Evidence-based medicine among health-care workers in hospitals in Iran: A nationwide survey
Ahmad Moosavi1, Alireza Sadeghpour2, Saber Azami-Aghdash3, Naser Derakhshani4, Mohammad Mohseni5, Dariush Jafarzadeh6, Aziz Rezapour4
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
|Date of Submission||09-Apr-2020|
|Date of Acceptance||25-Aug-2020|
|Date of Web Publication||29-Dec-2020|
Dr. Aziz Rezapour
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
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: Barriers, evidence-based medicine, facilitators, health care workers, hospitals
|How to cite this article:|
Moosavi A, Sadeghpour A, Azami-Aghdash S, Derakhshani N, Mohseni M, Jafarzadeh D, Rezapour A. Evidence-based medicine among health-care workers in hospitals in Iran: A nationwide survey. J Edu Health Promot 2020;9:365
|How to cite this URL:|
Moosavi A, Sadeghpour A, Azami-Aghdash S, Derakhshani N, Mohseni M, Jafarzadeh D, Rezapour A. Evidence-based medicine among health-care workers in hospitals in Iran: A nationwide survey. J Edu Health Promot [serial online] 2020 [cited 2023 Jun 7];9:365. Available from: https://www.jehp.net//text.asp?2020/9/1/365/305311
| Introduction|| |
Nowadays, the increasing awareness, practical researches, and expectations of health systems have made the health systems constantly thinking about enhancing the quality of healthcare.,, Health systems try to improve the quality of health services by formulating valid guidelines and standards and comparing their performance with it, and also, using results of the researches in the clinical practice is a way to expand the scientific basis and knowledge of experts in this field., Hence that Krugman believes that the use of research results can remove the traditional and uncertain practice and by replacing it with safe and reliable care will lead to the improvement of the health-care standards and quality of provided services by health-care professionals., Therefore, the realization of best practice to ensure the clinical effectiveness of health-care services needs to access the best evidence for “evidence-based decision-making.” Hence, health-care workers (HCWs) are showing a tendency toward evidence-based medicine (EBM).,,,
According to some authors, EBM has been noticed since the French Revolution in Paris for the first time, and some others would say that they have found its earlier roots in Chinese medicine. EBM is a set of abilities and skills in using and integrating the best evidence, which is achieved from repeatable and without bias clinical trials with the patient's preferences and conditions, The most common definition of EBM is provided by Dr. David Sackett. EBM is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”
Along with presenting and considering EBM in various fields, many studies have been performed around the world to evaluate the knowledge, attitude, and behavior in the field of EBM,,, its barriers and facilitators,,,,,,,,, understanding and perception of the concept of EBM,,,,,,, and its other aspects.
During the past few years, EBM is also considered in many areas of Medical Sciences in Iran., Conducted Studies in Iran have shown that the knowledge, attitude, and behavior of different groups of HCWs is low in this subject.,
Furthermore, consideration of the EBM in the health system can be useful for both staff and patients. Because identifying staff weaknesses in this area as well as identifying the gap in the country can be a guide for policymakers in choosing the policies needed in future. Given the importance of EBM, the acquisition of comprehensive and transparent information about the status of EBM among HCWs in hospitals can play an important role in promoting EBM. Therefore, this study was aimed to provide a comprehensive review of the status of EBM among HCWs in hospitals in Iran.
| Methods|| |
This study is a cross-sectional study which was conducted in 2018. The participants were all HCWs (physicians, nurses, midwives, and staff working in diagnostic units) in hospitals in Iran. To select the studied hospitals, 7 provinces were selected by simple random sampling among all the provinces of Iran. In each of the selected provinces, 5 hospitals were chosen randomly in the provincial capitals. Then, in the next stage of the research, 80 HCWs had been chosen and entered the study by quota sampling.
