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| ORIGINAL ARTICLE |
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| Year : 2017 | Volume
: 15
| Issue : 4 | Page : 359-367 |
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Dentists' knowledge, attitude, and practice regarding evidence-based practice in Davangere, India
Purvi Mahesh Bhate1, Sakeenabi Basha2, Prashant Manjunath Goudar3, Sushanth V Hirekalmath3, Imranulla Mohamed3, CR Allama Prabhu3
1 Department of Public Health Dentistry, YMT Dental College and Hospital, Kharghar, Navi Mumbai, Maharashtra, India
2 Department of Community Dentistry, Faculty of Dentistry, Taif University, Taif, KSA
3 Department of Public Health Dentistry, College of Dental Sciences, Davangere, Karnataka, India
| Date of Web Publication | 13-Dec-2017 |
Correspondence Address:
Purvi Mahesh Bhate
Lecturer, Department of Public Health Dentistry, YMT Dental College, Kharghar, Navi Mumbai, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jiaphd.jiaphd_53_17
Introduction: Evidence-based practice (EBP) is a widely accepted term in the medical field around the world. EBP means integrating individual clinical expertise with the best available external clinical evidence from systematic research, thus integrating and ensuring that the right treatment is given to the patient. Aim: This study aims to assess the existing level of knowledge, attitude, and practice regarding EBP among dentists in Davangere city, Karnataka, India. Materials and Methods: A cross-sectional questionnaire survey was conducted among 160 dentists in Davangere city. Pretested questionnaire was distributed to them, of which 117 responded. Descriptive statistics was applied. Results: The response rate was 73.12% (117); among the respondents, 94.8% (111) were aware of EBP and 77% (97) had come across the word at conferences/continuing dental education programmers. When faced with clinical uncertainty, 37% (53) dentists used electronic source with regard to EBP and only 38.5% (45) were aware of evidence-based pyramid. Conclusion: Most of the respondents were aware of the term EBP; however, the level of knowledge is limited. Dentists require adequate training to enable them to practice efficient EBP. Keywords: Attitude, evidence-based dentistry, knowledge, practice
How to cite this article:
Bhate PM, Basha S, Goudar PM, Hirekalmath SV, Mohamed I, Allama Prabhu C R. Dentists' knowledge, attitude, and practice regarding evidence-based practice in Davangere, India. J Indian Assoc Public Health Dent 2017;15:359-67 |
| Introduction | |  |
It is generally accepted that more experienced a health-care professional, better the quality of health care delivered.[1] However, a health professional “toolkit” is created during his/her training period and needs to be updated as health-care field is a science-based profession which is expected to evolve based on understanding of the science, and thus, corresponding treatment decisions need to evolve as well.[1],[2],[3]
The practice of dentistry is becoming more complex and challenging. Changing socioeconomic status patterns, knowledgeable health-care consumer, rapid technical advances, and information explosion place a greater demand on clinical decision-making.[4] In dentistry, however, evidence-based practice (EBP) is still an emerging concept.[4] Several studies have been carried out to evaluate the knowledge, attitude, and practice regarding EBP in both dental and medical fields.[5],[6],[7],[8],[9],[10] Considering EBP surveys carried out among dental faculty, most of the studies are carried out abroad,[4],[5],[7],[8],[9],[11],[12] and many [13],[14],[15],[16],[17],[18] of them have been done in India. Those done so far in India have been done in specific cities; however, India being such a diverse county, the results cannot be generalized to the other part. Thus, the objective of this study was to determine the level of knowledge, attitude, and practice regarding EBP among dentists in Davangere city, Karnataka, and to study the association of various factors to the utilization of EBP among dentists.
| Materials and Methods | | |
The present cross-sectional survey was conducted in December 2014, involving all the dentists of Davangere city, Karnataka, India. The study was approved by Institutional Ethics Committee (CODS/Exam/2611/2014-2015).
