Authors
- . Ahmad Moosavi 1
- . Alireza Sadeghpour 2
- . Saber Azami‑Aghdash 3
- . Naser Derakhshani 4
- . Mohammad Mohseni 5
- . Dariush Jafarzadeh 6
- . Aziz Rezapour 4
1 Department of Health and Community Medicine, Dezful University of Medical Sciences, Dezful, Iran
2 Department of Orthopedic Surgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
3 Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
4 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
5 Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
6 Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract
BACKGROUND: Evidence‑based medicine (EBM) plays an important and dominant role in
promoting effective decision‑making in the health system. This study was aimed to evaluate the
EBM performance among health‑care workers (HCWs) in hospitals in Iran.
METHODS: In this study (a cross‑sectional study), participants were 2800 HCWs in hospitals.
A researcher‑made questionnaire was designed, and judgments of 10 experts were used for the
improvement of content validity. The reliability of the questionnaire was assessed by the test‑retest
method (α = 0.85). Data were analyzed using the descriptive statistics, t‑test, and one‑way ANOVA,
in SPSS.16 software.
RESULTS: Eventually, 1524 questionnaires were completed (response rate: 54.4%). The results
of the study show that 62%of participants have not accessed scientific journals, 52% of them have
difficulties using the Internet at work, guidelines were not reachable for 76% of them, and about 80%
have not access to databases. About 39% of participants were not well informed about databases
of EBM, and 15.8% of them were immensely knowledgeable about EBM terminology. The most
important problems to increase HCWs information about EBM include research methodology‑ related
problems, lack of resources and motivation, and coordination problems. The most prominent facilitators
include: providing training courses in EBM and increased facilities. Only work experience showed
a significant correlation with barriers and facilitators, and gender revealed a significant correlation
with barriers (P < 0.05).
CONCLUSION: It seems that prioritizing the increased access to information resources and
databases, considering the research skills of the HCWs, extending the opportunities and increasing
the facilities such as workforce, equipment, physical environment, and accessibility can have a great
impact on the improvement of the activities associated with EBM.
Keywords
- Wallin L, Boström AM, Wikblad K, Ewald U. Sustainability in
changing clinical practice promotes evidence‐based nursing care.
J Adv Nurs 2003;41:509‑18.
2. Wijeysundera HC, Mitsakakis N, Witteman W, Paulden M,
van der Velde G, Tu JV, et al. Achieving quality indicator
benchmarks and potential impact on coronary heart disease
mortality. Can J Cardiol 2011;27:756‑62.
3. Azami‑Aghdash S, Mohammadi R. Using tracer methodology
in clinical setting and research to measure and improve quality.
J Clin Res Gov 2013;2:39‑40.
4. Kleinman LC, Dougherty D. Assessing quality improvement in
health care: Theory for practice. Pediatrics 2013;131 Suppl 1:S110‑9.
5. Polit DF, Beck CT. Nursing Research: Generating and Assessing
Evidence for Nursing Practice. Lippincott Williams & Wilkins;
2008.
6. Ghogazadeh M, Derakhshani N, Pournaghi‑Azar F,
Kolahdouzan K, Kalvani K, Shirmohammadi M. Knowledge,
attitude, and practice of epidemiology researchers in using
E‑epidemiology methods in medical sciences’ researches.
Depiction of Health 2019;9:31‑8.
7. Krugman M. Evidence‑based practice: The role of staff
development. J Nurs Prof Develop 2003;19:279‑85.
8. Miles A. From evidence‑based to evidence‑informed, from
patient‑focussed to person‑centered‑The ongoing “energetics”
of health and social care discourse as we approach the Third Era
of Medicine. J Eval Clin Pract 2017;23:3‑4.
9. MartisR, Ho JJ, Crowther CA; SEA‑ORCHID Study Group. Survey
of knowledge and perception on the access to evidence‑based
practice and clinical practice change among maternal and
infant health practitioners in South East Asia. BMC Pregnancy
Childbirth 2008;8:34.
10. Dalrymple PW, Lehmann HP, Roderer NK, Streiff MB. Applying
evidence in practice: A qualitative case study of the factors
affecting residents’ decisions. Health Informatics J 2010;16:177‑88.
