|Year : 2017 | Volume
| Issue : 2 | Page : 170-176
Knowledge and usage of evidence based practice among dentists in Modinagar City: A questionnaire based study
Jishnu Krishna Kumar, Basavaraj Patthi, Ashish Singla, Ritu Gupta, Monika Prasad, Kuldeep Dhama
Department of Public Health Dentistry, Divya Jyoti College of Dental Science and Research, Modinagar, Uttar Pradesh, India
|Date of Web Publication||13-Jun-2017|
Jishnu Krishna Kumar
Department of Public Health Dentistry, Divya Jyoti College of Dental Sciences and Research, Ajit Mahal, Niwari Road, Modinagar, Ghaziabad - 201 204, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Dentistry has witnessed various innovative advancements, and there is a requirement of evidence-laden progress to cater better oral care and clinical knowledge. Good and sound dental practice relies not on fragments of selected evidence but rather on the collection of best available research evidence. Aim: To determine the various factors affecting utilization of evidence-based practice among dental academicians, clinicians, and academicians with clinical practice. Materials and Methods: A close-ended questionnaire on evidence-based dentistry (EBD) was distributed among the dental fraternity in Modinagar city, India, to analyze their awareness, understanding, transitional views, and major barriers faced in practicing EBD. Data were analyzed using SPSS version 19.0 and were subjected to Chi-square test to determine the significant difference between the dental professionals (P < 0.05). Results: A significant difference (P ≤ 0.05) was noted between the percentage scores of all the three groups of dentists under comparison, except the context of awareness about systematic review and databases along with a term “number needed to treat.” Among all the dentists, 90% of full-time clinicians had only heard about EBD but had not utilized it in clinical practice and felt need for lengthy discussion with a patient to be the primary barrier to evidence-based practice, while 83.33% of academicians with clinical practice had read through scientific literature. Transitional views of 79.37% of academicians suggested seeking and applying evidence-based summaries to practice than applying conventional skills in EBD. Conclusion: Full-time dental practitioners were not sufficiently familiarized in utilizing EBD in comparison with the full-time academicians or dentists carrying out both academics and clinical practice. Clinicians relied on conventionally told facts than utilization of information technology to improve evidence-based practice.
Keywords: Dentistry, learning, perception, research, scientific
|How to cite this article:|
Kumar JK, Patthi B, Singla A, Gupta R, Prasad M, Dhama K. Knowledge and usage of evidence based practice among dentists in Modinagar City: A questionnaire based study. J Indian Assoc Public Health Dent 2017;15:170-6
|How to cite this URL:|
Kumar JK, Patthi B, Singla A, Gupta R, Prasad M, Dhama K. Knowledge and usage of evidence based practice among dentists in Modinagar City: A questionnaire based study. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2019 Dec 13];15:170-6. Available from: http://www.jiaphd.org/text.asp?2017/15/2/170/207917
| Introduction|| |
Quality improvement efforts have been a necessary requisite in every field of healthcare. However, progress should be scientifically oriented to prosper with the proven facts of the past. Dentistry has witnessed similar innovative advancement that has urged it to progress based on evidence. The improvement of scientific understanding and clinical observation marks the evidence to provide basis for meaningful dental care. Good and sound dental practice relies not on fragments of selected evidence but rather on the collection of best available research evidence. Research evidence is fundamental for dentistry in this era. It follows the models of evidence-based medicine, which focuses on answering clinical questions using a critical appraisal of research, assessing the dental literature, finding the relevant and valid scientific studies and applying their results to improve clinical care.
Evidence-based care is a global movement in all the health science disciplines, and it represents a pandemic shift in the approach to practice a shift that emphasizes evidence over opinion and at the same time judgment over blind adherence to rules. This approach provides a bridge between research and everyday patient care. A similar finding was noted by Bearman et al. wherein they studied the use of evidence-based practice after modeling and training and found a significant improvement in gender- and age-related direct correlation. Similar association was also noted by van Sonsbeek et al. in the Netherlands where a positive association was noted between evidence-based practice scores and education.
