Confirmatory factor analysis of the Evidence-Based Practice Attitude Scale in a large and representative sample of child and adolescent mental health practitioners: Is the use of a total scale score justified?

Research output: Contribution to journalArticle


Background: There is a call for valid and reliable instruments to evaluate implementation of evidence-based practices (EBP). The 15-item Evidence-Based Practice Attitude Scale (EBPAS) measures attitude toward EBP, incorporating four lower-order factor subscales (Appeal, Requirements, Openness, and Divergence) and a Total scale (General Attitudes). It is one of a few measures of EBP attitudes evaluated for its psychometric properties. The reliability of the Total scale has been repeatedly supported, but also the multidimensionality of the inventory. However, whether all of the items contribute to the EBPAS Total beyond their subscales has yet to be demonstrated. In addition, the validity of the Divergence subscale has been questioned because of its low correlation with the other subscales and low inter-item correlations. The EBPAS is widely used to tailor and evaluate implementation efforts but a Swedish version has not yet been validated. This study aimed to contribute to the development and cross-validation of the EBPAS by examining the factor structure of a Swedish-language version in a large sample of mental health professionals. Methods: The EBPAS was translated into Swedish and completed by 570 mental health professionals working in child and adolescent psychiatry settings spread across Sweden. The factor structure was examined using first-order, second-order and bifactor confirmatory factor analytic (CFA) models. Results: Adequate fit indices were observed for all CFA models with strong support for the reliability of the EBPAS Total score in this Swedish version. Support for the hierarchical second-order model was also strong, while the bifactor model gave mixed support for the subscales. The Openness and Requirements subscales came out best, while there were problems with both the Appeal (e.g. not different from the General Attitudes factor) and the Divergence subscales (e.g. low reliability). Conclusions: Overall, the psychometric properties were on par with the English version and the total score appears to be a valid measure of general attitudes towards EBP. This is the first study supporting this General Attitudes factor based on a bifactor model. Although comparatively better supported in this Swedish sample, we conclude that the use of the EBPAS subscale scores may result in misleading conclusions. Practical implications and future directions are discussed.


Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Psychology
  • Psychiatry


  • Evidence Based Practice, child and adolescent psychiatry, major depression, treatment implementation, Assessment
Original languageEnglish
JournalBMC Medical Research Methodology
Publication statusAccepted/In press - 2020 Sep 17
Publication categoryResearch