Evidence Review

Practicing Healthcare Professionals’ Evidence-­

Based Practice Competencies: An Overview of
Systematic Reviews
Hannele Saunders, PhD, MS, MPH, RN ●

Lynn Gallagher-Ford, PhD, RN, DPFNAP, NE-BC, FAAN ● Tarja Kvist, PhD, RN ●
Katri Vehviläinen-Julkunen, PhD, RN, FEANS

Key words ABSTRACT

evidence-based Background: Evidence-­ based practice (EBP) competencies are essential for all practicing
practice, healthcare professionals to provide evidence-­ based, quality care, and improved patient
knowledge, ­outcomes. The multistep EBP implementation process requires multifaceted competencies to
competence, successfully integrate best evidence into daily healthcare delivery.
systematic review,
Aims: To summarize and synthesize the current research literature on practicing health profes-
healthcare
sionals’ EBP competencies (i.e., their knowledge, skills, attitudes, beliefs, and implementation)
professional
related to employing EBP in clinical decision-­making.
Design: An overview of systematic reviews.
Methods: PubMed/MEDLINE, CINAHL, Scopus, and Cochrane Library were systematically
searched on practicing healthcare professionals’ EBP competencies published in January
2012–July 2017. A total of 3,947 publications were retrieved, of which 11 systematic reviews
were eligible for a critical appraisal of methodological quality. Three independent reviewers
conducted the critical appraisal using the Rapid Critical Appraisal tools developed by the
Helene Fuld National Institute for Evidence-­Based Practice in Nursing & Healthcare.
Results: Practicing healthcare professionals’ self-­reported EBP knowledge, skills, attitudes,
and beliefs were at a moderate to high level, but they did not translate into EBP implementa-
tion. Considerable overlap existed in the source studies across the included reviews. Few re-
views reported any impact of EBP competencies on changes in care processes or patient
outcomes. Most reviews were methodologically of moderate quality. Significant variation in
study designs, settings, interventions, and outcome measures in the source studies precluded
any comparisons of EBP competencies across healthcare disciplines.
Linking Evidence to Action: As EBP is a shared competency, the development, adoption,
and use of an EBP competency set for all healthcare professionals are a priority along with
using actual (i.e., performance-­based), validated outcome measures. The widespread mis-
conceptions and misunderstandings that still exist among large proportions of practicing
healthcare professionals about the basic concepts of EBP should urgently be addressed to
increase engagement in EBP implementation and attain improved care quality and patient
outcomes.

INTRODUCTION of critical work functions. In health care, “core competencies

Knowledge of the principles of evidence-­based practice (EBP)
and skills to perform the steps of the EBP implementation pro-
cess are essential competencies for all practicing healthcare
professionals (Melnyk, Gallagher-­Ford, & Fineout-­Overholt,
2014). In nursing, competence has been defined as the “abil-
ity to perform the task with desirable outcomes under the var-
ied circumstances of the real world” (Benner, 1984, p. 304),
referring to the expected knowledge, attitudes, beliefs, skills,
and abilities (i.e., competencies) for successful performance
offer a common shared language for all health professions
for defining what all are expected to be able to do to work
optimally” (Albarqouni et al., 2018, p. 2). However, defin-
ing core competencies in EBP (i.e., outlining the expected
EBP knowledge, skills, attitudes, beliefs, and implementation,
which are crucially important for improving care quality and
patient outcomes because they enable healthcare profession-
als to make clinical decisions grounded on best available ev-
idence and integrate the evidence into their daily practice;

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© 2019 Sigma Theta Tau International

