|Year : 2019 | Volume
| Issue : 1 | Page : 48-53
Knowledge, attitude, and perceived barriers toward evidence-based practice among dental and medical academicians and private practitioners in Pune: A comparative cross-sectional study
Ketaki Bhivasen Bhor1, Vittaldas Shetty1, Vikram Garcha1, Vineet Vinay1, Gargi C Nimbulkar2
1 Department of Public Health Dentistry, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
2 Department of Public Health Dentistry, Tatyasaheb Kore Dental College and Research Centre, Kolhapur, Maharashtra, India
|Date of Submission||24-Apr-2018|
|Date of Acceptance||28-Jan-2019|
|Date of Web Publication||15-Mar-2019|
Dr. Ketaki Bhivasen Bhor
Department of Public Health Dentistry, Sinhgad Dental College and Hospital, Pune - 411 041, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: The dental and medical practitioners are required to continuously update their knowledge and skills with respect to new diagnostic and treatment modalities to provide the patients with optimum treatment needed. Owing to a large amount of advances, it is almost impossible for dental and medical practitioners to keep track and be aware of all the updates. Aim: The aim of this study is to assess and compare the knowledge, attitude, and perceived barriers toward evidence-based practice (EBP) among dental and medical academicians and private practitioners in Pune city. Materials and Methods: A cross-sectional study was conducted among dental academicians (n = 150) and private practitioners (n = 150); medical academicians (n = 150) and private practitioners (n = 150) in Pune city. Data were collected using self-administered, pretested, validated, close-ended, structured questionnaire. Data were analyzed using unpaired t-test and analysis of variance using Statistical Package for the Social Sciences (Version 21.0). Results: The mean knowledge score of dental academicians, dental private practitioners, medical academicians, and medical private practitioners was 4.13±1.38, 3.03 ± 1.99, 4.94 ± 1.58, and 3.033 ± 1.99, respectively. A statistically significant difference between the mean knowledge score of dental academicians was seen as compared to the other three groups (P < 0.001). The attitude of dental and medical professionals toward EBP was positive. The important barriers to its use included lack of available time and lack of application of evidence in patients. Conclusions: It was found that significant proportion of respondents had inadequate knowledge of EBP; therefore, formal training and reinforcement are required.
Keywords: Academicians, evidence-based practice, private practitioners
|How to cite this article:|
Bhor KB, Shetty V, Garcha V, Vinay V, Nimbulkar GC. Knowledge, attitude, and perceived barriers toward evidence-based practice among dental and medical academicians and private practitioners in Pune: A comparative cross-sectional study. J Indian Assoc Public Health Dent 2019;17:48-53
|How to cite this URL:|
Bhor KB, Shetty V, Garcha V, Vinay V, Nimbulkar GC. Knowledge, attitude, and perceived barriers toward evidence-based practice among dental and medical academicians and private practitioners in Pune: A comparative cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2019 Mar 24];17:48-53. Available from: http://www.jiaphd.org/text.asp?2019/17/1/48/254337
| Introduction|| |
Medicine and dentistry is currently undergoing dramatic shift in healthcare technology, making their practice more complex and challenging. The medical and dental professionals are required to continuously update their knowledge and skills with respect to new diagnostic and treatment modalities to provide the patients with optimum treatment needed. The professional organizations worldwide encourage evidence-based practice (EBP), to overcome the gap between best practice and actual care.
EBP is an approach to health care wherein health professionals use the best evidence possible, i.e., the most appropriate information available, to make clinical decisions for individual patients. It involves complex and conscientious decision-making based not only on the available evidence but also on patient characteristics, situations, and preferences. It is said to be the current best approach to provide interventions, the advantages of which are scientifically proven to be safe, efficient, and cost-effective.
Owing to a large amount of new products and treatment modalities, it is almost impossible for dental and medical practitioners to keep track and be aware of all the updates. It is generally accepted that more the experience a physician or a dentist possesses, better the quality of health care delivery. However, recent studies have shown that there is, in fact, an inverse relationship between the number of years of practice and the quality of care provided; this is because dentists and physicians' “toolkit” is created during training and is not updated regularly. Practice innovations that involve theoretical shifts may be harder to incorporate into the practice of dentists and physicians who had been trained a long time ago.
