Abstract
BackgroundResearch evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice. This can result in the provision of ineffective services and an inefficient use of resources, the implications of which might be felt particularly acutely in low- and middle-income countries. Malaria prevention is a particularly compelling domain to study evidence/practice gaps given the proven efficacy, cost-effectiveness and disappointing utilization of insecticide-treated nets (ITNs).MethodsThis study compares what is known about ITNs to the related knowledge and practices of healthcare providers in four low- and middle-income countries. A new questionnaire was developed, pilot tested, translated and administered to 497 healthcare providers in Ghana (140), Laos (136), Senegal (100) and Tanzania (121). Ten questions tested participants' knowledge and clinical practice related to malaria prevention. Additional questions addressed their individual characteristics, working context and research-related activities. Ordinal logistic regressions with knowledge and practices as the dependent variable were conducted in addition to descriptive statistics.ResultsThe survey achieved a 75% response rate (372/497) across Ghana (107/140), Laos (136/136), Senegal (51/100) and Tanzania (78/121). Few participating healthcare providers correctly answered all five knowledge questions about ITNs (13%) or self-reported performing all five clinical practices according to established evidence (2%). Statistically significant factors associated with higher knowledge within each country included: 1) training in acquiring systematic reviews through the Cochrane Library (OR 2.48, 95% CI 1.30-4.73); and 2) ability to read and write English well or very well (OR 1.69, 95% CI 1.05-2.70). Statistically significant factors associated with better clinical practices within each country include: 1) reading scientific journals from their own country (OR 1.67, 95% CI 1.10-2.54); 2) working with researchers to improve their clinical practice or quality of working life (OR 1.44, 95% CI 1.04-1.98); 3) training on malaria prevention since their last degree (OR 1.68, 95% CI 1.17-2.39); and 4) easy access to the internet (OR 1.52, 95% CI 1.08-2.14).ConclusionsImproving healthcare providers' knowledge and practices is an untapped opportunity for expanding ITN utilization and preventing malaria. This study points to several strategies that may help bridge the gap between what is known from research evidence and the knowledge and practices of healthcare providers. Training on acquiring systematic reviews and facilitating internet access may be particularly helpful.
Highlights
Research evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice
372 healthcare providers participated in this study out of the 497 providers approached, yielding an overall response rate of 75% (107 of 140 from Ghana, 136 of 136 from Laos, 51 of 100 from Senegal, and 78 of 121 from Tanzania)
Very few participating healthcare providers selfreported performing all five clinical practices according to established evidence (2%), whether from Ghana (1%), Laos (1%), Senegal (4%) or Tanzania (5%)
Summary
Research evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice. An expanding number of studies continue to show that research evidence is not being disseminated to healthcare providers who need it to inform their clinical practice and improve the health of their patients Does this knowledge deficit lead to sub-optimal care, but it can result in the provision of ineffective services, inefficient use of resources and increasing inequities in health outcomes. This reality is devastating for low-and middleincome countries which suffer from greater resource limitations than more affluent high-income countries.
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