Melnyk et al., 2018; Wallen et al., 2010) has been a relatively
recent development both in nursing (Melnyk et al., 2014;
Stevens, 2009) and in health care (Albarqouni et al., 2018).
Moreover, the uptake and use of the EBP core competencies
in daily practice have been slow, which hinders healthcare
organizations from delivering highest quality, evidence-­based
health care via consistent, broad-­based EBP implementation.
Furthermore, systematic integration of best evidence into
practice is challenging due to the complexity of the EBP imple-
mentation process consisting of multiple sequential steps, the
mastery of which requires multifaceted interventions, such
as developing individual readiness for EBP, translating and
ensuring availability of best evidence in usable forms for clin-
ical practice, and building organizational readiness, culture,
and structures supportive of EBP (Melnyk, Gallagher-­Ford, &
Fineout-­Overholt, 2016; Saunders, Vehviläinen-­Julkunen, &
Stevens, 2016).
Similar to the idea of EBP itself (DiCenso, Cullum,
& Ciliska, 1998; Sackett, Rosenberg, Gray, Haynes, &
Richardson, 1996), the realization about the importance for
all healthcare professionals to develop a sufficient level of EBP
competence is not new, as the first Sicily statement (Dawes
et al., 2005) outlined that it is a minimum requirement for
all healthcare professionals to understand and implement the
principles and process of EBP. To this end, two sets of nurses’
EBP competencies have been developed through separate na-
tional consensus processes in the USA to evaluate practicing
nurses’ abilities to employ EBP (Melnyk et al., 2014) and to
guide EBP professional development and education programs
in nursing (Stevens, 2009). However, the EBP competencies
published thus far in nursing have been self-­reported and
discipline-­specific (i.e., they have focused on measuring the
perceived EBP competencies of nurses). Although there have
been a few actual (i.e., performance-­based) evaluation tools
developed in the last 10 years for more objective measure-
ment of EBP competencies, they have also been discipline-­
specific and undertaken primarily in the fields of medicine,
occupational therapy, physical therapy, and most recently,
in nursing (Halm, 2018; Ilic, Nordin, Glasziou, Tilson, &
Villanueva, 2013; Laibhen-­Parkes, Kimble, Melnyk, Sudia,
& Codone, 2018; McCluskey & Bishop, 2009; Spurlock &
Wonder, 2015; Tilson, 2010). However, as EBP is a shared
competency (i.e., the key principles and steps of the EBP pro-
cess are universal and applicable to all healthcare disciplines),
a unique opportunity exists to jointly develop interprofes-
sional core competencies in EBP that objectively measure the
actual EBP performance of all healthcare professionals.
THE CURRENT STATE OF PRACTICING
HEALTHCARE PROFESSIONALS’ EBP
COMPETENCIES
A recent integrative review on EBP readiness of nurses
(Saunders & Vehviläinen-­Julkunen, 2015) concluded that
EBP competencies of nurses internationally are at a low to
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© 2019 Sigma Theta Tau International
Evidence Review
moderate level, particularly in terms of their EBP knowl-
edge, EBP skills, and their confidence in employing EBP.
These results are consistent with the findings from other
recent reviews of EBP competencies across other health-
care disciplines (Mota da Silva, da Cunha Menezes Costa,
Narciso Garcia, & Oliveira Pena Costa, 2015; Scurlock-­
Evans, Upton, & Upton, 2014; Upton, Stephens, Williams,
& Scurlock-­Evans, 2014). Therefore, instead of setting high
performance expectations for EBP, it is essential to first
focus on advancing practicing healthcare professionals’ EBP
competencies, before they will be capable of consistently
implementing EBP and integrating best evidence into their
daily care delivery. Once healthcare professionals are com-
petent in EBP, they will be more likely to engage in EBP in
their daily work, and patient care delivery in most health-
care organizations will likely become more evidence-­based.
This substantial chasm between the EBP implementation
goals of healthcare organizations and the current EBP im-
plementation capabilities of large numbers of healthcare
professionals due to their low level of EBP competence is
precisely the gap that urgently requires attention and im-
mediate action in healthcare organizations worldwide.
AIMS
The aim of this overview of systematic reviews was to sum-
marize and synthesize the current international research
literature on practicing healthcare professionals’ EBP com-
petencies (i.e., their knowledge, skills, attitudes, beliefs, and
implementation of EBP) related to employing EBP in clini-
cal decision-­making. This overview addresses the ­following
research question: What do systematic reviews published in
international peer-­reviewed journals state about practicing
healthcare professionals’ EBP competencies?
DESIGN
Published systematic reviews on the EBP competencies of
all practicing healthcare professionals, including nurses,
physicians, physical therapists, occupational therapists, and
other allied health professionals, were considered for inclu-
sion in this overview of systematic reviews. The relevant
data in the reviews were systematically extracted, summa-
rized, and synthesized according to the guidelines provided
by the Cochrane Collaboration (Becker & Oxman, 2011).
The review process is presented according to the Preferred
Reporting Items for Systematic Reviews and Meta-­Analyses
(PRISMA) statement or guideline for reporting study meth-
ods and results (Moher, Liberati, Tetzlaff, Altman, & The
PRISMA Group, 2009).
METHODS
Systematic literature search methods were used to con-
duct electronic database searches in PubMed/MEDLINE,
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Cumulative Index for Nursing and Allied Health
