E-Learning of Evidence-Based Health Care (EBHC) to Increase EBHC Competencies in Healthcare Professionals: a Systematic Review
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Education Coordinating Group E-learning of evidence-based health care (EBHC) to increase EBHC competencies in healthcare professionals: a systematic review Anke Rohwer, Nkengafac Villyen Motaze, Eva Rehfuess, and Taryn Young A Campbell Systematic Review Published: March 2017 2017:4 Search executed: May 2016 The Campbell Library comprises: • Systematic reviews (titles, protocols and reviews) • Policies and Guidelines Series • Methods Series Go to the library to download these resources, at: www.campbellcollaboration.org/library/ Better evidence for a better world Colophon Title E-learning of evidence-based health care (EBHC) to increase EBHC competencies in healthcare professionals: a systematic review Institution The Campbell Collaboration Authors Rohwer, Anke Motaze, Nkengafac Villyen Rehfuess, Eva Young, Taryn DOI 10.4073/csr.2017.4 No. of pages 147 Last updated 2 March 2017 Citation Rohwer A, Motaze NV, Rehfuess E, Young T. E-learning of evidence-based health care (EBHC) in healthcare professionals: a systematic review. Campbell Systematic Reviews 2017:4 DOI: 10.4073/csr.2017.4 ISSN 1891-1803 Copyright ©Rohwer et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Roles and AR, TY and ER conceptualized the question for the review. AR did the searches. AR, responsibilities NVM, ER and TY were involved in selection of studies, data extraction and risk of bias assessment. AR did the analyses with input from TY, NVM and ER. AR drafted the manuscript. NVM, ER and TY critically engaged with the manuscript and provided input. All authors approved the final manuscript before submission. Sources of support Effective Health Care Research Consortium: AR, VNM and TY are supported in part by the Effective Health Care Research Consortium (evidence4health.org), which is funded by UKaid from the UK government for the benefit of developing countries (Grant: 5242). The views expressed do not necessarily reflect UK government policy. This research has also been supported by the US President’s Emergency Plan for AIDS relief (PEPFAR) through HRSA under the terms of T84HA21652 and via the Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI). This project is co-funded by the European Union under the Seventh Framework Programme (Grant Agreement No. 30614) INTEGRATE-HTA http://www.integrate-hta.eu Declarations of AR and TY are authors on the following overview of systematic reviews that is relevant to interest this systematic review: Young, T., Rohwer, A., Volmink, J., & Clarke, M. (2014). What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One, 9(1), e86706. doi:10.1371/journal.pone.0086706. EAR and NVM: none known. Corresponding author Anke Rohwer Centre for Evidence-based Health Care Faculty of Medicine and Health Sciences, Stellenbosch University E-mail: [email protected] Full list of author information is available at the end of the article. Campbell Systematic Reviews Editor-in-Chief Julia Littell, Bryn Mawr College, USA Editors Crime and Justice David B. Wilson, George Mason University, USA Charlotte Gill, George Mason University, USA Education Sandra Jo Wilson, Vanderbilt University, USA International Birte Snilstveit, 3ie, UK Development Hugh Waddington, 3ie, UK Social Welfare Brandy Maynard, St Louis University, USA Knowledge Translation Aron Shlonsky, University of Melbourne, Australia and Implementation Methods Therese Pigott, Loyola University, USA Ryan Williams, AIR, USA Managing Editor Chui Hsia Yong, The Campbell Collaboration Co-Chairs Crime and Justice David B. Wilson, George Mason University, USA Peter Neyroud, Cambridge University, UK Education Sarah Miller, Queen's University, UK Gary W. Ritter, University of Arkansas, USA Social Welfare Mairead Furlong, National University of Ireland Brandy Maynard, St Louis University, USA Knowledge Translation Robyn Mildon, CEI, Australia and Implementation Cindy Cai, AIR, USA International Peter Tugwell, University of Ottawa, Canada Development Hugh Waddington, 3ie, UK Methods Ariel Aloe, University of Iowa, USA The Campbell Collaboration was founded on the principle that systematic reviews on the effects of interventions will inform and help improve policy and services. Campbell offers editorial and methodological support to review authors throughout the process of producing a systematic review. A number of Campbell’s editors, librarians, methodologists and external peer reviewers contribute. The Campbell Collaboration P.O. Box 4404 Nydalen 0403 Oslo, Norway www.campbellcollaboration.org Table of contents PLAIN LANGUAGE SUMMARY 5 EXECUTIVE SUMMARY 7 Background 7 Objectives 7 Search methods 7 Selection criteria 7 Data collection and analysis 8 Results 8 Authors’ conclusions 10 1 BACKGROUND 11 1.1 The problem, condition or issue 11 1.2 The intervention 12 1.3 How the intervention might