11. Miles A. Evidence‑based medicine: Requiescat in pace? A
commentary on Djulbegovic, B, Guyatt GH, Ashcroft RE. Cancer
Control 16, 158‑168. J Eval Clin Pract 2009;15:924‑9.
12. Anuradha C, Jacob KS, Shyamkumar NK, Sridhar G.
Evidence‑based practice in radiology: Knowledge, attitude and
perceived barriers to practice among residents in radiology. Eur
J Radiol 2013;82:894‑7.
13. Kamouchi M. Stroke features and management in patients with
chronic kidney disease. Contrib Nephrol 2013;179:92‑9.
14. Chowdhury AM, Bhuiya A, Chowdhury ME, Rasheed S,
Hussain Z, Chen LC. Bangladesh: Innovation for universal
health coverage 1 the Bangladesh paradox: Exceptional health
achievement despite economic poverty. Lancet 2013;382:1734‑45.
15. Chuma J, Maina T, Ataguba J. Does the distribution of health care
benefits in Kenya meet the principles of universal coverage? BMC
Public Health 2012;12:20.
16. Adeodu A, Agius R, Madan I. Attitudes and barriers to
evidence‑based guidelines among UK occupational physicians.
Occup Med (Lond) 2009;59:586‑92.
17. Bölter R, Kühlein T, Ose D, Götz K, Freund T, Szecsenyi J,
et al. [Barriers to evidence‑based medicine encountered among
GPs‑an issue based on misunderstanding? A qualitative study in
the general practice setting]. Z Evid Fortbild Qual Gesundhwes
2010;104:661‑6.
18. Jacobs JA, Dodson EA, Baker EA, Deshpande AD, Brownson RC.
Barriers to evidence‑based decision making in public health:
A national survey of chronic disease practitioners. Public Health Rep 2010;125:736‑42.
19. Madoff RD, Winter DC, Nicholls JR, Rasmussen PC. Barrier
between scientific evidence and clinical practice. Ugeskr Laeger
2011;173:1033.
20. McKillop A, Crisp J, Walsh K. Barriers and enablers to
implementation of a New Zealand‑wide guideline for assessment
and management of cardiovascular risk in primary health care:
A template analysis. Worldviews on evidence‑based nursing/
Sigma Theta Tau International. Honor Soc Nurs 2012;9:159‑71.
21. Peters‑Klimm F, Natanzon I, Müller‑Tasch T, Ludt S, Nikendei C,
Lossnitzer N, et al. Barriers to guideline implementation and
educational needs of general practitioners regarding heart failure:
A qualitative study. GMS Z Med Ausbild 2012;29:Doc46.
22. Rapp CA, Etzel‑Wise D, Marty D, Coffman M, Carlson L, Asher D,
et al. Barriers to evidence‑based practice implementation: Results
of a qualitative study. Community Ment Health J 2010;46:112‑8.
23. Taba P, Rosenthal M, Habicht J, Tarien H, Mathiesen M, Hill S,
et al. Barriers and facilitators to the implementation of clinical
practice guidelines: A cross‑sectional survey among physicians
in Estonia. BMC Health Serv Res 2012;12:455.
24. Van’t Leven N, Graff MJ, Kaijen M, de Swart BJ, Olde Rikkert MG,
Vernooij‑Dassen MJ. Barriers to and facilitators for the use of
an evidence‑based occupational therapy guideline for older
people with dementia and their carers. Int J Geriatr Psychiatry
2012;27:742‑8.
25. Sadeghi‑Bazargani H, Tabrizi JS, Azami‑Aghdash S. Barriers to
evidence‑based medicine: A systematic review. J Eval Clin Pract
2014;20:793‑802.
26. Betz ME, Barber CW, Miller M. Firearm restriction as suicide
prevention: Variation in belief and practice among providers in
an urban emergency department. Inj Prev 2010;16:278‑81.
27. Halcón LL, Chlan LL, Kreitzer MJ, Leonard BJ. Complementary
therapies and healing practices: Faculty/student beliefs and
attitudes and the implications for nursing education. J Prof Nurs
2003;19:387‑97.
28. Heiwe S, Kajermo KN, Tyni‑Lenné R, Guidetti S, Samuelsson M,
Andersson IL, et al. Evidence‑based practice: Attitudes, knowledge
and behaviour among allied health care professionals. Int J Qual
Health Care 2011;23:198‑209.