The term EBP is widely used but not widely understood among medical and dental professionals due to lack of in-depth training to distinguish good science from poor science. Most of the professionals' clinical questions and problems are solved by training which relies heavily on clinical experience and information learned during graduation and postgraduation, seminars, or from colleagues which may or may not be based on scientific evidence, leading to inappropriate treatment outcomes experience.,
There is a lack of evidence from the literature regarding knowledge, attitude, and perceived barriers toward EBP among the medical and dental professionals. Hence, the study was conducted to assess and compare the knowledge, attitude, and perceived barriers toward EBP among medical and dental academicians and private practitioners in Pune, India.
| Subjects and Methods|| |
This cross-sectional study was conducted in two phases. In phase 1,, a questionnaire-based study was conducted among the dental and medical academicians and private practitioners of Pune city separately to assess their knowledge, attitude, and perceived barriers toward EBP over a period of 3 months for each group. The phase 2 consists of a comparative evaluation of knowledge, attitude, and perceived barriers toward EBP of all the four groups, i.e., dental academicians, dental private practitioners, medical academicians, and medical private practitioners. The reporting of the study is in accordance to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
The study protocol was reviewed by the Institutional Review Board (SDCH/IRB/2017-18/74) and the ethical clearance was granted. The necessary permission was also obtained from the authorities of the concerned medical and dental colleges in Pune city.
A pilot study was conducted before phase 1 to check for the face-and-content validity of the developed questionnaire as well as to test its reliability and to derive the sample size. The questions were framed after thorough review of the literature, and with the help of four experts, the questions were reviewed for content validity. Cronbach's coefficient was found to be 0.78, which showed good internal reliability of the questionnaire. The external reliability was established by test–retest method, among 40 dental interns selected who were not included in the main study.
Sample size derivation
The sample size was determined using single proportion formula: n = (Z α/2)2 P (1 – p)/d2 at 95% confidence interval, where Z α/2 = 1.96, P = 10% prevalence of knowledge of EBP from the pilot survey, and d = 5% of marginal error was taken. By substituting the values in the formula, the minimum sample size obtained was 138 which was rounded off as 150 study participants in each group, i.e., for dental – 150 academicians and 150 private practitioners and for medical – 150 academicians and 150 private practitioners. Therefore, the total sample size was 600 study participants.
All the dental academicians and private practitioners with minimum of Bachelor of Dental Surgery degree and all medical academicians and private practitioners with minimum of Bachelor of Medicine and Bachelor of Surgery, willing to participate in the study, were included. Medical and dental academicians working in medical and dental colleges with or without private practice were included. The medical and dental private practitioners registered in the Indian Dental Association (IDA) and Indian Medical Association (IMA) Pune branch, respectively, and practicing only private practice were selected. The academicians and private practitioners who were absent or clinics were closed on three consecutive visits were excluded. Systematic random sampling technique was used to obtain required sample size from the list of professionals from whom informed consent was obtained.
A self-administered, close-ended, structured questionnaire has three sections; 11 questions on knowledge, 5 on attitude, and 7 questions on perceived barriers were used for data collection. It also included questions on previous training in EBP and willingness to attend the training.
The correct answer for the knowledge-based questions was awarded 1 mark each while incorrect answer was awarded 0 mark. The inference was drawn based on the number of correct answers (minimum score = 0 and maximum score = 11): poor: 0–3, fair: 4–7, and good: 8–11.
The questions on attitude were scored on Likert scale where strongly agree and agree were awarded 1 mark while uncertain, disagree, and strongly disagree were awarded 0 mark for all attitude-based questions except for 2 questions, based on practicality of EBP and on devaluation of clinical experience due to EBP in the section which were given 1 mark for strongly disagree and disagree and uncertain, agree and strongly agree were scored as 0. Scores were based on the number of answers indicating positive attitude of the students. Those who scored >60% (≥3 correct answers out of 10) were considered as having positive attitude while score <60% (<3 correct answers) corresponded to negative attitude.
