An Evidence-Based Practice Profile of Practicing Filipino Speech-Language Pathologists

in the Philippines: A Descriptive Survey

Ivan Paul M. Bondoc

Catherine M. Borlongan
Ayra Judelle E. Esteban
Jonathan Elbert P. Grepo
Alyssa S. Ismael
Marilag B. Sadicon
Clarence Joy Y. Sese

Submitted to the Faculty of the

Department of Speech Pathology
College of Allied Medical Professions
University of the Philippines Manila

In partial fulfilment of the requirements

For the degree of
Bachelor of Science in
Speech Pathology
.

May 2015
ACCEPTANCE PAGE

The undergraduate thesis attached hereto, entitled, An Evidence-Based Practice Profile of

Practicing Filipino Speech-Language Pathologists in the Philippines: A Descriptive Survey,
prepared and submitted by Catherine M. Borlongan, Ayra Judelle E. Esteban, Jonathan Elbert P.
Grepo, Alyssa S. Ismael, Marilag B. Sadicon, and Clarence Joy Y. Sese, in partial fulfilment of
the requirements for the degree of Bachelor of Science in Speech Pathology is hereby accepted.
IVAN PAUL M. BONDOC, CSP-PASP
Research Supervisor
Date Signed

Accepted in partial fulfilment of the requirements for the degree of Bachelor of Science in
Speech Pathology.
JENNIFER U. SORIANO, MHPEd, CSP-PASP
Chair
Department of Speech Pathology
College of Allied Medical Professions
University of the Philippines Manila
Date Ssigned
JOCELYN CHRISTINA B. MARZAN, PhD, CCC-SLP
Dean
College of Allied Medical Professions
University of the Philippines Manila
Date Signed
CERTIFICATE OF ETHICAL REVIEW
2

This is to certify that the research proposal for the attached study was reviewed by the Ethical
Review Committee of the University of the Philippines Manila and was approved for
implementation pending minor revisions endorsed to the principal investigator and/or thesis
adviser. [Review of the final research report indicates that all ethical issues were appropriately
addressed].

(signature)
(printed name)
Chairperson
Ethical Review Committee
University of the Philippines Manila

Ethical issues endorsed to me by the Ethical Review Committee of the College of Allied Medical
Professions of the University of the Philippines Manila were adequately addressed in the conduct
of the study. The management of ethical concerns is effectively reflected in the research report.

(signature)
Ivan Paul M. Bondoc, CSP-PASP
Faculty Supervisor

STATEMENT OF INTELLECTURAL PROPERTY

3

This is to acknowledge that the attached research report entitled An Evidence-Based Practice
Profile of Practicing Filipino Speech-Language Pathologists in the Philippines: A Descriptive
Survey was completed in fulfillment of the requirement for SP 200. We are authors of the
attached research report for purposes of developing the research and technical writing skills that
the College of Allied Medical Professions seeks to hone in its undergraduate students.
Work on this research project was supervised by a faculty adviser, and conducted utilizing both
our personal resources and university resources. In view of this, we recognize the right of the
University of the Philippines and of our faculty adviser over the intellectual property that this
research report represents. This includes but is not limited to the right to submit for publication a
research report based on the attached and/or on the data gathered in the course of producing the
attached, to conduct further research related to the attached, and to present the output of this
study in conferences or to disseminate findings by any other means.
We understand that our faculty adviser and the University will endeavor to acknowledge our
contribution to this research work to the extent appropriate. In addition, if our faculty adviser
fulfilled this role in his/her capacity as Principal Investigator of this study, we acknowledge that
first authorship of the study belongs to him/her as Principal Investigator.
Should we ourselves intend to carry out further research related to this study and/or disseminate
the results of this study, we will do so only with the explicit consent of the competent authorities
within the UP Manila College of Allied Medical Professions.

Catherine M. Borlongan

Alyssa S. Ismael

Ayra Judelle E. Esteban

Marilag B. Sadicon

Jonathan Elbert P. Grepo

Clarence Joy Y. Sese

Acknowledgements

First and foremost, we would like to thank God for giving us the strength, knowledge,
and wisdom to pursue and finish this study.
We would also like to thank our loving parents for providing us with financial and moral
support to make this research paper possible.
We also would like to acknowledge all Filipino speech-language pathologists who
graciously participated in our study by answering our survey.
We would also like to show our appreciation to Professor Jennifer U. Soriano, MHPEd,
for answering our inquiries regarding the EBP curriculum of the Department of Speech
Pathology on EBP. We also thank Ms. Mae Catherine Sadicon, CSP-PASP and Ms. Danielle
Raymundo, CSP-PASP for welcoming our questions regarding the stand and position on EBP of
the Commission on Higher Education (CHED) and Philippine Association of Speech
Pathologists (PASP) respectively.
We would like to commend the whole research team for the success of this endeavor.
And most of all, we would like to extend our sincerest gratitude to our thesis adviser, Professor
Ivan Paul M. Bondoc, CSP-PASP, for guiding us throughout this undertaking and for bringing
out the best in the research team.

