Knowledge, Attitude, Access and Confidence in Evidence-based practice amongst French dental undergraduates: A transcultural adaptation and psychometrics analysis of French version of the KACE questionnaire

Questionnaires related to Evidence-Based Practice applied to dentists, faculty members or dental students: a scoping review

BACKGROUND

Numerous instruments have been suggested to analyze the essential Evidence-Based Dentistry (EBD) dimensions, but it is unclear whether they were comprehensive and validated appropriately.

AIM

To investigate instruments that assess EBD-related dimensions.

METHODS

We included primary studies involving dentists, faculty members, or dental students at any level of professional career that described validation or translation/transcultural adaptation processes of EBD instruments or reported the application of such instruments. Searches were conducted at PubMed, Embase, Web of Science, and Scopus, along with manual searches in EBD journals, Google Scholar and reference lists. Descriptive data were collected and standardized in tables, and summarized.

RESULTS

Fifty studies were included. The KACE (Knowledge, Attitudes, Access, and Confidence Evaluation) instrument demonstrated clarity, internal consistency, face validity, discriminant validity, and responsiveness, but neglected important dimensions such as EBD-related practices, patient benefits, barriers/facilitators, and willingness to learn and disseminate EBD practices. The modified Berlin questionnaire designed to measure perceived/actual knowledge, showed clarity, internal consistency, content validity, and discriminant validity, but lacked data on reproducibility, face validity, construct validity, and responsiveness. Other questionnaires, while broader, had significant limitations in reported reliability and validation.

CONCLUSIONS

Although the KACE instrument and the modified Berlin questionnaire underwent relatively rigorous reliability and validation testing, they were considered insufficiently comprehensive. When analyzed together, other questionnaires were found to be relatively more comprehensive, but they exhibited more significant limitations regarding reported reliability and validation assessments. This suggests the need for a novel instrument that fulfills a more significant number of validation phases and EBD-related dimensions.

Reliability and validity of Vietnamese version of the Knowledge, Attitudes, Access, and Confidence Evaluation questionnaire

OBJECTIVE

To effectively evaluate evidence-based dentistry (EBD) training outcomes, precise and validated assessment tools are essential. This study aimed to construct a Vietnamese version of the KACE questionnaire (Knowledge, Attitudes, Access, and Confidence Evaluation) and to assess its reliability and validity.

METHODS

After translating the original KACE questionnaire, we conducted tests for face validity, content validity, and discriminant validity test. Cronbach's alpha and intraclass correlation coefficients (ICC) were calculated to evaluate the internal consistency and reliability of the Vietnamese KACE questionnaire.

RESULTS

Thirty lecturers and 280 dental students completed the KACE questionnaire. Cronbach's alpha for the Attitude scale ranged from 0.90 to 0.97, for the Accessing Evidence scale from 0.90 to 0.96, and for the Confidence scale ranged from 0.83 to 0.93 across lecturers and dental student groups. The Knowledge scale had Cronbach's alpha from 0.55 to 0.79. The overall ICC of 0.861 indicated that the measurement is stable and consistent.

CONCLUSION

The Vietnamese adaptation of the KACE questionnaire is a reliable and valuable tool for assessing EBD competencies among Vietnamese dental students and practitioners.

An evidence-based teaching approach enhances student learning of periodontal disease pathogenesis

PURPOSE/OBJECTIVES

To evaluate the effects of implementing an evidence-based teaching approach (EBTA) in a traditional dental curriculum course on predoctoral dental students' knowledge and attitudes about evidence-based dentistry, and to determine its benefit on enhancing students' academic performance.

METHODS

Fundamentals of periodontics for first-year dental students (D1, n = 100) span a period of 12 weeks. In the first 6 weeks, we teach the basic principles of periodontal disease pathogenesis and introduce the concepts of EBTA (basics of research study design, statistical principles, literature search, and critically analyzing the evidence) without active implementation. In the second 6 weeks, we build on the initial knowledge of periodontal disease pathogenesis and actively implement EBTA activities to enhance the learning of the course content. Pre- and post-EBTA implementation, students completed a validated survey assessing students' knowledge, attitudes, access of evidence, and confidence related to evidence-based dentistry. Midterm and final grades were used to assess student academic performance.

RESULTS

Post-EBTA implementation survey responses showed: significant increase in students' knowledge regarding critical appraisal of the literature (p = 0.0001), significant improvement in students' attitudes about evidence-based dentistry (p = 0.0001), significant increase in students' frequency of accessing evidence from various sources (p = 0.01), and significant increase in students' confidence in evaluating various aspects of a published research report (p = 0.009). Post-EBTA final grade scores were significantly higher than pre-EBTA midterm grade scores (p = 0.0001).

CONCLUSIONS

Integrating an EBTA within a traditional dental curriculum course improves students' knowledge and attitudes about evidence-based dentistry as well as enhances students' academic performance.