The list of the practicing dentists was obtained from Indian Dental Association, Davangere Branch. The survey questionnaire was constructed after thorough review of literature.[5],[7],[10],[13],[14] The questions were customized as to fit into the criteria of the present study. The questionnaire was then face and content validated by five subject experts. It was pilot tested among 15 participants, who were not part of the final survey. The reliability of the questionnaire was assessed (Cronbach's alpha = 0.75). Minor changes were incorporated before using for the larger sample.
It contained two parts, i.e., Part A had demographic details and Part B had questionnaire proper with 12 close- and 2 open-ended questions. The questionnaire was personally disturbed to all the dentists (160) with objective of study being explained. Informed consent was obtained; filled questionnaire was then collected back with a single round of follow-up. Only completely filled questionnaire was considered for the study.
Data were entered into Microsoft Excel sheet 2007 and analysis was performed using the Statistical Package for Social Science version 20 (SPSS Inc., Chicago, IL, USA). Descriptive statistics was computed and it included frequency distribution for categorical data. Chi-square test was used to study the association between variables such as gender, age, qualification, type of practice, and participation in continuing dental education (CDE) program to the utilization of EBP among dentists. The level of significance was set at P < 0.05.
| Results | | |
Of the 160 questionnaires delivered, 117 were returned back corresponding to response rate of 73.12%, which were then screened for missing data and none were excluded. Among 117 dentists, 62.4% (73) were males, 62.1% (69) were aged between 25–34 years, 54.7% (64) had mixed practice (both private and institutionalized), 86.3% (101) were qualified in master of dental surgery (MDS), 50.4% (59) of the dentists had experience of 0–5 years, and 71% (83) were participating in CDE program for 3 years [Table 1].
Ninety-five percent (111) were aware of EBP and 77% (97) came across the word at conference. Seventy-six percent (89) practised EBP in decision-making; however, only 56.4% (66) felt that without EBP, their practice was inefficient. Forty-eight percent (56) dentist felt that EBP was obligatory, 36% (33) dentists felt they were professionally obligated, and 34.1% (31) felt they were ethically obligated and it was not associated statistically with any of the variable [Table 2]. | Table 2: Frequency distribution of participant's response to various questions
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When faced with clinical uncertainty, 37% (53) preferred electronic source and 23.8% (34) preferred asking a friend. Among the electronic source, PubMed was used by 34.3% (61) followed by Medline 19.1% (34) and E-journal 18% (32). Among printed sources, 48.9% (86) preferred using journals followed by books 26.7% (47) and guidelines 10.8% (19). Reason cited for preference of the source was ease of availability by 53.3% (72) dentists. Seventy-eight percent (92) dentists claimed that they critically evaluated back the evidence obtained, but only 38.5% (45) were aware of evidence-based pyramid.
When asked through open-ended question, only 6.8% and 12.9% correctly knew that expert opinion and case report formed the base and systematic review formed the apex of evidence-based pyramid [Figure 1] and [Figure 2]. Ninety percent (105) of the dentist felt the need to be trained in EBP, which was statistically significant when associated with qualification and number of years in participating CDE [Table 2]. | Figure 1: Response to the Question 12, studies that form the base of evidence-based pyramid
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 | Figure 2: Response of the Question 13, studies that form the apex of evidence-based pyramid. P = 0.046 (significant) continuing dental education programs
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It was found that none of the participant's response showed any association when compared to age and gender, except for question 2 in which association was seen with gender (P = 0.049). When asked about the various sources as to where they came across the word EBP, there was significant difference in total response; 79 (62.7%) were males and 47 (37.3%) were females (P = 0.049). Conferences/CDE were the sources, where 59 (60.8%) males and 38 (39.2%) females came across the word EBP.
Practice characteristics showed that 19 (16.2%) were Group I (private practice type), 34 (29.1%) Group II (institutional), and 64 (54.7) Group III (mixed practice type) [Table 2].