Abstract

An Evidence-Based Practice Profile of Practicing Filipino Speech-Language Pathologists

in the Philippines: A Descriptive Survey
Ivan Paul M. Bondoc
Catherine M. Borlongan
Ayra Judelle E. Esteban
Jonathan Elbert P. Grepo
Alyssa S. Ismael
Marilag B. Sadicon
Clarence Joy Y. Sese
RATIONALE. Allied health professionals in the Philippines such as physical and
occupational therapists in the Philippines have existing knowledge of, attitudes towards and
practices of evidence-based practice (EBP). No such data exist for speech-language pathologists.
OBJECTIVES. The purpose of this study is to determine the level of EBP
engagement and implementation of Filipino SLPs currently practicing in the Philippines by
obtaining quantitative data on their EBP competenciesy in terms of knowledge, attitudes, and
practice patternss.
METHOD. The 24-item self-administered Evidence-Based Practice Questionnaire
(EBPQ) by Upton & Upton (2006) was used to measure the participants EBP competenciesy in
terms of knowledge, attitudes and practices. Qualitative information about the participants was
obtained through the comments section of the questionnaire.
RESULTS. Mean scores per item and per area were generally above average, with
the Attitude area generating the highest mean score. Some participants requested for clarification
regarding the definition of EBP used in the survey.
CONCLUSION. There appears to be a disjunct between the above average EBPQ
scores and the apparent lack of consensus among some of the participants regarding the
definition of EBP. Further research into qualitative information regarding the EBP competency of
Filipino SLPs is highly recommended.
Keywords: evidence-based practice, speech-language pathologists, Philippines
List of Tables, Figures, and Appendices

Table 1Demographic Data of the Participants

Table 2Quantitative Data (Knowledge, Attitudes, Practice)
Table 3Quantitative Date: Practice
Table 4Quantitative Data: Attitude
Table 5

Quantitative Data: Knowledge

Table 6Qualitative Data (from Evidence-Based Practice Questionnaire)

Appendix A

Evidence-Based Practice Questionnaire (EBPQ) (Upton & Upton, 2006)

Appendix B

Gantt Chart

Evidence-based practice (EBP), as defined by the American Speech-Language-Hearing

Association (2005), is a conscientious, explicit, and judicious approach that aims to provide
high-quality services through the integration of (a) clinical expertise, (b) best current evidence
found in clinically relevant research conducted using valid and reliable methodology, and (c)
patients preferences, unique concerns, and values (Sackett & Straus, 2000; Lamb, 2008; Reilly,
2006; Orange & Johnson, 2006). In this way, clinicians will be able to provide the most optimal
and individualized clinical service to that client (Justice, 2008; Braun, et al, 2008). Findings from
research also support the conclusion that EBP leads to best quality care, improved patient
conditions, and decreased healthcare costs (Melynk, 2012).
The ASHA presents a trilateral model of the EBP (ASHA, 2004). In this view of EBP, the
research evidence is situated at the base of the triangle while the other components correspond to
the sides. Equal importance is given to all components (Reilly, 2006). Research evidence alone is
not adequate to guide action and propagation of EBP (Schriberg, et al., n.d.). Rather than being a
static model, research should have a dynamic part in providing client-specific services, although
still respecting the clinicians knowledge, expertise, and skills (Schlosser, 2003).
Different EBP implementation models have been created by different researchers. One of
these is the model by Strauss (2005), in which presentedthere are 5 steps: (1) asking a question,
where the gap or need for information is transformed into an answerable question, (2) searching
for evidence, where the best and most updated evidences are gathered to answer the question, (3)
appraising the evidence, where evidence is appraised through its validity (preciseness to the
truth), impact (size of effect to target population), and applicability (usefulness to field of
practice, (4) implementing the evidence to patient considering ones own expertise, where
evidence is applied while taking into consideration our own skills and our patients unique set of

skills and preferences, and (5) evaluating effectiveness of evidence, where the prior steps are
evaluated to ensure better outcomes in the future.
The concept of evidence-based practice began in the field of medicine (Foundations and
History of Evidence-Based Practice, n.d.). Those in the field of communication disorders, such
as speech language pathologists and audiologists, also began to see the relevance of EBP in
clinical practice (Zipoli & Kennedy, 2005). Worrall et al in 2001 reported that it has been
primarily medical speech-language pathology that has begun to discuss EBP (cited in Schlosser,
2003), while in the other non-medical subfields, the practice is something that is obvious and
that already occurs (Schlosser, 2003).
Among the first speech-language pathology associations to promote the use of EBP in
clinical practice is the Canadian Association of Speech-Language Pathologists and Audiologists
(CASLPA), who, in 1996, became affiliated with the Canadian Cochrane and Network Center, a
network of different professions mandated to advocate for the use of evidence-based practice
among healthcare workers (Orange, 2004). As early as 2000, the School of Communication
Sciences in the University of Western Ontario introduced required courses such as Methods in
Evidence-Based Practice and Critical Analysis & Evaluation for Research into the graduate level
curriculum (Orange, 2004). Meanwhile, the American Speech-Language-Hearing Association
(ASHA) published a technical report in 2004 describing the use of EBP in handling patients with
communication disorders, and discussed potential challenges and methods to increase the
evidence base (ASHA, 2004). They likewise published articles, policy statements, and online
resources (covering topics such as implementation, levels of evidence, guidelines development,
and curriculum modification to include EBP-related coursework), formed EBP-related
committees, and held conventions and a clinical forum (Apel & Wolter, 2004). Additionally, the

