Int J Clin Pharm DOI 10.1007/s11096-017-0425-7
RESEARCH ARTICLE
Knowledge, attitudes, practices, and barriers related to research utilization: a survey among pharmacists in Malaysia Sin Yee Tan1,2 • Ernieda Hatah1
Received: 4 March 2016 / Accepted: 3 January 2017 Ó Springer International Publishing 2017
Abstract Background Research utilization is part of evidence-based practice referring to the process of reviewing and critiquing scientific research and applying the findings to one’s own clinical practice. Many studies on research utilization have been conducted with doctors and nurses, but to our knowledge, none have been investigated amongst pharmacists. Objective To assess research utilization and its barriers among pharmacists and identify potential influencing factors. Setting Malaysia. Methods This cross-sectional survey was administered online and by mail to a convenient sample of pharmacists working in hospitals, health clinics, and retail pharmacies in rural and urban areas. Main outcome measure Pharmacists’ research utilization knowledge, attitudes, and practices. Results Six hundred surveys were mailed to potential respondents, and 466 were returned (77.7% response rate). Twenty-eight respondents completed the survey online. The respondents’ research utilization knowledge, attitudes, and practices were found to be moderate. Research utilization was associated with respondents’ knowledge and attitude scores (P \ 0.001). When factors related to research utilization were modelled, higher educational level was associated with higher level of research utilization (P \ 0.001) while less involvement in journal clubs, more years of service (3–7 years and more than 7 years) were associated with low and moderate research utilization, respectively. The
& Ernieda Hatah
[email protected] 1
Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
2
Pharmacy Department, Hospital Enche’ Besar Hajjah Khalsom, Km 5, Jalan Mersing, 86000 Kluang, Johor, Malaysia
main reported barrier to research utilization was lack of sufficient authority to change patient care procedures. Conclusion Pharmacists’ research utilization knowledge, attitudes, and practices can be improved by encouraging pharmacists to pursue higher degrees, promoting active participation in institutions’ journal clubs, and introducing senior clinical pharmacist specialization. Keywords Clinical pharmacy Malaysia Pharmacists Research utilization
Impacts on practice – –
Pharmacists’ research utilization knowledge, attitudes, and practices should be improved. A higher level of education, active involvement in a journal club, and fewer years of practice are significantly associated with the use of research reseources.
Introduction Research utilization is defined as the review and critique of scientific research and the application of the findings in clinical practice [1]. In evidence-based practice (EBP) clinical decisions, research utilization of the best available clinical evidence is commonly integrated with clinicians’ expertise and patients’ preferences [2, 3]. When utilizing research in EBP, clinicians need to be able to identify clinical problems; search the related literature that addresses clinical questions; critically appraise research articles’ validity, importance, and applicability; incorporate the research findings into clinical practice; and evaluate the actions [4]. The utilization of research with the highest
123
Int J Clin Pharm
quality of clinical practice should promote excellent healthcare services that improve patients’ health outcomes and reduce the variability of disease management [5]. Although EBP promotes research utilization, this is not always implemented. Situations in which research findings are not utilized in practice are known as ‘‘research–practice gaps’’ [6]. A previous study of research knowledge, attitudes, and practices among nurses in the United States of America (USA) reported that they had positive attitudes but required additional training in research utilization [4]. In a similar study conducted in Australia, paediatric occupational therapists had positive attitudes about research utilization and a willingness to access new information to guide their clinical practice but claimed to have low confidence in research findings and lacked sufficient time to read research and implement new ideas [7]. Time constraints were also reported as a reason for a research– practice gap among registered intensive care specialists in New Zealand and Australia [8]. Although many research utilization studies have been conducted by healthcare professionals worldwide, to our knowledge, few focused on the pharmacy profession [9, 10]. Those studies did not evaluate the specific practice of research utilization and potential associated factors among pharmacists [9], and one only included six respondents from the pharmacy area [10]. To ensure that the latest and highest-quality evidence is used in making recommendations for patient care, research utilization is important for pharmacists. With the introduction of pharmaceutical care, pharmacists have broader roles not limited to ensuring that medications are safely prepared and administered; they also have a vital role in therapeutic decision-making and monitoring the effects of medication on patients. These can be seen, for example, in pharmacists’ clinical services such as medication review and/or prescribing in the United Kingdom, USA, and Australia [11–14]. In Malaysia, clinical services such as inward pharmacist, warfarin clinic, medication therapy adherence clinic, and home medication review services may require pharmacists in government healthcare settings to use research findings to guide and support their therapeutic decision-making when discussing and planning patients’ medication management with other healthcare team members [15]. In Malaysian community pharmacy settings, pharmacists may utilize research to set up their services and help with patients’ therapeutic decision-making—for example, in treatment for common ailments.
