Knowledge, attitudes, practices and barriers in use of evidence-based medicine among resident physicians in Aga Khan University Hospital, Nairobi.

Background: Evidence based medicine (EBM) helps clinicians to integrate latest research evidence into their daily clinical practice. There is a need for all healthcare professions to adopt it in order to provide scientific, safe, efficient and most cost-effective care. Postgraduate residents are at the frontline of healthcare delivery and all medical institutions should strive to produce practitioners of EBM. Studies have shown that physicians are still struggling to adapt to this paradigm shift in the practice of medicine, especially in Sub Saharan Africa (SSA). However, very few studies have been done in SSA and none in East Africa to explore the knowledge, attitudes, practices and barriers of evidence-based practice among resident physicians. Objectives: This study was conducted to determine the knowledge, attitudes, and practices towards EBM among resident physicians at Aga Khan University Hospital Nairobi (AKUHN) and barriers that impede application of EBM in practice. Methods: A convergent parallel mixed methods study was conducted. The quantitative tool was developed and initially piloted on recently graduated residents from AKUHN. From this, a final questionnaire was developed and sent to all current AKUHN residents via an online survey application. In addition, purposive sampling was used to identify 18 participants for the qualitative study. In-depth interviews (IDIs) were conducted to gain an understanding of the knowledge, attitude and practice of residents towards EBM and their perceived barriers. Quantitative data were analyzed using descriptive statistics for continuous variables and linear regression analysis for testing associations between variables. Qualitative data were analyzed using thematic framework analysis. Results: A total of 101 residents participated in the quantitative study. The mean scores for knowledge, attitude and practice of EBM among residents were 73.88, 66.96 and 63.19 respectively, which were generally higher than in comparable studies. There was no significant association between knowledge/attitude of EBM and sex, age, department and year of residency but there was a significant association between department (p-value = 0.00) and year of residency (p-value= 0.01) with practice of EBM. The most common barriers faced by residents were lack of time (mean score of 3.35), lack of EBM skills (mean score of 2.97) and patients’ unawareness about EBM (mean score 2.83). Several key themes were identified from the qualitative findings and were merged with the quantitative findings where appropriate. From the IDIs, residents again demonstrated good knowledge and support of EBM but practice was low (only 20-30% of clinical practice is evidence based on a daily basis). Main themes that characterized the barriers to practicing EBM were: lack of motivation, lack of time, lack of skills, patient overload, lack of resources, intimidation from patients and fear of challenging the consultants. Conclusion: Residents are at the frontline of health care delivery and although there is a good understanding and support of EBM among residents at AKUHN both from the quantitative and qualitative studies, the practice of EBM among residents which rated quite high in the quantitative study was reported to be low in the qualitative study. Major barriers identified were lack of time and lack of skills to practice EBM. Residents reported high practice of EBM in the survey but this was not supported by qualitative findings. Therefore, enhancing the use of EBM concepts in a timely and accurate manner is highly recommended at both institutional and national level