Abstract
BackgroundEvidence-based practice (EBP) has been promoted for the last 40 years to enhance better health outcomes. This has led to developed countries such as the United Kingdom (UK) incorporating it into healthcare practice. Nevertheless, EBP is still relatively new in developing countries, despite being considered essential to maximise scarce healthcare resources (medicines, medical equipment, healthcare professionals, etc.). The barriers and facilitators to EBP use in healthcare practice in many developing countries are complex and remain largely unknown. EBP training enhances the use of evidence in healthcare practice, but the training is limited in developing countries. This thesis aimed to develop an EBP educational package for undergraduate healthcare students guided by the behavioural change wheel (BCW) model to increase EBP use and sustainability.
Methods
Makerere University College of Health Sciences (Mak-CHS) in Uganda was the site of the current research project. The systematic review (SR), a quantitative survey and qualitative research were conducted. The findings of the three studies were triangulated and used to develop an EBP package for undergraduate healthcare students. The systematic review question was formulated using the PICOT, which is derived from population, intervention, issue, comparison, outcome, and type. Studies published in English for the last 10 years were searched from various databases and used to answer the SR question. The generation of representative samples for each stratum in the quantitative survey was achieved by stratified random sampling techniques. After that, representative samples were chosen for each stratum using a random number generated by the computer in combination with a class list. 301 individuals completed an online self-completion questionnaire. Face-to-face structured interviews were conducted with a group of lecturers, with a total participant count of N =12. These lecturers were chosen using a technique known as purposive sampling.
Results
The SR found that there was a paucity of EBP training interventions for teaching undergraduate students in sub-Saharan Africa. The quantitative survey found that 69.1% of the participants had not had any formal training in EBP and that 65.4% rated themselves poorly regarding EBP skills. Surprisingly, 84% (or 254) of the respondents had positive attitudes towards EBP. In the qualitative study, participants agreed that EBP is a novel idea at Mak-CHS, but the study highlighted a lack of expertise among lecturers in teaching EBP to undergraduate students. The lecturers suggested that training the trainers for the lecturers would improve their knowledge and skills. Furthermore, the lecturers argued that training embedded in the curriculum is the most effective. The research was able to select focused EBP implementation strategies in the context of developing countries in Africa using the BCW and guided by the Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity (APEASE) criteria. The strategies include education, incentivisation, training, environmental restructuring, modelling, and enablement.
Conclusion
This study revealed individual and organisational EBP implementation challenges and enablers. Both healthcare students and lecturers lack EBP skills, knowledge, and behaviour. Lack of a supporting culture, accepted EBP values, and managerial assistance were also cited as barriers that prevent EBP implementation. There are also a few undergraduate EBP education interventions for developing countries. The development of an EBP educational package for undergraduate healthcare students at Mak-CHS, guided by the BCW framework, is the starting point for EBP implementation at Mak-CHS in Uganda. The package will be used to train the trainers first, and then it will be implemented among the undergraduate healthcare students. It can be argued that this strategy will serve to transfer the required EBP skills, knowledge, attitudes, and behaviours needed for future healthcare professionals in Uganda. Nevertheless, it is noteworthy that if other facilitators (e.g., local research evidence, financial support, time, a culture that supports EBP, infrastructure, a policy on EBP) are not provided, the skills and knowledge gained by healthcare undergraduate students may never be applied.
| Date of Award | 25 Mar 2024 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Katherine Sanderson (Supervisor), Josette Bettany-Saltikov (Supervisor) & Aloysius Gonzaga Mubuuke (Supervisor) |