The Measure of Evidence-Based Practice in Occupational Health<\/strong> (EBP-OHS) is a specialized, multidimensional psychometric instrument developed to evaluate the operationalization, integration, and cultural adoption of evidence-based practice<\/a> (EBP) within occupational health services (OHS). Originating in Finland to overcome the ecological and structural limitations of legacy instruments\u2014such as the Fresno test<\/a> or nursing-centric inventories\u2014the EBP-OHS captures the dual macro-level organizational infrastructure and micro-level practitioner competencies necessary for evidence-informed clinical and preventive decision-making. The instrument comprises 15 items evaluated across a distinctive 5-point Likert-type response scale (comprising Fully agree<\/em>, Agree<\/em>, Somewhat disagree<\/em>, Fully disagree<\/em>, and I cannot say<\/em>). Through structural analysis, the instrument operationalizes three distinct latent dimensions: Organisational support<\/em> (7 items), OHS practitioners' competence<\/em> (6 items), and OHS practitioners' attitudes<\/em> (2 items).<\/p>\n Psychometric evaluation of the EBP-OHS in a nationwide sample of 524 Finnish occupational healthcare professionals (occupational health physicians, occupational health nurses, and administrative supervisors) established robust empirical properties. Content validity was verified by a multi-expert panel yielding Item-Level Content Validity Index (I-CVI) values of ≥ 0.78 across retained items. Principal Component Analysis (PCA) confirmed a clear three-factor configuration explaining 60.3% of the total variance, with factor loadings spanning 0.51 to 0.84 and item communalities ranging from 0.37 to 0.79. The scale demonstrates excellent internal consistency reliability, indexed by an overall Cronbach's alpha<\/a> of 0.88. By accounting for the interdependence of workplace organizational backing, clinical mastery, and professional conviction, the EBP-OHS provides health service administrators, industrial hygienists, organizational psychologists, and clinical researchers with an actionable, empirically validated diagnostic instrument to identify implementation barriers, steer curricular interventions, and optimize institutional occupational safety systems<\/span>.<\/p>\n evidence-based practice, occupational health services, psychometrics, organizational support, clinical competence, professional attitudes, scale validation, implementation science, Joanna Briggs Institute, workplace healthcare<\/p>\n The Measure of Evidence-Based Practice in Occupational Health (EBP-OHS) was conceptualized, developed, and psychometrically validated by an interdisciplinary team of researchers and clinical leaders in occupational health, health sciences, and organizational epidemiology:<\/p>\n The fundamental purpose of the Measure of Evidence-Based Practice in Occupational Health (EBP-OHS) is to furnish an empirically robust, domain-specific assessment battery that measures how occupational health personnel and their employing service organizations assimilate, appraise, and implement scientific evidence into day-to-day enterprise and clinical operations. Occupational health services occupy an inherently complex nexus bridging clinical medicine, employee wellness, preventive safety, labor law, and organizational performance. Despite the proliferation of clinical guidelines, occupational health practices historically suffered from substantial implementation variance, frequently relying on clinical tradition, organizational habit, or non-systematic empirical consensus rather than verified scientific research.<\/p>\n Prior to the introduction of the EBP-OHS, academic researchers and clinic managers relied on assessment instruments imported from acute hospital care or general medicine. Classic measures such as the Fresno Test evaluate individual technical competencies (such as database search syntaxes, calculation of likelihood ratios, and statistical understanding), whereas measures like the Evidence-Based Practice Questionnaire (EBPQ) were constructed primarily around hospital-based nursing routines. These legacy instruments possess minimal ecological validity within occupational health environments. In occupational health, an intervention rarely targets an individual patient in clinical isolation; rather, interventions require coordinated interactions among multidisciplinary teams (occupational health physicians, occupational health nurses, occupational physiotherapists, and organizational psychologists), corporate human resource managers, workplace safety representatives, and enterprise executives.