It was noted that practice type had association with the response of most of the questions except Question 5a, 6, 12, 13, and 14. Sixty-four (57.67%) of the participants who were aware of EBP had a mixed (academic and clinical) type of practice when compared to 34 (30.63%) belonged to institutional practice (P = 0.001). Eighty-nine (76.1%) practised evidence-based approach when making decision for their patient, of which 55 (61.8%) belonged to mixed type of practice (P = 0.001) [Table 3]. | Table 3: Participants' responses to various questions when compared with type of practice
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Qualification had association with response of most of the questions except Question 12, 13. One hundred and one (91%) of those who were aware of the term EBP were MDS qualified (P = 0.001), and all of them had come across the word at a conference/CDE (P = 0.001). All the respondents(56.4%) who agreed that without EBP their practice was insufficient, were MDS qualified (P = 0.001). Forty-five (38.5%) of the total participants were aware of evidence-based pyramid belonged to MDS qualification (P = 0.001); however, when asked through an open question as to which studies formed the base (P = 0.081) and apex (P = 0.104) of evidence-based pyramid, qualification showed no association [Table 4]. | Table 4: Participant's responses to various questions when compared with qualification
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It was noted that participation in CDE had association with response of most of the questions except Question 5a and 12, 13. Eighty-three (74.8%) of those who were aware of EBP attended CDE for 3 years (P = 0.001). Among those who had heard the word EBP at conferences, 79 (81.4%) attended CDE for 3 years and 12 (12.4%) attended for 2 years (P = 0.001) PubMed was the electronic source of preference among 61 (34.3%) of participants, of which 46 (75.4%) had attended CDE for 3 years [Table 5]. | Table 5: Participant's responses to various questions when compared with participation in continuing dental education program
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| Discussion | | |
In the present study, the response rate was 73.12% which was much higher compared to study conducted by Yusof et al. (50.3%)[7] and Madhavji et al.,(32%);[9] the better response rate could be attributed to personal distribution and collection of the survey responses. The response rate of this study was less when compared to study conducted by Prabhu et al. (86.7%),[3] Nazir et al., (76%),[12] Gupta et al. (80%),[15] and Kumar et al. (91.95%).[18]
In this study, almost all dentists (94.8%) were aware of the term EBP, which is higher than study conducted by Pratap et al. (50.7%),[14] Yusof et al. (69.9%),[7] Gupta et al. (70.5%),[15] and Rajshekar et al. (84%).
[13] In the present study, three-fourth of the dentists came across the term at conferences/CDE which indicates that most of the dentists in the present study kept themselves updated by attending conferences/CDE, which is evident as 83 (74.8%) (P = 0.001) among the dentists have been attending CDE for 3 years [Table 5]. Thus, conferences/CDEs are the juncture where dentists are introduced to new terms or concepts.
Three-fourth of the dentists practised EBP in their decision-making about the patients; however, only half (56.4%) among them agreed that without EBP; their practice was inefficient. Thus, it indicates that not all dentists felt that EBP would make significant difference in their practice.
Almost half (47.9%) of the dentists felt that EBP was obligatory; among them, one-third (36.3%) felt that they were professionally obligated, and another one third (34.1%) felt ethical obligation. However, in the study conducted by Gavgani and Mohan,[10] the two most common reasons cited for obligation by physicians were professional (81.6%) and ethical (79.6%) which was much more when compared to our study.
When faced with clinical uncertainty, more than one-third (37%) of the dentists preferred using electronic source and 31.5% used both electronic and printed and only 23.8% preferred asking a friend/colleague. Electronic source in this study context is any evidence-based material that is accessed through the World Wide Web. The study findings are contrast when compared to study conducted by Yusof et al., (91.1%);[9] respondents asked friends and only 66.7% used electronic data base. Apparaju et al. (79%)[16] and Iqbal and Glenny (60%)[4] also have contrast findings in which most of the dentists preferred turning to colleagues/seniors for handling complicated cases. In study conducted by Singh et al., 21 (42%)[17] agreed that best and quickest way to find evidence is by reading textbooks or asking experienced colleagues.
