A Comprehensive Review of Tools Assessing Evidence-Based Practice Among Nurses

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Edirisinghe, Nirmala Rathnayake This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8388281/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Evidence-Based Practice (EBP) is a cornerstone of high-quality nursing care, integrating research evidence, clinical expertise, and patient preferences. Despite its recognized benefits, challenges such as limited access to resources, organizational barriers, and cultural differences hinder its consistent implementation. Measuring EBP competencies among nurses is essential for identifying gaps and enhancing practice; however, existing instruments vary in their validity, reliability, and contextual applicability. This review aimed to identify and analyze the range of available instruments, evaluate their psychometric properties, and explore the extent to which they capture context-specific challenges and cultural nuances. Methodology: A scoping review was conducted in May 2025, searching PubMed and CINAHL databases for studies published between 2000 and 2025. Keywords included "Evidence-based practice questionnaire," "Nursing," “Health care”, "Psychometric Properties", “Validity”, “Reliability,” and “Barriers.” Inclusion criteria focused on studies involving nurses, student nurses, or health professionals, quantitative methodologies, and instruments with reported validity or reliability. Out of 285 initially identified articles, 24 met the eligibility criteria. Results: Twelve distinct EBP measurement tools were identified, with most demonstrating strong internal consistency (Cronbach’s α: 0.69–0.984). The Evidence-Based Practice Questionnaire (EBPQ) and its adaptations (e.g., Indonesian, Chinese versions) were widely used, though some subscales, such as attitudes, showed lower reliability. Instruments like the Evidence-Based Practice Competence Questionnaire of Registered Nurses (EBP-COQ-Prof©) and EBP Beliefs Scale measured multidimensional constructs, including knowledge, skills, and organizational readiness. Key limitations of the tools included reliance on self-reported data, lack of performance-based indicators, and insufficient adaptation for low-resource or culturally diverse settings. Conclusion: While existing EBP instruments exhibit robust psychometric properties, their applicability is often constrained by cultural, contextual, and methodological limitations. The review emphasizes the need for a tailored, context-specific tool that addresses organizational readiness, cultural relevance, and longitudinal validity to better support EBP implementation in nursing practice globally. Future research should prioritize developing such instruments to bridge existing gaps and enhance EBP adoption. Evidence-Based Practice Nursing Measurement instruments Psychometric properties Barriers Scoping review Figures Figure 1 Introduction Evidence-Based Practice (EBP) is a systematic approach to clinical decision-making that integrates the best available research evidence, clinical expertise, and patient preferences to deliver high-quality, patient-centered care [ 1 ]. The key concepts of evidence-based practice include the systematic search for evidence, critical appraisal of the evidence, and the implementation of results into clinical practice while incorporating patient values and preferences [ 2 ]. The EBP process involves five key steps: formulating clinical questions using frameworks like PICO (P- Population, I – Intervention, C – Comparison, O – Outcome), searching for the best available evidence, critically appraising its validity and relevance, applying it to practice while considering patient preferences, and evaluating outcomes to determine improvements in patient care [ 3 , 4 ]. EBP is vital in nursing practice because it improves patient outcomes by ensuring that therapies are based on established methodologies, lowering medical mistakes, and increasing recovery rates. It also improves overall treatment quality by standardizing effective therapies while still allowing for patient-specific customization. Furthermore, EBP lowers healthcare expenditures by removing ineffective or needless operations. It promotes lifelong learning for nurses, keeping them up to date on the newest research and best practices. Moreover, EBP promotes informed decision-making by integrating scientific evidence, clinical judgment, and patient feedback [ 5 ]. Adopting EBP allows nurses to provide safer, more efficient, and patient-centered care, eventually enhancing the nursing profession and improving healthcare delivery. Measuring EBP among nurses is critical for various reasons. It mainly identifies knowledge and application gaps, allowing healthcare organizations to create tailored training programs [ 5 ]. Further, evaluating EBP competencies assures that nurses deliver high-quality, safe, and effective patient care [ 4 ]. According to the literature, despite the acknowledged benefits of EBP, many nurses experience challenges such as a lack of time, restricted access to research, and insufficient training. Measuring EBP involvement assists firms in meeting these issues by encouraging a culture of continuous learning and improvement [ 6 ]. The adoption of EBP can vary greatly among healthcare systems and cultural settings. Cultural factors such as patient preferences and values influence the use of EBP. Additionally, organizational and systemic issues within healthcare systems can have an impact on the success of EBP implementation [ 7 ]. Among the barriers to the adoption of EPB include cultural issues; patients' interests and values must be considered to achieve culturally sensitive and patient-centered care. For example, in some cultures, patients may prefer traditional healing techniques over evidence-based interventions, which must be acknowledged and integrated into care decisions [ 7 ]. The success of EBP implementation can be significantly impacted by organizational and structural elements, including the presence of EBP supporters, resource availability, and leadership support. Healthcare organizations that prioritize EBP and provide the required resources and assistance are more likely to succeed with implementation [ 7 ]. The assessment of EBP among nurses poses major challenges, owing to EBP's complexity as a multidimensional construct that includes knowledge, attitudes, skills, and behaviours. This complexity needs a comprehensive assessment framework, as EBP entails merging scientific knowledge with clinical expertise and patient values, necessitating the consideration of multiple dimensions when evaluating EBP [ 8 ]. While the availability of 55 different implementation outcome instruments, including widely used tools like the Evidence-Based Practice Attitude Scale (EBPAS) and the Evidence-Based Practice Questionnaire (EBPQ), offers a diverse set of metrics for assessing EBP implementation, this diversity also presents several limitations [ 8 ]. The proliferation of tools can lead to inconsistency in measurement across studies, making it difficult to compare findings or synthesize data through meta-analyses. Each tool may focus on distinct constructs (e.g., attitudes, knowledge, organizational readiness) with varying psychometric robustness, contributing to confusion over which instrument is most appropriate for a given context [ 9 , 10 ]. Many of these tools have been developed and validated primarily in Western, high-income settings, which may not translate well to low- and middle-income countries or culturally diverse populations. Cultural norms, professional hierarchies, and health system structures can significantly influence how EBP is perceived and implemented. Therefore, tools that do not account for these factors risk generating