Literature (CINAHL), Scopus, and Cochrane Library
for primary empirical studies and reviews published
between January 1, 2012, and July 31, 2017 (i.e., for a
period of approximately the last 5 years), without any
language restrictions. With the expert assistance of a
university librarian, keywords and search terms related
to the various healthcare disciplines, EBP, and compe-
tencies were first searched independently and then in
combination, with appropriate modifications made for
the various databases (e.g., MeSH terms in PubMed).
The term “research utilization” was not used as the aim
of this overview of systematic reviews was to focus on
healthcare professionals’ EBP competencies (i.e., their
EBP knowledge, skills, attitudes, beliefs, and imple-
mentation). Moreover, research utilization focuses on
the retrieval, critique, and use of the research results
from a single primary study, whereas EBP is commonly
considered to be a much broader concept including re-
search utilization and the integration of summarized and
translated best evidence from several well-­defined stud-
ies into clinical practice (Melnyk & Fineout-­O verholt,
2011). In addition to the searched databases, authors of
the ­i ncluded reviews were contacted for any missing key
information, the reviews were reference-­c hased, and the
lists of contents of the following peer-­reviewed journals
between the years of 2012–2017 were hand-­searched:
Worldviews on Evidence-­ Based Nursing, Journal of
Advanced Nursing, BMC Health Services Research, BMC
Medical Education, BMJ Open, Physiotherapy, and British
Journal of Occupational Therapy. These journals were se-
lected because they had published the majority of the
reviews focusing on the topic of healthcare profession-
als’ EBP competencies yielded by the systematic literature
searches conducted for this overview.
Inclusion and Exclusion Criteria
The inclusion and exclusion criteria for systematic re-
views are listed in Table S1. Systematic reviews were
defined as reviews that had clearly stated aims or objec-
tives, predetermined inclusion criteria, searched at least
three databases, performed data extraction, provided a
synthesis of data, and performed a quality appraisal of
the included studies. To be eligible for inclusion in this
overview, reviews were required to (a) focus on one or
more of the outcomes of interest (i.e., EBP competencies
of healthcare professionals), (b) fulfill the definition of
a systematic review, (c) meet the inclusion and exclusion
criteria, and (d) meet the benchmark set for the method-
ological quality of the reviews. Before undertaking this
overview of systematic reviews, the Cochrane Library and
the Joanna Briggs Institute Library of Systematic Reviews
were searched. No published or in-­progress systematic
reviews or overviews of systematic reviews on this topic
were found.
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Search Results and Data Evaluation
The database searches yielded a total of 3,932 publica-
tions, and 15 additional publications were identified
through other sources. Titles were screened, and du-
plicates as well as those not clearly indicating a focus
on practicing healthcare professionals’ EBP competen-
cies were excluded. All remaining abstracts (n = 407)
were screened against the purpose and inclusion cri-
teria before being selected for further appraisal. After
eliminating a total of 392 records that did not meet
one or more inclusion criteria, the second screen-
ing resulted in 12 reviews. Three reviews were added
through reference-­c hasing and hand-­searching tables
of content of the selected peer-­r eviewed journals, re-
sulting in a total of 15 full-­text reviews, which were
assessed for eligibility. Four full-­text reviews were ex-
cluded from the overview, as they contained no critical
appraisal of methodological quality and therefore did
not meet the definition of a systematic review outlined
for this overview. As a result, data were extracted from
11 systematic reviews. Figure S1 details the stages of
searching and selecting reviews for inclusion or ex-
clusion using the PRISMA f low diagram (Moher et al.,
2009).
Data Extraction
The following data were extracted for each of the 11 reviews
and organized in a data matrix, using a standardized data
extraction form developed according to the guidance from
the PRISMA statement (Moher et al., 2009): Author(s),
country, year of publication, types of participants, settings,
study design(s) included, EBP aspects reviewed, quality
appraisal(s) performed, main findings, and author’s con-
clusions. The data were extracted by one reviewer and in-
dependently checked for accuracy and consistency by two
other reviewers to ensure rigor and reproducibility. Any dif-
ferences in opinion between the three researchers were dis-
cussed until a mutual agreement was formed. All 11 reviews
were included in the critical appraisal of methodological
quality.
Critical Appraisal of Methodological Quality
The overall quality and differences in quality between the
included reviews were compared and contrasted, in order
to help interpret the results of the reviews synthesized in
this overview. The overall quality of the reviews was not
used as a criterion for inclusion, as the reviews included
in this overview were required to meet the definition of a
systematic review, specific inclusion criteria, and to pass a
critical appraisal of methodological quality, the main pur-
pose of which was to ensure that the included reviews con-
formed to usual research norms.
The criteria used by the three independent reviewers
for evaluating the methodological quality were those in the
Rapid Critical Appraisal (RCA) tool for systematic reviews
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© 2019 Sigma Theta Tau International