Aims This study aimed to assess (1) research utilization, (2) its barriers, and (3) factors associated with its practice among pharmacists in Malaysia.
123
Ethics approval Ethical approval was obtained from the Medical Research and Ethics Committee, Ministry of Health Malaysia (NMRR-14-1283-23398) and the Research and Ethics Committee, Universiti Kebangsaan Malaysia (UKM 1.5.3.5/244/NF-008-15).
Methods This study was a cross-sectional, self-administered survey of pharmacists practicing in hospitals, clinics, and retail pharmacies in urban and rural areas of Malaysia. Data were collected using a random selection of hospitals and clinics from February 1 to June 30, 2015. Included respondents were registered pharmacists or provisional registered pharmacists (PRPs) practicing in Malaysia during the data collection period. The study did not include pharmacists practicing in the pharmaceutical industry, working as enforcement officers, or whose scope of employment did not involve clinical practice. Based on the number of pharmacists in the institution, the total number of surveys, information sheets about the study, and returned self-addressed stamped envelopes were mailed to pharmacists who agreed to help with survey distribution and collection. Follow-up with the corresponding pharmacists was performed after 2 weeks if the completed surveys were not returned. For the online survey, which targeted community pharmacists and pharmacists practicing in private hospitals in Malaysia, the full questionnaire was uploaded and advertised via the Malaysian Pharmaceutical Society official website. No incentives were given to respondents in the study. The survey consisted of three parts: (1) research utilization knowledge, attitudes, and practices; (2) barriers to research utilization in the practice setting, and (3) demographic data. In section one, the respondents’ knowledge, attitudes, and practice were measured using the adapted versions of the validated tools developed for nurses’ research knowledge, attitudes, and practice by Van Mullem et al. [4] (used with permission). The current study evaluated three of the original survey’s five domains most relevant to research utilization: identifying clinical problems, establishing current best practices, and implementing research into clinical practice. In the first section, respondents ranked their levels of knowledge, attitudes, and practices on 15 statements using a 3-point scale with ratings of 1 (low), 2 (moderate), and 3 (high). The mean knowledge, attitude, and practice scores were calculated by summing the scores for all the items and dividing the sum by the number of items. The mean knowledge, attitude, and practice scores were classified according to the categories
Int J Clin Pharm
of Van Mullem et al. [4]: low (1.00–1.66), moderate (1.67–2.33), and high (2.34–3.00). In the second section of the survey, common barriers related to research utilization were evaluated using a validated questionnaire by Funk et al. [16]. The respondents rated the extent of their agreement with 29 statements regarding barriers to research using a 5-point Likert scale: 1 (no agreement), 2 (little agreement), 3 (moderate agreement), 4 (strong agreement), or 5 (no opinion). The statements comprise five subscales derived from confirmatory factor analysis assessing possible barriers to research utilization: the adopter’s barriers (values, skills, and awareness), the organization’s barriers (setting), the innovation’s barriers (quality of the research), and the communication barriers (presentation and accessibility of the research). Respondents were also asked to write other barriers not listed in the survey and to list three major barriers to and potential facilitators of research utilization [16]. The barriers to research utilization were ranked based on the mean score of each statement. Responses of ‘‘No opinion’’ (point 5) were excluded in the calculation. The third section collected respondents’ demographic characteristics and data related to research utilization such as gender, age, educational level, years of service, work location, involvement in research and journal clubs, time spent on searching and reading material related to research, use of any databases or search engines to access journal articles, and acquired research skills. A pilot test to evaluate the content validity and reliability of the survey was conducted with 20 pharmacists from government hospitals and clinics as well as community pharmacists. The internal consistency of the knowledge, attitude, practice, and barrier subscales was measured using Cronbach’s alpha, and the results showed internal consistencies of 0.70, 0.88, 0.72, and 0.80, respectively. Data were analysed using the Statistics Package for the Social Sciences (SPSS) version 22. Descriptive statistics were used to summarize respondents’ demographic data and subscale scores for research utilization knowledge, attitudes, practices, and barriers. Factors associated with respondents’ high research utilization practice scores were modelled using multiple logistic regression with backward elimination. Prior to the multiple logistic regression, a univariate analysis was performed using simple logistic regression analysis, and only the variables with a P value of B0.25 were included in the final model analysis. The final model considered variables with P values of\0.05 as statistically significant.