biased or incomplete data. Furthermore, contextual barriers such as limited resources, resistance to change, lack of training, and language differences vary widely between settings and may not be adequately captured by standardized instruments [ 11 ]. As a result, without cultural adaptation and contextual validation, the use of multiple EBP tools may hinder rather than facilitate the accurate evaluation and advancement of EBP across diverse health care environments. Given the wide array of existing instruments used to evaluate EBP, there is a pressing need to critically examine their utility, validity, and reliability. The proliferation of these tools, while offering variety, has led to inconsistencies in application and interpretation across settings. Moreover, many of these instruments were developed in specific cultural and healthcare contexts, raising concerns about their generalizability to diverse populations and low-resource environments. Contextual and cultural variations can significantly influence attitudes, behaviors, and barriers related to EBP, yet these factors are often underrepresented or overlooked in existing tools. Therefore, a comprehensive review is warranted to identify and analyze the range of available instruments, evaluate their psychometric properties, and explore the extent to which they capture context-specific challenges and cultural nuances. This review seeks to address these gaps and support the selection and adaptation of appropriate tools for more effective EBP implementation across different healthcare settings. Methods The scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) [ 12 ] guidelines in May 2025. A comprehensive search was conducted across two databases, PubMed and CINAHL, to identify all relevant publications on the topic. Further, the most relevant publications were added manually. The search used the terms “Evidence-based practice questionnaire” AND “Evidence-based practice” AND “Nurses” OR “Nursing Students” OR” Healthcare Professionals” AND “Psychometric properties” OR “Validity” AND “Reliability” AND “Barriers.” The review included only the studies published in English-language articles derived from original studies, reviews, books, and published guidelines from 2000 to 2024. Inclusion criteria Studies were included if they: 1) recruited nurses/student nurses/health professionals as participants, 2) aimed to measure the EBP knowledge, attitudes, practices/skills, competencies, and barriers of participants 3) presented results with validity or reliability test scores. Exclusion criteria Articles were excluded if they 1) duplicated publication, 2) were full-text articles that could not be accessed, 3) did not mention the details of the participants, 4) did not report results of each study variable, and 5) publications that did not meet the specified criteria. Data Extraction and Analysis Three independent reviewers were involved in the review process. Initially, all titles and abstracts were screened for relevance by two reviewers independently, and discrepancies were resolved through discussion and by involving the third reviewer. Full-text articles of the eligible studies were then retrieved and assessed based on predefined inclusion and exclusion criteria. Data were extracted using a structured format that included Instrument name Author(s) and year of publication Target population Country/setting of use EBP domains measured (e.g., knowledge, skills, attitudes, practice) Number of items and response format Reported psychometric properties (e.g., content validity, construct validity, internal consistency, test–retest reliability, etc.) Regular team meetings were held to ensure consistency, resolve conflicts, and maintain methodological rigor throughout the review process. The extracted data were tabulated and compared to assess the comprehensiveness, strengths, and limitations of each tool. Instruments were also evaluated for their suitability in clinical, academic, or low-resource settings. The process of extraction is shown in Fig. 1 . The quality of the selected papers was assessed by using the Critical Appraisal Skill Programme (CASP) checklist [ 13 ]. Results Search Outcomes In the initial search, 285 articles were found using the keywords. The inclusion and exclusion criteria were examined after the title, abstract, and full text were examined. As seen in Fig. 1 , a total of 24 papers were considered appropriate for review, and 12 articles were chosen for analysis of their psychometric qualities. Study characteristics Twelve distinct EBP instruments were retrieved in the twenty-four publications that made up the review. All instruments except one were self-report and required participants to rate their perceived level of knowledge, skills, and/or attitudes towards EBP and related factors. Participants were mainly practice nurses Measurement properties and validity of instruments The summary table (Table 1) presents 12 instruments used to measure EBP among nurses, spanning studies from 2000 to 2024. These instruments assess various dimensions of EBP, including knowledge, attitudes, skills, practices, and organizational readiness, using Likert-scale questions (typically 1–5). The widely used EBPQ, specifically to measure knowledge, attitude, and practices/skills of health care professionals, has been translated and validated for several languages [7, 15, 16, 17]. Further, the EBPQ has been modified by adding or removing items to match the specific contexts or profiles of participants [7, 15]. Broadly, these tools can be categorized into two types: self-report instruments and performance-based assessments. The review identified several multidimensional instruments used to assess EBP implementation among nurses. The EBP-COQ-Prof© [14] evaluated four key domains: attitudes, knowledge, skills, and utilization of EBP. Similarly, the EBP Beliefs Scale [18, 19] focused on beliefs, implementation, and the organizational culture surrounding EBP. Several instruments assessed knowledge, attitude, and practices towards EBP, while others captured a broader range of constructs such as relevance, sympathy, terminology, confidence, [20, 21] openness, divergence, appeal, requirements [22], barriers, training needs for EBP implementation, information sources, and information literacy [23]. With relevance to the applicable settings of instruments, educational settings commonly use S-EBPQ [7], and Evidence-Based Practice Competence Questionnaire (EBP-COQ) [16] to assess nursing students' competence, while others use them in clinical settings. Most instruments demonstrated strong internal consistency, with Cronbach’s alpha (α) values ranging from 0.69 to 0.984. For example, the EBP-COQ-Prof© [25] reported α = 0.888–0.948 for its subscales, while the EBPQ-Indonesian version [15] achieved α = 0.956 overall. However, some subscales, such as attitudes in the S-EBPQ-Chinese version [7], had lower reliability (α = 0.699). Collectively, these instruments encompass a wide array of variables related to EBP, including individual beliefs and attitudes, knowledge and skills, perceived barriers and facilitators, organizational culture, and the need for training. These factors are essential for a comprehensive understanding of EBP implementation among nursing professionals. Discussion This review reveals that numerous tools have been developed to measure EBP, each with unique strengths and limitations, while some report self-reported outcomes and some report performance-based outcomes. Among self-report instruments, the EBPQ, developed by Upton and Upton (2006), remains one of the most widely used and validated tools worldwide. Its internal consistency (α = 0.87) and availability in multiple language versions, including Indonesian (α = 0.956) [ 15 ] and Japanese (α = 0.90) [ 17 ], reflect its broad applicability. However, issues related to cultural interpretation and small sample sizes limit generalizability in some contexts. Moreover, the inherent limitations of self-reporting, such as social desirability and recall bias, undermine its ability to accurately capture actual clinical behaviour. The EBP2, validated in both Persian [ 20 ] and Australian [ 21 ] settings, offers comprehensive domain coverage with six subscales and excellent internal consistency (α > 0.96). Despite its psychometric strength, the tool’s length and cultural specificity may restrict its use in fast-paced or globally diverse clinical environments. Similarly, the Quick-EBP-VIK [ 24 ] evaluates values, knowledge, and implementation (α range: 0.66–0.84), while an instrument [ 23 ] focuses on training needs and information literacy with high internal consistency (α = 0.681–0.954). These instruments extend the measurement landscape by addressing both perceptual and structural barriers to EBP implementation. Another commonly used set of tools [ 18 , 19 ] includes the EBP Beliefs Scale, EBP Implementation Scale, and the Organizational Culture and Readiness Scale. These are concise, practical (three items per subscale), and suitable for routine clinical use, showing acceptable psychometric thresholds (α > 0.80). However, their brevity may compromise the depth of assessment and sensitivity to contextual variations. The EBP-COQ [ 16 ] and EBP-COQ-Prof© [ 14 ] developed for student and professional nurse populations, also show strong psychometric properties (α = 0.756–0.948), particularly in evaluating EBP utilization. In contrast to these self-report tools, the Fresno Test [ 25 ] stands out as a performance-based instrument that evaluates actual EBP competency through open-ended, scenario-based questions. With high inter-rater reliability (α = 0.88), it is particularly valuable for assessing critical thinking and applied skills. However, the tool's time-intensive nature and the requirement for trained evaluators limit its feasibility for widespread implementation. While the reviewed instruments vary in structure and content, some focusing on implementation, others on knowledge or organizational factors, most exhibit high internal consistency (typically α > 0.80). This reflects the overall psychometric soundness of available tools. Nevertheless, significant gaps remain. Few instruments comprehensively assess all five steps of EBP, particularly critical appraisal and outcome evaluation. Most rely heavily on self-reported data, which captures perceived rather than actual practice, thus weakening the ecological validity of the findings. Moreover, only a limited number of tools have been validated for use in Low- and Middle-Income Countries (LMICs) or in culturally diverse nursing populations, limiting their global relevance. Each existing instrument for evaluating EBP among nurses possesses its own unique advantages and limitations, with varying strengths across different domains such as knowledge, attitudes, and implementation barriers. Given this variability, a single tool cannot be considered a gold standard for comprehensive EBP assessment. To address this, a multi-method approach is recommended integrating self-report questionnaires with performance-based assessments to effectively capture both the cognitive and behavioural aspects of EBP. Such a strategy would provide a more accurate, context-sensitive, and holistic understanding of EBP competency, bridging the gap between theoretical knowledge and real-world clinical application. Conclusion This review identified wide range of EBP assessment tools mainly with self-reported and performance-based outcomes. many instruments, such as the EBPQ, EBP2, EBP-COQ, and Fresno Test own significant psychometric qualities and domain coverage, the majority were designed in high-resource environments and for specific cultural or professional contexts. A common limitation among instruments is their reliance on self-reporting and limited applicability in diverse healthcare systems with distinct structural and cultural constraints. Critically, none of the available techniques have been specially created or validated for LMICs like Sri Lanka. Many instruments necessitate extensive time, infrastructure, or language adaptation, rendering them unsuitable in settings where nurses frequently confront high patient loads, limited access to EBP resources, and no institutional support for research engagement. Given these shortcomings, there is an urgent need to create a new, shorter, user-friendly tools that maintain psychometric robustness and a context-sensitive instrument for assessing EBP among nurses in resource-limited settings such as Sri Lanka. Creating such a tool would not only improve the assessment of EBP competency but it would also assist targeted interventions to strengthen nursing practice and improve patient outcomes in resource-limited settings. Abbreviations EBP - Evidence-Based Practice EBPQ - evidence-based practice questionnaire EBP-COQ-Prof© - Evidence-Based Practice Competence Questionnaire of Registered Nurses EBP-COQ -Evidence-Based Practice Competence Questionnaire LMIC - Low- and Middle-Income Countries PRISMA- Preferred Reporting Items for Systematic Reviews and Meta-Analyses Declarations Acknowledgements The authors acknowledge that all aspects of the study, including study design, data collection, analysis, and manuscript preparation, were carried out solely by the authors, and no additional individuals or institutions contributed to this work. Author contributions Chandrani Herath - Conceptualization, Methodology, Formal analysis, Writing original draft preparation Nirosha P. Edirisinghe - Conceptualization, Methodology, Supervision, Writing- Reviewing and Editing Nirmala Rathnayake -Conceptualization, Methodology, Supervision, Writing- Reviewing and Editing All authors have read and approved the final version of the manuscript. Funding This study received no external funding Data availability Not applicable. This review is based on previously published studies, all of which are cited in the references section. No new data was generated or analyzed during this study. Ethics approval and consent to participate Not applicable. This study is a comprehensive review of previously published literature and does not involve human participants or personal data. Consent for publication Not applicable. This manuscript does not contain any individual person’s data in any form (including images, videos, or clinical details). AI-assisted technologies The authors declare that no generative AI or AI-assisted technologies were used in the data collection or analysis. Only language editing support with AI-based tools was applied during manuscript preparation, under full author supervision and responsibility. Competing interests The authors declare no competing interests. References Melnyk BM, Fineout-Overholt E. Evidence-based practice in nursing & healthcare: A guide to best practice. 4th ed. Philadelphia: Wolters Kluwer; 2019. Dusin J, Melanson A, Mische-Lawson L. Evidence-based practice models and frameworks in the healthcare setting: a scoping review. BMJ Open. 2023;13(5):1–9. Naz H, Ganaie NA. Evidence-based practice in nursing: a comprehensive review. Clin Med Health Res J . 2023;3(6):713–5. Available from: https://www.cmhrj.com/index.php/cmhrj/article/view/254 Stevens KR. The impact of evidence-based practice in nursing and the next big ideas. Online J Issues Nurs. 2013;18(2):4. Saunders H, Vehviläinen-Julkunen K. Nurses’ evidence-based practice beliefs and the role of evidence-based practice mentors at university hospitals in Finland. Worldviews Evid Based Nurs. 2017;14(1):35–45. Melnyk BM, Fineout-Overholt E, Gallagher-Ford L, Kaplan L. The state of evidence-based practice in US nurses: critical implications for nurse leaders and educators. J Nurs Adm. 2012;42(9):410–7. Zhang YP, Liu L, Wang Y, Li YF, Wang J. Developing student evidence-based practice questionnaire (S-EBPQ) for undergraduate nursing students: reliability and validity of a Chinese adaptation. J Eval Clin Pract. 