Sinicization and validation of reliability and validity of the Utrecht questionnaire (U-CEP) measuring knowledge on clinical epidemiology_Chinese Journal of Evidence-Based Medicine

Authors：

LIAO Jiaojiao ¹ , YAN Wenxin ² , LI Wenqiang ¹ , SHEN Pu ³ , WANG Zhaoyu ¹ , WANG Hui ¹ ,  ZENG Lin ¹ ,  TAO Liyuan ¹

1. Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing 100191, P. R. China;
2. Department of Epidemiology and Biostatistics, School of Public Health of Peking University, Beijing 100191, P. R. China;
3. Department of Teaching and Research, Peking University International Hospital, Beijing 102206, P. R. China;

Corresponding author：

ZENG Lin, Email: zlwhy@163.com; TAO Liyuan, Email: tendytly@163.com

Keywords：

Clinical epidemiology; U-CEP; Evidence-based practice; Validity; Reliability

DOI：

10.7507/1672-2531.202306018

Video：

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Objective The purpose of this study was to translate the U-CEP scale into Chinese, and evaluate the reliability and validity of the Chinese version of the U-CEP, in order to provide a measurement and evaluation tool for clinical epidemiology education and research. Methods The U-CEP scale was translated and adapted using the Brislin translation model. A nationwide survey of clinicians was conducted using the Chinese version of the U-CEP. Item analysis, reliability analysis, and validity analysis were performed using SPSS 26.0 software. Results The discriminant validity analysis showed that except for item 4, the critical value (CR) of the other twenty-four items differed significantly between high and low groups (P<0.01), with CR values ranging from 2.902 to 14.609. The ITCs of the 25 items were all positive, with 5 items having an ITC<0.15(20%), 2 items having ITC≥0.15~0.20 (8%), 6 items having ITC≥0.20~0.40 (24%) and 12 items having ITC≥0.40 (48%). In terms of reliability, the overall Cronbach’s α coefficient of the Chinese version of the U-CEP was 0.80, with Cronbach’s α coefficient ranging from 0.752 to 0.805 when deleting each item one by one. The test-retest reliability was 0.848 (P<0.001). The alternative-form reliability was 0.838 (P<0.001). In terms of validity, expert analysis showed that the content validity of the Chinese version of the U-CEP was good. The construct validity analysis showed that the cumulative contribution rate of the 25 items was 57.50%. No respondent scored full marks or zero marks, indicating that no ceiling or floor effects were found. There were statistically significant differences in the total scores among clinicians with different educational backgrounds or with or without systematic learning of relevant knowledge (P<0.05). Conclusion The Chinese version of the U-CEP has good reliability and validity, as well as good cultural adaptability. It can effectively assess a physician's knowledge of clinical epidemiology.

Citation： LIAO Jiaojiao, YAN Wenxin, LI Wenqiang, SHEN Pu, WANG Zhaoyu, WANG Hui, ZENG Lin, TAO Liyuan. Sinicization and validation of reliability and validity of the Utrecht questionnaire (U-CEP) measuring knowledge on clinical epidemiology. Chinese Journal of Evidence-Based Medicine, 2023, 23(12): 1378-1386. doi: 10.7507/1672-2531.202306018 Copy

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16.	Lynn MR. Determination and quantification of content validity. Nurs Res, 1986, 35(6): 382-385.
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19.	闫温馨, 刘珏. 中文版以人为本的基层卫生服务量表的信效度验证. 中国全科医学, 2022, 25(25): 3135-3142.
20.	Zwolsman SE, Wieringa-de Waard M, Hooft L, et al. Measuring evidence-based medicine knowledge and skills. The Dutch Berlin Questionnaire: translation and validation. J Clin Epidemiol, 2011, 64(8): 928-930.
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22.	Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines. A framework for improvement. JAMA, 1999, 282(15): 1458-1465.
23.	Ryan MA. Adherence to clinical practice guidelines. Otolaryngol Head Neck Surg, 2017, 157(4): 548-550.
24.	Swennen MH, van der Heijden GJ, Boeije HR, et al. Doctors' perceptions and use of evidence-based medicine: a systematic review and thematic synthesis of qualitative studies. Acad Med, 2013, 88(9): 1384-1396.
25.	杨辉, 许岩丽, 叶志康. 全科医学相关指南的开发、实施及应用效果. 中国全科医学, 2023, 26(1): 1-10.
26.	Bhatt NR, Czarniecki SW, Borgmann H, et al. A systematic review of the use of social media for dissemination of clinical practice guidelines. Eur Urol Focus, 2021, 7(5): 1195-1204.

