Information behaviour of doctors in Malawi : an evidence-based medicine perspective

Abstract

Evidence-based medicine (EBM) is important in the medical field and especially in developing countries like Malawi where it might promote efficient health services. An understanding of the information behaviour practices of doctors is important for the development of an EBM approach in training, education, and healthcare services, and for EBM practices in developing countries. This includes how doctors define their information needs in clinical settings, their information seeking preferences, self-rating of their information search skills, the nature of their information sources, their information use and how these relate to EBM. Doctors in Malawi are required to keep up with global standards of medical practice and EBM practices that demand active use of clinical evidence and information, and good access to information resources and information tools. They, however, face many local challenges such as; poor doctor to patient ratio (i.e. 1:60 against a desired 1:25), big disease burdens, heavy workloads, inadequate finances and poor access to information resources. Such challenges threaten the adoption of EBM practices. The study was conducted in Malawi as a developing country suffering from great economic challenges that bear negatively on the health services and infrastructure. The design of the study was influenced by the socio-cognitive paradigm of information behaviour and Wilson‟s 1996 model of information behaviour. A targeted sample of 200 doctors was identified from 400 doctors clustered within the Lilongwe, Blantyre, Zomba, Thyolo and Chiradzulu districts in Malawi. A mixed methods design was applied in which both quantitative and qualitative data was collected. Out of 200 doctors, 20 doctors were selected as key informants for the qualitative in-depth interviews. Data collection was done between September and October of 2015, and the response rate from the quantitative survey was 86.5%. SPSS was used to generate descriptive statistics from the quantitative data while thematic analysis was applied to the qualitative data from the in depth interviews. The study found that 73% of the doctors indicated that EBM was an operating policy in their establishments, which influenced their definition of information needs. The most popular information needs related to disease diagnosis, treatment, and general patient care. However, 80% of the doctors reported heavy workloads where many saw an average of 37 patients per day. This limited the amount of time at their disposal for information seeking/searching. Other barriers to information seeking/searching were lack of access to the Internet, lack of access to credible medical information sources and lack of training in information literacy skills and EBM. However, cellular phones played a critical role in accessing information from human sources and for enabling doctors with Internet search skills to access open source clinical evidence. The results demonstrate that it is one thing for medical doctors to have knowledge and a positive attitude towards EBM and yet another thing to apply it in resource poor countries such as Malawi. The results also show that there were both sociological and psychological factors at play in the information behaviour of medical doctors in Malawi. This confirms the socio-cognitive paradigm and Wilson‟s 1996 model as the best framework for understanding the information behaviour of the doctor in Malawi. Some of the activating mechanisms and intervening variables of information behaviour of medical doctors in Malawi are unique hence the study‟s adaptation of Wilson‟s 1996 model to a model more appropriate of information behaviour for doctors in a developing country. Based on the model, a number of changes to the policies and practices of the Malawian health and medical services are recommended to support and encourage effective EBM in the country.