Limited Evidence to Fully Determine the Implementation of Evidence-Based Practice by Healthcare Providers in Africa: A Systematic Review and Meta-Analysis

IF 3.6 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine Pub Date : 2025-05-15 DOI:10.1111/jebm.70032

Feleke H. Astawesegn, Kedir Y. Ahmed, Subash Thapa, Shakeel Mahmood, Anayochukwu Anyasodor, M. Mamun Huda, Setognal B. Aychilihum, Utpal K. Modal, Allen G. Ross

{"title":"Limited Evidence to Fully Determine the Implementation of Evidence-Based Practice by Healthcare Providers in Africa: A Systematic Review and Meta-Analysis","authors":"Feleke H. Astawesegn, Kedir Y. Ahmed, Subash Thapa, Shakeel Mahmood, Anayochukwu Anyasodor, M. Mamun Huda, Setognal B. Aychilihum, Utpal K. Modal, Allen G. Ross","doi":"10.1111/jebm.70032","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aim</h3>\n \n <p>Implementing evidence-based practice (EBP) is a complex process requiring healthcare providers to integrate evidence-based medicine (EBM) into clinical practice, ultimately improving clinical outcomes. This systematic review examined the sources of information for EBP, analyzed the extent of EBP implementation by healthcare providers, and explored the factors influencing EBP in Africa.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We identified articles published between January 1992 and March 2024 by searching Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMbase, PubMed, and Scopus databases. The pooled effect sizes for the prevalence of EBP and odds ratios (ORs) were estimated using random- and fixed-effects models as appropriate. For the qualitative component of the study, we performed a thematic analysis and subsequently integrated and interpreted findings from both the quantitative and qualitative analyses.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Thirty-three studies were included in this review, involving 9722 healthcare providers: 60.3% nurses, 15.9% physicians, and 15.4% midwives. Our findings revealed a lack of detailed information on how healthcare providers utilized different forms of EBM to inform EBP and clinical outcomes in Africa. Self-reported EBP was 57.3% among nurses and 37.3% among physicians. Nigeria had the highest self-reported EBP (75.2%), whereas Egypt had the lowest (18.9%). Common sources of information reported for EBP were PubMed, UpToDate, the Cochrane Library, clinical guidelines, and training programs. Factors associated with EBP included knowledge of EBP (OR = 2.13, 95% confidence interval [CI]: 1.83–2.47), positive attitude toward EBP (OR = 1.95, 95% CI: 1.76–2.15), and having EBM training (OR = 3.08, 95% CI: 2.08–4.57), and a managerial role (OR = 2.16, 95% CI: 1.37–3.41). The availability of guidelines (OR = 1.88, 95% CI: 1.5–2.37) and internet access (OR = 1.90, 95% CI: 1.54–2.34) were also found to increase EBP. Our qualitative analysis identified common barriers to EBP, including a lack of support, resistance to change, poor communication, and failure to integrate EBP courses into the continuing education curricula.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>This systematic review found limited information on the sources of EBM, how it was delivered, and its frequency of use in clinical practice. Thus, the correlation between EBM, EBP, and clinical outcomes was not fully transparent. Further studies are required to examine the medical conditions addressed within providers’ scopes of practice, the types of evidence utilized, the frequency and consistency of EBP implementation, and its effect on enhancing patient outcomes.</p>\n </section>\n </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.70032","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Evidence‐Based Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jebm.70032","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Aim

Implementing evidence-based practice (EBP) is a complex process requiring healthcare providers to integrate evidence-based medicine (EBM) into clinical practice, ultimately improving clinical outcomes. This systematic review examined the sources of information for EBP, analyzed the extent of EBP implementation by healthcare providers, and explored the factors influencing EBP in Africa.

Methods

We identified articles published between January 1992 and March 2024 by searching Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMbase, PubMed, and Scopus databases. The pooled effect sizes for the prevalence of EBP and odds ratios (ORs) were estimated using random- and fixed-effects models as appropriate. For the qualitative component of the study, we performed a thematic analysis and subsequently integrated and interpreted findings from both the quantitative and qualitative analyses.

