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Digital Education: Attaining Competencies of Clinical Practice Guidelines

Naglaa M. Elsayed*, Amel I. Ahmed, Dalia E. Khalil

Assistant lecturer, Community Health Nursing Department, Faculty of Nursing, Mansoura University, Egypt

Abstract: 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.

Keywords: clinical practice guidelines, competencies, digital education, healthcare professionals

Received October 19, 2023; Revised November 21, 2023; Accepted November 27, 2023

Citation: Naglaa M. Elsayed, Amel I. Ahmed, Dalia E. Khalil, Digital Education: Attaining Competencies of Clinical Practice Guidelines. American Journal of Educational Research, 11 (12). 792-796. January 2023. doi:10.12691/education-11-12-2

1. Introduction

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]. 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].

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. Aim

To evaluate the impact of digital education on attaining competencies of CPGs.

1.2. Research Hypotheses

H1: 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.

2. Method

2.1. Study Design

The researchers utilized a quasi-experimental (single-group pre-post-test) study design to conduct this study.

2.2. Setting

The study was conducted at the World Wide Web (WWW) for globalization.

2.3. Sampling Technique and Sample Size

The 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 Tools

The 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 Collection

The 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 Education

The 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 Education

The 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 Considerations

The 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 Analysis

Data 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.

3. Results

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 1. Healthcare professionals’ demographic and occupational characteristics

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 2. Mean difference in HCPs’ knowledge regarding CPGs pre, post, and follow-up after six months of implementing digital education

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 3. Mean difference in HCPs’ attitude pre, post, and follow-up after six months of implementing digital education

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).

Table 4. Mean difference in HCPs’ skills pre, post, and follow-up after six months of implementing digital education

4. Discussion

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.

5. Conclusion

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.

6. Recommendations

Based on the study findings: the study recommended. Implementing digital education on a large sample with interactive strategies for improving HCPs’ competencies of CPGs.

ACKNOWLEDGMENTS

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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