Exclusion criteria included: work experience <1 year, employment in administrative and managerial units (only those who were directly involved in providing services to patients), people who were working in hospitals and were also studying in the universities at the same time, people working in military hospitals and individuals who had not consented to participate in the research study. The data collection tool was a researcher-made questionnaire which has covered all the objectives of the study. The questionnaire was designed based on the literature review, and judgments of 10 experts were used for the improvement of the content validity of it. To assess the internal consistency of the questionnaire, the correlation between the questionnaire items was assessed by using the Cronbach's alpha, and the reliability of the questionnaire was assessed by using the test-retest reliability method with the contribution of 50 participants (α = 0.85).,,
The questionnaire consisted of two main parts: the first part related to the demographic information (6 questions), the second part of the main questions, respectively, included: Accessibility to the EBM databases (6 databases), familiarity with each of the EBM databases (6 databases), familiarity with any of the EBM terms (11 terms), information resources of EBM (4 sources), requiring performance improvement activities (4 activities), questions about barriers (15 questions), and questions related to the facilitators of EBM (6 questions).
In this study, the following formula was used to estimate the sample size.
In this formula, the confidence interval (CI) (Z) was equal to 2 and the foreseen average in the community (p) was considered equal to 0.5 because the investigators wanted to have the largest sample size for the study and also the accuracy of 0.02 was used. According to the above formula, the sample size was calculated to be 2500. To raise the accuracy of the study and also preventing a significant decrease in the number of the study participants, the sample size was increased by 10%, and finally, the ultimate sample size was equivalent to 2800. To collect data, some interviewers were chosen from selected provinces who were accustomed to the local language and customs of the people of those provinces. To collect data, some interviewers were chosen from selected provinces who were accustomed to the local language and customs of the people of those provinces. To create consistency and a common language between interviewers, a briefing had been held for interviewers and also a pilot study was conducted with a sample size of at least 50 people to ensure the inter-rater reliability.
The collected data have been reported by using descriptive statistics (frequency, percentage, mean, and standard deviation), t-test, one-way ANOVA, and have been analyzed by using the SPSS.16 software (version 16, SPSS Inc., Chicago, IL). In this study, the P = 5% was considered statistically significant.
Ethical considerations in this study included: permission from the Ethics Committee of the Iran University of Medical Sciences, coordinating with the authorities of the relevant hospitals and universities, obtaining informed consent from participants and ensuring the confidentiality of the information and profiles of the participants.
| Results|| |
Eventually, 1524 questionnaires were completed and collected from 2800 distributed questionnaires (response rate: 54.4%). The mean and standard deviation of the participants' age was 7.2 ± 31.2. The demographic characteristics of the participants are presented in [Table 1].
|Table 1: Demographic characteristics of the healthcare workers in hospitals of Iran|
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The results indicated that about 62% of participants have not accessed to scientific journals, 52% of them have difficulties to use the Internet at work, guidelines were not reachable for 76% of them, and about 80%, 38.6%, and 19.3% have not, respectively, accessed to databases, libraries, and the Internet. About 39% of participants were not well informed about databases of EBM and only 12.7% of participants were remarkably cultivated and knowledgeable about databases of EBM. Only about 10% of the participants were very familiar with bases Cochrane Database of Systematic Reviews, Database of Effective Health, and Abstracts of Reviews of Effectiveness Care Bulletins. About 39% of participants were not well informed about databases of EBM and 15.8% of them were immensely knowledgeable about EBM terminology.
About 39% of participants were not well informed about databases of EBM and 15.8% of them were immensely knowledgeable about EBM terminology. The knowledge of the participants about some terminologies such as meta-analysis, CI, heterogeneity, and the P value was at a low level. The participants were more familiar with the terminologies of the systematic review, relative risk, absolute risk, and number needed to treat.
More than half of the participants (55.5%) had not used articles as the information sources for EBM. About 64% of the participants were using textbooks, and about 61% of them had not used professors and experts as EBM sources. About 80% of the study participants had used the Internet as the information sources for EBM.
About two-thirds of the participants believed that practical contributions in programs and activities related to EBM and conducting EBM workshops can have a great impact on the improvement of activities related to EBM. A few percent believed that accessibility to the information sources of EBM and holding journal clubs associated with EBM can have a great effect on the improvement of activities related to EBM.
