Journal of Modern Medical

Introduction
To be up-to-date in their science, the medical community must have the ability to communicate in the electronic environment and search information sources. To prevent, diagnose, and treat diseases correctly and find a way to obtain the most useful information and keep up with the latest developments, strengthening research skills seems essential. Therefore, to strengthen these skills, an approach called evidence-based medicine (EBM) has been proposed, which focuses on setting relevant questions and using the best available evidence in making decisions about care and treatment. For this reason, it is necessary to have a valid and reliable tool to examine the attitude of medical community regarding searching in information sources by formulating clinical questions. This study aims to develop a valid and reliable questionnaire in Persian to evaluate the attitude of medical students towards the use of EBM approach in searching for health information resources online by formulating clinical questions.
Methods
This is a descriptive cross-sectional study. The study population consists of all medical students at the internship stage in Rasoul Akram and Firozgar hospitals (n=195). In order to identify all effective factors in measuring ability to search health information and designing the questionnaire, we used a panel of experts, including 2 experts in medical sciences and 3 experts in inknowledge and information science. The questionnaire was first answered on a trial basis by 64 medical students to determine the clarity and relevance of items. The questionnaire was distributed among medical students in the pretest and posttest phases. Of 195 students, 190 completed the questionnaire.
3. Results
Of 190 participants, 75 were male (39.5%) and 115 were female (60.3%). The participants were between 21 and 29 years old. Among them, 158 (83.2%) were single and 32 (16.8%) were married. Finally, 18 questions were determined with the approval of experts and the face validity of the tool was confirmed. The items were rated on a 5-point Likert scale from 1 to 5. Exploratory factor analysis method was used in SPSS software, version 22 to identify factorial structure of the questionnaire which showed four factors including self-learning, learning motivation, information proficiency, and analysis. The reliability of the questionnaire was determined using Cronbach’s alpha for all four factors which was above 60% (Table 1).


Six items were about self-learning (α=0.865), 5 items about learning motivation (α=0.850), 4 items about information proficiency (α=0.822), and 2 items about how to analyze information (α=0.700). The results of the confirmatory factor analysis also confirmed that the four-factor model had acceptable construct validity. The sampling adequacy test and Bartlett’s test results were obtained 0.822 and 0.934, respectively (P=0.000), which indicates the appropriateness of the obtained results.
Discussion
The present study aimed to develop and validate a questionnaire in Persian to evaluate the attitudes of medical students towards the use of EBM approach in searching for health information resources online by formulating clinical questions. The results showed the acceptable reliability of the 18-item questionnaire because the Cronbach’s alpha coefficient value was above the average level. It had four subscales including self-learning (6 items), learning motivation (5 items), information proficiency (4 items), and analysis (2 items). The self-learning domain assesses the attitudes towards the effect of EBM approach on factors such as staying up-to-date and the motivation for searching information sources. The learning motivation domain assesses the attitudes towards the effect of EBM approach compared to traditional methods on factors such as creating continuous self-learning behavior and helping to design learning strategies. The information proficiency domain the attitudes towards the effect of EBM approach on using information technology, the enjoyment of active search, helping to create a link between medical knowledge and skill, and motivating the search of information sources to find answers. The final domain called “analysis” measures the attitudes towards the effect of formulating clinical questions and search in information sources on the ability to make clinical decisions, and the ability to analyze the obtained information. Overall, it can be concluded that the developed questionnaire has acceptable validity and reliability to be used by medical community and in further studies.

Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval number IR.IUMS. REC1398.12635 of Iran University of Medical Sciences (IUMS).

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
Data curation, writing-original draft: Zahra Akbari; Methodology, formal analysis, writing-original draft: Omolbanin Asadi-Qadikolaei; Questionnaire designing, supervision, writing-review & editing: Zahra Emami.

Conflicts of interest
The authors declared no conflict of interest.


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