work 15 1.4 Why it is important to do the review 17 2 OBJECTIVES 19 3 METHODS 20 3.1 Criteria for considering studies for this review 20 3.2 Search methods for identification of studies 22 3.3 Data collection and analysis 23 4 RESULTS 27 4.1 Description of studies 27 4.2 Risk of bias in included studies 37 4.3 Synthesis of results 40 5 DISCUSSION 55 5.1 Summary of main results 55 5.2 Overall completeness and applicability of evidence 56 5.3 Quality of the evidence 58 5.4 Limitations and potential biases in the review process 59 5.5 Agreements and disagreements with other studies or reviews 59 6 AUTHORS’ CONCLUSIONS 61 6.1 Implications for practice and policy 61 3 The Campbell Collaboration | www.campbellcollaboration.org 6.2 Implications for research 61 7 REFERENCES 62 7.1 References to included studies 62 7.2 References to excluded studies 63 7.3 References to ongoing studies 65 7.4 Additional references 65 8 INFORMATION ABOUT THIS REVIEW 68 8.1 Review authors 68 8.2 Roles and responsibilities 69 8.3 Sources of support 70 8.4 Declarations of interest 70 8.5 Plans for updating the review 70 8.6 Author declaration 71 9 TABLES 72 9.1 Search strategy 72 9.2 Risk of bias assessment for RCTs and non-RCTs 74 9.3 Characteristics of included studies 76 9.4 Characteristics of ongoing studies 114 9.5 Characteristics of excluded studies 114 9.6 Summary of characteristics of included studies 116 9.9 Summary of results 120 10 FIGURES 121 11 DATA AND ANALYSES 123 11.1 Pure e-learning vs no learning 123 11.2 Blended learning vs no learning 126 11.3 Pure e-learning vs face-to-face learning 131 11.4 Blended learning vs face-to-face learning 133 11.5 Blended learning vs pure e-learning 136 11.6 Pure e-learning vs pure e-learning 138 12 SUMMARY OF FINDINGS 140 12.1 Pure e-learning vs no learning (3 studies) 140 12.2 Blended learning vs no learning (5 studies) 141 12.3 Pure e-learning vs face-to-face learning (6 studies) 143 12.4 Blended learning vs face-to-face learning (5 studies) 143 12.5 Blended learning vs pure e-learning (3 studies) 145 12.6 Pure e-learning vs pure e-learning (3 stuides) 146 13 DIFFERENCES BETWEEN PROTOCOL AND REVIEW 147 13.1 Outcomes 147 13.2 Subgroup analysis 147 4 The Campbell Collaboration | www.campbellcollaboration.org Plain language summary Blended learning is most effective in increasing evidence-based health care competencies of health workers E-learning is a useful strategy to increase EBHC knowledge and skills, and when combined with face-to-face learning, to increase EBHC attitude and behaviour. The review in brief Evidence-based health care (EBHC) is decision-making for health care, informed by the best research evidence. Doctors, nurses and allied health professionals need to have the necessary knowledge and skills to apply EBHC. The use of electronic learning (e-learning) for EBHC training is increasing. E-learning, compared to no learning, improves EBHC knowledge and skills but not attitudes and behaviour. There is no difference in outcomes when comparing e-learning to face-to-face learning. Combining e-learning with face-to-face learning (blended learning) has a positive impact on EBHC knowledge, skills, attitude and behaviour. What did the review study? Evidence-based health care (EBHC) involves phrasing questions based on a knowledge gap, searching for research that can answer the question, critically appraising and interpreting the research, applying the results and auditing the process. Electronic learning (e-learning) has become an increasingly popular method of teaching EBHC. This review assesses the effectiveness of e-learning of EBHC for increasing EBHC competencies in healthcare professionals. The primary outcomes are EBHC knowledge, skills, attitude and behaviour. What is the aim of this review? This Campbell systematic review examines the effectiveness of e-learning in improving evidence-based health care knowledge and practice. 5 The Campbell Collaboration | www.campbellcollaboration.org What studies were included? Eligible studies were randomised controlled trials (RCTs), cluster RCTs, non-RCTs, controlled before-after studies and interrupted time series of any healthcare professional evaluating any educational intervention on EBHC, and that was delivered fully (pure e-learning) or in part (blended learning) via an electronic platform compared to no learning, face-to-face learning or other forms of e-learning of EBHC. The review included 24 trials, comprising 20 RCTs and four non-RCTs, with a total of 3,825 participants. Participants were medical doctors, nurses, physiotherapists, physician assistants, athletic trainers and a combination of professionals at all levels of education. The studies included a variety of interventions. What are the main findings of this review? Compared to no learning, pure e-learning improves EBHC knowledge and skills but not attitudes and behaviour. Pure e-learning is no better than face-to-face learning in improving any of the primary outcomes.