Assessment of Physicians’ Attitude, Awareness and Knowledge of Evidence Based Medicine an Observation from Yemen

Research Article

J Fam Med. 2014;1(3): 5.

Assessment of Physicians’ Attitude, Awareness and Knowledge of Evidence Based Medicine an Observation from Yemen

Bin Briek AS1, Webair HH1*, Al-Tuhaify MM2

1Department of Family Medicine, Hadhramout University College of Medicine, Yemen

2A Graduate Medical Student, Hadhramout University College of Medicine, Yemen

*Corresponding author: Webair HH, Department of Family Medicine, Hadhramout University College of Medicine, Yemen

Received: October 01, 2014; Accepted: November 30, 2014; Published: December 03, 2014


Background: Evidence-based practice is essential for patient safety and high-quality health care. This study aims to assess physicians’ attitude, awareness and knowledge about evidence-based medicine (EBM) and to identify the barriers against its implication in daily medical practice.

Method: A questionnaire survey was conducted among physicians working in primary healthcare centers and public hospitals in Mukalla City, Yemen. The main outcome measures were physicians’ attitude, awareness and knowledge score.

Results: The response rate was 65.1%. Most of the respondents welcomed the current promotion of EBM (87%). While 14.7% of participants had used EBM resources in their clinical decision and an average of 46.9% of respondents know the EBM baseline methods. The main barrier against evidence based practice was the unavailability of the internet in the work place (57.2%) followed by lack of personal time (53.0%). Factors positively affected physicians’ attitude were older age, longer time since graduation, specialists versus residents, higher qualification and previous EBM training. Awareness and knowledge were affected by EBM training and qualification, respectively.

Conclusion: EBM attitude is favorable in the current study but it was not reflected on physicians’ awareness and knowledge. Efforts should be directed toward modifiable factors most probably EBM training with emphasizing on its quality and effectiveness and encouraging higher qualifications. We recommend making EBM electronic resources available in hospitals and health centers.

Keywords: Evidence-based medicine; Physicians; Practice; Knowledge; Awareness; Attitude


EBM: Evidence-based Medicine; PHCCs: Primary Health Care Centers


Evidence based medicine (EBM) is the use of best available evidence in making decisions about patient’s care explicitly, and sensibly [1]. EBM is especially useful to current medicine as physicians facing increasing demands to deliver the best possible outcomes while dealing with rapidly expanding medical knowledge [2]. So, nowadays it is not acceptable for care providers to depend on clinical experiences and narratives but instead all physicians should learn and practice EBM to provide optimal patient care [3].

The practice of EBM includes five steps: formulate answerable clinical questions, search for evidence, appraise your evidence, implement the valid applicable evidence, and evaluate [2]. Many studies had been conducted to assess the knowledge, attitude, perception, and practice of EBM among physicians. Most of them were quantitative by using a questionnaire survey [4-9]. Some studies targeted certain specialty examples are primary care or family physicians

[4,5,9-12], physiotherapists [13], dentists [14], and occupational health physicians [15]. On the other hand, Al- Omary and Al- Asmari have carried out a similar study among consultant physicians of different specialties [8]. A qualitative Canadian study about EBM in the primary care setting concluded that physicians welcomed the promotion of EBM but significant number of barriers and limitations to the implementation of EBM were identified [12]. Other studies also reported positive attitude of physicians toward EBM but lower level of awareness and knowledge [5,9]. The majority of previous work on EBM attitude and knowledge identified barriers against its application in daily practice. Nynke et al. conducted a systematic review on the barriers that residents experience in the application of evidence-based practice, the most frequently mentioned barriers for residents was lack of time [16].

To our knowledge, no similar published studies have been carried out in Yemen or a lower-middle-income country. Therefore, the aims of this study were to determine physicians’ attitudes, awareness and knowledge of EBM and to identify the barrier against evidencebased practice. The results would help to encourage greater use of EBM in patient care.


Study was carried out in four months period (March - July 2014). A cross- sectional study was carried out among physician working in primary health care centers (PHCCs) and governmental hospitals who were dealing with patients in their area of practice in Mukalla City. Mukalla City is the capital of Hadhramout Governorate, Yemen. It served by a total of 16 primary health care centers and three governmental hospitals.

The total number of residents and specialists was around 340 based on information from Department of Statistic and Information Office of Ministry of Public Health and Population Coastal Hadhramout. The self-administered questionnaire was distributed to all physicians in Mukalla City.

Data collection

The questionnaire adapted by Al-Ansary and Khoja for use in Saudi Arabia [9,17] from the British McColl’s original questionnaire [6] was used in this study. A pilot study was carried out which led to some modification and local adaptations. The covering letter for the questionnaires included Sacketts definition of EBM [1]. The questionnaire has 5 parts and includes questions addressing attitudes, awareness, and knowledge about EBM as well as associated variables and barriers to practice it. The first part of the questionnaire includes data about the personal characteristics of the physicians: age, sex, specialty, qualifications, time of graduation, number of consultations per day, and training for EBM. The second part addresses attitudes towards EBM: welcoming current promotion of EBM, colleagues’ positive attitudes towards EBM, whether EBM is useful in daily management, percentage of EBM in physician’s current clinical practice, whether EBM improves patient care and if EBM is of limited value or places additional demands on overloaded physicians. The third part includes information about barriers to EBM use in daily practice. The fourth part assesses awareness of various EBM resources including Pub Med, EBM (from BMJ publishing group), clinical evidences references, Cochrane database of systematic review, and Journal of EBM. The last part includes knowledge of baseline methods of EBM; sensitivity, specificity, odds ratio, absolute risk, mean, median, mode, standard deviation, positive predictive, and negative predictive.

Statistical analysis

Analysis was carried out to address the following main outcome measures: Dependent variables; respondents’ attitude, awareness and knowledge scores. The scores were calculated by the sum score of all items in each section. Independent variables; age, gender, years since graduation, number of patients seen per day, specialty, qualification and EBM training. Respondents’ attitude, awareness and knowledge about EBM, and their perception of barriers to use of EBM in clinical practice were described.

Tables of frequency and proportion were used to describe variables. The Mann-Whitney and Kruskal-Wallis tests were used to determine if there are statistically significant differences between subgroups of the independent variables because attitude, awareness and knowledge score are ordinal. The significance level was 0.05 (a confidence level of 95%). SPSS, version 20 was used for data entry and analysis.

Ethical considerations

Approval for the research was obtained from the research committee of Hadhramout University College of Medicine. A brief explanation of the study was written at the beginning of questionnaires and verbal consents were obtained from all participants. Confidentiality of data was assured.


The response rate was 65.1%. Of the respondents, 135(62.8%) were males; 170(79.0%) were below the age of 40 and 103(47.9%) have a master degree. Specialist doctors were 167(77.7%); most of them were internists, surgeons, pediatricians, obstetricians and gynecologists, family physicians, or dermatologists. Around two thirds of the physicians have graduated for less than 5 years. More than half of physicians 122(56.7%) saw less than 20 patients per day; and most of them 154(71.7%) have trained in EBM (Table 1).