1. Dutta S. Clinical epidemiology: principles, methods and applications for clinical research. D E Grobbee and A W Hoes. Int J Epidemiol, 2008, 39(1): 318-319.
2. Novack L, Jotkowitz A, Knyazer B, et al. Evidence-based medicine: assessment of knowledge of basic epidemiological and research methods among medical doctors. Postgrad Med J, 2006, 82(974): 817-822.
3. Kortekaas MF, Bartelink MEL, de Groot E, et al. The Utrecht questionnaire (U-CEP) measuring knowledge on clinical epidemiology proved to be valid. J Clin Epidemiol, 2017, 82: 119-127.
4. Ilic D, Nordin RB, Glasziou P, et al. Development and validation of the ACE tool: assessing medical trainees' competency in evidence based medicine. BMC Med Educ, 2014, 14: 114.
5. Ramos KD, Schafer S, Tracz SM. Validation of the Fresno test of competence in evidence based medicine. BMJ, 2003, 326(7384): 319-321.
6. Fritsche L, Greenhalgh T, Falck-Ytter Y, et al. Do short courses in evidence based medicine improve knowledge and skills. Validation of Berlin questionnaire and before and after study of courses in evidence based medicine. BMJ, 2002, 325(7376): 1338-1341.
7. Kortekaas MF, Bartelink ME, Zuithoff NP, et al. Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice. A cluster randomised controlled trial. BMJ Open, 2016, 6(9): e010537.
8. Albarqouni L, Hoffmann T, Glasziou P. Evidence-based practice educational intervention studies: a systematic review of what is taught and how it is measured. BMC Med Educ, 2018, 18(1): 177.
9. Kumaravel B, Hearn JH, Jahangiri L, et al. A systematic review and taxonomy of tools for evaluating evidence-based medicine teaching in medical education. Syst Rev, 2020, 9(1): 91.
10. Buljan I, Jerončić A, Malički M, et al. How to choose an evidence-based medicine knowledge test for medical students. Comparison of three knowledge measures. BMC Med Educ, 2018, 18(1): 290.
11. Costello A, Osborne JW. Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. Practical Assessment, Research and Evaluation, 2005, 10: 1-9.
12. Brislin RW. Comparative research methodology: cross-cultural studies. Int J Psychol, 1976, 11(3): 215-229.
13. 吴明隆. 问卷统计分析实务. 重庆: 重庆大学出版社, 2010.
14. Nunnally JC. Psychometric theory. New York: McGraw-Hill, 1967.
15. 史静琤, 莫显昆, 孙振球. 量表编制中内容效度指数的应用. 中南大学学报(医学版), 2012, 37(2): 152-155.
16. Lynn MR. Determination and quantification of content validity. Nurs Res, 1986, 35(6): 382-385.
17. Davis LL. Instrument review: getting the most from a panel of experts. Appl Nurs Res, 1992, 5(4): 194-197.
18. Reynolds CL. The measurement of health in nursing research. ANS Adv Nurs Sci, 1988, 10(4): 23-31.
19. 闫温馨, 刘珏. 中文版以人为本的基层卫生服务量表的信效度验证. 中国全科医学, 2022, 25(25): 3135-3142.
20. Zwolsman SE, Wieringa-de Waard M, Hooft L, et al. Measuring evidence-based medicine knowledge and skills. The Dutch Berlin Questionnaire: translation and validation. J Clin Epidemiol, 2011, 64(8): 928-930.
21. Baatiema L, Otim ME, Mnatzaganian G, et al. Health professionals' views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review. Implement Sci, 2017, 12(1): 74.
22. Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines. A framework for improvement. JAMA, 1999, 282(15): 1458-1465.
23. Ryan MA. Adherence to clinical practice guidelines. Otolaryngol Head Neck Surg, 2017, 157(4): 548-550.
24. Swennen MH, van der Heijden GJ, Boeije HR, et al. Doctors' perceptions and use of evidence-based medicine: a systematic review and thematic synthesis of qualitative studies. Acad Med, 2013, 88(9): 1384-1396.
25. 杨辉, 许岩丽, 叶志康. 全科医学相关指南的开发、实施及应用效果. 中国全科医学, 2023, 26(1): 1-10.
26. Bhatt NR, Czarniecki SW, Borgmann H, et al. A systematic review of the use of social media for dissemination of clinical practice guidelines. Eur Urol Focus, 2021, 7(5): 1195-1204.

Chinese Journal of Evidence-Based Medicine

Sinicization and validation of reliability and validity of the Utrecht questionnaire (U-CEP) measuring knowledge on clinical epidemiology

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