Clinical practice guidelines (CPGs) are used to support the clinical decisions of healthcare professionals (HCPs) and enhance patient outcomes particularly when they are developed based on a rigorous methodology. Lack of competencies regarding CPGs among HCPs hinders its integration into clinical practice. Innovative educational strategies such as digital education can improve HCPs’ competencies regarding CPGs. This study aimed to evaluate the impact of digital education on attaining competencies of CPGs. Method: quasi-experimental study design was utilized to carry out this study. Convenience sampling technique of 41 HCPs who have a bachelor’s degree or higher. Results: There was a statistically significant difference in the mean score of knowledge, attitude, and skills of HCPs regarding CPGs and retained up to 6 months of implementing digital education (P<0.05). Conclusion: Digital education can effectively improve the competencies of HCPs regarding CPGs. This improvement provides evidence for using digital education as an effective and interactive strategy for attaining the competencies of CPGs.
Clinical practice guidelines are recommendations for optimizing patient care which are developed based on evaluating the whole body of evidence through systematic reviews and assessment of the benefits and harms 1. Recently, using CPGs has been considered the basic source for improving the quality of the healthcare system, reducing inappropriate variations in clinical practice, and lowering cost of the healthcare 2.
Developing CPGs is considered the fundamental resource to implement evidence-based practice (EBP) approach and improve patient outcomes [1-27] 1. It is necessary to develop CPGs based on standardized, transparent, and rigorous methods due to the presence of large numbers of CPGs developed by national and international organizations 21. Developing CPGs should include a multidisciplinary team and systematic methodology for finding and evaluating the best evidence 6.
The presence of professional barriers hindered the development and implementation of CPGs such as lack of awareness of new CPGs, lack of competencies, and motivation for integrating CPGs into clinical practice 20. Therefore, healthcare organizations (HCOs) should build the competencies of HCPs for understanding the methodological development of CPGs, evaluating the quality of evidence, and implementing the final recommendations into clinical practice [21-28] 21.
Multifaceted interventions are considered an effective strategy for enhancing CPG uptake. Education of HCPs is a necessary part of these interventions 23. Digital education plays an important role in training HCPs which involves the utilization of innovative technology for delivering knowledge and skills to HCPs 12. It provides HCPs with accessible, standardized, relevant, timely, and affordable education. It helps in overcoming HCPs barriers such as inadequate quality of educators and outdated teaching styles [7-11-22-29]. Moreover, there is limited evidence of educating the competencies of CPGs for HCPs 19. To address this gap, this study aimed to evaluate the impact of digital education on attaining competencies of CPGs.
1.1. AimTo evaluate the impact of digital education on attaining competencies of CPGs.
1.2. Research HypothesesH1: Implementing digital education improves knowledge of HCPs regarding CPGs.
H2: Implementing digital education improves the attitude of HCPs regarding CPGs.
H3: Implementing digital education improves the skills of HCPs regarding CPGs.
The researchers utilized a quasi-experimental (single-group pre-post-test) study design to conduct this study.
2.2. SettingThe study was conducted at the World Wide Web (WWW) for globalization.
2.3. Sampling Technique and Sample SizeThe researchers used a convenience sampling technique to recruit 41 HCPs including head nurses, physicians, and pharmacists who have a bachelor’s degree or higher.
2.4. Study ToolsThe researchers developed two tools for data collection in this study as the following:
Tool I: Self-administered online questionnaire: it classified into three parts presented in Google form to assess demographic and occupational characteristics, knowledge, and attitude of HCPs regarding CPGs.
Part 1: HCPs’ demographic and occupational characteristics: It included 7 items; age, gender, years of experience, educational qualifications, occupation, working area, and attendance of training programs of CPGs.
Part 2: HCPs’ knowledge regarding CPGs: The researchers used this part to assess HCPs’ knowledge regarding CPGs pre, post, and six months after implementing digital education. It included 33 items arranged in 7 categories; definition & uses (n=7 items), development organizations of CPGs (n=3 items), benefits of CPGs for HCOs (n=3 items), benefits of CPGs for HCPs (n=4 items), benefits of CPGs for patients (n=3 items), development steps of CPGs (n=11 items), and definition of guideline adoption and adaptation (n= 2 items).