Results A total of 600 surveys were mailed to potential respondents during the study period, and 466 were returned (response rate of 77.7%). Nine surveys were excluded due to
incomplete demographic information. Only 28 online surveys were received. The total number of surveys included in the study was 485. The respondents’ demographic characteristics and other data are presented in Table 1. The majority of the respondents were female (82.7%), aged 20–29 years old (63.7%), single (59.6%), and only had an undergraduate pharmacy degree (91.8%). Almost half had fewer than 3 years of work experience (44.3%), and the majority worked in a hospital setting (95.0%). Since few respondents from retail and clinic environments participated, work setting was not included as an investigated variable in the modelling of high research utilization practice. Respondents’ scores on research utilization knowledge, attitudes, and practices were in the moderate range with mean scores and standard deviations of 1.89 ± 0.39, 2.11 ± 0.42, and 1.90 ± 0.37, respectively. When the individual subscales were analysed, the mean scores for highest knowledge, attitudes, and practice were in identifying clinical problems compared to subscales measuring establishing current best practices and implementing research into practice (see Table 2). Further analyses found that respondents’ practices had significant associations with their knowledge and attitudes about research utilization (r = 0.744, P \ 0.001 and r = 0.628, P \ 0.001, respectively; see Table 3). When respondents’ high ratings of research utilization practices were modelled, educational level, years of service, and involvement in journal clubs had significant associations with research utilization practices. Respondents with master’s degrees had higher research utilization practice than those with only undergraduate degrees with an adjusted odds ratio (AOR) of 29.20, 95% CI 4.72–180.63 P \ 0.001. Research utilization was also found to be associated with respondents’ years of practice; 3–7 and more than 7 years of experience had statistically significant lower ratings than those with fewer than 3 years of experience (AOR = 0.13, 95% CI 0.02–0.77, P = 0.020; AOR = 0.08, 95% CI 0.01–0.68, P = 0.021). Respondents who were not involved in journal clubs were also found to have lower research utilization practice than those who had participated in journal clubs (AOR = 0.07, 95% CI 0.02–0.31, P \ 0.001; Table 4). The following barriers to research utilization had high agreement among the respondents: (1) Pharmacists have insufficient authority to change patient care procedures (mean score = 3.13 ± 0.82), (2) research reports are not readily available (mean score = 3.10 ± 0.80), (3) statistical analyses are not understandable (mean score = 3.08 ± 0.80), and (4) there is insufficient time on the job to implement new ideas (mean score = 3.02 ± 0.81; see Table 5). When statements pertaining to barriers to research utilization were grouped, organizational barriers
123
Int J Clin Pharm Table 1 Respondents’ demographic and characteristic Variables
Value (%)
a
Table 2 Summary of research utilization knowledge, attitudes, and practices scores Variables
Mean scorea (n = 485)
Rank
Knowledge subscale total score
1.89 ± 0.39
Moderate
Attitudes subscale total score
2.11 ± 0.42
Moderate
Practices subscale total score Knowledge subscale
1.90 ± 0.37
Moderate
Factor 1: identifying clinical problems
2.06 ± 0.44
Moderate
Gender Female Male
401 (82.7) 84 (17.3)
Age 20–29
309 (63.7)
30 and above
176 (36.3)
Marital status Single
289 (59.6)
Othersb
196 (40.4)
Factor 2: establishing current best practices
1.85 ± 0.41
Moderate
445 (91.8)
Factor 3: implementing research into practice
1.87 ± 0.47
Moderate
Factor 1: identifying clinical problems
2.29 ± 0.50
Moderate
Factor 2: establishing current best practices
2.09 ± 0.46
Moderate
Factor 3: implementing research into Practice
2.06 ± 0.49
Moderate
Factor 1: identifying clinical problems
2.02 ± 0.43
Moderate
Factor 2: establishing current best practices
1.88 ± 0.39
Moderate
Factor 3: implementing research into Practice
1.88 ± 0.44
Moderate
Educational level Undergraduate degree Master’s degree
40 (8.2)
Attitudes subscale
Years of service \3 years
215 (44.3)
3–7 years
171 (35.3)
[7 years
99 (20.4)
Work setting Hospital
461 (95%)
Health clinic
11 (2.3%)
Community pharmacy
13 (2.7%)
Practices subscale
Work location Urban
347 (71.5)
Rural
138 (28.5)