The results about EBM barriers from the viewpoint of the study participants are shown in [Table 2]. Nearly 90% of the participants agreed with referred barriers in Table 2 as the EBM barriers in the Iranian hospitals (strongly agree + somewhat agree). Only about 8% of the participants did not agree with these barriers as the inhibitors of EBM in Iranian hospitals. The participants mostly agreed on the barriers, which include the following: difficulties associated with research (unrelated to the clinical issues, nontransparent results, nongeneralized results), lack resources (lack of physical environment, equipment, and the enormous number of patients), lack of motivation (lack of motivation to increase knowledge and use of information and lack of public service motivation), and coordination problems (coordination with colleagues, coordination with managers and authorities, poor teamwork).
|Table 2: Evidence-based medicine barriers from the perspective of health-care workers in hospitals of Iran|
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The results about EBM facilitators from the viewpoint of the study participants are shown in [Table 3]. Nearly 93% of the participants agreed with referred facilitators in Table 3 as the EBM facilitators in the Iranian hospitals (strongly agree + somewhat agree). Only about 5% of the participants did not agree with these facilitators as the facilitators of EBM in Iranian hospitals. The participants mostly agreed upon the facilitators, which include the following: conducting EBM workshops (research methodologies, search skills, assessment of articles quality), improving facilities such as human resources, physical environment, space, and accessibility).
|Table 3: Evidence-based medicine facilitators from the perspective of health care workers in hospitals of Iran|
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Results of the statistical tests indicated that from among all the demographic variables, only work experience showed a significant correlation with barriers and facilitators and gender revealed a significant correlation with barriers (P < 0.05).
| Discussion|| |
The results demonstrated that most of the participants have not accessed to scientific journals, most of them have difficulties to use the Internet at work. Guidelines and databases were not reachable for the majority of participants. The most dominant barriers to EBM include problems associated with research, lack of resources, and lack of motivation and coordination problems. The most prominent facilitators include: providing training courses in EBM and increased facilities. Results of the statistical tests revealed that from among all the demographic variables, only work experience showed a significant correlation with barriers and facilitators, and gender revealed a significant correlation with barriers.
As mentioned before, most of the participants had limited access to EBM resources. This result was consistent with earlier studies in Iran.,,,,,,, Therefore, given the importance of the availability of resources in motivating the HCWs and thereby improving EBM, health authorities and managers should plan and take the necessary steps to provide access to EBM resources.
The results demonstrated that awareness of the HCWs in Iran about the EBM terminologies and databases is at a low level. The least level of acquaintance and understanding in the field of the EBM terminologies is related to the terms of heterogeneity, CI, and odds ratio (Odd Ratio), which largely coincided with the results of previous studies.,, In this study, the participants' awareness of some of the terms like absolute risk and Systematic Review was higher than the other terms that may be caused by the literal meanings of these terms, because it seems that these terms have a simple and comprehensible denotation, but they have complicated and sophisticated definitions statistically and methodologically and this issue should be deliberated more precisely. Wholly, the results of understanding and perceiving the EBM expressions and terminologies indicated that the knowledge and awareness of the health care providers in the field of statistical and methodological expressions are lower than the practical expressions in the workplace. Hence, the need to provide the training in the field of the statistical and methodological issues for the HCWs is noticeable to promote the implementation of EBM. According to the other studies in this context, the skills of participants in EBM have increased after a precise and exquisite training program,, so a detailed and exact theoretical and practical planning with different methods is required for increasing the familiarity of the HCWs with EBM, including participation in workshops and training courses, journal clubs and the grand rounds, conferences, seminars, meetings, and gatherings, etc., Therefore, the necessity of developing an appropriate and comprehensive training curriculum in the field of EBM in the universities of medical sciences should be considered in future.