2019;25(4):536–42. Hoegen P, Scholten-Peeters GGM, Reinders-Messelink HA, et al. Measuring self-efficacy and outcome expectancy in evidence-based practice: a systematic review on psychometric properties. Int J Nurs Stud Adv. 2021;3:100024. 10.1016/j.ijnsa.2021.100024 . Saunders H, Vehviläinen-Julkunen K. Key considerations for selecting instruments when evaluating healthcare professionals’ evidence-based practice competencies: a discussion paper. J Adv Nurs . 2018;74(10):2301–11. 10.1111/jan.13802 Leung K, Trevena L, Waters D. Systematic review of instruments for measuring nurses' knowledge, skills and attitudes for evidence-based practice. J Adv Nurs. 2014;70(10):2181–95. Halm M. A compendium of evidence-based practice instruments for nursing education, practice and research. Worldviews Evid Based Nurs. 2024;21(1):6–13. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73. 10.7326/M18-0850 . Singh J. Critical appraisal skills programme. J Pharmacol Pharmacother. 2013;4:76–7. Ramos-Morcillo AJ, Fernández-Sola C, Huércanos-Esparza I, et al. Evidence-based practice nurses’ competency: Spanish national survey and establishment of a scale of the EBP-COQ-Prof©. J Nurs Manag. 2021;29(4):794–804. Fajarini M, Rahayu S, Setiawan A. Translating, adapting and testing the Indonesian version of the Evidence-based Practice Questionnaire (EBPQ). Unpublished manuscript; 2018. Ruzafa-Martinez M, Lopez-Iborra L, Barranco DA et al. Development and validation of the competence in evidence-based practice questionnaire (EBP-COQ) among nursing students. BMC Med Educ. 2013;13(1). Tomotaki A, Fukahori H, Sakai I, et al. The development and validation of the evidence-based practice questionnaire: Japanese version. Int J Nurs Pract. 2018;24(2):e12617. Melnyk BM, Gallagher-Ford L, Long LE, Fineout-Overholt E. Psychometric properties of the short versions of the EBP beliefs scale, the EBP implementation scale, and the EBP organizational culture and readiness scale. Worldviews Evid Based Nurs. 2021;18(4):243–50. 10.1111/wvn.12525 . Melnyk BM, Fineout-Overholt E, Mays MZ. The evidence-based practice beliefs and implementation scales: psychometric properties of two new instruments. Worldviews Evid Based Nurs. 2008;5(4):208–16. 10.1111/j.1741-6787.2008.00126.x . Elahifar R, Pourrahmat MM, Khodadadi E, et al. The validity and reliability properties of a Persian version of the evidence-based practice profile (EBP2) questionnaire among Iranian students of health-related fields. BMC Med Educ. 2024;24(1):1143. McEvoy MP, Williams MT, Olds TS. Development and psychometric testing of a trans-professional evidence-based practice profile questionnaire. Med Teach. 2010;32(9):e373–80. 10.3109/0142159X.2010.494741 . Maessen K, Scholten-Peeters GGM, Reinders-Messelink HA, et al. Development and validation of the Dutch EBPas-ve and EBPQ-ve for nursing assistants and nurses with a vocational education. Worldviews Evid Based Nurs. 2019;16(5):371–80. Majid S, Foo S, Luyt B, et al. Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. J Med Libr Assoc. 2011;99(3):229–36. 10.3163/1536-5050.99.3.010 . Connor L, McMillan D, Tufanaru C, et al. Measuring nurses’ value, implementation, and knowledge of evidence-based practice: further psychometric testing of the Quick-EBP-VIK survey. Worldviews Evid Based Nurs. 2017;14(1):10–21. 10.1111/wvn.12190 . Ramos KD, Schafer S, Tracz SM. Validation of the Fresno test of competence in evidence-based medicine. BMJ. 2003;326(7384):319–21. 10.1136/bmj.326.7384.319 . Table Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Cite Share Download PDF Status: Posted Version 1 posted 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. 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06:52:23","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103266,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8388281/v1/1e4860f290e2f5d8da2c30ae.html"},{"id":100854431,"identity":"47322a38-ba2c-49e6-821e-66495ac57ca4","added_by":"auto","created_at":"2026-01-22 06:52:22","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":72142,"visible":true,"origin":"","legend":"\u003cp\u003eSearch and Selection of Eligible Studies\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8388281/v1/523158f0df7be6b3e2555702.jpg"},{"id":103919625,"identity":"5e632b98-9626-40a1-b48d-7d015124cea3","added_by":"auto","created_at":"2026-03-04 13:57:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":588323,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8388281/v1/aeace72b-9066-48d5-b1ae-6ec6d7b008d0.pdf"},{"id":100854442,"identity":"645a6c04-3c14-48d9-95cf-1aed21a12380","added_by":"auto","created_at":"2026-01-22 06:52:23","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":25651,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8388281/v1/e0e3d3637ead0b0fbc9fa945.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Comprehensive Review of Tools Assessing Evidence-Based Practice Among Nurses","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEvidence-Based Practice (EBP) is a systematic approach to clinical decision-making that integrates the best available research evidence, clinical expertise, and patient preferences to deliver high-quality, patient-centered care [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The key concepts of evidence-based practice include the systematic search for evidence, critical appraisal of the evidence, and the implementation of results into clinical practice while incorporating patient values and preferences [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe EBP process involves five key steps: formulating clinical questions using frameworks like PICO (P- Population, I \u0026ndash; Intervention, C \u0026ndash; Comparison, O \u0026ndash; Outcome), searching for the best available evidence, critically appraising its validity and relevance, applying it to practice while considering patient preferences, and evaluating outcomes to determine improvements in patient care [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEBP is vital in nursing practice because it improves patient outcomes by ensuring that therapies are based on established methodologies, lowering medical mistakes, and increasing recovery rates. It also improves overall treatment quality by standardizing effective therapies while still allowing for patient-specific customization. Furthermore, EBP lowers healthcare expenditures by removing ineffective or needless operations. It promotes lifelong learning for nurses, keeping them up to date on the newest research and best practices. Moreover, EBP promotes informed decision-making by integrating scientific evidence, clinical judgment, and patient feedback [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Adopting EBP allows nurses to provide safer, more efficient, and patient-centered care, eventually enhancing the nursing profession and improving healthcare delivery.