<\/p>\n The clinical and administrative rationale underpinning the EBP-OHS rests on the premise that evidence-based occupational health cannot function as a solely individual cognitive skill. Rather, it constitutes an organizational ecosystem. Healthcare practitioners frequently experience individual readiness to deploy modern clinical guidelines but encounter insurmountable systemic barriers: prohibitive commercial workloads, absence of digital academic journal access, management indifference, or a lack of continuing professional education. Conversely, an institution may invest in subscriptions and clinical directives, but staff may harbor negative attitudes toward changing long-standing diagnostic habits. The EBP-OHS resolves this dilemma by systematically differentiating between individual competence, individual attitudes, and structural organizational facilitation. Consequently, the instrument serves clinical directors and policy planners as an actionable diagnostic audit. It enables organizations to pinpoint exactly why an evidence-to-practice gap exists\u2014whether it is driven by structural resource deficits, educational skill gaps, or philosophical resistance\u2014allowing for targeted structural interventions, customized continuing medical education, and longitudinal tracking of clinical quality improvement initiatives.<\/p>\n The EBP-OHS operationalizes evidence-based practice in occupational health as a multidimensional socio-cognitive and behavioral construct. Moving beyond reductionist conceptualizations of evidence utilization as a purely intellectual aptitude, the scale captures the interplay between individual professional traits and workplace environmental affordances. The construct spans three core dimensions:<\/p>\n The Organisational support<\/em> dimension captures the extent to which the practitioner perceives their work environment, administrative leadership, and operational infrastructure as actively fostering, enabling, and incentivizing evidence-based methodologies. Rooted in organizational climate theory, this subscale reflects systemic institutional commitment. Operationally, it measures managerial encouragement of scientific inquiry, systematic resource allocation (such as dedicated work hours for literature retrieval and paid participation in scientific congresses), institutional provision of ongoing vocational training, and the active maintenance of evidence-informed clinical guidelines within internal electronic health record workflows. A high score on this dimension reflects an organizational context characterized by psychological safety, proactive management, accessible scholarly databases, and explicit clinical governance where evidence utilization is formally embedded into the organizational standard operating procedures rather than relegated to voluntary off-duty professional conduct.<\/p>\n The Competence<\/em> dimension evaluates the self-reported functional mastery, procedural knowledge, and behavioral capability of the occupational health specialist to execute the core tenets of evidence-based healthcare. Rather than evaluating abstract biostatistical knowledge, this subscale targets pragmatic, applied clinical actions specific to occupational medicine. It gauges the practitioner's capacity to locate high-quality systematic reviews, critically evaluate the validity of clinical recommendations, translate epidemiological data to specific enterprise environments, and use scientific literature to justify clinical decisions to corporate clients and workers. Furthermore, it measures the practitioner's proficiency in selecting and defending evidence-supported workplace preventive services, risk assessments, and rehabilitation programs. Individuals with high scores demonstrate cognitive self-efficacy in operationalizing clinical research into routine patient consultations and enterprise-level occupational health agreements.