Statistical analysis was performed using IBM Statistical Package for the Social Sciences (Statistics for Windows, Version 21.0. Armonk, NY, USA: IBM Corp.). The descriptive summary statistics included percentages, means, and standard deviations. Chi-square test for proportion was used to compare the proportion of correct and incorrect answers. Analysis of variance was used to compare the means of knowledge and attitude scores between the medical and dental academicians and private practitioners. A P ≤ 0.05 was considered statistically significant for all analyses.
| Results|| |
A total of 600 questionnaires that were completely filled were analyzed corresponding to a response rate of 100%. Of those received, 150 (50%) were from dental academicians, 150 (50%) from dental private practitioners, 150 (50%) were from medical academicians, and 150 (50%) from medical private practitioners. Majority of dental professionals were in the age range of 35–45 years with 5–10 years of experience. Only 36 (24%) of dental academicians and 23 (15.3%) of private practitioners compared to 26 (17.3%) of medical academicians and 9 (6.0%) of private practitioners claimed to have attended EBP workshops or courses, but almost 80% of dental and medical academicians and private practitioners are willing to undergo training in EBP in the form of workshop of 5–8 h.
The majority of dental and medical academicians and private practitioners incorrectly selected the responses to each question on knowledge [Table 1]. Based on the predescribed grading for knowledge score, among the dental academicians, 56 (37.3) showed poor, 91 (60.7%) had fair, and only 3 (2%) had good knowledge regarding EBP, and among private practitioners, 113 (75.3%) and 37 (24.7%) showed poor and fair knowledge regarding EBP, respectively, whereas among the medical academicians, 59 (39.3) had poor knowledge and 91 (60.7%) had fair knowledge regarding EBP, and among private practitioners, 77 (51.3%) and 73 (48.7%) showed poor and fair knowledge regarding EBP, respectively. The mean knowledge score of dental academicians, dental private practitioners, medical academicians, and medical private practitioners was 4.13±1.38, 3.03 ± 1.99, 4.94 ± 1.58, and 3.033 ± 1.99, respectively. A statistically significant difference between the mean knowledge score of dental academicians was seen as compared to the other three groups (P < 0.001) [Figure 1].
|Table 1: Distribution of medical and dental academicians and private practitioners according to their knowledge score of evidence-based practice|
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|Figure 1: Comparison of mean knowledge and attitude score of dental and medical academicians and private practitioners|
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A positive attitude toward EBP was shown by 112 (74.6%) of dental academicians, 100 (66.3%) of dental private practitioners, 93 (66.0%) of medical academicians, and 118 (78.63%) of medical private practitioners who were in agreement with the benefits of application of EBP procedures and concepts. Almost more than 80% of the dental and medical professionals “agree” and “strongly agree” to EBP important in decision-making easy [Table 2]. The mean attitude score of dental academicians, dental private practitioners, medical academicians, and private practitioners was 3.21 ± 1.22, 2.83 ± 1.25, 2.77 ± 1.49, and 3.04 ± 1.33, respectively [Figure 1].
|Table 2: Distribution of dental academicians and private practitioners according to their attitude toward evidence-based practice|
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Even though a positive attitude was seen among the dental and medical professionals in practice of EBP, there exist certain barriers in its practice as depicted in [Table 3]. Lack of time, access to full-text articles, skills to appraise scientific journals, and difficulties in application into routine clinical practice were considered as the potential barriers toward EBP.
