Limited Evidence to Fully Determine the Implementation of Evidence-Based Practice by Healthcare Providers in Africa: A Systematic Review and Meta-Analysis

Abstract

Aim: Implementing evidence-based practice (EBP) is a complex process requiring healthcare providers to integrate evidence-based medicine (EBM) into clinical practice, ultimately improving clinical outcomes. This systematic review examined the sources of information for EBP, analyzed the extent of EBP implementation by healthcare providers, and explored the factors influencing EBP in Africa.

Methods: We identified articles published between January 1992 and March 2024 by searching Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMbase, PubMed, and Scopus databases. The pooled effect sizes for the prevalence of EBP and odds ratios (ORs) were estimated using random- and fixed-effects models as appropriate. For the qualitative component of the study, we performed a thematic analysis and subsequently integrated and interpreted findings from both the quantitative and qualitative analyses.

Results: Thirty-three studies were included in this review, involving 9722 healthcare providers: 60.3% nurses, 15.9% physicians, and 15.4% midwives. Our findings revealed a lack of detailed information on how healthcare providers utilized different forms of EBM to inform EBP and clinical outcomes in Africa. Self-reported EBP was 57.3% among nurses and 37.3% among physicians. Nigeria had the highest self-reported EBP (75.2%), whereas Egypt had the lowest (18.9%). Common sources of information reported for EBP were PubMed, UpToDate, the Cochrane Library, clinical guidelines, and training programs. Factors associated with EBP included knowledge of EBP (OR = 2.13, 95% confidence interval [CI]: 1.83-2.47), positive attitude toward EBP (OR = 1.95, 95% CI: 1.76-2.15), and having EBM training (OR = 3.08, 95% CI: 2.08-4.57), and a managerial role (OR = 2.16, 95% CI: 1.37-3.41). The availability of guidelines (OR = 1.88, 95% CI: 1.5-2.37) and internet access (OR = 1.90, 95% CI: 1.54-2.34) were also found to increase EBP. Our qualitative analysis identified common barriers to EBP, including a lack of support, resistance to change, poor communication, and failure to integrate EBP courses into the continuing education curricula.

Conclusion: This systematic review found limited information on the sources of EBM, how it was delivered, and its frequency of use in clinical practice. Thus, the correlation between EBM, EBP, and clinical outcomes was not fully transparent. Further studies are required to examine the medical conditions addressed within providers' scopes of practice, the types of evidence utilized, the frequency and consistency of EBP implementation, and its effect on enhancing patient outcomes.

Keywords: Africa; clinical outcomes; evidence‐based medicine; evidence‐based practice; healthcare providers.

FIGURE 1

Flow diagram illustrating the selection process of articles utilized in this systematic review [51]. CINAHL, Cumulative Index to Nursing and Allied Health Literature; EBP, evidence‐based practice.

FIGURE 2

Forest plot to estimate the pooled proportion of EBP among healthcare providers with 95% confidence interval (CI) on the basis of the random effects model.

FIGURE 3

Forest plots depicting the pooled effects for the significant findings from all studies. (A) gender; (B) educational level; (C) work experience; (D) current role; (E) presence of guideline; (F) availability of time (reference group*). CI, confidence interval.

FIGURE 4

Forest plots depicting the pooled effects for the significant findings from all studies. (A) knowledge; (B) attitude; (C) EBP training; (D) internet access (reference group*). CI, confidence interval.