Involvement in research Involvementc
327 (67.4)
No Involvement
158 (32.6)
Competence using research in daily practice
Journal club in the work setting Yes
191 (72.1)
No
74 (27.9)
Involvement in journal club Participates Does not participate
25 (9.6) 244 (90.7)
Spend at least 1 h per week searching and reading research material Yes
359 (74.0)
No
126 (26.0)
Using databases or search engines to search journal articles Yes
346 (71.3)
No
139 (28.7)
Acquired research skills Yesd
208 (42.9)
No
277 (57.1)
a
Data are presented as number (percentage) unless otherwise indicated
b
Yes
288 (59.4)b
No
191 (39.4)b
No answer
6 (1.2)b
a Data are presented as mean ± SD (standard deviation) unless otherwise indicated. The variables with the highest mean scores are in bold font. Rating rank of mean scores: ‘‘low’’ = 1.00–1.66; ‘‘moderate’’ = 1.67–2.33; ‘‘high’’ = 2.34–3.00 b
Data are presented as number (percentage)
and limitations were the most commonly reported (mean score = 2.85 ± 0.54). A total of 167 (34.4%) respondents suggested ways to facilitate an increase in research utilization. The most frequently mentioned methods were support from respondents’ management; cooperation from all staff members; more training and workshops; free access to full research articles at work and motivation, incentives, and rewards.
Married (n = 194); widowed (n = 1); divorced (n = 1)
c
Involved in supervising PRP’s research (n = 178); involved in other than PRP’s research (n = 126); involved in PRP’s research (n = 77) d
Attended GCP certification course (n = 93); research methodology course (n = 163); critical appraisal workshop (n = 2); bio-statistics course (n = 2)
123
Discussion This study evaluated pharmacists’ research utilization knowledge, attitudes, practices, and barriers in their clinical practice. The pharmacists’ research utilization
Int J Clin Pharm Table 3 Correlations between knowledge, attitudes, practices, and barriers to research utilization Variables
Knowledge
Attitudes
Practices
Insufficient authoritya
Literature accessa
Understanding statisticsa
Attitudes Correlation coefficient P value
0.526
–
\0.001
–
Practices Correlation coefficient P value
0.628
–
\0.001
0.744
\0.001
–
-0.022
Insufficient authoritya Correlation coefficient P value Literature access
0.009
-0.025
–
0.645b
0.840b
0.593b
–
0.046 0.319b
0.026 0.566b
-0.008 0.868b
0.146 0.002b
-0.061
-0.063
0.246
a
Correlation coefficient P value
– –
Understanding statisticsa Correlation coefficient P value
-0.168 b
b
b
\0.001
0.186
0.173
-0.011
-0.118 0.011b
0.124 b
b
–
\0.001
0.007
-0.096
0.236
0.160
0.197
0.040b
\0.001b
0.001b
\0.001b
–
Insufficient timea Correlation coefficient P value
0.808b
a
Only the four highest ranked barriers to research utilization were analyzed in this section. Pearson’s correlation was used unless otherwise indicated. Insufficient authority = I feel I don’t have enough authority to change patient care procedures; Literature access = Research reports/ articles are not readily available; Understanding statistics = Statistical analyses are not understandable; Insufficient time = There is insufficient time on the job to implement new ideas b
Spearman’s rho
knowledge, attitude, and practice scores were found to be in the moderate range. This may be because the majority of pharmacists in this study had been exposed to research methods including critical evaluation of the literature and EBP during their undergraduate pharmacy degree programs. Similar findings were also reported in previous studies conducted overseas [7, 15, 17]. In the studies among paediatric occupational therapists and academic healthcare professionals, moderate knowledge of research utilization was reported to be associated with the educational degrees of the respondents [7, 15, 17]. Moreover, the experience of conducting a research project during PRP training (pre-registration training) may explain the pharmacists’ moderate research utilization scores in the current study. This study found that the domain of ‘‘identifying clinical problems’’ had the highest mean score for pharmacists’ research utilization knowledge, attitudes, and practices. This result is probably because identifying clinical problems is the initial step in research and research utilization, and it was reported to be the easiest part of research utilization [10]. In addition, ‘‘identifying clinical problems’’ is also a fundamental skill required in providing pharmaceutical care in which pharmacists are usually trained.