and meta-­analyses of quantitative studies developed by the
Helene Fuld National Institute for Evidence-­Based Practice
in Nursing & Healthcare of the Ohio State University College
of Nursing ([OSUCN] 2017). The reviewers used the tool
to critically appraise the validity, reliability, and applicabil-
ity and generalizability through independently answering
a series of 15 appraisal questions and subquestions. In ad-
dition, an evaluation quantifying the strength of evidence
(i.e., quality + level of evidence) in the included reviews
was added to the standardized form for conducting the crit-
ical appraisal of methodological quality. The three indepen-
dent reviewers critically appraised the strength of evidence
as being low, moderate, or high, based on the percentage
of critical appraisal criteria fulfilled (0–33%, 34–66%,
and 67% and over). Any discrepancies and differences in
opinion in the critical appraisals of methodological quality
related to the included reviews were discussed among the
three researchers until consensus was reached. The bench-
mark of methodological quality for the reviews included in
this overview was set at a total minimum score of at least
five out of a total of 15 appraisal criteria on the RCA tool
fulfilled (i.e., 34%), indicating acceptable scientific rigor.
Data Synthesis
To answer the primary research question of this overview,
the data from the 11 included reviews on practicing health-
care professionals’ EBP competencies were summarized,
analyzed, and synthesized by using guidance from the
Cochrane Collaboration (Becker & Oxman, 2011). A narra-
tive synthesis is presented, as a meta-­analysis was not possi-
ble due to the heterogeneity of the source studies contained
in the reviews, including substantial variation in outcomes
and educational interventions, as well as the poor quality
of reporting of the results in some of the included reviews.
FINDINGS
Characteristics of the Systematic Reviews
Included in the Overview
The 11 included reviews originated from all around
the globe: Though the majority (n = 6, 55%) were from
Europe, another two were from Australia, and one each
were from Asia, South America, and North America. As
expected, almost one-­half (n = 5, 45%) of the included re-
views originated from English-­speaking countries, which
traditionally comprise the nations leading the interna-
tional EBP movement. Unexpectedly, the majority (n = 6,
55%) of the reviews originated from smaller countries,
such as Ireland, Greece, Finland, and the Netherlands,
many of which are non-­E nglish-­speaking and have em-
barked on the EBP journey more recently. The number
of source studies in the 11 included systematic reviews
ranged from n = 6 to n = 32, with a total of 204 source
studies from 24 different countries on six continents of
the world.
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Evidence Review
Seven (64%) of the 11 reviews included source stud-
ies using a cross-­sectional survey design, another seven
(64%) included randomized controlled trials (RCTs) or
cluster RCTs, six (55%) included source studies using a
pretest–posttest intervention or a cluster nonrandom-
ized study design, four (36%) included qualitative study
designs, two each of the 11 systematic reviews included
mixed-­methods study designs and longitudinal observa-
tional designs, and one each of the 11 reviews included
prospective cohort designs or reviews. Although the ma-
jority (n = 7, 64%) of the 11 included systematic reviews
contained one or more source studies using an experi-
mental design (i.e., used a second group for comparison),
the vast majority of the source studies were nonrandom-
ized, one-­group quasi-­e xperimental study designs, cross-­
sectional surveys, or qualitative study designs. Similarly,
although the vast majority of the total number of source
studies used a nonrandom sample (e.g., a convenience
or purposive sample), seven of the 11 (64%) systematic
­reviews included at least one source study that used a
­random sample.
Only five of the 11 included reviews discussed or dis-
played (e.g., in their extracted data tables) the response rates
of their source studies, and even when they were actually
reported, they frequently were not reported for all source
studies in the reviews. Overall, the reported response rates
were relatively low, and there was wide variability in the
response rates from 9% to 100%. Furthermore, healthcare
professionals’ EBP competencies were measured using a
wide variety of published and unpublished instruments,
some of which were general instruments measuring sev-
eral EBP competencies, such as the EBP Questionnaire
(Upton & Upton, 2005), whereas other instruments mea-
sured one specific EBP competency, such as the EBP Beliefs
Scale (Melnyk & Fineout-­Overholt, 2007). Selected charac-
teristics of the included reviews (n = 11) are presented in
Table S2.
Participants and Practice Settings in the
Systematic Reviews
A total of 59,382 healthcare professionals participated in
the source studies of the 11 included reviews published
between January 2012 and July 2017. Healthcare disci-
plines represented in the reviews were primarily nursing,
medicine, physical therapy, and occupational therapy,
but participants from at least 10 additional allied health
disciplines were included in the source studies of the re-
views, as listed in the Turnbull et al. (2009) model for al-
lied health professionals. In almost one-­half (n = 5, 45%)
of the systematic reviews, the source studies focused on
only one healthcare discipline (e.g., nurses). However, six
of the 11 included systematic reviews contained source
studies with multidisciplinary samples, which included
health professionals other than nurses, doctors, physical
therapists, and occupational therapists. All 11 included