\u003c/p\u003e \u003cp\u003eMeasuring EBP among nurses is critical for various reasons. It mainly identifies knowledge and application gaps, allowing healthcare organizations to create tailored training programs [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Further, evaluating EBP competencies assures that nurses deliver high-quality, safe, and effective patient care [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the literature, despite the acknowledged benefits of EBP, many nurses experience challenges such as a lack of time, restricted access to research, and insufficient training. Measuring EBP involvement assists firms in meeting these issues by encouraging a culture of continuous learning and improvement [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe adoption of EBP can vary greatly among healthcare systems and cultural settings. Cultural factors such as patient preferences and values influence the use of EBP. Additionally, organizational and systemic issues within healthcare systems can have an impact on the success of EBP implementation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong the barriers to the adoption of EPB include cultural issues; patients' interests and values must be considered to achieve culturally sensitive and patient-centered care. For example, in some cultures, patients may prefer traditional healing techniques over evidence-based interventions, which must be acknowledged and integrated into care decisions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe success of EBP implementation can be significantly impacted by organizational and structural elements, including the presence of EBP supporters, resource availability, and leadership support. Healthcare organizations that prioritize EBP and provide the required resources and assistance are more likely to succeed with implementation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe assessment of EBP among nurses poses major challenges, owing to EBP's complexity as a multidimensional construct that includes knowledge, attitudes, skills, and behaviours. This complexity needs a comprehensive assessment framework, as EBP entails merging scientific knowledge with clinical expertise and patient values, necessitating the consideration of multiple dimensions when evaluating EBP [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile the availability of 55 different implementation outcome instruments, including widely used tools like the Evidence-Based Practice Attitude Scale (EBPAS) and the Evidence-Based Practice Questionnaire (EBPQ), offers a diverse set of metrics for assessing EBP implementation, this diversity also presents several limitations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The proliferation of tools can lead to inconsistency in measurement across studies, making it difficult to compare findings or synthesize data through meta-analyses. Each tool may focus on distinct constructs (e.g., attitudes, knowledge, organizational readiness) with varying psychometric robustness, contributing to confusion over which instrument is most appropriate for a given context [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Many of these tools have been developed and validated primarily in Western, high-income settings, which may not translate well to low- and middle-income countries or culturally diverse populations. Cultural norms, professional hierarchies, and health system structures can significantly influence how EBP is perceived and implemented. Therefore, tools that do not account for these factors risk generating biased or incomplete data. Furthermore, contextual barriers such as limited resources, resistance to change, lack of training, and language differences vary widely between settings and may not be adequately captured by standardized instruments [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. As a result, without cultural adaptation and contextual validation, the use of multiple EBP tools may hinder rather than facilitate the accurate evaluation and advancement of EBP across diverse health care environments.\u003c/p\u003e \u003cp\u003eGiven the wide array of existing instruments used to evaluate EBP, there is a pressing need to critically examine their utility, validity, and reliability. The proliferation of these tools, while offering variety, has led to inconsistencies in application and interpretation across settings. Moreover, many of these instruments were developed in specific cultural and healthcare contexts, raising concerns about their generalizability to diverse populations and low-resource environments. Contextual and cultural variations can significantly influence attitudes, behaviors, and barriers related to EBP, yet these factors are often underrepresented or overlooked in existing tools. Therefore, a comprehensive review is warranted to identify and analyze the range of available instruments, evaluate their psychometric properties, and explore the extent to which they capture context-specific challenges and cultural nuances. This review seeks to address these gaps and support the selection and adaptation of appropriate tools for more effective EBP implementation across different healthcare settings.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] guidelines in May 2025. A comprehensive search was conducted across two databases, PubMed and CINAHL, to identify all relevant publications on the topic. Further, the most relevant publications were added manually. The search used the terms \u0026ldquo;Evidence-based practice questionnaire\u0026rdquo; AND \u0026ldquo;Evidence-based practice\u0026rdquo; AND \u0026ldquo;Nurses\u0026rdquo; OR \u0026ldquo;Nursing Students\u0026rdquo; OR\u0026rdquo; Healthcare Professionals\u0026rdquo; AND \u0026ldquo;Psychometric properties\u0026rdquo; OR \u0026ldquo;Validity\u0026rdquo; AND \u0026ldquo;Reliability\u0026rdquo; AND \u0026ldquo;Barriers.\u0026rdquo; The review included only the studies published in English-language articles derived from original studies, reviews, books, and published guidelines from 2000 to 2024.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003eStudies were included if they: 1) recruited nurses/student nurses/health professionals as participants, 2) aimed to measure the EBP knowledge, attitudes, practices/skills, competencies, and barriers of participants 3) presented results with validity or reliability test scores.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eArticles were excluded if they 1) duplicated publication, 2) were full-text articles that could not be accessed, 3) did not mention the details of the participants, 4) did not report results of each study variable, and 5) publications that did not meet the specified criteria.\u003c/p\u003e\n\u003ch3\u003eData Extraction and Analysis\u003c/h3\u003e\n\u003cp\u003eThree independent reviewers were involved in the review process. Initially, all titles and abstracts were screened for relevance by two reviewers independently, and discrepancies were resolved through discussion and by involving the third reviewer. Full-text articles of the eligible studies were then retrieved and assessed based on predefined inclusion and exclusion criteria.\u003c/p\u003e \u003cp\u003eData were extracted using a structured format that included\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eInstrument name\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAuthor(s) and year of publication\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTarget population\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCountry/setting of use\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEBP domains measured (e.g., knowledge, skills, attitudes, practice)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNumber of items and response format\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eReported psychometric properties (e.g., content validity, construct validity, internal consistency, test\u0026ndash;retest reliability, etc.)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e Regular team meetings were held to ensure consistency, resolve conflicts, and maintain methodological rigor throughout the review process.\u003c/p\u003e \u003cp\u003eThe extracted data were tabulated and compared to assess the comprehensiveness, strengths, and limitations of each tool. Instruments were also evaluated for their suitability in clinical, academic, or low-resource settings.