In the present study, the Internet and reference books were the best sources of information for the participants. However, several sources noted that books cannot be updated and suitable resources for finding evidence of clinical decision making, due to the fast development of medical sciences., In a study conducted in Malaysia on interns, it was reported that the first reference of acquiescing information was asking the other people (colleagues, professors, and medical staff) for >60% of the study participants. In a study on residents of the Wisconsin University of medical sciences of the United States of America, it was found that 100% of the participants in the research had used Up to Date database, and >70% of them had used Medline to access the information in 1 month before the study. According to the findings of this study, papers and magazines had the least application. While in a study by. Oliveri RS et al. in Germany papers and magazines were the main source of information. Due to the limited and out of date information of the reference books taking advantage of papers and magazines is recommended. Due to the low rate of making use of papers which can be resulted from lack of reading skills due to lack of English proficiency, lack of perceiving and understanding the results due to unfamiliarity with research and methodological issues or having poor access to articles, reviewing and removing these barriers and other possible barriers to EBM is essential.
The present study revealed that the most important barriers to EBM are related to the research problems, lack of resources, time limitations, and lack of education. This finding is consistent with most foreign studies.,,,,,,,,,,,,,, The results of the other reported studies demonstrated that lack of time and an enormous number of patients are the main barriers to the nurses for the use of research evidence in the health-care services., Another study has also indicated that the main recognized barriers in this field are the lack of time and lack of skills in implementing EBM. Results of other studies have confirmed that lack of facilities, lack of enough time for studying results and findings of other articles and the lack of support from management systems in both educational and clinical levels are major barriers to EBM, which are consistent with our findings. It seems that managers should also notice the importance and benefits of EBM, and should take steps to provide the hardware and software facilities and plan and implement the necessary training to overcome these barriers. According to the study participants' viewpoints, conducting workshops, and training courses in EBM (research methods, search, and assessment of papers quality) and increased facilities such as human resources, equipment, physical environment, and accessibility are considered as the most important facilitators to EBM. As well as barriers to EBM, these findings are also consistent with the results of the foreign studies.,,,,,,,,,,,, Therefore, according to the results of the current study and almost the same obtained results in other studies, providing appropriate facilities to implement the EBM, providing sufficient time for study and acting based on evidence through reducing the workload, enhancing human resources, teaching the time management, providing training in the fundamentals of research methodology and designing, conducting and taking advantage of research results as well as presenting training courses in the principles and standards of EBM and providing the legal, political, and administrative infrastructures for change and making use of research results by the service providers, of course, by monitoring the professional, ethical and legal principles, and also presenting solutions and incentives to boost medical cooperation in the field of EBM and conducting workshops and training courses for HCWs to increase their English proficiency in order to develop the success of the EBM seems inevitable.
Although this study was conducted on a large scale with the enormous number of participants from different kinds of HCWs and large-scale has also included the EBM topics, the impossibility of controlling the controversial nature of the EBM,, which can affect the results of the present study, is the main limitation of this study.
| Conclusion|| |
Results of the present study revealed that HCWs in the hospitals of Iran have limited access to EBM information sources. The knowledge of the HCWs from EBM terminologies and databases is relatively low. HCWs face many barriers in the field of EBM. According to the results of the present study in the field of the facilitators and the need for improvement activities, it seems that conducting workshops related to the EBM, practical participation in programs and activities related to the EBM and increasing resources and facilities such as human resources, equipment, physical environment, and accessibility can have a great impact on the improvement of related activities to the EBM.
Financial support and sponsorship
This study was supported by the Iran University of Medical Sciences (grant no 93-04-16-255).
Conflicts of interest
There are no conflicts of interest.
| References|| |
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.
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.
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.
Kleinman LC, Dougherty D. Assessing quality improvement in health care: Theory for practice. Pediatrics 2013;131 Suppl 1:S110-9.
Polit DF, Beck CT. Nursing Research: Generating and Assessing Evidence for Nursing Practice. Lippincott Williams & Wilkins; 2008.
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.
Krugman M. Evidence-based practice: The role of staff development. J Nurs Prof Develop 2003;19:279-85.
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.
Martis R, 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.
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.
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.
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.
Kamouchi M. Stroke features and management in patients with chronic kidney disease. Contrib Nephrol 2013;179:92-9.
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.
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.
Adeodu A, Agius R, Madan I. Attitudes and barriers to evidence-based guidelines among UK occupational physicians. Occup Med (Lond) 2009;59:586-92.
