EBP-Affinity Questionnaire for Nursing Home Caregivers

This article, “Development and Validation of the EBP- Affinity Questionnaire: A Mixed-Method Study,” by Tange et al. (2025), addresses the critical need for implementing Evidence-Based Practice (EBP) in nursing homes to improve the quality of care and reduce costs. The authors highlight that Certified Nurse Assistants (CNAs) and Vocationally-Trained Registered Nurses (VTRNs) form a significant portion of nursing home staff in the Netherlands and have an important role in EBP, despite EBP being scarcely covered in their education.

The study’s primary aims were twofold: (1) to develop a new questionnaire, the ‘Evidence-Based Practice-Affinity (EBP-Affinity) Questionnaire,’ specifically designed to measure affinity with EBP among CNAs and VTRNs in nursing homes, based on their specific roles; and (2) to assess the reliability and validity of this questionnaire. The need for such a tool arose because existing EBP instruments, like the EBPAS and EBPQ, were mainly for nurses with higher education and did not fully capture the concept of “affinity” (liking, understanding, and applying EBP) for this specific target group.

The research employed a mixed-method design following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

Key aspects of the methodology included:

• Phase 1: Questionnaire Development (September 2020 – January 2021). This phase involved three steps:
  • Collecting items from existing literature, professional profiles, educational qualification files, and interviews with EBP experts (N=5). Experts confirmed that CNAs and VTRNs can apply EBP steps, except for critically assessing evidence. The initial collection yielded 77 items across 10 topics.
  • Consensus rounds with a new group of experts (N=7) through online surveys, where items were rated for adequacy and comprehensibility. This process reduced the items to 28 across 5 topics.
  • Pilot testing with CNAs (N=5) and VTRNs (N=2) using the ‘thinking aloud’ method to refine the questionnaire. This step led to the removal of two more items.
• Phase 2: Psychometric Evaluation (February – April 2021). This phase assessed the questionnaire’s reliability and validity.
  • Data was collected from 428 CNAs and VTRNs in nine nursing homes via an online survey.
  • Principal Component Analysis (PCA) was used for dimensionality, revealing a two-factor structure: ‘Collecting practical information’ (14 items) and ‘Collecting theoretical information’ (12 items), explaining 42% of the total variance. Both factors showed good internal reliability (Cronbach’s alpha = 0.88).
  • Rasch model testing confirmed good fit for all items and measurement invariance for most items between CNAs and VTRNs, meaning the questionnaire provides similar information for both groups.
  • Test-retest reliability for the entire questionnaire was found to be good (Intraclass Correlation (ICC) = 0.76).
  • Construct validity was supported by expected higher mean sum scores for VTRNs and those in the First Responsible Carer (FRC) role.

The study concludes that the ‘Evidence-Based Practice-Affinity Questionnaire’ is a reliable and valid instrument for assessing EBP affinity among CNAs and VTRNs in nursing homes. It provides valuable insight into the roles CNAs and VTRNs can play in EBP, primarily as “users” and “replicators” of evidence, rather than “doers” who critically appraise evidence. This questionnaire can serve as a starting point for improving practice, guiding tailored training programs, and fostering a culture of EBP in nursing homes. Future research is recommended to validate the questionnaire in international settings and explore its responsiveness over time.

Reference: Tange, L. J., Heinen, M., Koopmans, R. T. C. M., Korne, D. F. D., Persoon, A., Lindeboom, R., Gerritsen, D. L., & Lovink, M. H. (2025). Development and Validation of the EBP- Affinity Questionnaire: A Mixed-Method Study. Nursing Open. https://doi.org/10.1002/nop2.70151