\u003c/p\u003e \u003cp\u003eThe process of extraction is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe quality of the selected papers was assessed by using the Critical Appraisal Skill Programme (CASP) checklist [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSearch Outcomes\u003c/h2\u003e \u003cp\u003eIn the initial search, 285 articles were found using the keywords. The inclusion and exclusion criteria were examined after the title, abstract, and full text were examined. As seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, a total of 24 papers were considered appropriate for review, and 12 articles were chosen for analysis of their psychometric qualities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy characteristics\u003c/h2\u003e \u003cp\u003eTwelve distinct EBP instruments were retrieved in the twenty-four publications that made up the review. All instruments except one were self-report and required participants to rate their perceived level of knowledge, skills, and/or attitudes towards EBP and related factors. Participants were mainly practice nurses\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasurement properties and validity of instruments\u003c/h3\u003e\n\u003cp\u003eThe summary table (Table 1) presents 12 instruments used to measure EBP among nurses, spanning studies from 2000 to 2024. These instruments assess various dimensions of EBP, including knowledge, attitudes, skills, practices, and organizational readiness, using Likert-scale questions (typically 1–5).\u003c/p\u003e\n\u003cp\u003eThe widely used EBPQ, specifically to measure knowledge, attitude, and practices/skills of health care professionals, has been translated and validated for several languages [7, 15, 16, 17]. Further, the EBPQ has been modified by adding or removing items to match the specific contexts or profiles of participants [7, 15]. Broadly, these tools can be categorized into two types: self-report instruments and performance-based assessments.\u003c/p\u003e\n\u003cp\u003eThe review identified several multidimensional instruments used to assess EBP implementation among nurses. The EBP-COQ-Prof© [14] evaluated four key domains: attitudes, knowledge, skills, and utilization of EBP. Similarly, the EBP Beliefs Scale [18, 19] focused on beliefs, implementation, and the organizational culture surrounding EBP.\u003c/p\u003e\n\u003cp\u003eSeveral instruments assessed knowledge, attitude, and practices towards EBP, while others captured a broader range of constructs such as relevance, sympathy, terminology, confidence, [20, 21] openness, divergence, appeal, requirements [22], barriers, training needs for EBP implementation, information sources, and information literacy [23]. With relevance to the applicable settings of instruments, educational settings commonly use S-EBPQ [7], and Evidence-Based Practice Competence Questionnaire (EBP-COQ) [16] to assess nursing students' competence, while others use them in clinical settings.\u003c/p\u003e\n\u003cp\u003eMost instruments demonstrated strong internal consistency, with Cronbach’s alpha (α) values ranging from 0.69 to 0.984. For example, the EBP-COQ-Prof© [25] reported α = 0.888–0.948 for its subscales, while the EBPQ-Indonesian version [15] achieved α = 0.956 overall. However, some subscales, such as attitudes in the S-EBPQ-Chinese version [7], had lower reliability (α = 0.699).\u003c/p\u003e\n\u003cp\u003eCollectively, these instruments encompass a wide array of variables related to EBP, including individual beliefs and attitudes, knowledge and skills, perceived barriers and facilitators, organizational culture, and the need for training. These factors are essential for a comprehensive understanding of EBP implementation among nursing professionals.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis review reveals that numerous tools have been developed to measure EBP, each with unique strengths and limitations, while some report self-reported outcomes and some report performance-based outcomes.\u003c/p\u003e \u003cp\u003eAmong self-report instruments, the EBPQ, developed by Upton and Upton (2006), remains one of the most widely used and validated tools worldwide. Its internal consistency (α\u0026thinsp;=\u0026thinsp;0.87) and availability in multiple language versions, including Indonesian (α\u0026thinsp;=\u0026thinsp;0.956) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and Japanese (α\u0026thinsp;=\u0026thinsp;0.90) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], reflect its broad applicability. However, issues related to cultural interpretation and small sample sizes limit generalizability in some contexts. Moreover, the inherent limitations of self-reporting, such as social desirability and recall bias, undermine its ability to accurately capture actual clinical behaviour.\u003c/p\u003e \u003cp\u003eThe EBP2, validated in both Persian [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and Australian [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] settings, offers comprehensive domain coverage with six subscales and excellent internal consistency (α\u0026thinsp;\u0026gt;\u0026thinsp;0.96). Despite its psychometric strength, the tool\u0026rsquo;s length and cultural specificity may restrict its use in fast-paced or globally diverse clinical environments. Similarly, the Quick-EBP-VIK [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] evaluates values, knowledge, and implementation (α range: 0.66\u0026ndash;0.84), while an instrument [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] focuses on training needs and information literacy with high internal consistency (α\u0026thinsp;=\u0026thinsp;0.681\u0026ndash;0.954). These instruments extend the measurement landscape by addressing both perceptual and structural barriers to EBP implementation.\u003c/p\u003e \u003cp\u003eAnother commonly used set of tools [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] includes the EBP Beliefs Scale, EBP Implementation Scale, and the Organizational Culture and Readiness Scale. These are concise, practical (three items per subscale), and suitable for routine clinical use, showing acceptable psychometric thresholds (α\u0026thinsp;\u0026gt;\u0026thinsp;0.80). However, their brevity may compromise the depth of assessment and sensitivity to contextual variations. The EBP-COQ [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and EBP-COQ-Prof\u0026copy; [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] developed for student and professional nurse populations, also show strong psychometric properties (α\u0026thinsp;=\u0026thinsp;0.756\u0026ndash;0.948), particularly in evaluating EBP utilization.\u003c/p\u003e \u003cp\u003eIn contrast to these self-report tools, the Fresno Test [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] stands out as a performance-based instrument that evaluates actual EBP competency through open-ended, scenario-based questions. With high inter-rater reliability (α\u0026thinsp;=\u0026thinsp;0.88), it is particularly valuable for assessing critical thinking and applied skills. However, the tool's time-intensive nature and the requirement for trained evaluators limit its feasibility for widespread implementation.\u003c/p\u003e \u003cp\u003eWhile the reviewed instruments vary in structure and content, some focusing on implementation, others on knowledge or organizational factors, most exhibit high internal consistency (typically α\u0026thinsp;\u0026gt;\u0026thinsp;0.80). This reflects the overall psychometric soundness of available tools. Nevertheless, significant gaps remain. Few instruments comprehensively assess all five steps of EBP, particularly critical appraisal and outcome evaluation. Most rely heavily on self-reported data, which captures perceived rather than actual practice, thus weakening the ecological validity of the findings. Moreover, only a limited number of tools have been validated for use in Low- and Middle-Income Countries (LMICs) or in culturally diverse nursing populations, limiting their global relevance.