Evidence-Based Practice and Associated Factors Among Health Care Providers Working in Public Hospitals in Northwest Ethiopia During 2017

Getenet Dessie; Dube Jara; Girma Alem; Henok Mulugeta; Tesfu Zewdu; Fasil Wagnew; Rachel Bigley; Sahai Burrowes

doi:10.1016/j.curtheres.2020.100613

Evidence-Based Practice and Associated Factors Among Health Care Providers Working in Public Hospitals in Northwest Ethiopia During 2017

Curr Ther Res Clin Exp. 2020 Nov 7:93:100613. doi: 10.1016/j.curtheres.2020.100613. eCollection 2020.

Authors

Getenet Dessie¹, Dube Jara², Girma Alem³, Henok Mulugeta³, Tesfu Zewdu⁴, Fasil Wagnew³, Rachel Bigley^{5

6}, Sahai Burrowes⁷

Affiliations

¹ Department of Nursing, School of Health Science, College of Medicine and Health Science, Bahr Dar University, Bahr Dar, Ethiopia.
² Department of Public Health, College of Health Science Debre Markos University, Debre Markos, Ethiopia.
³ Department of Nursing, College of Health Science Debre Markos University, Debre Markos, Ethiopia.
⁴ Department of Nursing, College of Health Science Assossa University, Assossa, Ethiopia.
⁵ School of Public Health, University of California, Berkeley, California.
⁶ School of Medicine, University of California-San Francisco, San Francisco, California.
⁷ Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, California.

Abstract

Background: Despite the fact that evidence-based practice (EBP) is believed to be associated with improved health, safety, and cost outcomes, most medical practice in low- and middle-income countries such as Ethiopia is not evidence-based. Understanding the extent of and barriers to EBP in Ethiopia is important for learning how to best to improve quality of care. Few studies have assessed EBP in Ethiopia.

Objective: This study aimed to assess reported level of EBP and associated factors among health care providers working in public hospitals in northwest Ethiopia.

Methods: A cross-sectional study was conducted with 415 randomly selected nurses, midwives, and physicians using stratified sampling (97.6% response rate). Data were collected using a structured, self-administered questionnaire that was developed by reviewing the literature and adapting the Melnyk and Fineout-Overholt EBP Implementation Scale. After validating scales, bivariate and multivariate linear regression models were used to identify factors associated with EBP implementation.

Results: The mean EBP implementation score was 10.3 points out of a possible 32 points and 60% of respondents scored below average. Most (60.2%) respondents reported poor confidence in their ability to judge the quality of research and half (50.1%) said that they were unable to find resources for implementing EBP. The most frequently mentioned barriers to EBP were lack of training (81.2%), poor health facility infrastructure (79.3%), and lack of formal EBP/patient education units in facilities (78.0%). The factors found to be significantly and independently associated with EBP implementation were years of work experience (β = -0.10; P < 0.05); having been trained as a bachelor's degree-level nurse (β = 3.45; P < 0.001) or a bachelor's degree-level midwife (β = 2.96; P < 0.001), a general practitioner (β = 7.86; P < 0.001), or a specialist physician (β = 15.04; P < 0.001) rather than a diploma-level nurse; working in a pediatrics ward (β = -1.74; P < 0.05); and reporting as barriers either a lack of clarity on the importance of EBP (β = -0.93; P < 0.05) or a lack of orientation sessions on new health priorities (β = -0.91; P < 0.05).

Conclusions: Health professionals had low levels of EBP implementation and poor EBP skills. These problems were particularly acute for providers with lower levels of training. A large number of respondents reported structural and institutional barriers to EBP. These results suggest that clear leadership and ongoing, cross-disciplinary, skill-building approaches are needed to increase EBP implementation in Ethiopia. (Curr Ther Res Clin Exp. 2020; 81:XXX-XXX).

Keywords: Ethiopia; evidence-based medicine; evidence-based practice; implementation.