Scoring system: each item was scored one for each correct answer and zero for the wrong answer. The scores were summed up to get the total knowledge score ranged from (0 to 33) marks and were classified into three categories; good in case of ≥75% (≥24.75marks), fair in case of 50% to less than 75% of total scores (16.5-<24.75 marks), and poor in case of <50% of total scores (<16.5 marks).
Part 3: HCPs’ attitude scale: The researchers used this part to assess HCPs’ attitude regarding CPGs pre, post, and six months after implementing digital education. It consisted of 25 statements classified into four categories; importance and usefulness, uses, characteristics, and barriers of CPGs.
Scoring system: each positive statement scored on a 3 Likert rating scale (1 to disagree; 2 to neutral; 3 to agree) while negative statement scored based on reversed code into (1 to agree; 2 to neutral; 3 to disagree). The scores were summed up to get the total attitude score ranged from (1 to 75 marks) and were categorized into two categories; positive attitude in case of ≥75% of total scores (≥56.25 marks), negative attitude in case of <75% of total scores (<56.25 marks).
Tool II: HCPs’ skills in developing, adapting and/or adopting CPGs checklist:
The researchers used this tool to assess HCPs’ skills regarding CPGs pre, post, and six months after implementing digital education by using the rubric checklist. It contained skills evaluations questions set out in columns, clear grading criteria for each question in the accompanying rows, and a continuum of quality rating scales with scores allocated for each category. Judgments on these criteria were made by the researchers. The tool consisted of 26 statements presented into seven categories: developing multidisciplinary team, scope, clinical questions, search strategy, evaluating the best evidence, extracting final recommendations, and adapting or adopting CPGs skills.
Scoring system: each statement scored based on 5 levels (1 for level 1 to 5 for level five). The scores were summed up to get the total skills score ranged from 1-130 marks. According to 17, the total skills scores were categorized into five levels; level 5: highly competent >80% (105-130 marks), level 4: adequately competent >60-80% (79-104 marks), level 3: partially competent >40-60% (53-78 marks), level 2: slightly competent >20-40% (27-52 marks), and level 1: incompetent ≤ 20% (1-26 marks) of the total scores.
2.5. Data CollectionThe researchers started data collection in April 2022 and ended in July 2023. Data was collected pre, post, and six months after implementing digital education to assess the improvement in HCPs’ competencies regarding CPGs.
Pre-test conducted by the researchers to assess HCPs’ demographic and occupational characteristics, knowledge, and attitude regarding CPGs using (Tool I) in a Google form through this link (https://forms.gle/TcUSXKTZqTGLXWxk7). Moreover, the assessment of HCPs’ skills throughout number of activities aligned with CPGs development steps using the rubric checklist (Tool II). The researchers classified HCPs into subgroups that involved 2-3 participants based on their interest topic or area of CPG. They sent the activities to HCPs through email and social apps (WhatsApp). HCPs sent their achieved activities to the researchers after completing them electronically by email according to the deadline time.
2.6. Digital EducationThe researchers provided HCPs with YouTube videos links which included 22 videos that presented the content in an attractive methods using illustrations as figures, images, and tables regarding CPGs development, adaptation, adoption steps. Moreover, each step supported by the way of documentation and an activity based on the video content. The researchers uploaded videos sequentially based on CPGs development steps.
2.7. Evaluation of Digital EducationThe researchers conducted post-test and follow up six months after implementing digital education to assess the improvement in HCPs’ competencies regarding CPGs using Tool I (Part 1; 2); Tool II.
2.8. Ethical ConsiderationsThe researchers obtained ethical approval from the Research Ethics Committee of the Faculty of Nursing-Mansoura University and formal informed consent from HCPs. The researchers introduced themselves and explained the study’s objectives simply. They assured HCPs that their participation in the study was voluntary. Information and responses of HCPs were treated anonymously, only used for the study, and confidentiality was assured. HCPs were informed that they have the right to withdraw from the study at any time without giving any reason.