Principles and methods of evidence-based dentistry (EBD) cater to the dentist the opportunity to implement relevant research findings for multidimensional care of their patients. The key to finding evidence is to start with a focused, well-built clinical question. Sbaraini et al. also suggested that scientific research-based evidence provides the most valid and reliable clinical practice. Therefore, academicians, dental students, and practicing dentists have to be aware of the variations surrounding scientific evidence, the technique by which the results of clinical studies are collected and analyzed, and the importance of proper implementation and outcome evaluation.
At present, EBD has opened new horizons in dental research along with the promotion of multidimensional learning organization concept improvised in various institutions in India. By the application of EBD into practice, the gap between the researcher and dentist decreases. Although there have been efforts in India to broaden the perspective of evidence-based practice throughout the country, there is lack of constant evaluation to ascertain the progress. The objective of this study was to assess various factors affecting utilization of EBD among academicians (Group I), clinicians (Group II), and academicians with clinical practice (Group III).
| Materials and Methods|| |
A questionnaire-based cross-sectional survey was conducted among all the 202 registered dental practitioners in Modinagar city over a period of 3 months from February to April 2016. Ethical approval was obtained from Institutional Review Committee. Informed consent was individually obtained from every participant after explaining the study.
A pilot study was conducted on total sample (n = 25) to check for the feasibility of the questionnaire and for its validity and reliability. The construct validity for each characteristic, values and terms pertaining to the questionnaire were calculated using Spearman's correlation between individual items for the particular construct and overall score of that construct. Construct validity of questionnaire was assured using Spearman's correlation coefficient (P < 0.001). The internal reliability for the responses to questions was determined using Cronbach's alpha coefficient (0.85).
The participants were divided into three groups; only academicians (Group I), only clinicians (Group II), and academicians with clinical practice (Group III). The academicians were primarily attached to two dental schools located within a span of 20 km 2. The full-time clinicians practiced in similar locality and academicians with clinical practice were attached to clinics in Modinagar, India. A total of 202 dentists either practicing or attached to two dental colleges in Modinagar, India, were approached for the study, of which 174 agreed to be a part of the study. The study was conducted over a time frame of 3 months from February 2016 to April 2016 using a pretested proforma consisting of closed-ended comprehensive evaluative questionnaire as proposed by McColl et al [Questionnaire 1]. The questionnaire consisted of 3 items to test awareness, 10 items to understand relevant technical terms, and 5 items to determine perceived barriers to evidence-based practice and transitional views to practice evidence dentistry.
Data were entered into Microsoft Excel 2007 and differences between the groups were checked using SPSS (Statistical Package for Social Sciences) Version 19.0; IBM SPSS Inc., Chicago, IL, USA. The data were subjected to quantitative analysis. Chi-square test was used to test the significant difference between the three groups of professionals (P < 0.05).
| Results|| |
A set of 174 questionnaires were distributed personally among the study participants. Of the pro forma distributed, 162 were returned, of which two which were incompletely filled were excluded thus, inferring a response rate of 91.95%.
Among Group I (full-time academicians), predominant share was occupied by 55.56% of males; similarly, in Group II (clinicians), 80% were males, whereas 54.17% of Group III (academicians with clinical practice) were females. Further, it was noted that the mean age of all the dentists was 33.8 ± 7.82 years. Practice characteristics showed that all dentists under Group I, 70% under Group II, and 58.33% under Group III (academicians with clinical practice) had practice size <5000 patients per year. It was noted that all Group I dentists and 87.50% Group III dentists were located in urban localities while 60% of the Group II dentists were located in semi-urban localities. Similarly, all Group I dentists along with 78.26% of Group III dentists had established internet connection at their workplace [Table 1].