In the present study, among the dentists who choose to ask their colleagues (23.8%), it was seen that 55.9% belonged to mixed type of practice (P = 0.1) and 73.5% attended CDE for 3 years (P = 0.027), which was similar to study finding by Madhavji et al.[9] The finding of the present study would indicate that the electronic source was used the most; as today, we are in the era of telecommunication where things are easily available at the press of the button on our computers and smartphones, and also as in recent years, there is the dramatic increase in the amount of journals that have been added to Medline and other electronic database.[5]
Among the various electronic sources, 34.3% dentists preferred using PubMed, 19.1% used Medline, and 16.3% used free web and 18% used E-journal. In the present study, only 6.2% dentists used Cochrane database which is much lower than study by Yusof et al. (41.5%),[7] Prabhu et al. (69.2%)[3] and Ashri et al. (15.20%)[5] and Madhavji et al. (55%).[9] The study thus indicates that though Cochrane is freely available and more reliable than PubMed, not many of them used it. It thus indicates poor knowledge about the various sources available and they should be educated about various online sources available for evidence-based literature.
In the present study, the majority of dentists, i.e. 92 (78%) said that they critically evaluated the evidence obtained which is simlar to Nazir et al., where 64 (70.3%)[12] evaluated the evidence obtained, which could be attributed to qualification and participation in CDE programs (P = 0.001). It may indicate that a master's degrees familiarizes a dentists better with concept of EBP.
When asked about the awareness of the evidence-based pyramid, only about one-third (38.5%) of them were aware and very few dentists correctly knew which studies formed the base (6.8%) and apex (12.8%) of evidence-based pyramid. The findings of the present study are similar to that conducted by Yusof et al.,[7] in which, out of 69% who had heard about EBP, more than 43% were unaware of the strength of the evidence in epidemiological studies. In study conducted by Nazir et al.,[12] only quarter 26.4% correctly stated that Systemic Reviews formed the strongest source of Evidence. This indicates that though many dentists critically evaluated, very few knew the strength of studies in EBP, which would make them to think that all evidence from scientific journals were acceptable.[7]
The evidence-based pyramid provides a hierarchy framework for ranking evidence that evaluates health-care interventions and indicates which studies should be given more preference, especially when the same question has been evaluated by different types of studies.[19],[20] Background information/expert opinion forms the base of the pyramid and the apex is formed by systematic reviews.[21],[22]
When asked about do you feel the need to be trained in the application of EBP, majority of dentists, i.e. 89.7% said yes which is similar to study conducted by Iqbal et al., where 80%[4] of respondents were further interested to find more about EBP. It indicates that most of dentists felt the need to be trained in EBP so that they can apply it better in their clinical practice and keep themselves updated and thus can deliver better care to patients at par with international standards.
Self-reported and self-judged responses were few limitations along with nonevaluation of barriers faced by dentists in practice of EBP. The present survey is carried out in single city; it cannot be generalized to entire nation like India.
Evidence-based dentistry is relatively a new paradigm in dentistry and thus may not be a well-known concept to every dentist. Thus, the study reflects the need to conduct CDE programs on EBP so as to give the dentists of Davangere better understanding regarding EBP so that they can apply it in their daily clinical practice and render a better quality care.
| Conclusion | | |
The awareness of the term EBP is high among the dentists of Davangere; however, their knowledge level is low and their practice is also limited and not very efficient as many did not have a clear concept regarding the strength of the studies in evidence-based pyramid. Although many dentists claim to use electronic sources for the evidence, many still only use PubMed and Google and very few are aware of Cochrane which is one of the best source and is freely available.
Acknowledgement
Authors would like to acknowledge all the survey participants.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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