grant of the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP)

requires that the applicant demonstrate knowledge of the processes used in research and the
integration of research principles into evidence-based clinical practice (ASHA, 2010).
Academic and clinical education in speech-language pathology is also expected by the
association to implement research principles in evidence-based clinical practice (ASHA, 2010).
The Royal College of Speech & Language Therapists (United Kingdom), Canadian Association
of Speech-Language Pathologists and Audiologists, New Zealand Speech-Language Therapists
Association, Speech Pathology Australia and ASHA consider it the clinicians -imperative to
either generate or use current evidence and research findings to ensure high quality care for
patients (The Royal College of Speech & Language Therapists, n.d.; Canadian Association of
Speech-Language Pathologists and Audiologists (2011); New Zealand Speech-Language
Therapists Association, 2014; Speech Pathology Australia, 2005; American Speech Language
Hearing Association, 2005).
Although interest in EBP increased over the past 2 decades, little research has been done
to explore EBP implementation among SLPs (Whites, Gumiela, Pitman, Janke, & Yaeger, 2007).
EBP implementation is relatively new in the field of speech-language pathology (Whites, et. al
2007) and only a few studies have been conducted to particularly determine the status of
knowledge, attitudes, and practice of EBP among SLPs across countries (Zipoli et al, 2005).
KAP questions about EBP reveal not only characteristic traits in knowledge, attitudes and
practices, but also how these things relate to personal, social, and other external factors like
beliefs and time. Focusing on knowledge, attitudes and practices of the participants intends to
identify perceptions, positions and actions commonly shared by a population (Gumucio &
Merica, 2011).

One of the few researches conducted was a preliminary study on 36 ASHA-certified

SLPs knowledge and use of EBP among SLPs (Whites, et. al, 2007). The results revealed that
majority of the SLPs acknowledged incorporation of EBP into their practice. However, most of
them gave incomplete or incorrect definitions of EBP and did not indicate evaluation of outside
sources in their practice, supposedly an essential feature of EBP (Whites, et. al, 2007). The
researchers suggest that it is possible experienced SLPs have misconceptions about EBP and that
knowledge of EBP is still limited in the profession (Whites, et. al, 2007).
Despite the increasing awareness and recognition of EBP among SLPs, in 2005, Zipoli
and Kennedy found from their survey of 240 speech-language pathologists that positive attitudes
of SLPs toward research and EBP are found to be highly dependent on their exposure to EBP
during graduate training. Furthermore, only exposure to research and EBP during the [clinical
fellowship year] predicted use of evidence-based resources" (Zipoli et al, 2005).
Perceived barriers were reported to hinder the application of EBP in SLP practice. In a
survey conducted among 378 speech-language pathologists in Victoria, Australia, respondents
cited factors such as insufficient time to review the literature, lack of evidence, and cost of
continuing education (Vallino-Napoli & Reilly, 2004). Among the challenges experienced by
SLPs, time was the main barrier (Vallino-Napoli et al, 2004).
Education on EBP is advocated as a potent intervention toward enhancing EBP uptake in
the allied medical professions (Cabatan, Gorgon, Guevarra, Santos, & Diongco, 2010; Gorgon,
Basco, & Manuel, 2013). In the Philippines, there is a growing number of studies regarding the
EBP competencies of allied health professionals, particularly physical therapists and
occupational therapists. No studies about EBP engagement and implementation among Filipino
SLPs were found.

Dizon et al (2014) measured the effectiveness of an EBP training program in improving

the knowledge and skills of Filipino physiotherapists. Knowledge, attitudes and behavior
towards EBP were found to have significantly improved among the participants after they
underwent the program (Dizon, J., Dizon R., Regino, & Gabriel, 2014). In another study,
occupational therapy students at the University of the Philippines Manila were found to have
generally positive attitudes towards EBP after undergoing a clinically-integrated learning module
(Cabatan, Belarmino, Cruz et al, 2010). A qualitative study by Batino et al (2008) further showed
that occupational therapists in Metro Manila know and apply EBP but are prevented from
extensively implementing it due to factors such as inadequate time, limitations in funding,
insufficient manpower, administrative concerns, and unclear documentation of technique
effectiveness.
There has been growing international interest and increased efforts to turn EBP into a formal
approach. However, there is an apparent paucity in research regarding Filipino SLPs EBP
orientation. It is uncertain how much Filipino SLPs know about EBP and how consistently they
implement it in their professional work. There is a need to answer these questions in order to
determine the possible concerns regarding EBP engagement and implementation among Filipino
SLPs.
Consequently, this may lead to changes in policies, standards, and guidelines for SpeechLanguage Pathology education by the Commission on Higher Education (CHED), curricular
revision or EBP course development by the Department of Speech Pathology in the University of
the Philippines Manila (UP Manila), or creation of standards on EBP implementation among
practicing Filipino SLPs by the Philippine Association of Speech Pathologists (PASP). Before
the implementation of new educational systems, an assessment of organizational culture and

workforce training needs (Upton & Upton, 2014) has to be conducted. Determining the
populations EBP knowledge, attitude, and extent of practice could be a way of conducting such
organizational assessment.
The purpose of this study was to determine the level of EBP engagement and
implementation of Filipino SLPs working in the Philippines. Specifically, the study aimed to
provide quantitative data on the knowledge, attitudes, and practice patterns of Filipino SLPs
practicing in the Philippines. The data collected and analyzed in this research could serve as a
foundation for further research on the subject (e. g. exploratory research) and could serve as a
basis for developing EBP education and implementation in the Philippines.
.
Method

Design
The study will make use of a quantitative descriptive cross-sectional research design.