It was noted that 90% of the Group II dentists were aware of EBD and databases while the least number of 83.33% of Group III dentists had read through scientific literature. The difference was noted to be statistically significant (P ≤ 0.05) between the three groups, except the context of “awareness of dentists about systematic reviews and databases” [Table 2].
|Table 2: Awareness of dentists about extracting journals, review publications, and databases relevant in carrying out evidence-based practice|
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It was found that 50%–99% of Group I dentists and 50%–100% of Group III dentists understood majority of the terms used in EBD and could explain it to others, while 60%–100% of Group II dentists had only some understanding about the terms used in EBD. The difference was noted to be statistically significant (P ≤ 0.05) with respect to the three groups, except the context of “number needed to treat” [Table 3].
|Table 3: Understanding of technical terms used in evidence-based dentistry|
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All the Group III dentists and 55.56% of Group I dentists felt lack of time to be the major barrier in utilizing evidence-based practice along with 28.57% of Group I dentists showed difficulty in involving their major practice into an evidence-based model. Furthermore, 90% of Group II dentists felt lengthy discussion with patients to be a primary barrier to evidence-based practice [Table 4].
|Table 4: Perceived major barriers to practicing evidence-based dentistry|
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About 79.37% of Group I dentists and 41.67% of Group III dentists preferred to seek and apply evidence-based summaries to practice, whereas 60% of Group II dentists suggested the idea of learning skills of EBD to promote evidence-based practice [Table 5].
|Table 5: Transitional views on moving from opinion based on evidence-based practice|
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| Discussion|| |
The present study was based on the pretested criteria to assess the perception and awareness of healthcare professionals about evidence-based practice by McColl et al. The study noted that all individuals agreed to a fact that evidence-based practice improves patient treatment outcome though a few had a vague idea or no idea about EBD or its importance in day-to-day practice. It was found that the highest percentage of academicians (76.19%) were member of a research community or were registered with a research organization, on the contrary the lowest percent of clinicians (60%) denoted a net poor lineage and trust towards evidence-based access. Further, it was noted that 60% of general practitioners were attached to rural population which might be a substantial reason of their inability to be in track with evidence-based practice along with a supportive finding, suggesting that 90% of these clinicians did not have established internet connectivity in their clinic.
On a whole, 51-91% of the academicians were aware of evidence-based databases such as Cochrane, Systematic reviews, and Scientific literatures in clinical practice but they felt, it would not be of any help in clinical decision-making. Whereas, 91.3-95% of academicians with clinical attachment kept track of the databases but disagreed to utilize it in their daily clinical practice. The reason behind it might be their requisites in both academics and its utilization in innovative clinical practice. Similarly, Gupta et al. found that practicing dentists had low knowledge score about evidence-based practice but showed a positive attitude toward adoption in the future.
On examining the awareness about the terms used in EBD, it can be noted that the term relative risk was understood by 63.75% of full-time academicians and they could explain it to others while only 2.5% of clinical practitioners had only some understanding about the term. In terms of absolute risk, it was noted that 56.88% of full-time academicians and the least of 1.25% of clinical practitioners had some understanding about the term. The variation in awareness about the terms used in EBD might be because of the experience and continuous update among academics regarding research methodology and EBD. Further, it was seen that the term “systematic review” was understood by all the academicians and they could explain it to others while majority of clinical practitioners could only understand the term. The probable reason for this is the probable ease of understanding or probable self-explanatory nature of the term systematic review. Studies conducted by Pratap et al. and Prabhu et al. found that only 27.8%–49.3% of the postgraduate students and academicians were unaware of EBD while the rest felt EBD would improve skills in clinical performance.,
The practice of EBD involves integrating individual clinical expertise with the best available external comprehensive clinical evidence from systematic research. Much of this clinical evidence in primary oral care has already been identified, critically appraised, and packaged in extracting journals and databases.
Most of the academicians and clinicians had computers at their office, but only a few more than half of the academicians read, and 90% of the clinicians were aware of evidence-based databases with most of them seldom used it in their day-to-day activity, due to lack of personal time. This was in agreement to a finding by Gioia and Dziadosz where they noted that to improve efficiency, evidence-based material must travel to dentists than expecting them to find individual time to be invested reading and accessing it. Another similar finding was proposed by a study conducted by Aarons et al., where they found that proficient organizational culture and less stressful environment contribute to success of evidence-based practice. Interpretation of evidence is a primary requisite in practicing EBD, and any lacunae in understanding could hinder interpretation and opaqueness in transforming evidence into primary dental care more difficult.