Effectiveness of educational strategies to teach evidence-based dentistry to undergraduate dental students: a systematic review

OBJECTIVES

Evidence-based dentistry (EBD) training has been widely promoted in dental schools around the world and policymakers ask for suitable strategies to teach EBD within undergraduate dental education. The present study aims to evaluate the effectiveness of these strategies on dental students' knowledge, attitude, and skills.

METHODS

PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, and Eric databases were searched using search terms obtained from Medical Subject Headings (MeSH) terms and free text method without time restrictions, up to November 2022. The identified articles were screened based on titles and abstracts for inclusion criteria. Subsequently, relevant articles underwent data extraction. Finally, the risk of bias was assessed through Joanna Briggs Institute critical appraisal checklists.

RESULTS

Twelve of 439 studies were included: nine quasi-experimental studies, two cross-sectional, and one randomized controlled trial study. Regarding the overlap among categories, six studies assessed knowledge, seven assessed attitude, and eight focused on skills or performance in EBD. Due to the heterogeneity of the interventions and results of included studies, a meta-analysis was not performed. EBD was mostly taught in small group collaborations. Interventions included lectures, workshops, seminars, small group sessions, journal clubs, online sessions, or a combination of them in various frequencies and duration.

CONCLUSIONS

EBD implementation into dental curricula is improving through strategies including designing continuing and frequent dental education courses, establishing collaborative student research groups, utilizing online tools for EBD education, and dividing EBD courses into shorter modules. The systematic review protocol was registered in PROSPERO (ID: CRD42022350238).

Knowledge changes after applying evidence-based dentistry educational interventions to dental students: A systematic review

PURPOSE

To critically evaluate the evidence on knowledge changes observed after the application of evidence-based dentistry (EBD) educational interventions to dental students.

METHODS

We included studies that assessed EBD knowledge after applying educational interventions to undergraduates. Studies that evaluated post-graduate students or professionals, that exclusively described educational interventions, programs, or the application of curriculum revisions were excluded. Electronic databases (PubMed, Embase, Scopus, and Web of Science), unpublished gray literature, and manual searches were performed. Data concerning "perceived" and "actual knowledge" was extracted. The quality of the studies was appraised according to the Mixed Methods Appraisal Tool.

RESULTS

The 21 selected studies enrolled students at different stages, and the intervention formats were diverse. The educational interventions could be categorized into three modalities, that is, regular, EBD-focused disciplines or courses, and other educational interventions including one or more of the EBD principles, methods, and/or practices. Despite the format, knowledge was generally improved after the implementation of educational interventions. Overall, perceived and actual levels of knowledge increased considering EBD general concepts, principles, and/or practices, and concerning the "acquire" and "appraise" skills. Among the selected studies, two were randomized controlled trials, while most were non-randomized or descriptive studies.

CONCLUSIONS

EBD-related educational interventions seem to improve dental students' perceived and actual knowledge, according to literature with a high risk of bias. Therefore, more complete, methodologically rigorous, and longer-term studies are still recommended to confirm and expand the current knowledge.

Dental Students’ Knowledge, Attitude, and Confidence toward Evidence-based Dentistry: A 5-year Retrospective Study

AIM

The purpose was to assess dental students' knowledge, attitude, and confidence toward evidence-based dentistry in five graduating Doctor of Dental Surgery (DDS) classes.

MATERIALS AND METHODS

All dental students (class of 2019, 2020, 2021, 2022, and 2023) enrolled in the D3 research design course were required to take a pre-Knowledge, Attitude, and Confidence in Evidence-based Dentistry (KACE) survey. On completion of the 11-week course, a post-KACE survey was distributed to compare the differences in the three domains of evidence-based dentistry (EBD). For the knowledge domain, the responses from the 10 questions were converted to either correct (1) or wrong (0) so that the compiled scores could range from 0 to 10. The attitudes and confidence domains used a five-point Likert scale. The compiled attitude score was a sum of the responses from 10 questions yielding a range from 10 to 50. For confidence, the compiled score ranged from 6 to 30.

RESULTS

The mean knowledge scores of all classes together before and after training were 2.7 and 4.4, respectively. Overall, there was a statistically significant difference between pre- and post-knowledge indicating an improvement in knowledge associated with the training (p < 0.001). The mean attitudes of all classes together before and after the training were 35.3 and 37.2, respectively. Overall, there was a statistically significant improvement in attitude (p < 0.001). The values of mean confidence of all classes together before and after the training were 15.3 and 19.5, respectively. Overall, there was a statistically significant improvement in confidence (p < 0.001).

CONCLUSIONS

A dental curriculum emphasizing Evidence-based practice (EBD) resulted in increased knowledge acquisition, improved attitude, and confidence toward EBD of dental students.

CLINICAL SIGNIFICANCE

Educational initiatives emphasizing evidence-based dentistry increase students' knowledge acquisition, improved attitude, and confidence toward EBD that may also translate to active implementation of EBD in their future practices.