Participants
The participants were all degree holders of Bachelor of Science in Speech Pathology. All
had at least two years of working experience as speech-language pathologists and have handled
at least one patient regularly for the last 12 months. All were bona fide Filipino citizen and were
currently residing in the country. Convenience sampling and snowball sampling were used by the
group to gather subjects that fit the inclusion criteria.

Materials

The Evidence-Based Practice Questionnaire (EBPQ) was used to measure the knowledge,
perceptions, attitudes and practices of the participants (see Appendix A). The EBPQ is a 24-item
survey tool originally developed by Upton and Lewis in 1999 to determine health professionals
attitude and knowledge regarding EBP (Rice et. al, 2010). An improved version was created by
Upton in the same year when it was administered to 370 nurses, midwives, and health visitors
(Rice et. al, 2010). In 2006, a principal component analysis further revealed that the tool has a
three-factor structure composed of attitude toward, knowledge of, and use of EBP (Rice et. al,
2010). This served as the basis for the three subscales in the survey tool. The later mentioned
2006 version will be used in this study. The EBPQ was chosen given its good psychometric
properties as identified in the methodological and narrative literature review of Upton et al
(2014). It has strong internal consistency with a Cronbachs alpha of 0.87 for the whole
questionnaire (Upton & Upton 2006). The knowledge, practice, and attitude subscales obtained
Cronbach alpha values of 0.91, 0.85, and 0.79 respectively (Upton et al, 2006). Additionally,
construct validity was found to be significantly correlated with tools measuring the same areas. It
also maintained high Cronbach alpha levels even when administered to other professional
groups.

Procedure
The research proposal was reviewed and approved by the College Technical Review
Board and the University if the Philippines Manila Research Technical Ethics Board.
A Google account was made by the research group which served as the primary data
storage for all the files needed for the study. Correspondences were made using this account to
keep track on the progress of data collection.

A list of clinics was obtained from the Philippine Association of Speech Pathologists
(PASP). It

contained

the

names of the

clinic, services

offered, names

of the

owner/administrator/consultant, email addresses and/or contact detailsnumber. Each clinic was

sent with a letter of invitation through email or phone, along with the request for a list of
practicing SLPs in the clinic with their corresponding email addresses and/or contact numbers.
Each speech-language pathologist was then given a letter of invitation which discussed
the background and purpose of the study, along with confidentiality measures to ensure the
protection of the prospective participants. Respondents who agreed to participate were given an
option to answer the survey through a hard copy (provided through personal visits to their
respective centers), or through an online form sent via google link (provided through email).
Each participant was assigned a control number to ensure confidentiality of responses and
for the group to track down completion of the forms. Responses to the Google form were directly
sent to a Google spreadsheet, which were downloaded from the Internet and stored as a
Microsoft Excel file on a laptop. Answers obtained from the hard copies of the survey, on the
other hand, were encoded in a Google spreadsheet, following the same format for the soft copy
responses. All responses were then collated in one spreadsheet for data analysis. A total of 65
responses were obtained and analyzed.
.
Data Analysis
The quantitative data obtained from the EBPQ were analyzed through the Microsoft
Excel. The mean or average score of all respondents for each statement was obtained and
compared across statements per area of the questionnaire. Consequently, the mean for each area
(practice, attitude, knowledge) was also calculated by getting the overall score of all statements

in each area. The overall mean of an area was then compared across other areas to obtain the
highest and lowest competency in terms of EBP implementation. Inter-rater reliability was also
done to ensure accuracy of the results.
.

Results

Demographic Data
There were Fifty-eight58 speech-language pathologists (SLPs) who participated in the study.
Twenty-five answered the survey manually and thirty-three answered the online form. Out of the
58 respondents, 48 were female and 10 were male. The participants were composed of clinicians
ages 20-29 years old (65%), followed by those who are 30-39 years old (26%), 40-49 years old
(7%), and 50-59 years old (2%).
Most of the respondents (52%) obtained their degrees between the years 2008-2013. 27% of
them graduated from 2002-2007, 16% from 2001-1996, 3% from 1995-1990, and 2% from 19891984. Majority of them (67%) were undergraduate degree holders only. Some (22%) of the
respondents (n=13) had taken some masteral units from UP Manila (69.23%), UP Diliman
(30.77%), Cebu Doctors University (7.69%), and Nova State University in Florida (7.69%). Out
of the 10% of the respondents (n=6) who took a masteral degree, 90% studied at UP Manila and
10% obtained their degree abroad. The minority of the respondents (4%) took some doctoral
units.
Majority of the respondents (68%) were solely clinicians. Some of them (17%) were
working as clinicians and administrators and 13% of them had duties in the academe (e.g.

