The importance of evidence-based practice (EBP) in healthcare cannot be overstated. It is a critical approach that ensures safe, high-quality patient care, reduces unnecessary costs, and bridges the persistent gap between research and clinical application. Despite its significance, many healthcare professionals, especially nurses, face challenges in routinely implementing EBP. This systematic review synthesizes current evidence on the effectiveness of various educational interventions aimed at increasing EBP skills among nurses and physiotherapists in primary healthcare settings. By examining diverse strategies, their outcomes, and implementation considerations, this work provides valuable insights for stakeholders committed to fostering a culture of evidence-informed practice.
1. Introduction
The global healthcare landscape has increasingly emphasized the importance of quality improvement and patient safety, driven by influential reports such as “To Err is Human” (1999) and “Crossing the Quality Chasm” (2001). These initiatives have raised awareness about the necessity for healthcare systems to adopt evidence-based approaches that align clinical decisions with the best available research evidence, patient preferences, and healthcare professionals’ expertise.
Evidence-based practice (EBP) integrates multiple sources of knowledge, including the latest scientific literature, clinical skills, and patient values, to inform decision-making. In nursing, EBP is regarded as a cornerstone of professional competency, guiding clinical reasoning and ensuring that care is both effective and patient-centered. However, despite widespread acknowledgment of its value, the routine application of EBP remains inconsistent. Barriers such as limited skills, lack of access to relevant evidence, time constraints, and organizational resistance hinder its integration into daily practice.
Educational interventions are pivotal in overcoming these barriers. They aim to enhance healthcare professionals’ understanding, skills, and confidence in applying EBP. Nonetheless, the literature reveals heterogeneity in the types and structures of these interventions, with no clear consensus on the most effective approaches. This review addresses this gap by systematically evaluating the impact of various educational strategies on nurses’ and physiotherapists’ EBP competencies.
2. Materials and Methods
This review adhered to the PRISMA guidelines [36], ensuring a rigorous and transparent process. The protocol has been previously published [39]. We included studies involving registered nurses and physiotherapists working in primary healthcare, as well as students in these fields, across diverse settings such as clinics, community health centers, and hospital outpatient departments.
A comprehensive search across ten bibliographic databases was conducted up to September 30, 2022, including Medline, PubMed, Embase, CINAHL, Cochrane, PsycINFO, Web of Science, PEDro, JBI, and Trip. Grey literature and unpublished studies were also explored. Studies of various designs—RCTs, quasi-experimental, cohort, and mixed methods—were considered if they evaluated educational interventions aimed at improving EBP skills.
Data extraction was performed independently by multiple reviewers, capturing study characteristics, intervention details, and outcomes. The risk of bias was assessed using validated tools: the Newcastle–Ottawa Scale for cohort studies, ROBINS-I for non-randomized studies, and RoB 2.0 for RCTs. Due to heterogeneity, meta-analyses were not feasible; instead, descriptive analysis summarized findings.
3. Results
3.1 Search Results and Study Characteristics
From an initial pool of over 18,000 references, 15 studies met inclusion criteria. These studies spanned from 2011 to 2022 and were conducted mainly in the USA, Taiwan, Portugal, Finland, Spain, and India. The total sample included 2,712 participants—primarily nurses, with a few involving nursing students and nurse educators. Participants ranged from 19 to 65 years of age, predominantly female.
Study designs comprised four RCTs, ten quasi-experimental studies, and one cohort study. Settings included primary care clinics, hospitals, nursing schools, and specialized units. The interventions varied widely, from online modules and journal clubs to mentoring programs and multifaceted curricula.
3.2 Interventions and Outcomes
The educational strategies fell into three categories:
-
Multifaceted strategies with mentoring/tutoring: These involved models like ARCC and CREATE, emphasizing ongoing mentorship, critical appraisal, and organizational culture. For example, programs with dedicated EBP mentors guiding participants through exploring databases, appraising evidence, and implementing projects showed significant improvements in EBP beliefs and competencies.
-
Single strategies, often online: Computer-based modules, flipped classrooms, and self-directed learning were common. These strategies enhanced knowledge, attitudes, and perceived skills, especially when combined with interactive components like tutorials and practice exercises.