‘‘Establishing current best practices’’ and ‘‘implementing research into practice’’ may have received lower scores for knowledge, attitudes, and practice than did ‘‘identifying clinical problems’’ because those domains require involvement of third parties, such as management or medical teams, in the decision-making process, which makes the process more complex. Availability of established practice guidelines may cause a lower score in the ‘‘establishing current best practice’’ domain as pharmacists may rely on these without critiquing the primary evidence themselves. The final model revealed that a higher level of education, active involvement in a journal club, and fewer years of practice had significant associations with research utilization practices. Higher educational level and active participation in a journal club may have had a significant association with pharmacists’ higher research utilization ratings because it helped develop the skills required for research. The syllabuses in higher degree programs, such as master’s programs in clinical pharmacy or research, usually have a research component, which might have helped respondents’ research utilization practice [18–20]. Coomarasamy and Khan reported that classroom workshops and clinically integrated teaching such as research
123
Int J Clin Pharm Table 4 Factors associated with respondents’ high scores on research utilization practices Variables
Univariate analysis Crude OR
Multiple logistic regression 2
Adjusted OR
(95% CI)
Wald’s v2 (df)
P value
0.850
–
–
–
–
0.04 (1)
0.841
–
–
–
–
0.27–1.09
3.00 (1)
0.084
–
–
–
Ns*
3.12–14.22
24.02 (1)
29.20
4.72–180.63
13.17 (1)
\0.001
(95% CI)
Wald’s v (df)
0.47–2.53
0.04 (1)
0.49–1.80
P value
Gender Male
1.00
Female
1.09
Age 20–29
1.00
C30
0.94
Marital status Single Others
1.00 0.54
Educational level Undergraduate degree
1.00
Master’s degree
6.66
\0.001
Years of service \3 years
1.00
3–7 years
0.58
0.26–1.25
1.94 (1)
0.164
0.13
0.02–0.77
5.45 (1)
0.020
[7 years
1.27
0.60–2.71
0.40 (1)
0.528
0.08
0.01–0.68
5.35 (1)
0.021
Work location Urban
1.00
Rural
1.55
0.81–2.99
1.76 (1)
0.185
–
–
–
Ns*
1.27
0.64–2.55
0.47 (1)
0.494
–
–
–
–
0.40–2.20
0.03 (1)
0.870
–
–
–
–
0.05–0.38
14.23 (1)
0.07
0.02–0.31
12.58 (1)
\0.001
0.43
–
–
–
–
Involvement in research Participates
Do not participate 1.00 Journal club in the work setting Yes
1.00
No
0.93
Involvement in a journal club Yes
1.00
No
0.13
\0.001
Spend at least 1 h per week on searching and reading research material Yes
1.00
No
0.74
0.34–1.58
0.62(1)
Using databases or search engines to search journal articles Yes
1.00
No
0.23
0.08–0.67
7.40 (1)
0.007
–
–
–
Ns*
0.27–0.96
4.36 (1)
0.037
–
–
–
Ns*
\0.001
–
–
–
Ns*
Acquired research skills Yes
1.00
No
0.51
Competence in using research in daily practice Yes 1.00 No
0.14
0.05–0.40
13.46
OR odds ratio, CI confidence interval, Ns not significant * Variables were removed from the final model due to lack of significance
literature appraisal and EBP application to patient management, which are typically used as learning methods in master’s degree programs, can improve practitioners’ knowledge about research and research utilization [21].