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systematic reviews focused on practicing healthcare pro-
fessionals, but four of the 11 (36%) systematic reviews
also contained small subsamples of healthcare students
in some of their source studies. The clinical settings of
the source studies were poorly identified with only gen-
eral statements such as “various settings” or “any clinical
setting,” or the settings were not described at all in the
majority (n = 7, 64%) of the included reviews. However,
some of the included reviews did disclose containing
source studies from hospital, primary care, and commu-
nity care settings.
Outcomes Measured and Overlap Between the
Included Reviews
Outcomes measured in the included reviews varied
considerably, with several reviews containing other
outcomes in addition to those related to healthcare pro-
fessionals’ EBP competencies. Moreover, the instruments
used to measure the outcomes also varied considerably.
Healthcare professionals’ EBP competencies were meas-
ured by using self-­report assessments in the source stud-
ies of all of the 11 included reviews (i.e., perceived EBP
competencies were measured, instead of using more
objective measures of actual performance, such as EBP
knowledge tests). A total of 204 source studies were con-
tained in the 11 reviews included in this overview. There
was substantial overlap across the included reviews in
terms of their source studies, as the 11 included reviews
with a total of 204 source studies referred to a total of
133 separate studies, of which 48 were included in more
than one review. An effort was made to avoid double
counting which might lend extra weight to those study
results that had been included in more than one review.
A summary of the main findings from the source studies
can be found in the fuller version of this overview pub-
lished online. Table S3 summarizes the EBP competency
outcomes of healthcare professionals from the included
reviews.
Overall Quality and Completeness of Reporting
in the Included Systematic Reviews
The overall quality of the included reviews was appraised
using guidance from the Cochrane Collaboration (Becker &
Oxman, 2011). All of the reviews met the definition of sys-
tematic reviews as outlined for this overview. Interestingly,
although two of the 11 included reviews were character-
ized as a “scoping review” or a “systematic scoping review,”
they nevertheless included a critical appraisal of methodo-
logical quality of their source studies, which reflects the
wide variety of terms that are used, sometimes inconsist-
ently, to describe the various types of reviews published in
the international literature.
The critical appraisal of methodological quality con-
ducted by the three reviewers with the RCA tool (OSUCN,
2017) revealed a broad range of strength of evidence among
180
the included reviews. The benchmark for the strength of
evidence indicating acceptable methodological quality was
set at 34% (i.e., a total minimum score of at least 5 out of
a total of 15 critical appraisal criteria fulfilled). All 11 in-
cluded reviews met this minimum standard for acceptable
scientific rigor, with 10 out of the 11 reviews appraised at
moderate quality. The median score (0–15) was 8 (mod-
erate), with the scores ranging from 5 to 10 (out of 15).
Only one of the 11 included reviews barely attained a high
score (i.e., a score of at least 10 out of 15 appraisal criteria
fulfilled).
The pronounced heterogeneity in the source studies
of the included reviews in terms of their study designs,
practice settings, outcome measures, outcomes of inter-
est, and educational interventions, combined with poor
and inconsistent reporting quality (e.g., not reporting
source study settings) and missing or incomplete data
(e.g., only one of the 11 reviews reported effect sizes for
the source studies and few reported p-­values or confi-
dence intervals), prompted the results of this overview
to be narratively summarized. This also precluded any
comparisons of EBP competencies across healthcare dis-
ciplines. In particular, there was considerable variation
in the outcome measures used in the source studies of
the reviews, including unpublished, not theoretically
based, and not psychometrically tested instruments,
which were inconsistently or incompletely described.
Moreover, many assertions were made in the reporting
of the source studies, but few assertions were backed up
by actual data in the reviews. Furthermore, although the
educational interventions may have had a positive effect
on EBP competencies, the impact of the improved EBP
competencies on patient outcomes or practice changes
remains unclear, as healthcare professionals’ improved
EBP competencies may not necessarily have influenced
practice in any way.
On the other hand, although the vast majority of the
source studies in the included reviews used nonprob-
ability sampling methods and cross-­ sectional survey,
­pretest–posttest intervention, or qualitative study designs,
it is important to acknowledge that seven (64%) of the
11 reviews contained at least one RCTs or cluster RCT
as a source study. In total, the 11 reviews contained 33
RCTs or cluster RCTs as source studies, some of which
were included in more than one review. These results
are consistent with the findings of Young, Rohwer,
Volmink, and Clarke (2014), who found that despite the
commonly held perception of relatively rare use of ex-
perimental study designs such as RCTs in some health-
care disciplines, the reviews included in their overview
nevertheless included a total of 25 RCTs. In summary,
the overall quality and completeness of evidence in the
included reviews of this overview was low to moder-
ate at best, as the majority of the reviews did not con-
tain a comprehensive literature search, report on both
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© 2019 Sigma Theta Tau International

