Use of a mobile application for learning evidence-based practice: A multi-method approach

Abstract

Introduction

Evidence-based practice (EBP) involves making informed decisions about the best patient care. Practicing and learning EBP is guided by the following five steps: asking questions (Ask), searching for research evidence (Access), critically appraising the evidence (Appraise), applying the evidence (Apply), and evaluating the EBP process (Audit). EBP teaching interventions should be interactive, multifaceted, clinically integrated, and assessed. While digital technology and mobile applications (apps) are relevant in facilitating interactive learning, few examples exist within EBP. A mobile app called EBPsteps was developed to support interactive EBP learning in health and social care education in Norway. Usability testing, alongside the development of learning apps, is needed to ensure that apps are user-friendly and relevant. To our knowledge, few previous studies have investigated the usability of EBP apps.

Aims

The overall aim of this thesis was to enhance our knowledge of how health and social care students use a new and innovative mobile app learning EBP. In addition, the aim was to broaden our understanding of methods and attributes relevant to usability studies of mobile apps for health care education.

Methods

This thesis employed a multi-method approach, which included three studies with different designs. Health and social care students’ experiences of learning EBP using the mobile app EBPsteps during their clinical placements were explored in an interpretive description study (Paper I). EBP skills, as reported through the mobile app EBPsteps, were assessed among four occupational therapy (OT) student cohorts in a cross-sectional study (Paper II). Usability methods and attributes applied in usability studies of mobile apps for health care education were identified in a scoping review (Paper III).

Results

Paper I: We found that students experienced triggers and barriers towards using the EBPsteps app. Triggers identified were information needs, academic requirements, and expectations from clinical instructors to use EBP during clinical placement. Barriers identified were insufficient EBP knowledge, the absence of academic demands, and clinical instructors not expecting students to apply EBP in practice. The design features of the app also affected students’ use of the app. Students experienced that the app provided a useful overview of the EBP steps and functioned as a digital notebook. However, when students encountered technical problems such as difficulty in navigation and unfamiliar icons, it negatively impacted their use of the app.

Paper II: Among 150 OT students, 119 (79%) used the EBPsteps, and they produced 240 Critically Appraised Topics (CATs). We found that most students were able to perform the first EBP steps (Ask, Access, and Appraise). A positive association was found between formulating the PICO/PICO elements and identifying research evidence. Most of the students were not able to report the two final EBP steps correctly (Apply and Audit).

Paper III: The scoping review consisted of 88 articles that encompassed 98 studies, primarily centered on nursing and medical students. The most common usability methods identified were inquiry methods that included the use of questionnaires. The most frequently reported usability attributes were satisfaction, usefulness, and ease of use.

Conclusion

We found that students used the EBPsteps app when they were required to do so, either in EBP assignments or during clinical placement (Paper I). The lack of EBP knowledge and design features of the app hindered its use. We found that students struggled to report the EBP steps Apply and Audit when using EBPsteps (Paper II). The reason behind this could be a lack of EBP competence, low technology literacy, design features of the app, or cognitive load. A limited range of usability methods was used to evaluate health care educational apps, and the most used attributes were satisfaction, usefulness, and ease of use (Paper III). Selecting a wider variety of usability methods and attributes when conducting a study can provide more thorough usability testing.

According to the findings in Paper III, both objective and subjective usability methods are necessary, and researchers must select relevant attributes to examine when conducting a usability study. To further evaluate the EBPsteps app’s usability, future research should perform cognitive interview studies, such as think-aloud methods and other pilot studies. Only students were included in the first two studies of this thesis (Papers I and II), and as such, future studies are needed to test the usability of EBPsteps among other populations. Therefore, future research should examine how teachers implement the use of EBPsteps in their teaching practices.