Results

Thirty-three studies were included in this review, involving 9722 healthcare providers: 60.3% nurses, 15.9% physicians, and 15.4% midwives. Our findings revealed a lack of detailed information on how healthcare providers utilized different forms of EBM to inform EBP and clinical outcomes in Africa. Self-reported EBP was 57.3% among nurses and 37.3% among physicians. Nigeria had the highest self-reported EBP (75.2%), whereas Egypt had the lowest (18.9%). Common sources of information reported for EBP were PubMed, UpToDate, the Cochrane Library, clinical guidelines, and training programs. Factors associated with EBP included knowledge of EBP (OR = 2.13, 95% confidence interval [CI]: 1.83–2.47), positive attitude toward EBP (OR = 1.95, 95% CI: 1.76–2.15), and having EBM training (OR = 3.08, 95% CI: 2.08–4.57), and a managerial role (OR = 2.16, 95% CI: 1.37–3.41). The availability of guidelines (OR = 1.88, 95% CI: 1.5–2.37) and internet access (OR = 1.90, 95% CI: 1.54–2.34) were also found to increase EBP. Our qualitative analysis identified common barriers to EBP, including a lack of support, resistance to change, poor communication, and failure to integrate EBP courses into the continuing education curricula.

Conclusion

This systematic review found limited information on the sources of EBM, how it was delivered, and its frequency of use in clinical practice. Thus, the correlation between EBM, EBP, and clinical outcomes was not fully transparent. Further studies are required to examine the medical conditions addressed within providers’ scopes of practice, the types of evidence utilized, the frequency and consistency of EBP implementation, and its effect on enhancing patient outcomes.

查看原文本刊更多论文

有限的证据，以充分确定实施循证实践的医疗保健提供者在非洲：系统评价和荟萃分析

实施循证实践（EBP）是一个复杂的过程，要求医疗保健提供者将循证医学（EBM）整合到临床实践中，最终改善临床结果。本系统综述检查了EBP的信息来源，分析了医疗保健提供者实施EBP的程度，并探讨了影响非洲EBP的因素。方法通过检索护理与相关健康文献累积索引（CINAHL）、EMbase、PubMed和Scopus数据库，筛选出1992年1月至2024年3月间发表的文章。采用随机效应和固定效应模型对EBP患病率和优势比（or）的合并效应大小进行估计。对于研究的定性部分，我们进行了专题分析，随后整合和解释了定量和定性分析的结果。结果本综述纳入33项研究，涉及9722名医疗服务提供者：护士60.3%，医生15.9%，助产士15.4%。我们的研究结果显示，缺乏关于医疗保健提供者如何利用不同形式的循证医学来告知非洲的循证bp和临床结果的详细信息。自我报告的EBP在护士中占57.3%，在医生中占37.3%。尼日利亚自我报告的EBP最高（75.2%），而埃及最低（18.9%）。EBP报告的常见信息来源是PubMed、UpToDate、Cochrane图书馆、临床指南和培训计划。与EBP相关的因素包括EBP知识（OR = 2.13, 95%可信区间[CI]: 1.83-2.47）、对EBP的积极态度（OR = 1.95, 95% CI: 1.76-2.15）、接受过EBM培训（OR = 3.08, 95% CI: 2.08-4.57）和管理角色（OR = 2.16, 95% CI: 1.37-3.41）。获得指南（OR = 1.88, 95% CI: 1.5-2.37）和上网（OR = 1.90, 95% CI: 1.54-2.34）也会增加EBP。我们的定性分析确定了EBP的常见障碍，包括缺乏支持、抗拒变革、沟通不良以及未能将EBP课程整合到继续教育课程中。结论本系统综述发现关于循证医学的来源、传播方式和临床应用频率的信息有限。因此，EBM、EBP与临床结果之间的相关性并不完全透明。需要进一步的研究来检查在提供者的业务范围内处理的医疗状况、所使用的证据类型、实施EBP的频率和一致性，以及它对提高患者预后的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Evidence‐Based Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

11.20

自引率

1.40%

发文量

期刊介绍： The Journal of Evidence-Based Medicine (EMB) is an esteemed international healthcare and medical decision-making journal, dedicated to publishing groundbreaking research outcomes in evidence-based decision-making, research, practice, and education. Serving as the official English-language journal of the Cochrane China Centre and West China Hospital of Sichuan University, we eagerly welcome editorials, commentaries, and systematic reviews encompassing various topics such as clinical trials, policy, drug and patient safety, education, and knowledge translation.