123
Such learning, which is consistent with the concept of adult learning theory, may explain why respondents who were involved in advanced research education were more willing to apply their knowledge to their daily practice [15, 22]. In
Int J Clin Pharm Table 5 Barriers to research utilization Rank order
Factor
Variables
% rating item as great or moderate barrier
No opinion (%)
Mean score* (n = 485)
1
1
I feel I don’t have enough authority to change patient care procedures (Insufficient authority)
74.6
6.4
3.13 ± 0.82
2
4
Research reports/articles are not readily available (Literature access).
78.6
1.6
3.10 ± 0.80
3
4
Statistical analyses are not understandable (Understandable statistics)
75.5
2.7
3.08 ± 0.80
4
1
There is insufficient time on the job to implement new ideas (Insufficient time)
72.4
5.8
3.02 ± 0.81
5
2
I feel the results are not generalizable to my own setting
68.9
7.0
2.97 ± 0.80
6
1
The facilities are inadequate for implementation
67.2
5.4
2.96 ± 0.82
7
2
Implications for practice are not made clear
72.0
3.7
2.94 ± 0.78
8
4
The relevant literature is not compiled in one place
63.7
9.3
2.91 ± 0.84
9
1
I don’t have time to read research articles
64.3
4.3
2.84 ± 0.87
10
1
Physicians will not cooperate with implementation
60.0
9.9
2.83 ± 0.89
11
3
I feel incapable of evaluating the quality of the research
64.1
4.3
2.81 ± 0.84
12
2
The amount of research information is overwhelming
61.0
5.8
2.76 ± 0.85
13
2
The research has methodological inadequacies
55.9
13.8
2.75 ± 0.78
14
2
The literature reports conflicting results
56.9
9.3
2.73 ± 0.83
15
2
The research has not been replicated
55.9
14.6
2.72 ± 0.80
15
1
Other staffs are not supportive of implementation
54.4
9.9
2.72 ± 0.89
17 18
2 1
Research reports/articles are not published fast enough Administration will not allow implementation
54.6 53.0
11.8 13.8
2.70 ± 0.94 2.68 ± 0.88
18
2
I am uncertain whether to believe the results of the research
55.1
7.2
2.68 ± 0.89
20
4
The research is not reported in a clear and readable manner
54.4
7.6
2.65 ± 0.81
21
2
The conclusions drawn from the research are not justified
52.0
8.5
2.60 ± 0.80
22
1
I feel isolated from knowledgeable colleagues with whom to discuss the research
53.4
6.4
2.57 ± 0.97
23
3
I feel the benefits of changing practice will be minimal
47.2
9.3
2.52 ± 0.89
24
3
I am unaware of the research
46.6
4.5
2.42 ± 0.95
25
3
There is not a documented need to change practice
41.0
9.7
2.37 ± 0.90
26
4
The research is not relevant to pharmacy practice
41.0
9.9
2.36 ± 0.91
27
3
I see few benefits for myself
37.9
7.6
2.23 ± 0.94
28 29
3 3
I do not see the value of research for practice I am unwilling to change/try new ideas
33.8 26.6
4.7 3.5
2.09 ± 0.94 1.92 ± 0.93
* Data are presented as mean ± SD (standard deviation). Factor 1 = Organizational barriers and limitations, factor 2 = Quality of research, factor 3 = Pharmacists’ research values, skills, and awareness, factor 4 = Presentation and accessibility of the research
the adult learning model, learning is self-directed and selfmotivated rather than dependent [22]. In the current study, participation in a journal club might have had a positive association with pharmacists’ research utilization practice because it could have increased their knowledge of critical appraisal of the literature and EBP [21]. A journal club is a well-recognized quality improvement strategy in which a group of health practitioners meets regularly to critique recent health literature and improve their understanding of research design and statistics. Previous studies reported that involvement in a
journal club usually is associated with research utilization as it usually aims to share current knowledge and translate it into evidence-based care [23, 24]. An increase in a healthcare provider’s knowledge of critical appraisal research skills can be positively associated with the practice of research utilization [22]. Nevertheless, the model showed that longer service (more than 3 years) had a significant association with lower research utilization practices compared to shorter service. The practice of research utilization may not be significant after 3 years as pharmacists who mainly work in
123
Int J Clin Pharm