-
Strategies using the five steps of EBP: These included structured approaches such as asking clinical questions (PICO), searching for evidence, appraising literature, integrating findings with clinical expertise and patient preferences, and evaluating outcomes. Interventions employing these steps, often with a blend of lectures, case studies, and online activities, demonstrated positive effects on EBP behaviors and confidence.
3.3 Primary and Secondary Outcomes
Across all studies, eleven primary outcomes were evaluated using diverse instruments, revealing consistent improvements post-intervention:
-
Beliefs and attitudes: Measured by scales like the Evidence-Based Practice Belief Scale, most studies reported significant positive shifts, especially following multifaceted mentorship programs.
-
Knowledge and skills: Assessed via tools such as the Fresno Test and EBP Knowledge Assessment Questionnaire, with notable gains observed after intensive training programs.
-
Self-efficacy and behaviors: Participants demonstrated increased confidence and reported more frequent evidence-based activities in clinical practice, although some studies noted declines over time without reinforcement.
-
Perceptions of organizational culture: Improvements in perceived readiness for EBP were documented, highlighting the importance of organizational support.
Secondary outcomes included measures of group cohesion, job satisfaction, nurse productivity, and attrition. Findings indicated that well-structured educational interventions could positively influence these organizational variables, fostering a supportive environment for EBP.
3.4 Quality of Evidence
Methodological quality varied. The cohort study was rated as poor, while quasi-experimental studies generally showed moderate quality. RCTs were rated as having some concerns regarding bias. Despite limitations, the consistent use of validated assessment tools enhances confidence in the observed effects.
4. Discussion
The review underscores the pivotal role of educational interventions in cultivating EBP competencies among nurses. Multifaceted strategies incorporating mentoring, tutoring, and active learning appear most effective, aligning with the principles of adult education and organizational change theories. Computer-based learning, due to its cost-effectiveness and flexibility, emerges as a particularly promising approach, especially when integrated with ongoing mentorship and feedback.
The persistent barriers—such as lack of time, access to evidence, and organizational support—must be addressed alongside educational efforts. Frameworks like the Consolidated Framework for Implementation Research (CFIR) [82,83] provide valuable guidance for understanding and overcoming these obstacles. Applying such models during all phases of implementation can optimize adoption and sustainability of EBP.
Despite encouraging findings, gaps remain. The heterogeneity of interventions and measurement tools complicates direct comparisons. There is a pressing need for high-quality, large-scale studies across diverse healthcare settings and professions, including physiotherapists, to establish standardized, effective educational protocols.
4.1 Limitations
Limitations of this review include possible publication bias and language restrictions. The diversity of healthcare systems and socioeconomic contexts was not extensively analyzed. The scarcity of studies involving physiotherapists limits generalizability. Nonetheless, the inclusion of multiple study designs and validated instruments strengthens the overall conclusions.
4.2 Recommendations for Future Research and Practice
Future investigations should explore interprofessional educational interventions and examine contextual factors influencing EBP implementation. Incorporating models like the CFIR systematically can enhance understanding of facilitators and barriers. Emphasizing continuous, tailored, and mentorship-supported learning will likely produce sustainable improvements in EBP adoption.
Healthcare organizations and educators should prioritize integrating multifaceted, technology-supported educational strategies into both pre-service curricula and ongoing professional development. Cultivating a supportive organizational culture, with committed leadership and accessible resources, remains essential to embed EBP into routine practice.
5. Conclusions
This systematic review highlights that educational interventions—particularly those combining multiple strategies and ongoing mentorship—are effective in enhancing nurses’ EBP skills. While the evidence is promising, further high-quality research is needed to identify the most impactful approaches across different healthcare contexts. Embedding robust, tailored educational programs within organizational structures and fostering a culture of continuous learning are critical steps toward making evidence-based practice a standard component of nursing care. Ultimately, such efforts will translate into safer, more effective, and patient-centered healthcare delivery.
Explore how healthcare systems worldwide are adapting to evidence-based practices. Recognizing the factors that influence successful implementation, such as organizational culture and leadership, can be guided by models like the CFIR, which emphasize contextual readiness and ongoing evaluation.
In addition, understanding the data environments that support quality improvement efforts, including the types of datasets that enhance patient outcomes, is vital. For insights into these factors, see what data set helps improve the outcomes of home healthcare.