included and excluded studies, or discuss the potential
biases of the reviews. Lastly, some of the reviews did not
report on the response rates, the number of participants
in their source studies, or match the stated objectives
of the review with what was actually discussed in the
review.
DISCUSSION
The first Sicily statement (Dawes et al., 2005) outlined that
knowledge and understanding of the principles of EBP and
skills to implement the steps of the EBP process are es-
sential competencies for all practicing healthcare profes-
sionals. To that end, this overview of systematic reviews
summarized and synthesized evidence from 11 system-
atic reviews containing 204 source studies that assessed
the current state of the EBP competencies for practicing
healthcare professionals, provided critical appraisals of
their ability to implement the steps of the EBP process,
and evaluated the effectiveness of various educational in-
terventions for advancing their EBP competencies using a
wide variety of study designs, outcome measures, and out-
comes of interest.
Although the majority of healthcare professionals
across disciplines indicated familiarity with both the
concept of “evidence-­based practice” and the discipline-­
specific terms of (e.g., “evidence-­ based nursing” or
“evidence-­ based medicine”) widespread confusion
appeared to exist among large proportions of health-
care professionals about the commonly accepted defi-
nitions of EBP and the meanings of the basic concepts
related to EBP (Condon, McGrane, Mockler, & Stokes,
2016; Scurlock-­ Evans et al., 2014; Ubbink, Guyatt, &
Vermeulen, 2013; Upton et al., 2014), which were
consistent with the results of other reviews (Saunders
& Vehviläinen-­ Julkunen, 2015). This is disconcerting
because the lack of clarity about even the most basic
definitions and concepts of EBP among large propor-
tions of healthcare professionals impedes healthcare
organizations from delivering the highest quality,
evidence-­based health care. It also may contribute to a
perception among healthcare professionals and organi-
zations that EBP is being implemented, when in real-
ity, clinical care delivery is still more closely associated
with the traditions, routines, and customs of opinion-­
based practice (Saunders & Vehviläinen-­ Julkunen,
2015; Wonder, Spurlock, Lancaster, & Gainey, 2017).
Furthermore, large proportions of healthcare profes-
sionals across disciplines appear to hold a variety of
misconceptions, misinterpretations, and misunder-
standings of what actually constitutes EBP (Saunders,
Stevens, & Vehviläinen-­Julkunen, 2016; Scurlock-­Evans
et al., 2014; Upton et al., 2014). For example, Scurlock-­
Evans et al. (2014) contended that physical therapists
may not only be confused as to the meaning of the
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© 2019 Sigma Theta Tau International
Evidence Review
term “evidence,” they may also be confused about how
they should go about integrating evidence and about
what type of evidence they should be implementing
in practice.
Practicing healthcare professionals’ self-­ reported
EBP attitudes toward and beliefs in the importance and
value of EBP for improving care quality and patient out-
comes were mainly positive across health disciplines,
and generally at a higher level than their self-­reported
EBP knowledge and skills. Unfortunately, however, these
EBP competencies did not translate into EBP behaviors,
as EBP implementation in daily practice was generally at
a low level across disciplines (Saunders & Vehviläinen-­
Julkunen, 2015; Scurlock-­Evans et al., 2014; Ubbink et al.,
2013; Upton et al., 2014). Furthermore, although health-
care professionals’ self-­rated EBP knowledge and skills
were higher than their EBP implementation, healthcare
professionals across disciplines rated their EBP knowledge
and skills to be at an insufficient level for integrating best
evidence into daily practice. Perhaps for this reason, large
proportions of healthcare professionals across disciplines
did not use best available evidence or implement EBP in
daily care delivery. This is consistent with the findings of
previous studies indicating that the majority of clinicians
do not consistently engage in EBP (Melnyk, Fineout-­
Overholt, Gallagher-­Ford, & Kaplan, 2012; Melnyk et al.,
2016; Wallen et al., 2010).
Another concern related to the included reviews was
failing to measure the impact of healthcare professionals’
EBP competencies on patient outcomes, even when it was
explicitly stated as one of the objectives of the review.
Although four of the 11 included reviews reported mea-
suring the impact of healthcare professionals’ EBP com-
petencies on practice changes or patient outcomes as a
stated objective, only one review actually discussed any
results related to patient outcomes. The lack of measur-
ing the impact on patient outcomes of healthcare pro-
fessionals’ EBP competencies and that of educational
interventions promoting healthcare professionals’ EBP
competencies is consistent with the results of other re-
views (Hecht, Buhse, & Meyer, 2016; Häggman-­L aitila,
Mattila, & Melender, 2016) and overviews (Young et al.,
2014).
LIMITATIONS IN THE OVERVIEW
The main limitation of this overview of systematic reviews
is the potential for various biases, including selection,
publication, and indexing biases. To reduce the poten-
tial for bias, we followed guidance from the Cochrane
Collaboration and PRISMA on the methodology for con-
ducting rigorous systematic reviews and reporting their
results, followed a prespecified review protocol, and sys-
tematically searched multiple electronic databases in col-
laboration with a university librarian, using keywords and
181
EBP Competencie
search terms modified appropriately for the various data-
bases. In addition, we searched for ongoing systematic re-
views prior to undertaking this overview, reference-­chased
