Edith Cowan University: NUM1204 Literature Search Protocol for EBP

This report details a literature search protocol for evidence-based practice (EBP), specifically addressing the impact of family caregivers' health literacy on the functional health status of elderly individuals. The report begins with a justification of EBP's importance in clinical decision-making, emphasizing its role in delivering effective care and improving patient outcomes. It then outlines the PICO (Population, Intervention, Comparison, Outcome) framework used to formulate the research question and guide the search strategy. The search strategy protocol, including the databases used (PubMed, CINAHL, MEDLINE, EMBASE), search terms, and inclusion/exclusion criteria, is thoroughly described. The results of the search, including the number of articles found at each stage of the filtering process, are presented in a clear and concise manner. Finally, the report includes a list of relevant references and an appendix with the 10 articles found to meet the inclusion criteria. The report demonstrates a structured approach to literature searching, emphasizing the importance of rigorous methodology in the application of EBP to inform clinical practice and improve patient outcomes, particularly concerning the health literacy of caregivers and the well-being of the elderly.

Running head: EVIDENCE-BASED PRACTICE 1
Evidence-Based Practice
Name
Institution

EVIDENCE-BASED PRACTICE 2
A Justification of the Application of EBP
Evidence-based is important in clinical decision-making because it ensures that patients can get
access to the most effective care thus improving patient outcomes. Patients must receive the most
effective and sophisticated care based on the best available evidence. According to Majid et al.
(2011), nurses can apply critical appraisal of scientifically proven evidence to ensure that quality
healthcare is delivered to a specific population by the use of the evidence-based practice. An
evidence-based practice relies on a competent clinical reasoning cycle to combine several pieces
of information from four primary sources that include clinical expertise, information from the
context of practice, best accessible research evidence, and the values and circumstances of a
patient. The initial step of evidence-based practice is to convert the needed information into an
answerable clinical question. The second step is finding the best and most suitable evidence to
answer the question (Drisko & Grady, 2019). This is then followed by critically appraising the
evidence to prove that it is applicable and valid. The fourth and final step is the integration of the
retrieved evidence into clinical reasoning.
Evidence-based practice can be used to identify and discuss the effect of family caregivers’
health literacy on functional health status in elderly people. According to Yuen et al. (2016),
family caregivers play a crucial role in the care and support of elderly patients with chronic
conditions, physical impairments, or cognitive impairments. Low levels of health literacy among
caregivers can massively affect the adequate provision of care thus impacting on health
outcomes of patients. It is important to improve the health literacy of family caregivers because
poor health literacy leads to poor health outcomes, ineffective disease self-management, an
increase in the use of healthcare services, a reduction in the psychological well-being of both the

EVIDENCE-BASED PRACTICE 3
patient and the caregiver, and an increased mortality rate among the elderly patients (Bostock &
Steptoe, 2012).
Healthcare practitioners must use the best piece of evidence to inform clinical reasoning and
decision-making. This is because evidence-based practice ensures that nurses can access
adequate scientific research to make informed decisions in clinical practice. Through evidence-
based practice, healthcare can apply the most recent and up to date scientific research in clinical
practice to improve health outcomes and reduce the demand for healthcare resources.
The Breakdown of the Answerable Question
To break down the answerable question, a PICO format is used to identify valid search terms. It
is important to note that the PICO format helps in identifying and describing all the necessary
elements required in a researchable clinical question. The PICO format helps in defining an
answerable question by framing, assessing, locating, and repeating the question until a valid
answer is achieved. Most studies define P to stand for population, the letter I to stand for an
intervention, C to stand for a comparison for the intervention and O to stand for the outcome of
the intervention. In the provided answerable question (what is the effect of family caregivers’
health literacy on functional health status in elderly people?); P will be used to describe the
patients as the population of the study. The most appropriate intervention is health literacy
among caregivers and it is represented with the letter I. The lack of health literacy is the
comparative option and is represented by the letter C. Finally, the outcome will be the changes in
health outcomes of the patient and is represented by the letter O. Some other words that could be
used to describe each letter of the PICO format are used in the table below and they were also
used in the search strategy protocol.

EVIDENCE-BASED PRACTICE 4
Problem/population Intervention Comparison Outcome
Patient Available health
literacy.
Absent health
literacy.
Health outcomes
Patients Caregivers’ health
literacy.
Illiteracy among
caregivers.
Changing health
outcomes
Client Health Literacy in
elderly care.
Illiteracy in elderly
care.
Patient well-being
Clients Health literacy and
older adults.
Illiteracy and older
adults.
Care outcomes
Search Strategy Protocol
A combined search from various medical databases was performed. These databases included
PubMed, CINAHL, MEDLINE, and EMBASE. A Boolean search was performed with the help
of the following terms: available health literacy, caregivers’ health literacy, health literacy in
elderly care, and health literacy and older adults. They were combined with health outcomes,
changing health outcomes, patient well-being, and care outcomes. To narrow down the search
the words patient and caregiver were added. Initially, caregivers’ health literacy was searched as
the intervention. An outcome; health outcome and related search terms were added to narrow
down the search. Finally, the population of patient and clients were added to narrow down the
search even further.