29. Jette DU, Bacon K, Batty C, CarlsonM, FerlandA, HemingwayRD,
et al. Evidence‑based practice: Beliefs, attitudes, knowledge, and
behaviors of physical therapists. Phys Ther 2003;83:786‑805.
30. Larios SE, Wright S, Jernstrom A, Lebron D, Sorensen JL.
Evidence‑based practices, attitudes, and beliefs in substance
abuse treatment programs serving American Indians and Alaska
Natives: A qualitative study. J Psychoactive Drugs 2011;43:355‑9.
31. Tariman JD, Berry DL, Cochrane B, Doorenbos A, Schepp KG.
Physician, patient, and contextual factors affecting treatment
decisions in older adults with cancer and models of decision
making: A literature review. Oncol Nurs Forum 2012;39:E70‑83.
32. Thorsteinsson HS. Icelandic nurses’ beliefs, skills, and resources
associated with evidence‑based practice and related factors:
A national survey. Worldviews Evid Based Nurs 2013;10:116‑26.
33. Adib‑Hajbaghery M. Evidence‑based practice: Iranian nurses’
perceptions. Worldviews Evid Based Nurs 2009;6:93‑101.
34. Mozafarpour S, Sadeghizadeh A, Kabiri P, Taheri H, Attaei M,
Khalighinezhad N. Evidence‑based medical practice in
developing countries: The case study of Iran. J Eval Clin Pract
2011;17:651‑6.
35. Ahmadi‑Abhari S, Soltani A, Hosseinpanah F. Knowledge
and attitudes of trainee physicians regarding evidence‑based
medicine: A questionnaire survey in Tehran, Iran. J Eval Clin
Pract 2008;14:775‑9.
36. Tahmasebi fard N, Nakhshab M, Shafiei M. A primary study on
the attitude, knowledge and behavior of speech and language
pathologists toward evidence‑based practice. Research in
Rehabilitation Sciences. 2012;8 (1):65‑76.[In Persian].
37. Barghouti FF, Yassein NA, Jaber RM, Khader NJ, Al Shokhaibi S,
Almohtaseb A, et al. Short course in evidence‑based medicine
improves knowledge and skills of undergraduate medical
students: Abefore‑and‑after study. Teach Learn Med 2013;25:191‑4.
38. Bacharova L, Hlavacka S, Rusnakova V. Basic estimate of needs
for training in evidence‑based medicine in Slovakia. J Manag Med
2000;14:362‑82.
39. Frenk J. Leading the way towards universal health coverage:
A call to action. Lancet 2015;385:1352‑8.
40. Frenk J, Gómez‑Dantés O. Health systems in Latin America:
The Search for Universal Health Coverage. Arch Med Res
2018;49:79‑83.
41. Frenk J, Gómez‑Dantés O, Knaul FM. The democratization of
health in Mexico: Financial innovations for universal coverage.
Bull World Health Organ 2009;87:542‑8.
42. Agorreta A, Domínguez‑Domínguez O, Reina RG, Miranda R,
Bermingham E, Doadrio I. Phylogenetic relationships and
biogeography of Pseudoxiphophorus (Teleostei: Poeciliidae)
based on mitochondrial and nuclear genes. Mol Phylogenet Evol
2013;66:80‑90.
43. Hajebrahimi S, Sadeghi‑Ghyassi F, Olfati N, Dastgiri S,
Maghbouli L. Evidence based practice: Perspectives of Iranian
urologists. Urol J 2014;10:1099‑105.
44. Olfati N, Dastgiri S, Hajebrahimi S, Jahanbin H. Factors influencing
evidence‑based practice by Iranian general practitioners. Int J
Health Care Qual Assur 2013;26:360‑74.
45. Salehi M, Khatiri M. A study of risk based auditing barriers: Some
Iranian evidence. Afr J Bus Manag 2011;5:3923‑34.
46. Ghojazadeh M, Azami‑Aghdash S, Pournaghi Azar F, Fardid M,
Mohseni M, Tahamtani T. A systematic review on barriers,
facilities, knowledge and attitude toward evidence‑based
medicine in Iran. J Anal Res Clin Med 2015;3:1‑11.
47. Al‑Ansary LA, Khoja TA. The place of evidence‑based medicine
among primary health care physicians in Riyadh region, Saudi
Arabia. Fam Pract 2002;19:537‑42.
