36 is a short scale, these latter authors emphasized that alpha coefficients between 0.6 and 0.7 did not exclude the use of the subscales (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). However, future studies should consider how and why subscale scores and reliability may vary depending on the context.\u003c/p\u003e\u003cp\u003eStructural validation of our model by reproducing the original 12-factor model showed borderline fit indices. This may be due to the limited sample size for analyses with so many items (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The standardized factor loadings between the EBPAS-36F items and the sub-dimensions of the 12-factor structure were all correct (\u0026gt;\u0026thinsp;0.5) (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), except for five of the 36 items (items 4, 7, 19, 23, 36).This may be due to the limited sample size for such analyses (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) or the non-normality of our data, a common problem in psychometric data (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur sample was characterized by a mean attitude of 2.63, which is similar to (even if slightly inferior) that of another European population evaluated with the same tool (in Norway). Indeed, a mean attitude between 2.67 and 2.78 was found in a population of Norwegian mental health professionals (N\u0026thinsp;=\u0026thinsp;792, including 671 psychologists and 121 nurses) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough the EBPAS-36F scale was derived from a 50 items version of the EBPAS (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) to be user-friendly and shorter to complete, 39% of the 346 eligible respondents did not complete it. This may be due to the design of our study, which used a three-part questionnaire that might have been too long for some respondents to complete. This may also reflect a lack of interest or knowledge of the target population regarding the EBP. Indeed, preliminary results from the qualitative portion of the survey showed that more than a quarter of this population (57 of 211 (27,0%)) could not provide any definition of EBP, illustrating the lack of understanding of the concept that may be a barrier to the adoption of such practices. Respondents may also have responded in a socially desirable manner (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), avoiding appearing unsupportive of EBP in their daily practice.\u003c/p\u003e\u003cp\u003eAmong the studied factors, gender was not a determinant of attitude level in our sample. Although most of the available literature shows higher levels of attitude in women (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), another study observed no gender differences in attitudes towards EBP (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). We did not find any significant association between attitude and age, level of initial training, or duration of work experience. Regarding age and level of training, these results contrast with previous studies that linked lower age and higher level of training with higher attitudes (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). No previous study has directly evaluated the association between the duration of professional experience and attitudes towards EPB. However, in a sample of German psychotherapists (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), psychotherapists in training had a higher level of attitude than licensed psychotherapists, suggesting that a shorter duration of professional experience may be associated with a higher level of attitude.\u003c/p\u003e\u003cp\u003ePractising in a service affiliated with a university center or practising at least part-time in a tertiary care service was associated with a higher level of attitude. Consistently, among Norwegian psychologists and nurses, non-research clinicians had a lower level of attitude than research clinicians (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Tertiary care positioning of providers should, in theory, require greater expertise in a targeted area, often fuelled by training and a service culture supportive of EBP. In addition, professionals dealing with complex situations may be more likely to rely on the literature.\u003c/p\u003e\u003cp\u003eFurthermore, a higher attitude in academic or tertiary care services could be explained by a better climate (how the organizational atmosphere and working conditions impact the psychological state of the professionals involved) and organizational culture (set of values and knowledge held by an organization) within these services. Indeed, a positive organizational climate and culture is associated with a favourable attitude at the individual level (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Interestingly, some interventions can help foster a more positive organizational culture towards EBP, even in services that are not tertiary care- or university-affiliated. In a literature review concerning nurses, a service culture that values EBP (conferences, scientific events) was found to be a facilitator of EBP implementation (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Moreover, a pilot study demonstrated that providing EBP training to nursing teams improved the integration of EBP into routine care (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Encouraging the training of paramedical health professionals in the research and concept of EBP could improve their attitudes and implementation of such practices. Promoting collaborations between primary and tertiary care services, as well as between university and non-university services, may also lead to a more positive organizational culture of a service or team towards the use of EBP. Such networking could also be improved by the development of mixed positions, including partial activities in tertiary care units. In our study, some of the professionals included in the analysis for this factor worked only part-time in tertiary care.