the systematic reviews included in this overview, and
hand-­searched the tables of contents of the peer-­reviewed
scientific journals in which the majority of the systematic
reviews on healthcare professionals’ EBP competencies had
been published. As hand-­searching the tables of contents
did not result in additional searches, we believe that our
search strategy would effectively capture most of the rel-
evant systematic reviews published on this topic between
January 2012 and July 2017. However, as in any review, it
is possible that some relevant systematic reviews were not
identified.
Second, three reviewers independently used a study
design-­specific critical appraisal tool to evaluate the meth-
odological quality of each included review, with any dis-
crepancies and differences discussed to form a mutual
agreement, which increased the reliability of the data. In
addition, all of the included reviews, originating from 10
different countries worldwide, had passed an international
peer review and had been published in high-­quality scien-
tific journals. As the majority (n = 6, 55%) of the included
reviews originated from non-­ English-­speaking countries
representing six different languages, publication and lan-
guage biases, although possible, are unlikely.
Third, self-­reported assessments were used to measure
healthcare professionals’ EBP competencies in all of the 11
included reviews (i.e., perceived EBP competencies were as-
sessed, instead of using more objective measures of actual
performance, such as EBP knowledge tests). Because of a lack
of congruence between self-­reported and more objectively
measured knowledge and ability, especially when measur-
ing complex tasks such as EBP implementation (Saunders,
Vehviläinen-­ Julkunen, et al., 2016; Scurlock-­ Evans et al.,
2014; Wonder et al., 2017), using self-­reports may result in
bias (through the participants giving more socially accept-
able responses than nonrespondents), and in overestima-
tion of some EBP competencies, such as EBP knowledge, for
which more objective measures are available.
Fourth, the search term “research utilization” was not
used for our overview of systematic reviews as the aim was
to focus on the EBP competencies that practicing health-
care professionals need to successfully integrate translated
best evidence into daily clinical practice. However, we
acknowledge that it is not uncommon for research uti-
lization to be used in studies as if it were an alternative
term for EBP, and therefore, we are aware that some of
the published systematic reviews may have been missed
by our search. Fifth, the modest methodological quality
of the identified systematic reviews and the relatively low
quality of reporting of the results in the systematic reviews
may have affected the results of this overview. Finally, effect
sizes were not reported in all but one of the included sys-
tematic reviews. Therefore, generalizability of the results is
182
limited, and the results of this overview should be extrap-
olated with caution.
IMPLICATIONS FOR PRACTICE AND
RESEARCH
Evidence-­ based practice competencies are essential for
all practicing healthcare professionals in guiding their
integration of best evidence into their clinical decision-­
making and thus enabling them to provide higher-­quality
care and produce better patient outcomes. However, as EBP
is a shared competency and the steps of EBP implementa-
tion are universal, there is an urgent need for the collabo-
rative development, implementation, and evaluation of an
EBP competency set for all healthcare professionals (i.e.,
an interprofessional set of EBP competencies that can be
used by all practicing healthcare professionals from any
healthcare discipline). Recently, the development of a first
set of such interprofessional core competencies in EBP for
all healthcare professionals was published as a consensus
statement based on a systematic review and Delphi survey
(Albarqouni et al., 2018), which contained 68 core com-
petencies in EBP applicable to all healthcare profession-
als. This type of interprofessional core competencies in
EBP for all healthcare professionals should be the focus
of future research studies, as the EBP competencies will
guide the development of interprofessional EBP compe-
tency measures (via self-­ratings or actual performance) as
well as joint EBP curricula for practicing healthcare pro-
fessionals, and thus, their subsequent uptake, adoption,
and use in clinical practice should be a high priority for
all practicing healthcare professionals. In addition, ad-
dressing the widespread misconceptions and misunder-
standings currently existing among large proportions of
healthcare professionals about the basic concepts of EBP
is crucially important for increasing their engagement in
EBP implementation and for attaining improved care qual-
ity and patient outcomes.
Nursing and some allied health disciplines, such as
physical therapy and occupational therapy, have tradition-
ally relied on measuring competencies through self-­report
assessments even when the constructs of interest, such as
EBP knowledge, ability, or competence, could be assessed
through more objective measures. Therefore, future stud-
ies should focus on developing and using actual, that is,
performance-­based, validated outcome measures for EBP
competencies through using rigorous study and review
methodologies and robust reporting practices. Although
EBP is a shared competency, implementation of EBP is a
complex process requiring multifaceted educational inter-
ventions that contain interacting components, and thus, it
should be investigated whether the differences in health-
care professionals’ primary roles, educational backgrounds
across disciplines, and in contextual factors may influence
the effects of the EBP educational interventions.
Worldviews on Evidence-Based Nursing, 2019; 16:3, 176–185.
© 2019 Sigma Theta Tau International