The findings showed a pragmatic variation in the study group, with 90% of academicians with clinical practice felt that need for lengthy discussion as a basic barrier to practice of EBD though 58% of full-time academicians suggested that ignorance of patients and doctor to perceive and understand its necessity is another probable factor. It was also found that academicians with clinical attachment along with 80% of the full-time clinicians and 56% of the full-time academicians expressed lack of personal time to be the major perceived barrier. This was in agreement to the findings of a study conducted by Nawabi and Shahravan, where they found the mean knowledge score of dentists about EBD to be 3.66 ± 1.19. This was backed up by the findings that 44.1% of the respondents felt lack of time to be the primary setback to evidence-based practice along with 42.8% of dentists could spare <1 h/week for internet usage. Rathod et al. in Nagpur found that academicians had a positive attitude toward EBD when compared to rest of the dental fraternity, and this difference was statistically significant (P ≤ 0.01). This fall-back might be improved by emphasizing on postgraduate education towards training in accessing, evaluating, and interpreting evidence rather than spending hours on lectures. The applicative skill of evidence has to be stressed on to inculcate a habit of evidence-based learning in every dentist.
The prospective view of 79% of the full-time academicians and 43% of the academicians with clinical attachment was that seeking and applying evidence-based summaries are the best ways to evolve evidence-based practice.
The results suggest that an application-based involvement of EBD both in dental curriculum and in clinical practice improves the stand of Indian dentists in pan-nation health sector. Similar results were pointed out by Raghavan et al., where they found that successful implantation of evidence-based practice is possible only through systematic long-term involvement of healthcare organizations, governmental agencies, and political leaders.
Moreno in Chile found that private universities had a slightly higher proportion of evidence-based research subjects in their curriculum and suggested a balance of evidence-based education in between private and government universities.
Werb and Matear found that general practitioners who spent at least an hour searching and reading evidence-based material would make drastic strides in their academic and clinical life. They also pointed out that the residents who worked on problem-based learning and evidence-based healthcare interventions had better knowledge of medical topics than their counterparts.
Weng et al. found that physicians had better knowledge about evidence-based practice than nurses, pharmacists, physical therapists, technicians, and other allied healthcare professional. The hierarchical pattern of distribution of decision-making power might also hamper the learning environment along. Lagali-Jirge et al. suggested that evidence-based education must be improved in the Indian dental curriculum; it improves diagnosis, prognosis, and therapy and solves clinical and other healthcare issues.
The study included only two dental teaching institutions along with the practicing clinicians in an urban, semi-urban locality with a smaller study population. Since there has not been any reliance on EBD in both curriculum and practice, the net improvement over the years could not be studied. The paucity of recent and relevant literature pertaining to the individual contexts has limited its comparability.
Compulsory inclusion of evidence-based curriculum and yearly update or modification of syllabus can aid better root level update of the evidence-based facts. Symposium, seminars, and continuing education program related to evidence-based practice can be a major add-on to the dental workforce in India. The 21st century is laid on technological advancement, and this leap infused into EBD is ought to change the face of Indian healthcare sector globally. Advertising and improving access to evidence-based material have to be considered with special emphasis on continuing educational programs along with inclusion of evidence-based material into undergraduate and postgraduate curriculum. Further studies may be conducted to analyze the interspecialty variations among the dental fraternity stressing on difference in their taught course and practice.
| Conclusion|| |
Full-time dental practitioners are not sufficiently familiarized with EBD in comparison with the full-time academicians or the dentists carrying out both academic and clinical practice. It was noted that the clinicians have a tendency to use more conventional methods to find answers to clinical questions, such as consultations with colleagues, rather than using the internet and other electronic resources. There is a lack of evidence based education in dental schools and thus, most of the respondents in the present study were not familiar with the need for evidence-based practice.
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Conflicts of interest
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]