\u003c/p\u003e\u003cp\u003eOrganizational climate may be regarded as another potential target. A degraded organizational climate may lead to a defensive climate within the unit, characterized by greater rigidity and mistrust, in which the priority of professionals is to protect themselves (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Such a climate can hinder the innovation necessary for integrating new practices. The interaction between EBP implementation and a supportive climate may be bidirectional. In a study comparing groups of child welfare professionals (one delivering usual care and the other receiving training to implement EBP), both incentives and training in EBP were found to significantly reduce emotional exhaustion (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEventually, the fit between innovation and professional values is a critical parameter for the effectiveness and sustainability of practice integration (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). While some of these values can be inferred from organizational culture (depending on the characteristics of the service), it is also possible that the staff's values influence this adjustment at the local and individual levels. Asking professionals about the values central to their care practices may be an important complementary variable in this regard.\u003c/p\u003e\u003cp\u003eThe interpretation of these results is subject to certain limitations, as follows. Unlike other studies, we aimed to include all types of service professionals (e.g., speech therapists, educators, and nurses). However, most of our respondents were medical doctors, even though nurses outnumbered them in the target population (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). This may be due to a greater interest in the topic among French medical doctors, whose initial university training tends to be more oriented towards evidence-based practice (EBP).\u003c/p\u003e\u003cp\u003eSecond, the small sample size (n\u0026thinsp;=\u0026thinsp;211) of the present study, as well as some of its characteristics that are not representative of the actual distribution in the target population (high average level of education in our sample and distribution of occupations), may explain some of the discrepancies observed in previous studies.\u003c/p\u003e\u003cp\u003eThird, our analysis focused on public and non-profit service sectors. Further studies should include professionals in the private for-profit sector, which could yield different results (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFourth, the cross-sectional design of our study only allowed for the establishment of associations, and not causal relationships, between attitude levels and the factors studied in the linear regression analysis. Future studies are needed to test the impact of specific implementation strategies at the individual level, as well as strategies that include the different factors involved in the implementation.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis is the first study to validate the French version of the EBPAS-36, a tool for measuring attitudes towards EBP in a French sample of child and adolescent psychiatric professionals. Using the EBPAS-36F scale, we reported a moderate attitude in this population. The study also suggests that practice in a tertiary care facility or in a service affiliated with a university center promoted a more positive attitude towards EBP. Our findings suggest that health professionals' awareness of research and the concept of EBP is a strong lever for increasing their individual propensity to adopt evidence-based practices. Specific implementation strategies at the individual level can be supported by developing relevant tools. Strategies considering the professionals\u0026rsquo; own values as well as strategies including the systemic factors involved in the implementation might be relevant. One perspective is more frequent networking between university and non-university structures and between specialized and more generalist structures, particularly in training logic.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eEthics approval and consent to participate :\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional observational online survey study was approved by the Ethics Committee of Claude Bernard Lyon 1 University (IRB 2020-11-17-02) in accordance with the Declaration of Helsinki. All the participants provided informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eConsent for publication:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAvailability of data and materials:\u0026nbsp;\u003c/u\u003e\u003c/strong\u003eData can be shared upon request by contacting the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eDeclaration of competing interest:\u003c/u\u003e\u003c/strong\u003e The authors declare no conflicts of interest related to the subject of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAuthor Contributions:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePP and MMG contributed to the conception and design of the study. GB, PP and LJ were responsible for data acquisition and analysis. RR, LJ, and GA contributed to the interpretation of the data. All authors participated in drafting the manuscript. All authors approved the final version of the manuscript and agree to be accountable for their own contributions as well as to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAcknowledgements\u003c/u\u003e\u003c/strong\u003e: The authors would like to thank B. Lamothe for her kind help with the translation and back-translation of the EBPAS-36F. We would also like to thank Dr. M. Nourredine for his advice on the statistical aspects of this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eFunding\u003c/u\u003e\u003c/strong\u003e: This work was supported by grants from the Scientific Committee of the Center Hospitalier Le Vinatier.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eSupplementary Material\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003cu\u003ei\u003c/u\u003encluding EBPAS-36F (French version of the EBPAS-36 scale) (p. 1) \u0026nbsp;inclusion and selection process p.9; eligible and analyzed population characteristics p.10; internal consistency of EBPAS36-F subscales p.11, the confirmatory factor analysis model p.12; multiple linear regression model p.13.