\u003c/p\u003e \u003cp\u003eEach existing instrument for evaluating EBP among nurses possesses its own unique advantages and limitations, with varying strengths across different domains such as knowledge, attitudes, and implementation barriers. Given this variability, a single tool cannot be considered a gold standard for comprehensive EBP assessment. To address this, a multi-method approach is recommended integrating self-report questionnaires with performance-based assessments to effectively capture both the cognitive and behavioural aspects of EBP. Such a strategy would provide a more accurate, context-sensitive, and holistic understanding of EBP competency, bridging the gap between theoretical knowledge and real-world clinical application.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e This review identified wide range of EBP assessment tools mainly with self-reported and performance-based outcomes. many instruments, such as the EBPQ, EBP2, EBP-COQ, and Fresno Test own significant psychometric qualities and domain coverage, the majority were designed in high-resource environments and for specific cultural or professional contexts. A common limitation among instruments is their reliance on self-reporting and limited applicability in diverse healthcare systems with distinct structural and cultural constraints.\u003c/p\u003e \u003cp\u003eCritically, none of the available techniques have been specially created or validated for LMICs like Sri Lanka. Many instruments necessitate extensive time, infrastructure, or language adaptation, rendering them unsuitable in settings where nurses frequently confront high patient loads, limited access to EBP resources, and no institutional support for research engagement.\u003c/p\u003e \u003cp\u003eGiven these shortcomings, there is an urgent need to create a new, shorter, user-friendly tools that maintain psychometric robustness and a context-sensitive instrument for assessing EBP among nurses in resource-limited settings such as Sri Lanka.\u003c/p\u003e \u003cp\u003eCreating such a tool would not only improve the assessment of EBP competency but it would also assist targeted interventions to strengthen nursing practice and improve patient outcomes in resource-limited settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eEBP\u003cstrong\u003e\u0026nbsp;-\u0026nbsp;\u003c/strong\u003eEvidence-Based Practice\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEBPQ - evidence-based practice questionnaire\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEBP-COQ-Prof© - Evidence-Based Practice Competence Questionnaire of Registered Nurses\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEBP-COQ -Evidence-Based Practice Competence Questionnaire\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLMIC - Low- and Middle-Income Countries\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePRISMA- Preferred Reporting Items for Systematic Reviews and Meta-Analyses\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge that all aspects of the study, including study design, data collection, analysis, and manuscript preparation, were carried out solely by the authors, and no additional individuals or institutions contributed to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChandrani Herath - Conceptualization, Methodology, Formal analysis, Writing original draft preparation\u003c/p\u003e\n\u003cp\u003eNirosha P. \u0026nbsp;Edirisinghe - Conceptualization, Methodology, Supervision, Writing- Reviewing and Editing\u003c/p\u003e\n\u003cp\u003eNirmala Rathnayake -Conceptualization, Methodology, Supervision, Writing- Reviewing and Editing\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no external funding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This review is based on previously published studies, all of which are cited in the references section. No new data was generated or analyzed during this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This study is a comprehensive review of previously published literature and does not involve human participants or personal data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not contain any individual person\u0026rsquo;s data in any form (including images, videos, or clinical details).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAI-assisted technologies\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no generative AI or AI-assisted technologies were used in the data collection or analysis. Only language editing support with AI-based tools was applied during manuscript preparation, under full author supervision and responsibility.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMelnyk BM, Fineout-Overholt E. Evidence-based practice in nursing \u0026amp; healthcare: A guide to best practice. 4th ed. Philadelphia: Wolters Kluwer; 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDusin J, Melanson A, Mische-Lawson L. Evidence-based practice models and frameworks in the healthcare setting: a scoping review. BMJ Open. 2023;13(5):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaz H, Ganaie NA. Evidence-based practice in nursing: a comprehensive review. \u003cem\u003eClin Med Health Res J\u003c/em\u003e. 2023;3(6):713\u0026ndash;5. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cmhrj.com/index.php/cmhrj/article/view/254\u003c/span\u003e\u003cspan address=\"https://www.cmhrj.com/index.php/cmhrj/article/view/254\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStevens KR. The impact of evidence-based practice in nursing and the next big ideas. Online J Issues Nurs. 2013;18(2):4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaunders H, Vehvil\u0026auml;inen-Julkunen K. Nurses\u0026rsquo; evidence-based practice beliefs and the role of evidence-based practice mentors at university hospitals in Finland. Worldviews Evid Based Nurs. 2017;14(1):35\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelnyk BM, Fineout-Overholt E, Gallagher-Ford L, Kaplan L. The state of evidence-based practice in US nurses: critical implications for nurse leaders and educators. J Nurs Adm. 2012;42(9):410\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang YP, Liu L, Wang Y, Li YF, Wang J. Developing student evidence-based practice questionnaire (S-EBPQ) for undergraduate nursing students: reliability and validity of a Chinese adaptation. J Eval Clin Pract. 2019;25(4):536\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoegen P, Scholten-Peeters GGM, Reinders-Messelink HA, et al. Measuring self-efficacy and outcome expectancy in evidence-based practice: a systematic review on psychometric properties. Int J Nurs Stud Adv. 2021;3:100024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijnsa.2021.100024\u003c/span\u003e\u003cspan address=\"10.1016/j.ijnsa.2021.100024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaunders H, Vehvil\u0026auml;inen-Julkunen K. Key considerations for selecting instruments when evaluating healthcare professionals\u0026rsquo; evidence-based practice competencies: a discussion paper. \u003cem\u003eJ Adv Nurs\u003c/em\u003e. 2018;74(10):2301\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jan.13802\u003c/span\u003e\u003cspan address=\"10.1111/jan.13802\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeung K, Trevena L, Waters D. Systematic review of instruments for measuring nurses' knowledge, skills and attitudes for evidence-based practice. J Adv Nurs. 2014;70(10):2181\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHalm M. A compendium of evidence-based practice instruments for nursing education, practice and research. Worldviews Evid Based Nurs. 2024;21(1):6\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7326/M18-0850\u003c/span\u003e\u003cspan address=\"10.7326/M18-0850\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh J. Critical appraisal skills programme. J Pharmacol Pharmacother. 