ABSTRACT
Evidence based medical imaging practice in Nigeria is underreported. A cross-sectional non-experimental descriptive study conducted in Abuja and Jos Nigeria. The target population was all the Radiographers in the area of study. A semi-structured questionnaire was also used. The data collected was analyzed, using a descriptive statistical method. The result was then presented on a simple frequency tables and pie chart. Of the 55 radiographers surveyed 96% of the respondents reads journal articles in radiography, as against 4% that do not (n= 55). The respondent`s response showed that, 82% makes deliberate effort to audit practice in their workplace. Ninety-six percentage of respondents agreed that evidence based medical imaging practice is worth adopting into practice. The research also showed that 16.4% of the respondents will evaluate the evidence when it contradicts clinical judgement (departmental protocols), 72.7% will overlook the evidence. Threat to clinical freedom (16.4%), No access to evidence based medical imaging practice resourses (34.5%), as barriers to evidence based medical imaging practice, was noted. The knowledge of Radiographers about EBMI is quite high but their attitude towards it is low. Results suggest we should practice EBMI and not departmental protocols, such as knowing when to do a particular exam or opting for another means most suitable and evidence based.
Keywords: Evidence Based Medical Imaging, Radiographers, knowledge, attitude, clinical practice.
LISTS OF TABLES AND FIGURES.
TABLES.
TABLE 1: shows demographic characteristics of Radiographers…………………32
TABLE 2: shows respondent`s response on EBMI adoption into practice………..34
TABLE 3: shows barriers to the use of EBMI in practice…………………..……..38
FIGURES.
FIGURE 1: Shows responses of those who reads journal articles in Radiography……...33
FIGURE 2: Shows responses on evaluation of practices in their work places...………...35
FIGURE 3: Action of Radiographers when evidence contradicts clinical judgment……37
FIGURE 4: Shows respondent`s responses on patient ability in EBMI participation.…..36
TABLE OF CONTENTS
Title page……..…………………………………………………………….......i
Dedication …………..…………………………………………………….......ii
Approval page……………..……………………………………………….....iii
Certification ……………………..………………………………………....... iv
Acknowledgement ……………………..………………………………….......v
Table of contents……….……………………………………………….....….vi
List of tables…………...…………………………………………….....……..vii
List of figures......................................................................................………..viii
Abstract ………………………………………………………….....… ……. ix
CHAPTER ONE: INTRODUCTION
1.1 Background of study...................................................................................1
1.2 Statement of problem..........................................................................3
1.3 Objective of study.............................................................................3
1.4 Significance of study........................................................................3
1.5 Scope of study................................3
1.6 Operational definition of terms...................................................3
CHAPTER TWO: LITERATURE REVIEW
2.1 Origin and definition of medical imaging practice................................................................5
2.2 perspectives on evidence based medical imaging practice....................................................6
2.3 Development and implementation of evidence based medical imaging................................9
2.4 attitude and knowledge of radiographers towards evidence based medical imaging...........13
2.5 theoretical background of the study..........................................16
2.5.1 framework for evidence based occupational therapy practice............................................17
2.5.2 Asking clinical questions....................19
2.5.3 Searching the literature for evidence..........................22
2.5.4 Critical appraisal.................27
2.5.5 Using the evidence for individual clinical decisions...........................................................28
2.5.6 Action taken towards evidence based practice...................................................................30
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 research design.....................31
3.2 Area of study.........................31
3.3 Population.......................................................31
3.4 Sample size......................................................31
3.5 Instrument of data collection.......................31
3.6 Data Analysis...................................31
3.6.1 Objective one analysis..............31
3.6.2 Objective two analysis.......................31
CHAPTER FOUR: RESULTS
4.1 Demographic characteristics of the Radiographers studied....................................................32
4.2 Responses of those who reads journal articles in Radiography...............................................33
4.3 Responses on evidence based medical imaging adoption.......................................................34
4.4 Evaluation of practices in their work place.........................35
4.5 Respondents action when evidence contradicts clinical judgements......................................36
4.6 Respondents on patients ability in EBMI participation...........................................................37
4.7 Barriers to the use of EBMI resources..................................38
CHAPTER FIVE: DISCUSSION AND CONCLUSION
5.1 Discussion................................................................39
5.1.1 Background characteristics of the respondents............................39
5.1.2 Objective one ( to assess the level of awareness of Radiographer to evidence based medical imaging practice)....39
5.1.3 Objective two( to assess the attitude of Radiographers to evidence based medical imaging practice........41
5.2 Summary of findings......................................42
5.3 Conclusion.......................................................43
5.4 Recommendation...................................................43
5.5 Limitation...............................................44
5.6 Area of further research...................................44
REFERENCES....................................................................45
APPENDIX.....................................................................50
INTRODUCTION
Nigeria has one of the poorest health indicators in the world (WHO/UNAIDS/UNICEF (2011)1. The country is divided into six geo-political zones, of which North central is one. Health care system across the region is characterized by limited resources, poor infrastructure, poor national health insurance schemes and large burden of disease. Despite these sobering issues that are affecting this region, the government spends far more in capital projects outside the health sector and on legislative and executive allowances than on health sector and education. Health spending as a share of GDP in Nigeria is 5% as against 7.9% - 10% in developed world (www.sunnewsonline.com2). Because of financial constraints, people are forced to choose cheap medical attention and sometimes, no treatment at all.
In many rural areas, people have to travel long distances by cattle, cars or public transport, so that even the sub-optimal treatment is also delayed3. The people of this region cannot waste resources on a single treatment that is not effective. Equally important is the time and money that patients spend on their health care. In the present scenario practicing rational imaging technique based on sound scientific evidence is of utmost importance especially in the developing countries where resources are scarce and low4 Evidence based medical imaging practice can be a solution for providing optimal health care with limited resources.
The concept of systematically using research findings in medical imaging practice, or evidence based medical imaging practice (EBMIP), was first expounded in the mid to late 1990s. EBMIP is defined as a conscientious, explicit and judicious use of current best evidence in making decision regarding the care of individual patients5. Another definition also includes the integration of best research evidence with clinical experience and patient values 6.The evidence based approach to medical care has been recognized as a key competency issue for the health care professionals7,8.
A lot of interest has also been generated in the area of evidence based medical imaging. Evidence based imaging is an important tool for the determination of which patients should undergo diagnostic imaging and what imaging approach should be applied. Accordingly, evidence based imaging encompasses the formulation of a clinically relevant question, searching the medical literature, critically analyzing the data, summarizing the evidence, and applying the evidence to practice 9. The practice of evidence based medical imaging (EBMI) should be geared towards improving patient care, health outcome, cost and quality of life. Evidence based radiography is underreported1. Only a few authors have dealt specifically on this subject of study.