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGuyatt G. Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. 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Feuille de route sant\u0026eacute; mentale et psychiatrie. Site du minist\u0026egrave;re des Solidarit\u0026eacute;s et de la sant\u0026eacute; fran\u0026ccedil;ais. 2018 .31 pages. https://solidarites-sante.gouv.fr/IMG/pdf/180628_-_dossier_de_presse_-_comite_strategie_sante_mentale.pdf\u003c/li\u003e\n\u003cli\u003eLomas J. Diffusion, Dissemination, and Implementation: Who Should Do What? Ann NY Acad Sci. 1993;703(1 Doing More Go):226‑37.\u003c/li\u003e\n\u003cli\u003eAarons GA, Hurlburt M, Horwitz SM. Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public-Service Sectors. Adm Policy Ment Health. 2011;38(1):4‑23.\u003c/li\u003e\n\u003cli\u003eMoullin JC, Dickson KS, Stadnick NA, Rabin B, Aarons GA. Systematic review of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Implementation Sci. 2019;14(1):1.\u003c/li\u003e\n\u003cli\u003eWilliams NJ, Beidas RS. 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The effects of the ARC organizational intervention on caseworker turnover, climate, and culture in children\u0026rsquo;s service systems. Child Abuse \u0026amp; Neglect. 2006;30(8):855‑80.\u003c/li\u003e\n\u003cli\u003eAarons GA, Fettes DL, Flores LE, Sommerfeld DH. Evidence-based practice implementation and staff emotional exhaustion in children\u0026rsquo;s services. Behaviour Research and Therapy. 2009;47(11):954‑60.\u003c/li\u003e\n\u003cli\u003eKlein KJ, Sorra JS. The Challenge of Innovation Implementation. The Academy of Management Review.1996;21(4):1055.\u003c/li\u003e\n\u003cli\u003eDirection de la recherche, des \u0026eacute;tudes, de l\u0026rsquo;\u0026eacute;valuation et des statistiques. D\u0026eacute;mographie des professionnels de sant\u0026eacute;. France. Mise \u0026agrave; jour 2022. https://drees.shinyapps.io/demographie-ps/\u003c/li\u003e\n\u003cli\u003eDe Pa\u0026uacute;l J, Indias S, Arruabarrena I. Adaptation of the Evidence-Based Practices Attitude Scale in Spanish child welfare professionals. Psicothema. 2015;(27.4):341‑6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Child and adolescent psychiatry, Implementation, Attitudes, Evidence-based practices, France","lastPublishedDoi":"10.21203/rs.3.rs-7427023/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7427023/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe enhancement of evidence-based practice (EBP) implementation is essential within healthcare systems. The attitudes of practitioners towards EBP can significantly influence the adoption of these practices. This study sought to validate the French version of the Evidence-Based Practice Attitudes Scale 36 (EBPAS-36F), assess the attitudes towards EBP among professionals in child and adolescent psychiatry in France, and examine the factors potentially associated with these attitudes in this context.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional observational study was conducted. Data were gathered through an online survey distributed to medical, paramedical, and educational professionals and students engaged in diagnostic or care activities in child and adolescent psychiatry in France. The study utilized a French-language version of the EBPAS-36 scale, which underwent translation and back-translation. Population and attitude characteristics were described, and validation tests of the EBPAS-36F were performed. A multiple linear regression model was employed to assess the association between attitudes and various individual and organizational factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 400 professionals responded to at least one question, with 211 respondents completing all items of the questionnaire and thus being included in the analysis. The face, content, and convergent validity, as well as the internal consistency of the EBPAS-36F, were found to be satisfactory. The mean attitude level in the study population was 2.63 (95% CI\u0026thinsp;=\u0026thinsp;2.57\u0026ndash;2.69). Two factors were significantly associated with attitude level: affiliation with a university center and employment in a tertiary care facility.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis study is the first to validate the French version of the Evidence-Based Practice Attitude Scale (EBPAS-36F). The attitude towards evidence-based practices in child and adolescent psychiatry in France was consistent with those in other European countries. These findings will enable the development of targeted strategies to improve EBP implementation in mental health services in France.\u003c/p\u003e","manuscriptTitle":"French adaptation of the Evidence Based Practice Attitude Scale 36 (EBPAS36-F) and attitudes of French health professionals in child and adolescent psychiatry towards evidence-based practices","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-15 07:59:38","doi":"10.21203/rs.3.rs-7427023/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-28T08:34:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"35129905162053696498151081782899628766","date":"2025-11-21T14:33:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-05T16:23:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-05T15:36:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-05T13:50:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-05T10:27:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-09-05T10:19:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"357d2615-89f4-4482-b88e-a46f755c7977","owner":[],"postedDate":"September 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-15T07:59:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-15 07:59:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7427023","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7427023","identity":"rs-7427023","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}