|Table 3: Distribution of dental academicians and private practitioners according to their perceived barriers toward evidence-based practice|
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| Discussion|| |
Evidence is the basis for almost every human decision and action. The field such as the medical and dental profession that deals with the health and lives of individuals should ensure the utmost care in diagnosing and treating a patient. EBP helps ensure that the right treatment is given to the right patient. EBP is said to be the current best approach to provide interventions as it improves dentist's and physician's skills and knowledge as well as quality of treatment provided to the patients. In this study, only 44% of dental academicians and 38% of dental private practitioners knew about EBP which is in contrast to the study conducted by Sabounchi et al. among dental academicians in Iran and by Iqbal and Glenny among general dental practitioners practicing in Northwest England wherein only 8% and 29%, respectively, were aware of EBP. Similarly, only 44% of medical academicians and 32.7% of medical private practitioners knew about EBP which is in contrast to the study conducted by Abeysena et al. in Sri Lanka and Al Omari et al. in Jordan among doctors wherein 52.6% and 17.7%, respectively, were aware of EBP. The lack of knowledge about definition of EBP may be because majority of them were unaware that even patient's opinion forms one of the important component of EBP.
The systematic literature review is the key tool in the evidence-based approach for the explicit and well-documented scientific methodology to reduce errors or biases and to provide a more, objective, comprehensive view of the research literature. Only 2.7% of dental academicians, 2.7% of medical academicians, 0.7% of dental private practitioners, and 0.7% of medical private practitioners correctly answered the definition of systematic review. The results were in contrast to the study conducted by Iqbal and Glenny among general dental practitioners in Northwest England where 49% answered correctly and by Al Omari et al. among general physicians where 31.7% knew the answers.
The dental and medical professionals had little understanding of the technical terms used in EBP. However, a large proportion was unaware of the components of EBP that integrates evidence, clinical experience, and patient preference. The low level of knowledge about the systematic review and components of EBP may be because majority of the practitioners relied on clinical expertise, rather than on reading systematic reviews and unawareness that even patient's opinion forms one of the important components of EBP. Majority of the dental and medical academicians had fair knowledge scores as compared to dental and medical private practitioners who had poor knowledge scores. The difference may be attributed to more exposure of theoretical knowledge among dental academician as they are recruited from institutes which have postgraduate courses as compared to the private practitioners.
The attitude of the dental and medical professionals toward EBP was positive to the fact that evidence-based dental practice brings quick knowledge update, helps in clinical decision-making, improves patient care, and reduces health care costs, and evidence-based dentistry should be a part of dental school curriculum; the findings are in accordance with the study by Rajshekar et al., Yusof et al., Prabhu et al., and Rajagopalachari et al. This positive attitude should be looked upon as an opportunity to identify weakness and promote understanding of the concept of EBP by conducting seminars on evidence-based dentistry or by recommending the introduction of EBP into the dental education curriculum.
In terms of perceived barriers in use of EBP, lack of access to full-text articles followed by lack of time difficulties in application into routine clinical practice and lack of skill to appraise scientific journals are the most common barriers. The results may be because lack of wired or wireless internet connection available at the workplace of the professionals and also due to requirement of paid subscription for journals. The lack of knowledge regarding the terms used in EBP resulted in lack of skill to appraise scientific journals.
Most respondents felt that the use of EBP is important and showed great interest in finding out further information by attending workshop on EBP. The positive attitude shown by the professionals plays an important role in arranging for training program in EBP. Therefore, more EBP courses are needed to provide the patients with the optimal treatment.
There are certain limitations of our study. Since it was a questionnaire study, knowledge, attitude, and perceived barriers of EBP among the respondents may or may not be predicted, reflecting the inherent limitation of the study. Further studies are needed to evaluate the knowledge, attitude, and perceived barriers to EBP by taking in-depth interviews, focus group discussions, comparisons between different age groups, years of experience, different specialties, etc.
Another limitation of the study was that the sample size was small, and hence, it is difficult to generalize the findings to the larger population. The sampling frame for private practitioners included only the members who were registered under IDA and IMA Pune branch. Other practicing dental and medical practitioners were not considered. Moreover, around one-third of the invited academicians and practitioners refused to take part in the survey. This group might have had different levels of attitudes and usage of EBP compared to those who actually completed the questionnaire (presumably less favorable attitude and lower use). Therefore, studies with relatively larger population involving all institutes in the states are highly recommended.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]