government healthcare facilities are generally promoted to a higher grade [25]. Such promotions, which are based on length of service, usually require pharmacists to spend more time doing managerial types of work such as managing human resources rather than clinical duties. This causes them to have greater job demands with more workrelated stress that may cause them to lose the link to research utilization, unlike junior pharmacists. The main barriers to research utilization reported in this study concerned organizational barriers and limitations. These barriers included lack of sufficient authority to change patient-care procedures and insufficient time in the work setting to implement new ideas, which were reported in previous studies [26–30]. In addition, physicians’ unreceptive attitudes toward pharmacists’ recommendations and a lack of facilities were also reported to be common barriers to research utilization [15]. These results were similar to the findings of the current study. As pharmacists do not have full authority to make decisions about research utilization—for example, implementing research into practice—this was foreseen as a potential barrier to research utilization [31]. A high workload and the multitasking nature of the job could also be a reason why pharmacists feel they have insufficient time to utilize research in their daily practice. In addition, weak organizational policies such as the perception of inadequate appreciation or promotions and lack of support from management may also cause stress among workers and affect research utilization [32]. There are some limitations of the present study. First, the adapted survey was developed for different healthcare professionals and may not reflect the pharmacists’ role in research utilization. However, the pilot test conducted among pharmacists from various areas of practice showed good reliability and validity. Secondly, the invitations to participate in the study for pharmacists practicing in retail and private healthcare institutions were done mostly through online survey. This method may result in respondents being mainly from the government health sector; therefore, generalization to other pharmacists, such as retail pharmacists, might not be possible. Thirdly, this study was conducted using a cross-sectional design, which is limited to a particular point in time.
Conclusion Pharmacists’ research utilization knowledge, attitudes, and practices can be improved using strategies, such as encouraging more pharmacists to pursue higher degrees, promoting active participation in institutional journal clubs, and changing the job scope of senior pharmacists in
123
Malaysia to one with a more clinical-practice orientation, such as specialization in clinical pharmacy practice. Acknowledgements We would like to thank our site-investigators Mrs. Farizan Abdul Ghaffar, Ms. Salmi Abd Razak, Mrs. Syahirah Zainudi, Mrs. Shamini A/P Rama, Mrs. Sharifah Sazlin Syed Zainuddin, Mrs. Siti Rahimah Ismail, and Mrs. Hamiza Aziz from the Malaysia Ministry of Health as well as others who helped us with the survey distribution and collection. We also wish to thank the Clinical Research Centre of the hospitals that provided administrative support for this research. Funding Funding for this study was provided by the Research Development Fund Faculty of Pharmacy, Universiti Kebangsaan Malaysia (DPP-2015-FFAR). Conflicts of interest The authors report no conflicts of interest in this work.
References 1. Estabrooks CA. The conceptual structure of research utilisation. Res Nurs Health. 1999;22(3):203–16. 2. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312(7023):71–2. 3. Porzsolt F, Ohletz A, Thim A, Gardner D, Ruatti H, Meier H, et al. Evidence-based decision making—the six step approach. Evid Based Med. 2003;8:165–6. 4. Van Mullem C, Burke LJ, Dohmeyer K, Farrell M, Harvey S, John L, et al. Strategic planning for research use in nursing practice. J Nurs Adm. 1999;29(12):38–45. 5. Melnyk BM, Gallagher-Ford L, Long LE, Fineout-Overholt E. The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in realworld clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews Evid Based Nurs. 2014;11(1):5–15. 6. Hodge M, Kochie LD, Larsen L, Santiago M. Clinician-implemented research utilisation in critical care. Am J Crit Care. 2003;12(4):361–6. 7. Lyons C, Brown T, Tseng MH, Casey J, McDonald R. Evidencebased practice and research utilisation: perceived research knowledge, attitudes, practices and barriers among Australian paediatric occupational therapists. Aust Occup Ther J. 2011;58(3):178–86. 8. Heighes PT, Doig GS. Intensive care specialists’ knowledge, attitudes, and professional use of published research evidence: a mail-out questionnaire survey of appropriate use of research evidence in clinical practice. J Crit Care. 2014;29(1):116–22. 9. Burkiewicz JS, Zgarrick DP. Evidence-based practice by pharmacists: utilisation and barriers. Ann Pharmacother. 2005;39(7):1214–9. 10. Eller LS, Kleber E, Wang SL. Research knowledge, attitudes and practices of health professionals. Nurs Outlook. 2003;51(4):165–70. 11. Pharmaceutical Services Negotiating Committee (PSNC). Medicines use review (MUR). http://psnc.org.uk/services-com missioning/advanced-services/murs/. Accessed 29 July 2016. 12. American Pharmacists Association. Medication Therapy Managament. https://www.pharmacist.com/medication-therapymanagement-services. Accessed 29 July 2016.