<\/p>\n The Attitudes<\/em> dimension quantifies the affective, motivational, and philosophical value that occupational healthcare professionals ascribe to evidence-based practice. In accordance with the Theory of Planned Behavior<\/a>, behavioral intention and subsequent clinical actions are substantially governed by internal attitudes toward that behavior. This subscale measures the fundamental professional belief that clinical and preventive activities must be substantiated by empirical scientific research to be ethically and clinically legitimate. Rather than perceiving scientific guidelines as an infringement on clinical autonomy, a practitioner scoring high on this dimension views empirical literature as an indispensable pillar of professional integrity, client safety, and optimal clinical practice.<\/p>\n The architectural foundation of the EBP-OHS is grounded primarily in the Joanna Briggs Institute (JBI) Model of Evidence-Based Healthcare<\/strong> (Jordan et al., 2119\/2019<\/a>; Pearson et al., 2005<\/a>; Lockwood, 2017<\/a>). The updated JBI Model conceptualizes evidence-based healthcare not as an isolated endpoint, but as a cyclical, global continuum organized around four pivotal operational phases: Evidence Generation<\/em>, Evidence Synthesis<\/em>, Evidence Transfer<\/em>, and Evidence Implementation<\/em>.<\/p>\n The EBP-OHS specifically operationalizes and integrates the final two phases of this framework within occupational health units:<\/p>\n Furthermore, the EBP-OHS intersects JBI theory with socio-technical systems theory and implementation science models, such as the Consolidated Framework for Implementation Research (CFIR). CFIR posits that intervention execution depends inextricably on the interplay between the "outer setting" (societal, legislative, and insurance mandates), the "inner setting" (structural culture, leadership engagement, and resource climate within the health center), and individual characteristics (practitioner knowledge, self-efficacy, and professional identity). By aligning its subscale construction with these theoretical structures, the EBP-OHS provides a theoretically integrated assessment of healthcare implementation.<\/p>\n The psychometric evaluation of the EBP-OHS demonstrated strong evidence of both content and construct validity across systematic developmental phases in accordance with international testing standards (Mikkonen et al., 2022<\/a>; Polit & Hungler, 1999):<\/p>\n Content validity was evaluated using a structured expert panel approach. A specialized Delphi-oriented review was conducted with 12 independent experts encompassing senior occupational health physicians, academic clinical researchers, occupational nursing educators, and evidence-based medicine methodologists. Panelists systematically evaluated every draft candidate item for domain relevance, contextual clarity, representativeness, and phrasing precision relative to occupational health workflows. The Item-Level Content Validity Index (I-CVI) was calculated for each prospective statement. Items were strictly retained only if they attained an I-CVI threshold of ≥ 0.78, satisfying the conservative psychometric criteria established by Polit and colleagues<\/a>. This procedure eliminated ambiguous items, refined clinical terminology, and ensured comprehensive domain coverage<\/span>.<\/p>\n Construct validity was formally evaluated on a nationwide cross-sectional opportunity sample of 524 Finnish occupational health professionals collected between November 2020 and August 2021. The demographic distribution represented key clinical roles within the service delivery model: 55% occupational health nurses (n<\/em> = 289), 32% occupational health physicians (n<\/em> = 166), and 13% multidisciplinary experts and administrative supervisors (n<\/em> = 69)<\/span>.<\/p>\n The sample size met recommended thresholds for stable covariance matrix estimation (Nunnally & Bernstein, 1994<\/a>). Initial statistical checks confirmed data adequacy for factor extraction: the Kaiser-Meyer-Olkin (KMO)<\/a> measure of sampling adequacy yielded an outstanding coefficient of 0.90, well above the recommended 0.60 ceiling, while Bartlett's Test of Sphericity confirmed significant matrix correlation divergence from an identity matrix. Principal Component Analysis demonstrated that the 15 items loaded onto three conceptually distinct factors corresponding precisely to theoretical dimensions, demonstrating robust internal structural validity without anomalous cross-loadings.