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.
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.
Madoff RD, Winter DC, Nicholls JR, Rasmussen PC. Barrier between scientific evidence and clinical practice. Ugeskr Laeger 2011;173:1033.
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.
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.
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.
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.
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.
Sadeghi-Bazargani H, Tabrizi JS, Azami-Aghdash S. Barriers to evidence-based medicine: A systematic review. J Eval Clin Pract 2014;20:793-802.
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.
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.
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.
Jette DU, Bacon K, Batty C, Carlson M, Ferland A, Hemingway RD, et al
. Evidence-based practice: Beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther 2003;83:786-805.
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.
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.
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.
Adib-Hajbaghery M. Evidence-based practice: Iranian nurses' perceptions. Worldviews Evid Based Nurs 2009;6:93-101.
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.
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.
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].
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: A before-and-after study. Teach Learn Med 2013;25:191-4.
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.
Frenk J. Leading the way towards universal health coverage: A call to action. Lancet 2015;385:1352-8.
Frenk J, Gómez-Dantés O. Health systems in Latin America: The Search for Universal Health Coverage. Arch Med Res 2018;49:79-83.
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.
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.
Hajebrahimi S, Sadeghi-Ghyassi F, Olfati N, Dastgiri S, Maghbouli L. Evidence based practice: Perspectives of Iranian urologists. Urol J 2014;10:1099-105.
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.
Salehi M, Khatiri M. A study of risk based auditing barriers: Some Iranian evidence. Afr J Bus Manag 2011;5:3923-34.
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.
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.
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.
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.
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.
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.
Uysal A, Temel AB, Ardahan M, Ozkahraman S. Barriers to research utilisation among nurses in Turkey. J Clin Nurs 2010;19:3443-52.
Miles A, Loughlin M, Polychronis A. Medicine and evidence: Knowledge and action in clinical practice. J Eval Clin Pract 2007;13:481-503.
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.
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.
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.
Straus SE, Richardson WS, Glasziou P, Haynes RB. Evidence-Based Medicine: How to Practice and Teach EBM. 3rd
ed. Edinburgh: Churchill Livingstone; 2005.
Adams D. Breaking down the barriers: Perceptions of factors that influence the use of evidence in practice. J Orthop Nurs 2001;5:170-5.
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.
Agarwal R, Kalita J, Misra UK. Barriers to evidence based medicine practice in South Asia and possible solutions. Neurol Asia 2008;13:87-94.
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.
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.
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.
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.
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.
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.
Bertulis R. Barriers to accessing evidence-based information. Nurs Stand 2008;22:35-9.
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.
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.
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.
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.
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.
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.
Carrion M, Woods P, Norman I. Barriers to research utilisation among forensic mental health nurses. Int J Nurs Stud 2004;41:613-9.
Omer T. Research utilization in a multicultural nursing setting in Saudi Arabia: Barriers and facilitators. J Nurs Res 2012;20:66-73.
Parahoo K. Barriers to, and facilitators of, research utilization among nurses in Northern Ireland. J Adv Nurs 2000;31:89-98.
Glacken M, Chaney D. Perceived barriers and facilitators to implementing research findings in the Irish practice setting. J Clin Nurs 2004;13:731-40.
Bratucu E, Lucenco L. Gastroesophageal reflux disease-current trends. Chirurgia (Bucur) 2012;107:147-53.
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.
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.
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.
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.
Asadoorian J, Hearson B, Satyanarayana S, Ursel J. Evidence-based practice in healthcare: An exploratory cross-discipline comparison of enhancers and barriers. J Healthc Qual 2010;32:15-22.
Meline T, Paradiso T. Evidence-based practice in schools: Evaluating research and reducing barriers. Lang Speech Hear Serv Sch 2003;34:273-83.
Worrall LE, Bennett S. Evidence-based practice: Barriers and facilitators for speech-language pathologists. J Med Speech Language Pathol 2001;9):11-6.
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.
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.
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
[Table 1], [Table 2], [Table 3]
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