Int J Clin Pharm 13. Australian Government Department of Health. Medication Management Review. http://www.health.gov.au/internet/main/ publishing.nsf/Content/medication_management_reviews.htm. Accessed 29 July 2016. 14. Nissen L. Pharmacist prescribing: what are the next steps? Am J Health Syst Pharm. 2011;68(24):2357–61. 15. American College of Clinical Pharmacy. Standards of practice for clinical pharmacists. Pharmacotherapy. 2014;34(8):794–7. 16. Funk SG, Champagne MT, Wiese RA, Tornquist EM. BARRIERS: the barriers to research utilisation scale. Appl Nurs Res. 1991;4(1):39–45. 17. Black AT, Balneaves LG, Garossino C, Puyat JH, Qian H. Promoting evidence-based practice through a research training program for point-of-care clinicians. J Nurs Adm. 2015;45(1):14–20. 18. Universiti Kebangsaan Malaysia. Faculty of pharmacy: courses. http://www.ukm.my/farmasi/index.php/en/courses. Accessed 10 July 2015. 19. Universiti Sains Malaysia. Master of pharmacy. 2013. http:// www.pha.usm.my/index.php/programme/2013-02-14-03-03-21/ master-of-pharmacy. Accessed 10 July 2015. 20. Universiti Teknologi MARA. Postgraduate. http://www.phar macy.uitm.edu.my/v1/programmes/postgraduate.html. Accessed 10 July 2015. 21. Coomarasamy A, Khan KS. What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. BMJ. 2004;329(7473):1017. 22. Knowles M. The modern practice of adult education: andragogy versus pedagogy. New York: Cambridge Adult Education; 1980. 23. Deenadayalan Y, Grimmer-Somers K, Prior M, Kumar S. How to run an effective journal club: a systematic review. J Eval Clin Pract. 2008;14(5):898–911.
24. Milbrandt EB, Vincent JL. Evidence-based medicine journal club. Crit Care. 2004;8:401–2. 25. Ministry of Health Malaysia Official Portal. Career development for pharmaceutical officers in Ministry of Health Malaysia e-Book, 2012. http://www.moh.gov.my/english.php/pages/view/ 65. Accessed 5 Feb 2016. 26. Carrion M, Woods P, Norman I. Barriers to research utilization among forensic mental health nurses. Int J Nurs Stud. 2004;41(6):613–9. 27. Oh EG. Research activities and perceptions of barriers to research utilization among critical care nurses in Korea. Intensive Crit Care Nurs. 2008;24(5):314–22. 28. Strickland RJ, O’Leary-Kelley C. Clinical nurse educators’ perceptions of research utilization: barriers and facilitators to change. J Nurses Staff Dev. 2009;25(4):164–71. 29. Tawfik MY, Mohamed NI, Moussa M. Barriers and facilitates of research utilization as perceived by nurses of Suez Canal University Hospital- Ismailia-Egypt. J Am Sci. 2014;10(2s):89–96. 30. Da Silva TM, Costa Lda C, Garcia AN, Costa LO. What do physical therapists think about evidence-based practice? a systematic review. Man Ther. 2015;20(3):388–401. 31. Armstrong D. Clinical autonomy, individual and collective: the problem of changing doctors’ behaviour. Soc Sci Med. 2002;55(10):1771–7. 32. Alqahtani AA. Organizational stress: causes and management. Int J Innov Bus. 2012;1(1):1–11.
123