clinical supervisors, instructors, or faculty members). 38% of the respondents had been working
for 6-10 years; some others have worked for less than or at least 5 years (35%), for 15-20 years
(12%), for 10-15 years (10%), and for 20-25 years (5%). Most of the respondents were
predominantly catering to the pediatric population (81%) over the geriatric population (5%); the
remaining 14% accommodating to both populations. Language (32%) was noted to be the most
specialized area of practice among the respondents.
For the questions regarding work settings (current and previous), the participants were
allowed to answer in multiple responses. More than half of the SLPs are currently working in
clinics/hospitals (56%); similarly, majority (29%) of the respondents had previous working
experience in the same setting. The remaining 44% of the SLPs provide services in other work
settings such as home care (17%), academe (15%), school (9%), others (2%), and community
(1%).
With regard to EBP, majority of the SLPs did not undergo training (68%) nor were exposed
to EBP (57%). Out of the 19 respondents who were trained in EBP, majority of them (78%)
learned EBP through lectures, seminars, or workshops. Others have acquired EBP training
through continuing education (e.g. masterals, graduate studies) (17%) and undergraduate degree
(5%). Out of the 24 respondents who were exposed to EBP, 31% attended workshops (e.g.
PROMPT, LSVT). Others have been exposed to EBP when they were interns (23%), in their
personal practice (19%), in their graduate studies (19%), and as faculty (8%).

Table 1. Demographic Data (n = 58)

Respondent Characteristics

Frequency (n)
Position

Clinician and Academe (instructor,

CS)
Clinician and Administration (owner,
10

Percentage (%)

10

17%

13%

co-owner, chief SLP)

Solely Clinician
Others: private practitioner and
government employee

39

68%

2%

Year Qualified
29
15
9
2
1
Specialty

52%
27%
16%
3%
2%

Language (pediatric language,

literacy, adolescent)

25

32%

Developmental disorder (ASD,

ADHD, DS, CP, Child Development)

12

15%

12%

16

21%

4
3
2

5%
4%
3%

10
48

17%
83%

2013-2008
2007-2002
2001-1996
1995-1990
1989-1984

Neurogenic disorders (aphasia,

dysphagia, cognitive, adult
neurogenic communication disorder)
Craniofacial and oromotor disorders
(CLAP, Speech Motor, CAS)
Aural/Hearing
Voice
AAC
Sex
Male
Female
Age Range
20-29
30-39
40-49
50-59

38
15
4
1
Years of Experience
Less than or equal to 5 years
20
6-10 years
22
10-15 years
6
15-20 years
7
20-25 years
3
Predominant Area of Practice
Pediatric
47
Geriatric
3
Both
8
Educational Attainment
Undergraduate degree
37
11

65%
26%
7%
2%
35%
38%
10%
12%
5%
81%
5%
14%
64%

Undergraduate degree with some

Masters degree units
Masters degree
Masters degree with some Doctoral
degree units
Doctoral degree

13

22%

10%

4%

0%

School
UP Manila
UP Diliman
CDU
Others: ____ (CSUN, Florida)

53
2
1
2
EBP Training
Yes
19
No
39
EBP Exposure
Yes
24
No
34
EBP Training (Location and Description)
Workshop/Lecture/Seminar
14
Masters Degree
3
Undergraduate degree
1
EBP Exposure (Location and Description)
Workshop/Seminar/Trainings
8
EBP implementation as an intern
6
EBP implementation as observed by
2
faculty
Graduate School/Masters Degree
5
Personal Practice
5
Current Work Setting
Academe
15
Clinic or Hospital
55
Community
1
Home Care
16
School
9
Others: Research, Government
2
Previous Work Setting
Academe
15
Clinic or Hospital
33
Community
7
Home Care
27
School
21
Others: Research
1
NA
9

91%
4%
2%
3%
32%
68%
41%
59%
78%
17%
5%
31%
23%
8%
19%
19%
15%
56%
1%
17%
9%
2%
13%
29%
6%
24%
19%
8%
1%

.
Table 2 Quantitative Data (Knowledge, Attitude, Practice) (n = ?)
Inter-Area
12

Mean

Practice
Attitude
Knowledge

5.252874
5.423256
5.07389
2

The data gathered from the survey show that the EBP score of Filipino SLPs for all areas
(Knowledge, Attitude, Practice) were generally above average; the average being 4. The SLPs
scored the highest in the Attitude subscale and lowest in the Knowledge subscale.

Table 3 Quantitative Data: Practice

Practice
a. Formulated a clearly answerable question as the beginning of the process towards filling
this gap.
b. Tracked down the relevant evidence once you have formulated the question.
c. Critically appraised, against set criteria, any literature you have discovered.
d. Integrated the evidence you have found with your expertise.
e. Evaluated the outcomes of your practice.
f. Shared this information with colleagues.
OVERALL

Mean
5.517241
5.155172
4.62069
5.689655
5.431034
5.103448
5.252874

For the Practice subscale, Item 4 which was integrating evidence with expertise,
generated the highest mean. On the other hand, Item 3 which was critically appraising, against
set criteria, any literature, had the lowest mean. The mean scores for every item were above
average (x > 4), making the overall score for Practice above average as well.

