Evidence-Based Practice Competence Questionnaire for Nursing Students: A Validation Study in Albania

Abstract

Evidence-based practice (EBP) is a key element among nurses to ensure high-quality, advanced care in contemporary healthcare systems. Nursing students, as future healthcare professionals, must develop competence in EBP. However, in the Albanian context, there is a lack of instruments to assess EBP competence among undergraduate nursing stu-dents.  This study aimed to translate, culturally adapt and validate the Evidence-Based Practice Competence Questionnaire (EBP-COQ) into Albanian, and to test its psychometric properties. A cross-sectional validation study was conducted using a convenience sample of undergraduate Albanian nursing students. The translated EBPCOQ was tested for reliability and construct validity. Construct validity was initially assessed using an exploratory factor analysis (EFA), and internal consistency was assessed using Cronbach’s alpha and McDonald’s omega. 

A total of 357 nursing students participated, with a mean age of 22.25 years and 82.6% female. The internal consistency of the Albanian EBP-COQ was high (Cronbach’s alpha = 0.866; McDonald’s omega = 0.855). Exploratory factor analysis identi-fied three factors: Attitude toward EBP, Perceptions toward EBP, and Knowledge and Skills in EBP. The three factors together explained 44% of the total variance, comparable to values reported in previous validation studies of the EBP-COQ. All three factors showed statistically significant positive correlations with overall EBP competence. This study has some limitations, including data collection from a single university and the absence of test-retest reliability as-sessment, which may limit the generalizability of the findings. Conclusions: The Albanian EBP-COQ shows strong validity and reliability for assessing attitudes, skills, and knowledge in EBP among nursing populations in this geographic area. This scale can be used to assess baseline competence and guide educators and researchers in designing strategies to strengthen EBP. Additionally, it may be used to evaluate the effectiveness of EBPrelated courses or workshops, monitor changes in students’ competence over time, and identify factors associ-ated with EBP competence. 

CONFLICT OF INTEREST

The authors declare no conflict of interest.

