Experiences of the Iowa Model Users: A Mixed Methods Descriptive Study

The science supporting evidence-based practice (EBP) is continually expanding; therefore, models of EBP must reflect these trends in order to remain relevant. A team convened to re-evaluate the Iowa Model for use in the current health care environment. The collaborative team included members from University of Iowa (UI) Hospitals and Clinics and the UI College of Nursing (CON), representing past authors with continued interest and experts on campus with ongoing experience using the Iowa Model. Since the revised Iowa Model was published in 2001, we have received 3,000 requests to use it. A database, maintained by the Department of Nursing at the UI Hospitals and Clinics with contact information for persons requesting permission to use the Iowa Model, provided an opportunity to query users about their experiences. The purpose of this study was to survey individuals who have requested permission to use the Iowa Model about their experiences in order to inform model revisions.

A mixed-methods descriptive design was used to survey people who have used the Iowa Model in order to determine what was most useful in the model and what problems were encountered. A list containing 2,052 unique e-mail addresses of individuals who requested permission to use the Iowa Mode, either for themselves or their institutions, since the last revision in 2001 (12/1/01-5/9/2013) was generated. An electronic survey was developed and administered after approval by the Institutional Review Board. The survey queried participants’ about their use and experience level with the Iowa Model and demographics. Open-ended questions were asked about problems identified and suggested improvements for each step of the Iowa Model. Descriptive statistics (frequency and percentages) were used to summarize quantitative data. The research team of EBP experts divided the Iowa Model into sections for small group data review and suggested revisions. The team then discussed suggestions, achieved consensus and worked step-by-step through the model to make revisions. Participant feedback was again reviewed to validate incorporation of the provided suggestions.

A total of 431 potential users responded to the survey (21.0% response rate) and 379 reported using the Model and continued with the survey (18.5%). Most participants used the Iowa Model as part of a team (234/379, 63.4%). Current role reported by participants was: educator (44.3%), clinician (41.1%), researcher (29.4%), administrator (25.5%), student (13%), other (11.9%) or not employed/retired (<0.5%). Most were employed by hospitals (72.5%) or a college or university (28.3%) from 46 US states (96.3%) and representing 10 other countries (3.7%). Self-report of knowledge/experience was rated as novice (9.0%), advanced beginner (30.6%), competent (25.2%), proficient (20.2%) and expert (14.8%). Participants most frequently reported problems in the following steps of the Iowa Model: Critique and synthesize research for use in practice (29.0%), institute the practice change (21.9%), and pilot the change in practice (21.0%). On a 4-point Likert scale (1=not useful to 4= very useful), the vast majority of participants rated the Iowa Model as useful (3 = 26.0% and 4 = 68.4%) in the EBP process. Themes identified in the qualitative data were used to guide discussion and inform revisions.

Despite the overall usefulness of the Iowa Model, experienced users identified problematic areas and made suggestions for revision. The 2015 Revised Iowa Model was then reviewed by expert groups for clarity and completeness. Current work is focused on publication which will include the 2015 Revised Iowa Model and discussion of problem-prone areas, many identified by experienced users in this study.