2.9. Statistical AnalysisData were sorted, coded, organized, categorized and transferred into specifically designed formats. Analysis was performed using SPSS (Stands for Statistical Product and Service Solutions) version 23. Categorical variables were described using the number and percent. Continuous variables were presented as mean ±SD (standard deviation). Repeated measured analysis of variance (RM-ANOVA) was used to compare means in different follow-up durations. A statistical test with a p-value ≤0.05 was considered statistically significant deviation.
Table 1 illustrates that 56.1% of HCPs aged from 30 to less than 40 years with a mean of 32.68 (5.83) and 90.2% of them were females. Moreover, 48.8% of them had experience from one to less than ten years with a mean of 9.63 (5.66). The results presented that 78% of HCPs had master’s degrees and were head nurses. While 63.4% of HCPs worked in urban areas and they didn’t attend any training programs of CPGs.
Table 2 shows that the total knowledge score was increased by 144% after 6 months of implementing digital education. The results revealed significant differences between the mean scores of the pre-test 12.39 (5.01) and the mean scores of follow-up after 6 months 30.26 (3.34). The difference was significant F=400.03 (p<0.000).
Table 3 portrays that the total attitude score was increased by 13.6% after 6 months of implementing digital education. The results revealed significant differences between the mean scores of the pre-test 60.04 (6.22) and the mean scores of follow-up after 6 months 68.24 (5.32). The difference was significant F= 32.39 (p=0.000).
Table 4 presents that there were significant differences for all categories of CPGs skills between the mean scores of the pre-test and follow-up after 6 months (p<0.05). The total skills score was increased by 318% after 6 months of implementing digital education. The results revealed significant differences between the mean scores of the pre-test 28.56 (2.60) and the mean scores of the follow-up after 6 months 119.39 (11.23). The difference was significant F= 2442.16 (p=0.000).
Healthcare professionals are expected to remain updated with the best evidence by integrating CPGs into clinical practice 24. It is difficult for HCPs to understand the development process, applicability, and drawbacks of CPGs 15. Therefore, HCOs should conduct educational programs to improve the HCPs’ competencies of CPGs 8. Digital education is one of the most popular strategy in the education of HCPs 4. Therefore, this study aimed to evaluate the impact of digital education on attaining competencies of CPGs.
The present study is the first study that evaluated the impact of digital education on attaining competencies of CPGs. There was a significant increase in HCPs’ knowledge of CPGs after implementing digital education, especially steps of developing CPGs. These findings agree with [10-12-23-24] who concluded that digital education as module-based and spaced-education interventions was beneficial for improving HCPs knowledge of CPGs. The improvement in knowledge could be attributed to 63.4% of HCPs do not attend any training program regarding CPGs.
According to 13 who showed that the participants had positive attitude toward CPGs in general and they considered guidelines as useful and reliable tools. Also, training programs increase the attitude and familiarity of CPGs. These results are in harmony with the present study findings that showed a significant increase in HCPs’ attitudes after implementing digital education. On the other hand, 5 disagrees with the study results. They reported that some participants expressed negative attitudes toward CPGs due to the presence of an unwieldy number of guidelines, changes in evidence, and conflicting recommendations in different guidelines.
For instance, there is the first study evaluated the impact of digital education on HCPs’ skills of CPGs. Previous studies [16-18-26-29] showed that digital education improved the competencies of HCPs regarding EBP skills. As EBP skills considered part of the development steps of CPGs such as developing clinical questions by using the PICO framework, searching for the evidence, and evaluating the best evidence to extract final recommendations. There are in a harmony with the current study results. In contrast to the study results, [9-14-25] reported that the preliminary assessment presented that the majority of the participants were confident in EBP skills due to attending training programs regarding the previous skills. The current study found that digital education improves the HCPs’ competencies of CPGs through presenting the content using attractive illustrations.
Digital education can effectively improve the HCPs’ competencies of CPGs. This improvement provides evidence for using digital education as an effective and interactive strategy for attaining the competencies of CPGs.
Based on the study findings: the study recommended. Implementing digital education on a large sample with interactive strategies for improving HCPs’ competencies of CPGs.
We would like to express our sincere gratitude to all healthcare professionals who took an enthusiastic part in the study regardless of their involvement in clinical practice.