Table 4 Quantitative Data: Attitude

Attitude
g. New evidence is so important that I make the time in my work schedule.
h. I welcome questions on my practice.
i. Evidence based practice is fundamental to professional practice.
j. My practice has changed because of evidence I have found.
OVERALL
13

Mean
5.08620
7
5.362069
5.896552
5.317073
5.423256

For the Attitude subscale, Item 3, which was evidence based practice is fundamental to
professional practice, garnered the highest score. The lowest mean, however, was noted to be
Item 1, which was new evidence is so important that I make time in my work schedule. The
scores per item and for Attitude component were all above average (x > 4).

Table 5 Quantitative Data: Knowledge

Knowledge
k. Research skills
l. IT skills
m. Monitoring and reviewing of practice skills
n. Converting your information needs into a research question
o. Awareness of major information types and sources
p. Ability to identify gaps in your professional practice
q. Knowledge of how to retrieve evidence
r. Ability to analyze critically evidence against set standards
s. Ability to determine how valid (close to the truth) the material is
t. Ability to determine how useful (clinically applicable) the material is
u. Ability to apply information to individual cases
v. Sharing of ideas and information with colleagues
w. Dissemination of new ideas about care to colleagues
x. Ability to review your own practice
OVERALL

Mean
4.758621
4.724138
5.206897
4.655172
4.982759
5.362069
5.017241
4.793103
4.844828
5.448276
5.517241
5.172414
5.068966
5.482759
5.073892

For the Knowledge subscale, Item 11, which was ability to apply information to
individual cases, got the highest mean out of all the items in the scale. They scored the lowest,
however, on Item 4 which was converting information needs into a research problem. Overall,
there was a high score (above average scores) in all items in the Knowledge subscale.
Consequently, the overall score for the Knowledge component was higher than average.
The table below shows the comments from SLPs obtained from the last section of the
EBP Questionnaire. These were collated to supplement the quantitative findings of the study.

14

Table 6 Qualitative Data

1. You have to define clearly what EBP is. Professionals may have different understanding
of what EBP is.
2. Gathering evidence to support practice should be a priority for health professionals. But
sometimes, the "bravery" to try out a new method (of course within ethical boundaries)
without any significant evidence yet is key to starting the foundation for building evidence
for this method. Aside from a strict adherence to ethics, sound clinical reasoning is also needed
for this.
3. Please provide a clear definition of EBP because there's evidence-based practice based on
collective practice/research and evidence-based on personal practice and would the rating
based on how you grade yourself in comparison to yourself on the standards set by the
profession.
4. Some items were vaguely stated.
5. You might want to expound or elucidate the meaning regarding IT skills (i.e. typing?
computation? what do you mean by IT skills?

Discussions
.
In 2007, Whites et al conducted a preliminary study of evidence-based practice in Speech
Language Pathology with 36 experienced SLP clinicians in the United States. Through this study,
data regarding knowledge and use of EBP were obtained. Results from the survey administered
showed that majority of SLPs (67%) think that they have sufficient knowledge about EBP while
81% believe that they are able to apply EBP in their professional work. Meanwhile, positive
attitude toward EBP was identified in a study by Zipoli et al involving 240 SLPs. Similar to the
findings in those researches, the EBP knowledge, skills and attitude of the participants of this
study lean towards a perception of adequacy in knowledge and practice and positive attitudes.
15

A comparison of the three components was not provided in previous studies. In this study
however, it was seen that EBP attitude is higher than EBP knowledge and practice. This may
suggest that while there is a general positive disposition on EBP, there are certain limitations to
knowledge and application. Subsequently, new insight regarding areas of limitation were also
gathered in this study. Since the items in the EBPQ correspond to the steps in the EBP process, a
comparison of mean scores will indicate which steps clinicians may have difficulties in.
Considering the mean scores of the knowledge and practice areas, it was seen that the
respondents obtained the lowest scores in items corresponding to research skills such as
converting information to a research question and critically appraising literature. On the other
hand, high scores were obtained in items related to application of evidence to clinical practice. In
a survey conducted by Zipoli et al (2005), time constraints were reported as a primary barrier to
EBP implementation. Similarly, this study reflects how clinicians have limitations in
accommodating EBP application in their schedule due to the large amount of workload. In the
attitude part of the survey, the item saying that clinicians are able to make time for studying new
evidence generated the lowest mean score. On the other hand, the item stating that EBP is
fundamental to professional practice generated the highest mean score. These information can
guide future policy changes or program and curriculum development by addressing specific areas
of limitation.
Aside from the 24-item Likert scale questions of the EBPQ, additional data regarding the
respondents knowledge and attitudes regarding EBP were obtained from the comments section
of the questionnaire. Some comments were regarding the participants expression of interest in
the results of the study, one expressed personal opinion regarding EBP, while others requested
clarifications. Common clarifications were regarding the definition of EBP. One asked that EBP