REFERENCES

Abdi, A., Mohammadi, M., Mohammadi, A., Ashrafi, H., & Zahabi, H. (2026). Predicting the adoption of evidence-based practice (EBP) based on critical thinking levels among nursing students. BMC Nursing, 25(1), 181. https://doi.org/10.1186/s12912-026-04323-6 Abdelrahman H, Al Qadire M. Patient safety competencies and their association with evidencebased practice among nursing students: a multicountry study. Nurse Educ. 2026;51(2):E147E152. https://doi.org/10.1097/NNE.0000000000002073 Alsadaan, N., & Ramadan, O. M. E. (2025). Barriers and facilitators in implementing evidencebased practice: A parallel cross-sectional mixed methods study among nursing administrators. BMC Nursing, 24(1), 403. https://doi.org/10.1186/s12912-025-03059-z Chien, L. Y. (2019). Evidence-based practice and nursing research. Journal of Nursing Research, 27, e29. https://doi.org/10.1097/JNR.0000000000000346 Dolezel, J., Zelenikova, R., Finotto, S., Mecugni, D., Patelarou, A., Panczyk, M., et al. (2021). Core evidence-based practice competencies and learning outcomes for European nurses: Consensus statements. Worldviews on EvidenceBased Nursing, 18(3), 226–233. https://doi.org/10.1111/wvn.12506 Farag KA, Mohamed MA, Abo Baker ZM, Binsaud BMM, Jaber AM. The impact of sample size on explora-tory and confirmatory factor analysis: a simulation study. Int J Environ Sci. 2025;11(6):1691-1695. https://doi.org/10.64252/bvgzkb65 Fiset, V. J., Graham, I. D., & Davies, B. L. (2017). Evidence-based practice in clinical nursing education: A scoping review. Journal of Nursing Education, 56(9), 534–541. https://doi.org/10.3928/01484834-20170817-04 Galanis P. Translation and cross-cultural adaptation methodology for questionnaires in languages other than Greek. Arch Hell Med. 2019;36(1):124-35 Gallegos C, Saul T, Timmerman RA, Chu F, Bindler RJ, Billings C. EBP beliefs, competencies, implementation self-efficacy, and access to mentors in a large U.S. healthcare system: An updated assessment of where we are now. Worldviews Evid Based Nurs. 2026;23(1),e70107. https://doi.org/10.1111/wvn.70107 Ha rko nen, H., Hannila, H. M., Oikarinen, A., Ka a ria inen, M., Ylima ki, S., Hietaniemi, A. M., et al. (2025). The measurement of evidence-based healthcare competence of nurses and associated background factors: A scoping review. Research in Nursing & Health, 48(5), 581–593. https://doi.org/10.1002/nur.70004 Horntvedt, M. T., Nordsteien, A., Fermann, T., & Severinsson, E. (2018). Strategies for teaching evidence-based practice in nursing education: A thematic literature review. BMC Medical Education, 18, 172. https://doi.org/10.1186/s12909-0181278-z Howard MC. A systematic literature review of exploratory factor analyses in management. J Bus Res.2023;164:113969. https://doi.org/10.1016/j.jbusres.2023.113969 Hu, S., Liu, S,, Li X, Chen W, Li J, Jiale H, et al. Evidence-based leadership in nursing: an evolutionary concept analysis. J Adv Nurs. 2025;81(7):3633–3646. https://doi.org/10.1111/jan.16682 Jafari F, Azadi H, Abdi A, Salari N, Faraji A. Cultural validation of the competence in evidencebased practice questionnaire (EBP-COQ) for nursing students. J Educ Health Promot. 2021;10:464. https://doi.org/10.4103/jehp.jehp_1534_ 20 Komuhangi G, Neuhann F, Louis VR, Ocan M, Kinengyere AA, Wacker J. Efficacy of problem based learn-ing approach for teaching evidence based practice in midwifery and nursing education: a systematic re-view. BMC Nurs. 2025;24(1):1412. https://doi.org/10.1186/s12912-025-04101-w Lana A, Ferna ndez-Arce L, Gonza lez-Garcï a M, Ferna ndez-Iglesias R, Andina-Dï az E, Ferna ndez Feito A. The association between nursing work environment and evidence-based practice. Worldviews Evid Based Nurs. 2025;22(6):e70082. https://doi.org/10.1111/wvn.70082 Landsverk, N. G., Olsen, N. R., & Brovold, T. (2023). Instruments measuring evidence-based practice behavior, attitudes, and self-efficacy among healthcare professionals: A systematic review of measurement properties. Implementation Science, 18(1), 42. https://doi.org/10.1186/s13012023-01301-3 Lorenzo-Seva U, Ferrando PJ. Determining sample size requirements in EFA solutions: a simple empirical proposal. Multivariate Behav Res. 2024;59(5):899-912. https://doi.org/10.1080/00273171.2024.2342324 Li Y, Xu W, Gao Y, Xu M, Du S. Mapping strategies and outcomes of evidence-based practice training for clinical nurses: a scoping review. Nurse Educ Today. 2026;162:107034. https://doi.org/10.1016/j.nedt.2026.107034 Li H, Xu R, Gao D, Fu H, Yang Q, Chen X, Hou C, Gao J. Evidence-based practice attitudes, knowledge and skills of nursing students and nurses: a systematic review and meta-analysis. Nurse Educ Pract.2024;78:104024. https://doi.org/10.1016/j.nepr.2024.104024 Pallant J. SPSS survival manual: a step-by-step guide to data analysis using IBM SPSS. 7th ed. London:Routledge;2020. https://doi.org/10.4324/9781003117452 Panczyk M, Iwanow L, Gaworska-Krzemin ska A, Grochans E, Ko zka M, Kulik H, et al. Validation study and setting norms of the evidence based practice competence questionnaire for nursing students: a cross-sectional study in Poland. Nurse EducToday.2020;88:104383. https://doi.org/10.1016/j.nedt.2020.104383 Parra Gonza lez LM, Uren a MP, Andrade D, Vergara-Escobar OJ, Palacios C, Camargo-Figuera F. Validation of an instrument to measure knowledge, attitudes and skills towards evidence-based practice in nursing students in Colombia. Nurse Educ Pract. 2024;76:103904. https://doi.org/10.1016/j.nepr.2024.103904 Patelarou, A. E., Mechili, E. A., Ruzafa-Martinez, M., Dolezel, J., Gotlib, J., Skela-Savic , B., et al. (2020). Educational interventions for teaching evidence-based practice to undergraduate nursing students: A scoping review. International Journal of Environmental Research and Public Health,17(17),6351. https://doi.org/10.3390/ijerph17176351 Patelarou A, Schetaki S, Giakoumidakis K, Lialiou P, Patelarou E. Validation of the evidence-based practice competence questionnaire for nursing students: a cross-sectional study in Greece. Nurs Rep. 2021;11:73. https://doi.org/10.3390/nursrep11040073 Ruzafa-Martinez M, Lopez-Iborra L, Moreno-Casbas T, Madrigal-Torres M. Development and validation of the competence in evidence-based practice questionnaire (EBP-COQ) among nursing students. BMC Med Educ. 2013;13:19. https://doi.org/10.1186/1472-6920-13-19 Schetaki S, Patelarou E, Giakoumidakis K, Kleisiaris C, Patelarou A. Evidence-based practice competency of registered nurses in the Greek National Health Service. Nurs Rep. 2023;13(3):1225–1235. https://doi.org/10.3390/nursrep13030105 Skela-Savic , B., Gotlib, J., Panczyk, M., Patelarou, A. E., Bole, U., Ramos-Morcillo, A. J., et al. (2020). Teaching evidence-based practice (EBP) in nursing curricula in six European countries: A descriptive study. Nurse Education Today,94,104561. https://doi.org/10.1016/j.nedt.2020.104561 Youssef N, Gebreal A, Saleeb M, Alanazi A, Shepherd A, Al Asaad SH, et al. Comparing evidencebased practice competencies, adoption, barriers, and predictors among nurses and other healthcare professionals across the Eastern Mediterranean region. Worldviews Evid Based Nurs.2026;23(1):e70097. https://doi.org/10.1111/wvn.70097 Yildiz, E.; & Gu ngo rmu ¸s, Z. The validity and reliability study of the Turkish version of the evidence-based practice evaluation competence questionnaire. Nurse Educ. Today. 2016,45,9195. https://doi.org/10.1016/j.nedt.2016.05.030 Wang SY, Chappell L, Buxton T. Translation and validation of English version of evidence-based practice competence questionnaire. J Nurs Meas. 2023;31(1):89-95. https://doi.org/10.1891/JNM2021-0010

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