Knowledge of Cochrane, evidence-based medicine and the Cochrane Library at Defence Force Medical Services: a baseline cross-sectional survey among military health personnel in Zambia

Objectives: Evidence-based medicine (EBM) is a core competency for all healthcare professions including military healthcare personnel. We surveyed military health personnel knowledge and experience with Cochrane, EBM and the Cochrane Library at Defence Force Medical Services in Zambia.Materials and Methods: During May 2013 and March 2014, we used a pretested self-administered survey to collect data from the study participants. Categorical associations was tested by Chi-squared or Fisher's exact test. The strength of association between categorical variables was expressed using odds ratio (OR) with 95% confidence interval (CI).Results: The overall participation rate was 92% (57/62). The sample consisted of doctors, nurses, clinical officers, medical licentiates and other professions. Nearly 44% worked in military clinics, 28% hospitals, 23% head office and 5% in training schools. Most (79%) of respondents have heard of EBM, but 84% had low knowledge and 88% lacked EBM training. Nearly 77% agreed that EBM was useful in clinical practice, 98% showed interest in EBM training and 46% declared workplace EBM promotion. Awareness about Cochrane was 53% and only two recognized Cochrane South Africa as their reference centre. Awareness and usage of the Cochrane Library was generally very poor and only one knew the database. Medical doctors were roughly five times more likely to cite organizational barriers to the Cochrane Library compared to nurses and clinical officers (Adjusted OR=5.19, 95% CI, 1.15–23.52, P=0.03).Conclusions: Military medical personnel encounter considerable barriers to adopt EBM in clinical practice. Addressing their multifaceted barriers would facilitate the delivery of evidence-based healthcare and improve patient outcomes.Keywords: Evidence-based medicine, Cochrane, Cochrane Library, barriers, military healthcare practitioners, Zambi