16

be defined clearly, since other professionals may have a different understanding of what [it] is,
while another also requested for a clarification and pointed out that there's evidence-based
practice based on collective practice/research and evidence-based on personal practice.
These comments may indicate either one or both of two things: that a) among Filipino
speech-language pathologists in the Philippines, there is no consensus regarding the definition
and nature of EBP; and/or that b) these SLPs understanding of EBP may be inconsistent with the
trilateral model used by ASHA and in the development of the EBPQ. From these and the other
comments, it may also be inferred that more emphasis is placed by the respondents on the
evidence/research component of the trilateral model, when the three components (which also
include client values and clinicians expertise) have equal bearing in the process of EBP
implementation (Reilly, 2006).
As such, it is possible that the results from the EBPQ reflect the SLPs EBP knowledge,
attitudes and practices based on their own construct of EBP, one that is different from the
trilateral model. The lack of consensus among SLPs regarding its definition is not an entirely
new phenomenon, as it was reported in a study conducted by Whites et al (2007) that the
participants definitions were characterized as incorrect or incomplete. It was then concluded that
misconceptions regarding EBP persist among the SLPs surveyed. In this current study, the
respondents use of a different construct of EBP may account for the disjunct between their
positive scores in the Likert scales and the misconceptions on the definition of EBP among the
respondents. In the same study by Whites et al, positive scores for attitudes towards EBP were
generated from the participants while incorrect and incomplete definitions were at the same time
produced. It remains, however, that questions regarding the definition used by the researchers in
this current study were raised only by twoa very small portion of the respondents (n=2). Hence,

17

the claim that there is a lack of consensus among SLPs regarding the definition of EBP cannot be
immediately generalized. Nonetheless, the questions that were raised are deemed as a point of
concern and can be a subject of further study.
The limitations of this study include a small sample size and restricted time in conducting
data collection. In a span of two weeks, the researchers tried to cover all regions of the country in
obtaining responses. However, several contact numbers and email addresses were either inactive
or were not reached. Furthermore, most of the speech-language pathologists reached were from
the Greater Manila Area; only a small portion of them were from Visayas and Mindanao. All of
these contributed to the limited sample size of 58. As such, the results of this study cannot be
generalized to the entire population of Filipino speech-language pathologists in the Philippines.
Additionally, the researchers only generated and analyzed the averages of the responses per
item and per area in the survey. No correlations between and among variables were made.
The research focuses on the quantitative aspect of the EBP profile of SLPs through a
quantitative descriptive study. Given the results and limitations of the study, the research team
recommends the implementation of a qualitative study that could better illustrate the knowledge,
attitudes and practices of Filipino SLPs. A qualitative research would also provide a more
detailed comparison of SLPs perceptions regarding their knowledge and practices and their
actual use and knowledge of EBP. This kind of study could be done through interviews and
focused group discussions.
The data that would be collected in this kind of research could be used to support the
possible policy changes involving the educational curriculum of the BS SP/SLP program
managed by CHED or the Department of Speech Pathology, University of the Philippines

18

Manila. Currently, neither the CHED or UP require the implementation of an EBP course in the
program.
In addition, the research team also recommends getting data from other regions if ever the
study on the EBP profile of Filipino SLPs will be continued. Being able to include participants
from the provinces would provide us with a more extensive and comprehensive picture of the
knowledge, attitudes and practices of Filipino SLPs in the Philippines.

Conclusion

The results of the study reveal that Filipino SLPs perception of their engagement and
implementation of EBP in the Philippines was relatively positive as reflected by the above
average scores in the areas of knowledge, attitude, and practice patterns. Furthermore, there
appeared to be a general positive disposition on EBP as the area of attitude obtained the highest
mean compared to knowledge and practice.
However, there seemed to be a mismatch between the quantitative (the scores in the
survey) and the qualitative data (the comments and questions) as several of the respondents
presented misconceptions and inquiries about the definition of EBP. These findings may imply
that either a number of Filipino SLPs have a construct of EBP different from the trilateral
construct of ASHA or they do not have a consensus regarding the definition and nature of EBP.
Given this contrast, it can be concluded that the EBPQ was not able to accurately measure the
EBP competency of the Filipino SLP population.
The researchers, therefore, suggest the need to conduct a qualitative study exploring the
Knowledge, Attitude, and Practice of Filipino SLPs in the Philippines.

19

References

American Speech-Language-Hearing Association. (2010). ASHA Documents. Retrieved from

http://chs.utep.edu/speechlanguagepathology/wp-content/uploads/sites/4/2014/11/3-ASADocuments.pdf
American Speech-Language-Hearing Association. (2005). Evidence-based practice in
communication disorders [Position Statement]. Retrieved from
http://www.asha.org/policy
American Speech-Language-Hearing Association. (2004). Evidence-based practice in
communication disorders: an introduction [Technical Report]. Retrieved from
http://www.asha.org/policy
Bogue, B., Campbell, N., Carey, M., Clawson, E., Faust, D., Florio, K., & Woodward, W. (2004).
Implementing evidence-based practice in community corrections: The principles of
effective intervention. Crime and Justice Institute. Retrieved from
http://www.bscc.ca.gov/downloads/Implementing_EBP_in_Community_Corrections_Th
e_Principles_of_Effective_Intervention_NIC.pdf
Cabatan, M., Belarmino, J., Cruz, G., Go, J., Rivera, S., Enriquez, E., & Calawad, L. (2010).
Describing attitudes of Occupational Therapy Interns toward Evidence-Based Practice
after undergoing a clinically-integrated learning module. (Unpublished dissertation).
UPM-CAMP, Philippines