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| In article | |||
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| In article | View Article PubMed | ||
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| In article | View Article PubMed | ||
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| In article | View Article PubMed | ||
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| In article | View Article PubMed | ||
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| In article | View Article | ||
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| In article | View Article PubMed | ||
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| In article | View Article PubMed | ||
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Published with license by Science and Education Publishing, Copyright © 2023 Naglaa M. Elsayed, Amel I. Ahmed and Dalia E. Khalil
This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit
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| [1] | Institute of Medicine (IOM) (2011) (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines; Graham R, Mancher M, Miller Wolman D, et al., editors. Clinical Practice Guidelines We Can Trust. Washington (DC): National Academies Press (US); 2011. Available from: https://www.ncbi.nlm.nih.gov/books/NBK209539. | ||
| In article | |||
| [2] | Wang, T., Tan, J. Y. B., Liu, X. L., & Zhao, I. (2023). Barriers and enablers to implementing clinical practice guidelines in primary care: an overview of systematic reviews. BMJ open, 13(1), e062158. | ||
| In article | View Article PubMed | ||
| [3] | Akindele, M., Rabiu, M., & Useh, E. (2020). Assessment of the awareness, adherence, and barriers to low back pain clinical practice guidelines by practicing physiotherapists in a low‐resourced country. Physiotherapy Research International, 25(1), 1811. | ||
| In article | View Article PubMed | ||
| [4] | Bajpai, S., Semwal, M., Bajpai, R., Car, J., & Ho, A. H. Y. (2019). Health professions’ digital education: Review of learning theories in randomized controlled trials by the Digital Health Education Collaboration. Journal of medical Internet research, 21(3), e12912. | ||
| In article | View Article PubMed | ||
| [5] | Baynouna Al Ketbi, L. M., & Zein Al Deen, S. (2018). The attitudes and beliefs of general practitioners towards clinical practice guidelines: a qualitative study in Al Ain, United Arab Emirates. Asia Pacific family medicine, 17, 1-9. | ||
| In article | View Article PubMed | ||
| [6] | Bierbaum, M., Rapport, F., Arnolda, G., Nic Giolla Easpaig, B., Lamprell, K., Hutchinson, K., ... & Braithwaite, J. (2020). Clinicians’ attitudes and perceived barriers and facilitators to cancer treatment clinical practice guideline adherence: a systematic review of qualitative and quantitative literature. Implementation Science, 15(1), 1-24. | ||
| In article | View Article PubMed | ||
| [7] | Bloomfield, J. G., Fisher, M., Davies, C., Randall, S., & Gordon, C. J. (2023). Registered nurses’ attitudes towards e-learning and technology in healthcare: A cross-sectional survey. Nurse Education in Practice, 69. | ||
| In article | View Article PubMed | ||
| [8] | Correa, V. C., Lugo-Agudelo, L. H., Aguirre-Acevedo, D. C., Contreras, J. A. P., Borrero, A. M. P., Patiño-Lugo, D. F., & Valencia, D. A. C. (2020). Individual, health system, and contextual barriers and facilitators for the implementation of clinical practice guidelines: a systematic metareview. Health research policy and systems, 18, 1-11. | ||
| In article | View Article PubMed | ||
| [9] | Enejjari, Z., & Bouziane, A. (2022). Knowledge, attitudes and practices towards Evidence-Based-Dentistry regarding dental practitioner: A cross-sectional study. Annals of Medicine and Surgery, 81, 104289. evidence-based practice. Journal of Athletic Training, 49(2), 220-233. G. (2014). Perceived outcomes of web-based modules designed to enhance athletic trainers' knowledge of | ||
| In article | View Article PubMed | ||