48. O’Donnell CA. Attitudes and knowledge of primary care
professionals towards evidence‑based practice: A postal survey.
J Eval Clin Pract 2004;10:197‑205.
49. Amin M, Saunders JA, Fenton JE. Pilot study of the knowledge
and attitude towards evidence based medicine of otolaryngology
higher surgical trainees. Clin Otolaryngol 2007;32:133‑5.
50. Taheri H, Mirmohammad Sadeghi M, Adibi I, Ashourioun V,
Sadeghizadeh A, Adibi P. The effect of an evidence based
medicine workshop on undergraduate medical students’ skills
in applying EBM. Iran J Med Educ 2006;6:71‑8.
51. Rafiei S, Ghajarzadeh M, Habibollahi P, Fayazbakhsh A. The effect
of introducing evidence based medicine on critical appraisal skills
of medical students. Iran J Med Educ 2008;8:149‑53.
52. Uysal A, Temel AB, Ardahan M, Ozkahraman S. Barriers
to research utilisation among nurses in Turkey. J Clin Nurs
2010;19:3443‑52.
53. Miles A, Loughlin M, Polychronis A. Medicine and evidence:
Knowledge and action in clinical practice. J Eval Clin Pract
2007;13:481‑503.
54. Lai NM, Nalliah S. Information‑seeking practices of senior medical
students: The impact of an evidence‑based medicine training
programme. Educ Health (Abingdon) 2010;23:151.
55. Feldstein DA, Maenner MJ, Srisurichan R, Roach MA,
Vogelman BS. Evidence‑based medicine training during
residency: A randomized controlled trial of efficacy. BMC Med
Educ 2010;10:59.
56. Oliveri RS, Gluud C, Wille‑Jørgensen PA. Hospital doctors’
self‑rated skills in and use of evidence‑based medicine‑A
questionnaire survey. J Eval Clin Pract 2004;10:219‑26.
57. Straus SE, RichardsonWS, GlasziouP, HaynesRB. Evidence‑Based
Medicine: How to Practice and Teach EBM. 3rd ed. Edinburgh:
Churchill Livingstone; 2005 - 58. Adams D. Breaking down the barriers: Perceptions of factors
that influence the use of evidence in practice. J Orthop Nurs
2001;5:170‑5.
59. Adily A, Ward JE. Enhancing evidence‑based practice in
population health: Staff views, barriers and strategies for change.
Aust Health Rev 2005;29:469‑77.
60. Agarwal R, Kalita J, Misra UK. Barriers to evidence based
medicine practice in South Asia and possible solutions. Neurol
Asia 2008;13:87‑94.
61. Aicken CR, Armstrong NT, Cassell JA, Macdonald N, Bailey AC,
Johnson SA, et al. Barriers and opportunities for evidence‑based
health service planning: The example of developing a Decision
Analytic Model to plan services for sexually transmitted infections
in the UK. BMC Health Serv Res 2012;12:202.
62. Al‑Almaie SM, Al‑Baghli N. Barriers facing physicians practicing
evidence‑based medicine in Saudi Arabia. J Contin Educ Health
Prof 2004;24:163‑70.
63. Al‑Gelban KS, Al‑Khaldi YM, Al‑Wadei AM, Mostafa OA.
Barriers against application of evidence‑based medicine in general
hospitals in aseer region, kingdom of saudi arabia. J Family
Community Med 2009;16:1‑5.
64. Amodeo M, Lundgren L, Cohen A, Rose D, Chassler D,
Beltrame C, et al. Barriers to implementing evidence‑based
practices in addiction treatment programs: Comparing staff
reports on Motivational Interviewing, Adolescent Community
Reinforcement Approach, Assertive Community Treatment,
and Cognitive‑behavioral Therapy. Eval Program Plann
2011;34:382‑9.
65. Arnall F, McCarthy CJ. The world wide web as a tool to break
down the barriers between research and evidence‑based practice.
Physiother 2003;89:627‑8.
66. Belizan M, Meier A, Althabe F, Codazzi A, Colomar M, Buekens P,
et al. Facilitators and barriers to adoption of evidence‑based
perinatal care in Latin American hospitals: A qualitative study.
Health Educ Res 2007;22:839‑53.
67. Bertulis R. Barriers to accessing evidence‑based information. Nurs
Stand 2008;22:35‑9.
