Determinants of Evidence-Based Practice Competency Among Undergraduate Nursing Students in Sindh, Pakistan: Implications for Bridging the Theory–Practice Gap

Abstract

Background: Evidence-Based Practice (EBP) is a core competency in contemporary nursing education, integrating research evidence, clinical expertise, and patient values to improve healthcare quality and safety. Despite curricular inclusion of EBP concepts, a persistent theory–practice gap limits effective translation into clinical decision-making, particularly in low- and middle-income settings such as Pakistan, where institutional and structural constraints may impede implementation. Objective: To assess EBP competency among undergraduate nursing students in Sindh, Pakistan, and to compare knowledge, attitudes, and self-reported practices across academic years and institutional sectors. Methods: A comparative cross-sectional observational study was conducted among 242 BSN students (2nd–4th year) from selected public and private nursing colleges in Sindh. Data were collected using the validated Evidence-Based Practice Questionnaire (EBPQ). Descriptive statistics summarized domain and overall scores. Independent sample t-tests compared institutional sectors, and one-way ANOVA with Tukey post-hoc tests examined differences across academic years. Effect sizes and 95% confidence intervals were calculated. Internal consistency was assessed using Cronbach’s alpha. Results: The mean overall EBP score was 114.90 ± 24.76, indicating moderate competency. Knowledge scores averaged 22.76 ± 7.36. Academic year was significantly associated with competency (F(2,239)=6.774, p=0.001; η²=0.054), with fourth-year students scoring significantly higher than second-year students (mean difference=14.59; 95% CI: 5.83–23.35). No significant difference was observed between public and private institutions (p=0.060; d=0.25). Reliability was excellent (Cronbach’s α=0.917). Conclusion: EBP competency improves with academic progression but remains moderate overall, underscoring the need for structured, clinically integrated, competency-based EBP education to narrow the theory–practice gap in undergraduate nursing programs.