2013;4:76\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamos-Morcillo AJ, Fern\u0026aacute;ndez-Sola C, Hu\u0026eacute;rcanos-Esparza I, et al. Evidence-based practice nurses\u0026rsquo; competency: Spanish national survey and establishment of a scale of the EBP-COQ-Prof\u0026copy;. J Nurs Manag. 2021;29(4):794\u0026ndash;804.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFajarini M, Rahayu S, Setiawan A. Translating, adapting and testing the Indonesian version of the Evidence-based Practice Questionnaire (EBPQ). Unpublished manuscript; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuzafa-Martinez M, Lopez-Iborra L, Barranco DA et al. Development and validation of the competence in evidence-based practice questionnaire (EBP-COQ) among nursing students. BMC Med Educ. 2013;13(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTomotaki A, Fukahori H, Sakai I, et al. The development and validation of the evidence-based practice questionnaire: Japanese version. Int J Nurs Pract. 2018;24(2):e12617.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelnyk BM, Gallagher-Ford L, Long LE, Fineout-Overholt E. Psychometric properties of the short versions of the EBP beliefs scale, the EBP implementation scale, and the EBP organizational culture and readiness scale. Worldviews Evid Based Nurs. 2021;18(4):243\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/wvn.12525\u003c/span\u003e\u003cspan address=\"10.1111/wvn.12525\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelnyk BM, Fineout-Overholt E, Mays MZ. The evidence-based practice beliefs and implementation scales: psychometric properties of two new instruments. Worldviews Evid Based Nurs. 2008;5(4):208\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1741-6787.2008.00126.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1741-6787.2008.00126.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElahifar R, Pourrahmat MM, Khodadadi E, et al. The validity and reliability properties of a Persian version of the evidence-based practice profile (EBP2) questionnaire among Iranian students of health-related fields. BMC Med Educ. 2024;24(1):1143.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcEvoy MP, Williams MT, Olds TS. Development and psychometric testing of a trans-professional evidence-based practice profile questionnaire. Med Teach. 2010;32(9):e373\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3109/0142159X.2010.494741\u003c/span\u003e\u003cspan address=\"10.3109/0142159X.2010.494741\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaessen K, Scholten-Peeters GGM, Reinders-Messelink HA, et al. Development and validation of the Dutch EBPas-ve and EBPQ-ve for nursing assistants and nurses with a vocational education. Worldviews Evid Based Nurs. 2019;16(5):371\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMajid S, Foo S, Luyt B, et al. Adopting evidence-based practice in clinical decision making: nurses\u0026rsquo; perceptions, knowledge, and barriers. J Med Libr Assoc. 2011;99(3):229\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3163/1536-5050.99.3.010\u003c/span\u003e\u003cspan address=\"10.3163/1536-5050.99.3.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConnor L, McMillan D, Tufanaru C, et al. Measuring nurses\u0026rsquo; value, implementation, and knowledge of evidence-based practice: further psychometric testing of the Quick-EBP-VIK survey. Worldviews Evid Based Nurs. 2017;14(1):10\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/wvn.12190\u003c/span\u003e\u003cspan address=\"10.1111/wvn.12190\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamos KD, Schafer S, Tracz SM. Validation of the Fresno test of competence in evidence-based medicine. BMJ. 2003;326(7384):319\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmj.326.7384.319\u003c/span\u003e\u003cspan address=\"10.1136/bmj.326.7384.319\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Evidence-Based Practice, Nursing, Measurement instruments, Psychometric properties, Barriers, Scoping review","lastPublishedDoi":"10.21203/rs.3.rs-8388281/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8388281/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Evidence-Based Practice (EBP) is a cornerstone of high-quality nursing care, integrating research evidence, clinical expertise, and patient preferences. Despite its recognized benefits, challenges such as limited access to resources, organizational barriers, and cultural differences hinder its consistent implementation. Measuring EBP competencies among nurses is essential for identifying gaps and enhancing practice; however, existing instruments vary in their validity, reliability, and contextual applicability. This review aimed to identify and analyze the range of available instruments, evaluate their psychometric properties, and explore the extent to which they capture context-specific challenges and cultural nuances.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e A scoping review was conducted in May 2025, searching PubMed and CINAHL databases for studies published between 2000 and 2025. Keywords included \"Evidence-based practice questionnaire,\" \"Nursing,\" “Health care”, \"Psychometric Properties\", “Validity”, “Reliability,” and “Barriers.” Inclusion criteria focused on studies involving nurses, student nurses, or health professionals, quantitative methodologies, and instruments with reported validity or reliability. Out of 285 initially identified articles, 24 met the eligibility criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Twelve distinct EBP measurement tools were identified, with most demonstrating strong internal consistency (Cronbach’s α: 0.69–0.984). The Evidence-Based Practice Questionnaire (EBPQ) and its adaptations (e.g., Indonesian, Chinese versions) were widely used, though some subscales, such as attitudes, showed lower reliability. Instruments like the Evidence-Based Practice Competence Questionnaire of Registered Nurses (EBP-COQ-Prof©) and EBP Beliefs Scale measured multidimensional constructs, including knowledge, skills, and organizational readiness. Key limitations of the tools included reliance on self-reported data, lack of performance-based indicators, and insufficient adaptation for low-resource or culturally diverse settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e While existing EBP instruments exhibit robust psychometric properties, their applicability is often constrained by cultural, contextual, and methodological limitations. The review emphasizes the need for a tailored, context-specific tool that addresses organizational readiness, cultural relevance, and longitudinal validity to better support EBP implementation in nursing practice globally. Future research should prioritize developing such instruments to bridge existing gaps and enhance EBP adoption.\u003c/p\u003e","manuscriptTitle":"A Comprehensive Review of Tools Assessing Evidence-Based Practice Among Nurses","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-22 06:52:17","doi":"10.21203/rs.3.rs-8388281/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0c7388d9-71f1-4b03-b225-23a88064534d","owner":[],"postedDate":"January 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T13:56:40+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-22 06:52:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8388281","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8388281","identity":"rs-8388281","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}