EVIDENCE-BASED PRACTICE 5
The Boolean search returned some results that were further refined by applying limitations. The
inclusion criteria included English journals to ensure that only articles published in the English
language were included in the study. Additionally, the caregiver had to be for an adult care
recipient for the publication to be included in the search. A date limit was then set to ensure that
the most recent resources are used. The date was set to include publications from the past 6 years
(2014-2020). The fourth limiter involved only including peer-reviewed journals to ensure highly
sophisticated and accurate scientific information that can help in making informed decisions.
Articles were excluded if they were not written in English; if they were older than 6 years; if the
caregiver did not belong to an adult recipient; if they were not peer-reviewed.
Search Results
The online databases returned a total of 3768 results when only the intervention was included in
the search terms. Adding the outcome to the search terms narrowed the search down to 2542
articles. When the population was added to the Boolean search, the results were narrowed down
to 1981 articles. Limitations were then included in the search to refine the results even further.
Limiting the results to English language only returned 1871 results. The articles were then
limited to caregivers of recipients older than 18 years and this yielded 1276 results. When a date
limiter was included, 576 results were eliminated and this only left 700 results. Only peer-
reviewed articles were needed so the results were narrowed down to 218 articles. The remaining
218 articles were screened for full-text download and we were left with 67 articles. The final 67
articles were further scrutinized using titles and keywords to determine if they were relevant to
the answerable question. 10 articles from the 67 were found to have met the inclusion criteria
and they were the most relevant in the study and they are included in the appendix section of this
paper. The table below shows the inclusion criteria of the search results.

EVIDENCE-BASED PRACTICE 6
Inclusion Criteria Search Results
Interventions included 3768
Outcome included 2542
Population included 1981
English Language only 1871
Caregivers of recipients older than 18 years 1276
2014-2020 700
Peer-reviewed 218
Full-text download 67

EVIDENCE-BASED PRACTICE 7
References
Bostock, S., & Steptoe, A. (2012). Association between low functional health literacy and
mortality in older adults: longitudinal cohort study. BMJ, 344(mar15 3), e1602-e1602.
https://doi.org/10.1136/bmj.e1602
Drisko, J., & Grady, M. (2019). The Steps of Evidence-Based Practice in Clinical Practice: An
Overview. Essential Clinical Social Work Series, 39-68. https://doi.org/10.1007/978-3-
030-15224-6_3
Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y., Chang, Y., & Mokhtar, I. (2011). Adopting
evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and
barriers. Journal Of The Medical Library Association : JMLA, 99(3), 229-236.
https://doi.org/10.3163/1536-5050.99.3.010
Yuen, E., Knight, T., Ricciardelli, L., & Burney, S. (2016). Health literacy of caregivers of adult
care recipients: A systematic scoping review. Health & Social Care In The
Community, 26(2), e191-e206. https://doi.org/10.1111/hsc.12368

EVIDENCE-BASED PRACTICE 8
Appendix
Abdel Rahman, T. (2020). Health Literacy: Prevalence among Elderly Care Givers and Its
Impact on the Frequency of Elderly Hospitalization and Elderly Health Related Quality
of Life. Retrieved 18 March 2020, from https://www.scirp.org/html/5-
2420147_51454.htm
Chesser, A. K., Keene Woods, N., Smothers, K., & Rogers, N. (2016). Health literacy and older
adults: A systematic review. Gerontology and geriatric medicine, 2, 2333721416630492.
Erickson, S., & LeRoy, B. (2015). Health literacy and medication administration performance by
caregivers of adults with developmental disabilities. Journal Of The American
Pharmacists Association, 55(2), 169-177. https://doi.org/10.1331/japha.2015.14101
Fields, B., Rodakowski, J., James, A., & Beach, S. (2018). Caregiver health literacy predicting
healthcare communication and system navigation difficulty. Families, Systems, &
Health, 36(4), 482-492. https://doi.org/10.1037/fsh0000368
Findley, A. (2015). Low Health Literacy and Older Adults: Meanings, Problems, and
Recommendations for Social Work. Social Work In Health Care, 54(1), 65-81.
https://doi.org/10.1080/00981389.2014.966882
Ju, H., Oh, H., & Lee, H. (2014). Impact of oral health literacy on oral health-related quality of
life among adults. Journal Of Korean Academy Of Oral Health, 38(4), 220.
https://doi.org/10.11149/jkaoh.2014.38.4.220

EVIDENCE-BASED PRACTICE 9
Levy, H., & Janke, A. (2016). Health Literacy and Access to Care. Journal Of Health
Communication, 21(sup1), 43-50. https://doi.org/10.1080/10810730.2015.1131776
Serper, M., Patzer, R., Curtis, L., Smith, S., O'Conor, R., Baker, D., & Wolf, M. (2014). Health
Literacy, Cognitive Ability, and Functional Health Status among Older Adults. Health
Services Research, 49(4), 1249-1267. https://doi.org/10.1111/1475-6773.12154
Yuen, E., Knight, T., Ricciardelli, L., & Burney, S. (2016). Health literacy of caregivers of adult
care recipients: A systematic scoping review. Health & Social Care In The
Community, 26(2), e191-e206. https://doi.org/10.1111/hsc.12368
Zhang, N. J., Terry, A., & McHorney, C. A. (2014). Impact of health literacy on medication
adherence: a systematic review and meta-analysis. Annals of Pharmacotherapy, 48(6),
741-751.