CONCLUSIONS
The findings of this overview of systematic reviews sug-
gest that irrespective of their healthcare discipline, large
proportions of practicing healthcare professionals per-
ceive their EBP competencies to be insufficient for em-
ploying EBP in daily care delivery. These perceptions as
well as widespread confusion, misconceptions, and mis-
understandings about the meanings of the most basic
concepts of EBP among healthcare professionals across
disciplines contribute to their low levels of EBP imple-
mentation both in terms of the principles and in terms of
the process of EBP (i.e., healthcare professionals neither
using translated best evidence as the basis for clinical
decision-­making in daily practice nor implementing all
the steps of the EBP process). As EBP is a shared compe-
tency, practicing healthcare professionals should actively
participate in the uptake, adoption, and use of the in-
terprofessional core competencies in EBP for all health-
care professionals as well as collaboratively advance EBP
implementation through the development and evaluation
of the effectiveness of research-­based EBP interventions,
strategies, and tools. WVN
LINKING EVIDENCE TO ACTION
• EBP competencies are essential for all practicing
healthcare professionals as they guide healthcare pro-
fessionals’ integration of best evidence into their clini-
cal decision-making and thus, enable them to provide
higher-quality care to patients, resulting in better pa-
tient outcomes.
• It is important to recognize that EBP is a shared com-
petency; that is, the key principles and steps of the EBP
implementation process are universal and applicable
to all healthcare disciplines.
• There is an urgent need for conducting research stud-
ies on the applicability in practice, as well as the up-
take, adoption, and evaluation of the interprofessional
core competencies in EBP for all healthcare profession-
als recently published as a consensus statement based
on a systematic review and Delphi survey (Albarqouni
et al., 2018).
• Future research studies should also focus on develop-
ing and using actual, that is, performance-based,
validated outcome measures for assessing nurses’ EBP
competencies, instead of continuing to evaluate
perceived (i.e., self-rated) competencies via self-
­ org/10.1186/1472-6920-5-1
assessments, even when the constructs of interest,
such as EBP knowledge and ability, could be assessed
through more objective, performance-based measures.
Worldviews on Evidence-Based Nursing, 2019; 16:3, 176–185.
© 2019 Sigma Theta Tau International
Evidence Review
Author information
Hannele Saunders, Post-Doctoral Researcher, Research
Manager, Department of Nursing Science,  Faculty of Health
Sciences,  University of Eastern Finland, Kuopio, Finland;
South-Eastern Finland University of Applied Science, Kuopio,
Finland; Lynn Gallagher-Ford, Senior Director and Director,
Clinical Core, Helene Fuld Health Trust National Institute
for EBP in Nursing & Healthcare, Columbus, OH, USA, and
The Ohio State University College of Nursing, Columbus,
OH, USA; Tarja Kvist, Assistant Professor, Department of
Nursing Science,  Faculty of Health Sciences,  University of
Eastern Finland, Kuopio, Finland; Katri Vehviläinen-Julkunen,
Professor, Department of Nursing Science, Faculty of Health
Sciences,  Kuopio University Hospital,  University of Eastern
Finland, Kuopio, Finland
This research was supported by grants awarded to Dr.
Saunders from the Finnish Work Environment Fund, which
are gratefully acknowledged.
Address correspondence to Hannele Saunders,
Department of Nursing Science, Faculty of Health Sciences,
University of Eastern Finland, POB 1627, 70211 Kuopio,
Finland; hannele.saunders@uef.fi
Accepted 9 December 2018
© 2019 Sigma Theta Tau International
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WVN 2019;16:176–185

SUPPORTING INFORMATION
Additional supporting information may be found in the online version of this article at the publisher’s web site:

Figure S1. The modified PRISMA Flow diagram (Moher et al., 2009): Identification, screening and selection of systematic
reviews for inclusion in the overview.
Table S1. Inclusion and Exclusion Criteria for the Overview of Systematic Reviews.
Table S2. Characteristics of Included Systematic Reviews in the Overview.
Table S3. Summary Table of EBP Outcomes in the Systematic Reviews Included in the Overview.

Worldviews on Evidence-Based Nursing, 2019; 16:3, 176–185. 185

© 2019 Sigma Theta Tau International