68. Bloe C, Mair C, Call A, Fuller A, Menzies S, Leslie SJ. Identification
of barriers to the implementation of evidence‑based practice for
pre‑hospital thrombolysis. Rural Remote Health 2009;9:1100.
69. Borneman T, Koczywas M, Sun VC, Piper BF, Uman G, Ferrell B.
Reducing patient barriers to pain and fatigue management. J Pain
Symptom Manage 2010;39:486‑501.
70. Bennett S, Tooth L, McKenna K, Rodger S, Strong J, Ziviani J, et al.
Perceptions of evidence‐based practice: A survey of Australian
occupational therapists. Australian Occup Ther J 2003;50:13‑22.
71. Zokaie Yazdi S, Mosayyeb Moradi J, Mehran A. Perspective of
the nursing staff at hospitals affiliated to the Tehran University of
Medical Sciences on the roles and activities of the nurses. J Hayat
2002;8:22‑32.
72. Taleb B, Mostajer M, Mostajer A, editors. Assessing the level
of awareness of treatment groups about evidence‑based
performance and organizational and professional barriers to
its implementation. National Congress of Evidence‑Based Care
Mashhad: Mashhad University of Medical Science; 2010.
73. Briggs M, Paley G, Cash K, Closs J. Improving research utilisation
for community and mental health nurses. Foundat Nurs Stud
Dissem Series 2004;2:1‑4.
74. Carrion M, Woods P, Norman I. Barriers to research utilisation
among forensic mental health nurses. Int J Nurs Stud 2004;41:613‑9.
75. Omer T. Research utilization in a multicultural nursing setting in
Saudi Arabia: Barriers and facilitators. J Nurs Res 2012;20:66‑73.
76. Parahoo K. Barriers to, and facilitators of, research utilization
among nurses in Northern Ireland. J Adv Nurs 2000;31:89‑98.
77. Glacken M, Chaney D. Perceived barriers and facilitators to
implementing research findings in the Irish practice setting. J Clin
Nurs 2004;13:731‑40.
78. Brătucu E, Lucenco L. Gastroesophageal reflux disease‑current
trends. Chirurgia (Bucur) 2012;107:147‑53.
79. Goderis G, Borgermans L, Mathieu C, Van Den Broeke C,
Hannes K, Heyrman J, et al. Barriers and facilitators to evidence
based care of type 2 diabetes patients: Experiences of general
practitioners participating to a quality improvement program.
Implement Sci 2009;4:41.
80. Vasse E, Vernooij‑Dassen M. Barriers and facilitators to implement
evidence based psychosocial care in dementia: A focus group
approach using multinational and multidisciplinary expert
groups. Int Psychog 2011;23:S370‑1.
81. Davis EM, Jamison P, Brumley R, Enguídanos S. Barriers and
facilitators to replicating an evidence‑based palliative care model.
Home Health Care Serv Q 2006;25:149‑65.
82. Leasure AR, Stirlen J, Thompson C. Barriers and facilitators to
the use of evidence‑based best practices. Dimens Crit Care Nurs
2008;27:74‑82.
83. Asadoorian J, Hearson B, Satyanarayana S, UrselJ. Evidence‑based
practice in healthcare: An exploratory cross‑discipline comparison
of enhancers and barriers. J Healthc Qual 2010;32:15‑22.
84. Meline T, Paradiso T. Evidence‑based practice in schools:
Evaluating research and reducing barriers. Lang Speech Hear
Serv Sch 2003;34:273‑83.
85. Worrall LE, Bennett S. Evidence‑based practice: Barriers and
facilitators for speech‑language pathologists. J Med Speech
Language Pathol 2001;9):11‑6.
86. Bartelt TC, Ziebert C, Sawin KJ, Malin S, Nugent M, Simpson P.
Evidence‑based practice: Perceptions, skills, and activities of
pediatric health care professionals. J Pediatr Nurs 2011;26:114‑21.
87. Miles A, Polychronis A, Grey JE. The evidence‑based health care
debate‑2006. Where are we now? J Eval Clin Pract 2006;12:239‑47.
88. Miles A, Loughlin M, Polychronis A. Evidence‑based healthcare,
clinical knowledge and the rise of personalised medicine. J Eval
Clin Pract 2008;14:621‑49.v
)