20

Dawes, M., Summerskill, W., Glasziou, P., Cartabellotta, A., Martin, J., Hopayian, K., &
Osborne, J. (2005). Sicily statement on evidence-based practice. BMC Medical
Education. Retrieved from http://www.biomedcentral.com/1472-6920/5/1
Dizon, J. M., Grimmer-Somers, K., & Kumar, S. (2014). Effectiveness of the tailored Evidence
Based Practice training program for Filipino physical therapists: a Randomized
Controlled trial. The Internet Journal of Allied Health Sciences and Practice. Retrieved
from http://ijahsp.nova.edu/articles/Vol10Num2/pdf/Dizon.pdf
Goodman, K. (n.d.) Foundations and history of evidence-based practice. Cambridge University
Press. Retrieved from http://assets.cambridge.org/97805218/19336/excerpt/978052181
9336_excerpt.pdf
Gorgon, E. J., Basco, M. D., & Manuel, A. (2013). Teaching evidence based practice in physical
therapy in a developing country: a national survey of Philippine schools. BMC Medical
Education. Retrieved from http://www.biomedcentral.com/1472-6920/13/1s54
Gorgon, E., Cabatan, M., Dema-ala, J., Gracia, B., Nolasco, M., & Villegas, N. (2009).
Educational Needs of Filipino Physical Therapists to acquire competence in evidencebased practice. (Unpublished dissertation). UPM-CAMP, Philippines
Gumucio, S. & Merica, M. (2011). The KAP Survey Model. Medecins du Monde, 5-6.
Lamb, K., Carlson, S., Pittman, S., Rue, L., & Whites, M. (2008). Speech-language pathologists
knowledge and beliefs about evidence-based practice. [PDF Document]. Retrieved from
http://www.asha.org/events/convention/handouts/2008/2602_whites_margery/
Melnyk, B.M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The State of
Evidence-Based Practice in US Nurses: Critical implications for nurse leaders and
educators. The Journal of Nursing Administration, Volume 42, pp 410-417.

21

Mendoza, T., Batino, K., Billones, M., Dalisay, J., & Samonte, K. (2008). Perceptions of
Evidence-Based Practice among Filipino Occupational Therapists working in Metro
Manila. (Unpublished dissertation). UPM-CAMP, Philippines
Schreiber, J. & Stern, P. (2005). A review of the literature on evidence-based practice in physical
therapy. The Internet Journal of Allied Health Sciences and Practice. Retrieved from
http://ijahsp.nova.edu/articles/vol3num4/Schreiber-Stern.htm
Trochim, W.M. (2006). The Research Methods Knowledge Base, 2nd Edition. Retrieved from
http://www.socialresearchmethods.net/kb/
Upton, D. & Upton, P. (2014). The Reach, Transferability, and Impact of the Evidence-Based
Practice Questionnaire: A Methodological and Narrative Literature Review. Worldviews
on Evidence-Based Nursing. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/
wvn.12019/full
Whites, M. M. (2002). So just exactly what do speech language pathologists do? Poster
presented at the American Speech Language Hearing Association Convention, Atlanta.
Retrieved from ______________
Whites M., Gumiela, S., Pitman, A., Janke, N., & Yaeger, K. (2007). A Preliminary Study of
Evidence-Based Practice in Speech-Language Pathology. American Journal of Speech
Language Pathology. Retrieved from http://ajslp.pubs.asha.org/
Zippoli, R. & Kennedy, M. (2005). Evidence-based practice among speech-language
pathologists: Attitudes, Utilization, and Barriers. American Journal of Speech Language
Pathology. Retrieved from http://ajslp.pubs.asha.org/
Speech Pathology Australia. (2010). Evidence-Based Practice in Speech Pathology. Melbourne.
Retrieved from http://www.speechpathologyaustralia.org.au/library/position_statements/
22

EBP_in_SP.pdf
New Zealand Speech-Language Therapists Association. (2014). The New Zealand Speechlanguage Therapists Association Professional Development Policy. (7th ed.). Retrieved
from http://www.speechtherapy.org.nz/wp-content/uploads/2013/09/ProfessionalDevelopment-Policy-v61.pdf
Canadian Association of Speech-Language Pathologists and Audiologists (2011). Proposed
Practice Competencies for Speech-Language Pathologists in Canada. Ontario. Retrieved
from http://www.cacup-aslp.ca/PDFs/English/SLP%20ENGLISH%20APRIL%
202011.pdf

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Documentation of Informed Consent

Permission to Participate in the Study: Clinic

24

Documentation of Informed Consent

Permission to Participate in the Study: Clinician/SLP Consultant (NCR)

25

Documentation of Informed Consent

Permission to Participate in the Study: Clinician/SLP Consultant (non-NCR patients)

26

Plan for Administrative Support

Budget
27

The research group allotted a budget of P 1,500 for the study. This encompassed the
money spent on photocopying services, purchase of supplies such as bond paper and ink, and
transportation.

APPENDIX A. Evidence-Based Practice Questionnaire (Upton & Upton, 2006)

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29

30

APPENDIX
B. Gantt Chart

31