| [10] | Iida, H., Okada, T., Nemoto, K., Hasegawa, N., Numata, S., Ogasawara, K., Miura, K., Matsumoto, J., Hori, H., Iga, J. ichi, Ichihashi, K., Hashimoto, N., Yamada, H., Ohi, K., Yasui-Furukori, N., Fukumoto, K., Tsuboi, T., Usami, M., Furihata, R., … Hashimoto, R. (2023). Satisfaction with web-based courses on clinical practice guidelines for psychiatrists: Findings from the “Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)” project. Neuropsychopharmacology Reports, 43(1), 23–32. | ||
| In article | View Article PubMed | ||
| [11] | Jensen, L. X., Buhl, A., Hussain, S., Karan, A., Konradsen, F., & Bearman, M. (2023). Digital education for health professionals in India: a scoping review of the research. BMC Medical Education, 23(1), 561. | ||
| In article | View Article PubMed | ||
| [12] | Konstantinidis, S. T., Bamidis, P. D., & Zary, N. (2021). Introduction to digital innovation in healthcare education and training. In Digital Innovations in Healthcare Education and Training (pp. 3-15). | ||
| In article | View Article | ||
| [13] | Kuronen, R., Jallinoja, P., & Patja, K. (2011). Use of and attitudes toward current care guidelines among primary and secondary care nurses in Finland. Clinical Nursing Research, 20(3), 310-325. | ||
| In article | View Article PubMed | ||
| [14] | Leach, B., Parkinson, S., Gkousis, E., Abel, G., Atherton, H., Campbell, J., ... & Sussex, J. (2022). Digital facilitation to support patient access to web-based primary care services: Scoping literature review. Journal of Medical Internet Research, 24(7), e33911. | ||
| In article | View Article PubMed | ||
| [15] | Lima, J. P., Mirza, R. D., & Guyatt, G. H. (2023). How to recognize a trustworthy clinical practice guideline. Journal of Anesthesia, Analgesia and Critical Care, 3(1), 9. | ||
| In article | View Article PubMed | ||
| [16] | Park, M., Jeong, M., Lee, M., & Cullen, L. (2020). Web-based experiential learning strategies to enhance the evidence-based-practice competence of undergraduate nursing students. Nurse education today, 91, 104466. | ||
| In article | View Article PubMed | ||
| [17] | Ramsburg, L. (2010). An Initial Investigation of the Applicability of the Dreyfus Skill Acquisition Model to the Professional Development of Nurse Educators. Digital Scholar Theses. http://mds.marshall.edu/etd. | ||
| In article | |||
| [18] | Rohwer, A., Motaze, N. V., Rehfuess, E., & Young, T. (2017). E‐learning of evidence‐based health care (EBHC) to increase EBHC competencies in healthcare professionals: a systematic review. Campbell Systematic Reviews, 13(1), 1-147. | ||
| In article | View Article | ||
| [19] | Saunders, H., Gallagher‐Ford, L., Kvist, T., & Vehviläinen‐Julkunen, K. (2019). Practicing healthcare professionals’ evidence‐based practice competencies: An overview of systematic reviews. Worldviews on Evidence‐Based Nursing, 16(3), 176-185. | ||
| In article | View Article PubMed | ||
| [20] | Stander, J., Grimmer, K., & Brink, Y. (2020). Factors influencing clinical practice guideline uptake by South African physiotherapists: A qualitative investigation of barriers and facilitators. Journal of Evaluation in Clinical Practice, 26(3), 728–737. | ||
| In article | View Article PubMed | ||
| [21] | Sultan, S., Morgan, R. L., Murad, M. H., Falck-Ytter, Y., Dahm, P., Schünemann, H. J., & Mustafa, R. A. (2020). A theoretical framework and competency-based approach to training in guideline development. Journal of general internal medicine, 35, 561-567. | ||
| In article | View Article PubMed | ||
| [22] | Tudor Car, L., Poon, S., Kyaw, B. M., Cook, D. A., Ward, V., Atun, R, ... & Car, J. (2022). Digital education for health professionals: an evidence map, conceptual framework, and research agenda. Journal of medical Internet research, 24(3), e31977. | ||
| In article | View Article PubMed | ||
| [23] | Tudor Car, L., Soong, A., Kyaw, B. M., Chua, K. L., Low-Beer, N., & Majeed, A. (2019). Health professions digital education on clinical practice guidelines: a systematic review by Digital Health Education collaboration. BMC medicine, 17(1), 1-16. | ||
| In article | View Article PubMed | ||
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| In article | View Article PubMed | ||
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