<\/p>\n The reliability of the EBP-OHS was evaluated through classical test theory metrics, concentrating on internal consistency and scale cohesion across the total scale and its sub-components:<\/p>\n The complete 15-item EBP-OHS achieved an overall Cronbach's alpha<\/a> coefficient of α = 0.88<\/strong> in the primary validation cohort (N<\/em> = 524). In psychometric literature, an alpha value between 0.80 and 0.90 is widely recognized as indicating high reliability and harmonious internal consistency without exhibiting the item redundancy often observed when alpha exceeds 0.95<\/span>.<\/p>\n Analysis of subscale reliability similarly revealed strong internal cohesion across factors:<\/p>\n Item-total correlations across the inventory confirmed that every item correlated substantially with the overall scale score, with no single item removal improving the overall alpha index. This stability verifies that the EBP-OHS yields dependable, low-error variance scores suitable for cross-sectional institutional bench-marking, health services research, and longitudinal evaluations.<\/p>\n To determine the internal latent dimensionality of the 15-item instrument, the developers performed exploratory factor extraction via Principal Component Analysis (PCA)<\/strong> utilizing orthogonal and oblique rotations on the validation sample (N<\/em> = 524)<\/span>.<\/p>\n The PCA extracted a three-factor solution that accounted for a substantial 60.3% of the total cumulative variance<\/strong> in the data matrix. In health sciences psychometrics, an explained variance threshold exceeding 50–60% indicates that the extracted components represent the underlying latent construct well. All three retained factors comfortably satisfied Kaiser's criterion (eigenvalues > 1.0), with each factor recording an empirical eigenvalue of 1.3 or greater<\/strong><\/span>.<\/p>\n The factor matrix revealed a clean, theoretically interpretable structure:<\/p>\n Across all 15 items, communality coefficients ranged from 0.37 to 0.79<\/strong>. These coefficients confirm that the shared variance accounted for by the factor solution was adequate to strong across the item inventory, validating the tripartite model of evidence-based occupational practice.<\/p>\n The EBP-OHS is an operational self-report assessment battery structured as follows:<\/p>\n The Measure of Evidence-Based Practice in Occupational Health was formally published and validated in 2024<\/strong> through an empirical research collaboration between Finnish academic institutions and healthcare insurers, published in the peer-reviewed journal La Medicina del Lavoro<\/em> (Ruotsalainen et al., 2024<\/a>).<\/p>\n Licensing and Academic Access:<\/strong> The instrument is protected by intellectual copyright held by the original authors and the publishing journal. The individual items of this scale are proprietary and are not publicly reproduced in the open literature. Researchers, clinicians, and organizational administrators seeking to review, license, translate, or deploy the complete 15-item EBP-OHS for academic research, health service evaluation, or commercial workforce audits must contact the corresponding author directly (Jani Ruotsalainen, j.h.ruotsalainen@gmail.com<\/a>) to request formal usage authorization, scoring manuals, and the approved Finnish inventory or official translations.<\/p>\n Bianchi, M., Bagnasco, A., Bressan, V., Barisone, M., Timmins, F., Xing, W., & Sasso, L. (2018). A review of the role of nurse leadership in promoting and sustaining evidence-based practice. Journal of Nursing Management<\/em>, 26(8), 918–932. https:\/\/doi.org\/10.1111\/jonm.12638<\/a><\/p>\n Brämberg, E. B., Nyman, T., Kwak, L., Almin, J., & Hermansson, L. (2017). Development of evidence-based practice in occupational health services in Sweden: A 3-year follow-up of attitudes, barriers and facilitators. International Archives of Occupational and Environmental Health<\/em>, 90(4), 335–348. https:\/\/doi.org\/10.1007\/s00420-017-1200-8<\/a><\/p>\n da Silva, A. M., Valentim, D. P., Martins, A. L., & Padula, R. S. (2023). Instruments to assess evidence-based practice among health care professionals: A systematic review. Health Education & Behavior<\/em>, 50(6), 841–854. https:\/\/doi.org\/10.1177\/10901981231170154<\/a><\/p>\n Finnish National Board on Research Integrity. (2019). The ethical principles of research with human participants and ethical review in the human sciences in Finland<\/em>. TENK Guidelines 2019. https:\/\/tenk.fi\/sites\/default\/files\/2021-01\/Ethical_review_in_human_sciences_2020.pdf<\/a><\/p>\n Heselmans, A., Donceel, P., Aertgeerts, B., Van de Velde, S., & Ramaekers, D. (2010). The attitude of Flemish occupational health physicians toward evidence-based occupational health and clinical practice guidelines. International Archives of Occupational and Environmental Health<\/em>, 83(2), 201–208. https:\/\/doi.org\/10.1007\/s00420-009-0449-y<\/a><\/p>\n Jordan, Z., Lockwood, C., Munn, Z., & Aromataris, E. (2019). The updated Joanna Briggs Institute Model of Evidence-Based Healthcare. International Journal of Evidence-Based Healthcare<\/em>, 17(1), 58–71. https:\/\/doi.org\/10.1097\/XEB.0000000000000155<\/a><\/p>\n Kinnunen-Amoroso, M. (2013). How occupational health care professionals experience evidence-based guidelines in Finland: A qualitative study. Journal of Evaluation in Clinical Practice<\/em>, 19(4), 612–616. https:\/\/doi.org\/10.1111\/j.1365-2753.2012.01850.x<\/a><\/p>\n Korhonen, T., Siltanen, H., Hahtela, N., & Holopainen, A. (2018). Toteutuuko näyttöön perustuva toiminta Suomessa? Raportti nykytilasta hoitotyön edustajien kuvaamana<\/em> [Does evidence-based practice take place in Finland? Report on the current situation as described by nursing representatives]. Hoitotyön tutkimussäätiö (Hotus).<\/p>\n Lockwood, C. (2017). Applying theory informed global trends in a collaborative model for organizational evidence-based healthcare. Journal of Korean Academy of Nursing Administration<\/em>, 23(2), 111–115. https:\/\/doi.org\/10.11111\/jkana.2017.23.2.111<\/a><\/p>\n Mikkonen, K., Tomietto, M., & Watson, R. (2022). Instrument development and psychometric testing in nursing education research. Nurse Education Today<\/em>, 119, 105603. https:\/\/doi.org\/10.1016\/j.nedt.2022.105603<\/a><\/p>\n Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory<\/em> (3rd ed.). McGraw-Hill.<\/p>\n Paul, F., Connor, L., McCabe, M., & Ziniel, S. (2016). The development and content validity testing of the Quick-EBP-VIK: A survey instrument measuring nurses' values, knowledge and implementation of evidence-based practice. Journal of Nursing Education and Practice<\/em>, 6(5), 118–128. https:\/\/doi.org\/10.5430\/jnep.v6n5p118<\/a><\/p>\n Pearson, A., Wiechula, R., Court, A., & Lockwood, C. (2005). The JBI model of evidence-based healthcare. International Journal of Evidence-Based Healthcare<\/em>, 3(8), 207–215. https:\/\/doi.org\/10.1111\/j.1479-6988.2005.00026.x<\/a><\/p>\n Polit, D. F., & Hungler, B. P. (1999). Nursing research: Principles and methods<\/em> (6th ed.). Lippincott Williams & Wilkins.<\/p>\n Ramos, K. D., Schafer, S., & Tracz, S. M. (2003). Validation of the Fresno test of competence in evidence based medicine. BMJ<\/em>, 326(7384), 319–321. https:\/\/doi.org\/10.1136\/bmj.326.7384.319<\/a><\/p>\n Ruotsalainen, J., Päätalo, K., Martimo, K.-P., & Oksanen, T. (2024). Measure of Evidence-Based Practice in Occupational Health. La Medicina del Lavoro<\/em>, 115(5), Article e2024040. https:\/\/doi.org\/10.23749\/mdl.v115i5.16286<\/a><\/p>\n Shaneyfelt, T., Baum, K. D., Bell, D., Feldstein, D., Hershberger, P. J., Baumann, P. C., & Smetana, G. W. (2006). Instruments for evaluating education in evidence-based practice: A systematic review. JAMA<\/em>, 296(9), 1116–1127. https:\/\/doi.org\/10.1001\/jama.296.9.1116<\/a><\/p>\n Upton, D., & Upton, P. (2006). Development of an evidence-based practice questionnaire for nurses. Journal of Advanced Nursing<\/em>, 53(4), 454–458. https:\/\/doi.org\/10.1111\/j.1365-2648.2006.03739.x<\/a><\/p>\nKeywords<\/h2>\n
Authors<\/h2>\n
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Purpose<\/h2>\n
Psychological Construct<\/h2>\n
1. Organisational Support (7 Items)<\/h3>\n
2. OHS Practitioners' Competence (6 Items)<\/h3>\n
3. OHS Practitioners' Attitudes (2 Items)<\/h3>\n
Theoretical Framework<\/h2>\n
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Validity<\/h2>\n
Content Validity<\/h3>\n
Construct and Structural Validity<\/h3>\n
Reliability<\/h2>\n
Internal Consistency Reliability<\/h3>\n
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Factor Analysis<\/h2>\n
Variance and Eigenvalues<\/h3>\n
Factor Loadings and Communalities<\/h3>\n
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Instrument \/ Measurement Tool<\/h2>\n
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Permissions & Fee and Test Year<\/h2>\n
References<\/h2>\n
Items of the Scale<\/h2>\n